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What a pleasure it is to read this second volume of papers by the late Bryce Boyer. He worked with the very ill patients whom all of us treat sooner or later, and who for some of us constitute a special interest. The papers in this volume are chosen to represent particular concerns over the course of his long and productive work with such patients.
The papers specifically focus on his two main ideas about the treatment of such patients: encouraging transference regression, and using countertransference for crucial data. He reviews the history of these concepts, shows how he has contributed to their expansion and use, and gives case examples of their application. His cases are unusually detailed and open. They allow some entree into his technique, which he saw as orthodox: use of the couch, four to five sessions per week, relative technical neutrality, and reconstruction of the developmental past. His therapeutic courage and optimism, crucial in treating the very ill, are apparent.
Because this is a collection of previously published papers, the work makes no attempt to engage recent issues in the care of the very ill. But these issues bear on his ideas and their relationship to technique, and the interested and knowledgeable reader will inevitably ponder them.
One issue is the issue of diagnosis. His treatment recommendations made no distinction among the diagnostic categories of the very ill. Without such distinctions we cannot know which patients will benefit from his method, short of a trial analysis. This carries the well-known danger of making some people worse while the trial is going on—for some, a life-threatening proposition. The danger is particularly acute because of his recommendations for regression and for tolerance of so-called transference psychosis. Yet sometimes such treatment can be lifesaving. Such heroic analyses cry out for specificity in diagnosis and technique. This is the modern thrust in psychiatry, but psychiatry lacks the fine observations a