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Newirth is relatively rare in encompassing practically all major theoretical perspectives, one of a growing cadre of authors open to and familiar with the broader psychoanalytic landscape. He takes a historical perspective in the Introduction, delineating themes and considering different versions of the concept of the unconscious. He notes how an author's favouring one view over another can reflect the history of the psychoanalytic movement, as theories may be formed as a reaction to earlier theories, influenced by the current zeitgeist or reflecting the theorist's personal preferences.
Focusing on the changing cultural context of the unconscious, Newirth emphasizes clinical relevance in a theoretical text. He reminds us that unconscious derivatives appear in works of art, reflecting cultural moments and challenges, demonstrating that evidence of changing perspectives of the unconscious is not limited to familiar personal experiences like dreams but also manifests through works of art. In chapter 1, “The Evolution of Freud's Theory of the Unconscious,” Newirth presents a critical analysis of the development of the unconscious and its evolution from a positivist to a postmodern frame of reference, presenting five theories offering different conceptualizations of the unconscious that contain a wealth of ideas that can enrich our clinical work.