Impasse and Interpretation: By Herbert Rosenfeld. The New Library of Psychoanalysis, No. 1. General Editor: David Tuckett. New York and London: Tavistock Publications in association with The Institute of Psycho-Analysis, London. 1987. Pp. 324.

Sadly to say, this book by Dr Herbert Rosenfeld, an important synthesis of his recent contributions to psychoanalysis, was completed by him only shortly before his death on 29 November 1986 and therefore was not published in his lifetime. The book's subtitle: 'Therapeutic and Anti-Therapeutic Factors in the Psychoanalytic Treatment of Psychotic, Borderline, and Neurotic Patients' precisely describes its broad scope. Rosenfeld wanted to bring together the development of his theoretical formulations and clinical approach to a wide range of patients, most of them suffering from severe psychopathology.

After pioneering in the application of Kleinian theory to the psychoanalytic treatment of psychotic, particularly schizophrenic patients in the 1950s and early 60s, Rosenfeld turned his attention to pathological narcissism in a series of distinguished papers published between 1964 and 1978. He then went on to apply his ideas to the broader field of patients with borderline pathology, psychosomatic symptoms, and latent psychotic states, and he explored the relationship between masochism, narcissism, and severe self-destructiveness as a general characteristic of borderline and psychotic psychopathology.

Rosenfeld had linked a Kleinian approach to the treatment of patients with narcissistic personality disorder, describing their structural characteristics and their transference developments. He developed an original theory of the aetiology of pathological narcissism and proposed a technical approach to its treatment. I have found these ideas particularly useful. He then went on to describe what he called 'destructive narcissism', which has its roots in the contamination of self-idealization by the idealization of the omnipotent destructive parts of the self. As a next step, he linked this phenomenon of self-destructiveness with a most severe form of the negative therapeutic reaction. All these ideas receive further development in this book.

In 1977, Rosenfeld presented