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Dr Little's book represents the body of her work from over a period of thirty years and falls within two main perspectives: those chapters in which she presents her basic clinical and theoretical ideas and a second section of poems, thoughts, and commentaries entitled 'Personal Experience'. This is a book which is intensely personal, idiosyncratic yet earnest and straightforward. It is never dull and while many will have differing
theoretical ideas it is impossible not to empathize with her struggles to help her severely disordered patients and with her own personal search for understanding and growth.
The first section of her book, Parts I–III, derived from her clinical experience with severely disturbed patients as well as her own personal analyses, consists of previously published and some unpublished papers beginning with the summary of work with a disturbed woman first seen in 1941. Here, Little begins to describe the development of her key ideas about psychoanalytic theory and practice in relation to borderline and other severely ill patients. Her unique conceptualizations lie in her descriptions of 'delusional transferences' and what she calls 'basic unity'. Little states that delusional transferences or transference psychoses are encountered in a group of patients not easily defined but 'including people suffering from character disorders, sexual perversions, some psychosomatic conditions, psychopaths, etc., i.e. "sane" people with a great deal of both persecutory and depressive anxiety'. She writes, that where the transference is delusional there is no 'stand-in' or 'as-if' quality to it. To the patient the analyst is both the idealized parents and their opposities. The parents are 'deified and diabolized'.
For Dr Little the analysis of a delusional transference depends on the presentation of reality to the patient in a way that becomes undeniable and inescapable. This, she writes, often involves ways that are out of place in a usual analysis beca