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Herbert Rosenfeld's contributions to psychoanalysis greatly increased our understanding of difficult-to-treat patients: the psychotic, severely schizoid, borderline, and pathologically narcissistic. Of particular note is that working within the traditions established by Freud and Melanie Klein, he articulated and extended the conceptualization of two notable components of these extreme conditions: destructive narcissism and the fragmentation and confusion associated with excessive use of projective identification. His bold yet disciplined clinical approach to the difficult-to-treat patient has been of lasting value. Through teaching and supervisory work, Rosenfeld extended his influence well beyond that achieved through his publications.
That today his name is not often cited is, I believe, attributable in large part to the fact that many of his ideas have become part of taken-for-granted Kleinian discourse. Perhaps equally important in this regard are the controversial technical ideas he advanced late in his career concerning the avoidance and resolution of clinical impasses. What cast a shadow over the latter part of his career now casts an intriguing shadow over this volume, rightly dedicated as it is to honoring Rosenfeld for his earlier and still valued contributions. The intriguing issues covered by this shadow concern the therapeutic action of psychoanalysis, a topic that continues to be hotly debated in the wide world of psychoanalysis; for this reason I believe that Rosenfeld's changed orientation deserves further discussion later in this review.
Based in large part on a conference held in 2000, the book begins with two clinically centered essays. Edna O'Shaughnessy discusses Rosenfeld's work on projective identification. Using clinical examples, she illustrates the unconscious phantasies that frequently accompany projective identification and give form to its influence, actual and imagined. Most of all,