The Psychotic: Aspects of the Personality: By David Rosenfeld. London: Karnac Books. 1992. Pp. 366.

Rosenfeld's clinically rich, penetrating and thoughtful book will, I believe, come to be regarded by many as an indispensable work on object relations theory. Whether writing about holocaust survivors, transplant patients, autistic children, people suffering from hypochondria or other problems, Rosenfeld illustrates the wide range of psychotic levels of organisation.

Kernberg writes in his foreword: '[the] vicissitudes of the intrapsychic organisation of the internalised

object relations emerge as the basic frame that differentiates various types of defensive organisation and clinical developments in the treatment of psychotic patients'. At one end of the spectrum Rosenfeld places patients whose 'internalised object relations have been dismantled under conditions of primitive terror'; at the other end patients who, through splitting, can differentiate between idealised and persecutory relationships. Between the two extremes come the 'autistic encapsulation of early object relations' which appears in situations of extreme trauma and the 'fused or undifferentiated relations between self and object'.

In Rosenfeld's opinion a number of patients whose object relations are so damaged can be helped if the primitive defences (namely pathological projective identification, denial, splitting), which impair the capacity for thinking and getting in touch with one's psychic reality, are thoroughly analysed. Transference and countertransference are the fundamental tools. Rosenfeld stresses repeatedly the importance of the correct use of countertransference. Clinical examples illustrate the handling of transference and countertransference in highly disturbed patients, and also show how to manage such tools from the technical point of view.

Of course there are patients who, despite the correct use of analytic tools and technique, show very little improvement. The analyst can transform the knowledge gained from such situat