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American psychoanalysts see classical psychoanalysis as being challenged from two slightly different positions; the first being what Merton Gill calls the relational perspective, which is roughly equivalent to the British object relations school, and the second being self-psychology. In this overview of changes and developments in psychoanalytic theory, he tries to relate the clinical aspects of these theories to their wider philosophical and epistemological bases, i.e. the shift between natural science and hermeneutics, and positivism to constructivism. (I think we would probably say subjectivism.) Gill has been involved in the theoretical move away from classical theory to a more relational view of transference, but in this book he tries to summarize the strengths and weaknesses of each position as impartially as he can. One problem for the British reader is that he assumes quite a high level of familiarity with the details of the arguments as presented in the American literature. The book contains virtually no clinical material; many British psychotherapists, being empirically minded, will probably reject it immediately on that account. But, although it is by no means an easy read, it does set out in a systematic way the various alternative assumptions that must underlie all our clinical statements, whether we are aware of them or not, and along the way he makes many interesting, sensible, even creative, comments and connections between different aspects of psychoanalytical therapy.
He starts out by discussing the various theories about the role of internal and external reality. The central tenet of psychoanalytic theory is that internal fantasy is the expression of universal innate drives, but throughout its history there has been debate as to what extent reality external to the subject needs to be taken account of in explaining his or her state of mind. The two later positions tend to stress the interrelations between subject and subjectively viewed object - or