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I was, initially, somewhat disappointed as I began to read this book. I had imagined from the title and subtitle that it would address these topics in terms of specific instances. Instead the author takes the view, as she remarks at the end of the final chapter, that uncertainty and dilemma are implicit in the everyday work of the psychotherapist, and something to be continually struggled with. On further reading my disappointment was replaced by appreciation, and I found this book to be a careful, honest and deeply thoughtful account of the author's work with some of her more problematic patients over the years in private practice. She divides these in Part I into three chapters dealing with obsess ional disorders, problems of space, relying heavily on the work of Balint and his ‘philobats’ and ‘ocnophils’ (p. 16) and those patients who carry a sense of entitlement. Part II, which I found much the most interesting section of the book, is entitled ‘Love, Hate and the Erotic’. And Part III consists again of three chapters with the overall title of ‘Challenges to the Psychotherapeutic Frame’ and deals, firstly, with hysterical patients and the effect they may have on the therapist in terms of countertransference enactment, followed by a long account of a patient who was largely absent from her sessions. The final chapter does address individual examples of dilemmas she has encountered, but these, although doubtless significant in terms of transference/countertransference, are what I would call management issues: whether or not to fetch a glass of water for a thirsty patient, or remove a spider on the ceiling above a patient who is phobic about insects.
The three chapters in the middle section are written, as is most of the book, from the point of view of the author's subjectivity and present an account of a therapist constantly struggling to define and redefine those elements of her own humanity that her patients can most make use of.
In the first of these chapters, on