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Herbert Rosenfeld died just before the publication of this book. It represents, therefore, the final attempt by a distinguished clinician and gifted teacher to grapple with some of the most difficult problems in analysis and psychotherapy. Dr Rosenfeld was noted for his work with psychotic patients, with the severely narcissistic, and with
those whose treatment reaches an impasse; i.e. they seem to be stuck, getting worse, or to have unsuccessfully tried analysis several times. To treat such patients is to have to listen very hard and to think very carefully and clearly; and in this book Dr Rosenfeld shows us how he did it.
He begins with an account of how he became interested in the psychoanalytic treatment of psychosis; with his early, surprisingly successful attempts to treat schizophrenic patients amid the widespread scepticism of the period that anything at all could be done for the severely mentally ill. At one stage he was forced to discontinue treating a suicidal patient by psychotherapy and to have him admitted to hospital. The patient could not forgive him. He resolved to try to treat schizophrenic patients by psychotherapy whenever he could. Like other analysts of the time, when he first heard of Melanie Klein's ideas he could understand better some of his difficult patients, and he entered analysis with her.
In the second part he discusses the analyst's contribution to making the treatment successful or unsuccessful. In an impasse it is worth thinking about three areas. In our attitude to the patient we have to steer between the Freud-Bion model of surgical detachment ‘without memory or desire’, which makes us over-ready to make interpretations about sadistic attacks, and the motherly figure some patients want, which makes us tend toward corrective emotional experience. We may also be making too vague interpretations, or making them too quickly or too slowly. That an interpretation is right and aimed at the patient's current anxiety is not enough; our ow