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We all now work with patients who show more disturbances than the psychoneuroses on whom early psychodynamic theory was based. We see more people now whose state of mind could be called ‘borderline’, ‘narcissistic’, ‘psychotic’. Partly, the population has changed since the earlier days; certainly the culture has changed. By a natural process some therapeutic techniques which used to be unthinkable, or daring innovations, are now taken for granted. Margaret Little has contributed to this evolution, and it is this which makes her collection of essays, written over many years, so fascinating. For various reasons our resistance against manifesting and perceiving deep disturbances is now less strong. This has implications for us psychotherapists as it affects both our experience of our patients and our experience of ourselves. What about deep disturbances, ours and other people's? It is Margaret Little's view that these can never be entirely analysed away or worked through. Therefore we, both ourselves and our patients, have to find ways of containing them, even making creative use of them (see for instance the essay on Self-Analysis - chapter 19).
Margaret Little's views can be found in most of her chapters, from one perspective or another: that the terrors surrounding survival and identity create disturbances at deeper levels than those affected by fear of loss or pain, that without (ego) strength there is nothing in the patient which can use interpretations, that techniques can he