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This book is a compilation of twenty-four of Searles's recent papers. I was impressed and stimulated by the author's observations, less so by his theoretical formulations of the problems, and only rarely by the solutions he proposed. The sedulous study of Searles's imaginative ideas will reward the alert reader with a keener awareness of the meanings and uses of countertransference. The clinical vignettes about his treatment of Mrs. Hendrick and of Mr. Bennett confirmed Searles as a skillful clinician and astute observer of human behavior who is at his best when discussing the inner world of severe borderline and chronic schizophrenic patients.
The main idea in the book is expressed in the chapter on therapeutic symbiosis, "to the extent that the analyst can become able comfortably and freely to immerse himself in the autistic patient as constituting his (the analyst's) world, the patient can then utilize him as a model for identification as regards the acceptance of such very primitive dependency needs, and can come increasingly to exchange his erstwhile autistic world for the world consisting of, and personified by, the analyst" (pp. 189-190). According to Searles, an early level of ego functioning—that of pathologic symbiosis—becomes accessible in the evolution of the transference making it possible for interpretable, therapeutically symbiotic processes to occur. This phase of therapeutic symbiosis ushers in the individuation phase. In "The Patient as Therapist of His Analyst," the interesting observation that transferentially the patient's illness is expressive of his unconscious attempt to cure the doctor is carried too far. Searles states that he knows of "no other determinant of psychological illness that compares, in etiologic importance, with this one" (p. 381). His excellent discussion on the feeling of guilt in the psychoanalyst is flawed by his characteristically provocative, reproachful, and blame-shifting interpretative comments to the patient.
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