Reflections on Clinical Theory: Patterns: Building Blocks of Experience. By Marilyn Charles Hillsdale, NJ:  The Analytic Press, 2002,  185 pp., $39.95.

Patterns is a difficult book to read. Marilyn Charles's vision is a grand and all-encompassing one, but—like impressionist art—is best viewed at a distance. Up close the picture lacks details and becomes fuzzy. Likewise, Charles presents an intriguing view of how the vicissitudes of early development—intensity of affect and affective attunement with caretakers particularly—inf luence later life and are played out in the analytic relationship. However, when one examines the details of her presentation, it comes across as lacking clarity and precision. Her writing is decidedly more poetic than scientific. Her style is allusive and evocative, perhaps as much an example as an explication of what she is trying to communicate. She is often repetitive and tends to wander, so that a reader is not sure how each chapter's topic differs from that of a preceding chapter. This style gives the book a disorganized appearance, suggesting that it may have benefited from a good editing.

Charles's argument is that we all experience early life in “patterns”: “The preverbal world is one of sensation, in which meanings accrue though the regularities and disregularities in our experience” (p. 1). In addition, even in later life traumatic memories are encoded primarily as these sensorimotor patterns, rather than verbally and symbolically. Affect is experienced primarily as regularity or disruption of soothing regularity in these patterns of sensation, and overwhelming affect becomes a traumatic disruption so that experiences associated with intense affect cannot be “known” in verbal, symbolic ways.

Charles relies heavily on Daniel Stern's conceptualization of development (1985), in which the organization of early self-experience