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Harold F. Searles is one of the rare breed of psychoanalysts who are able to communicate their clinical work in such a way that they immediately win the admiration of any practising psychoanalytic clinician, regardless of theoretical orientation. Searles, a Washington analyst, spent a good proportion of his life on the staff of Chestnut Lodge, a sanatorium specializing in the treatment of severely disturbed patients. It was to a great extent his work with psychotic and borderline patients that brought a psychoanalytic influence to the treatment offered at Chestnut Lodge and in large part accounts for the international reputation of this establishment. He is one of the North American pioneers of the psychoanalytic approach to the treatment of psychosis and stands out from his psychoanalytic peers not only by his remarkable clinical insight but his consistent, almost painful, honesty about his countertransference reactions and how these come to be incorporated into the treatment process.
The book is a collection of his papers, all of them previously published, but most of them not readily accessible. The papers are ‘strung together’ rather than ‘welded’ and inevitably this makes for some repetition and inconsistency. The preface which Searles wrote for the book states clearly his position on that nebulous entity known as ‘borderline’. This introduction points up the sense in which the book is erroneously titled, in that Searles regards ‘borderline pathology’ as a feature of all psychoanalytic patients and one which is readily fostered by the psychoanalytic situation. The therapeutic regressions which he terms ‘borderline transferences’ he