Coasting in the Countertransference: Conflicts of Self Interest between Analyst and Patient. By Irwin Hirsch. New York:  The Analytic Press, 2008,  240 pp., $34.95.

Irwin Hirsch's book explores a group of analytic impasses that are well captured by his title, Coasting in the Countertransference. Coasting takes place when the analyst chooses “comfort or equilibrium over creating useful destabilization … at some cost to patients” (p. 2). Hirsch is candid to a fault as he delves into several categories of such analytic pitfalls. His observations will be challenging and thought-provoking for all readers. I

came away with great respect for his analytic acumen and his capacity for relentless self-scrutiny.

In his second chapter he examines “situational factors” that may limit the analyst's optimal emotional availability to the patient. Illustrating his point with one of his early cases, he shows that the analyst's personal loneliness may help create “dependent and crisis-oriented patients” (p. 34). He suggests that we can extricate ourselves from clinical impasses once we are willing to “abandon preferred relational states that have created comfortable mutual equilibrium” (p. 38), and then “introduce a somewhat different mode of relatedness” (p. 192). He wonders “how much sexual transferences to us are stimulated by our efforts to develop these desires” in the patient (p. 42). All too often, I suspect.

Another astute insight is Hirsch's point that an impasse may arise when the analyst's theory has an all-too-comfortable fit with the analyst's personality. Ernst Ticho noted, by contrast, that analysts may conversely select a theory to restrain troubling elements in their personalities. For example, Anna Ornstein once quipped, “If anyone needed a theory of empathy, it was Heinz [Kohut].” Hirsch usefully reminds us that “Ferenczi and Rank sharply criticized clinical psychoanalysis for becoming excessively dominated by theory” (p. 109). Although he is a respected relational analyst, Hirsch argues that relational theory may lead analysts to discourage exploration of the patient's anger. Lest this appear to be an anomalous lapse in his gro