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This book is an interesting and valuable integration of Dr Coen's clinical experience and a review of the psychoanalytic literature. It is rich in material and potentially controversial ideas. Among its many strengths is the author's careful delineation of the specific patient population on whom this study is focused. These patients initially appear analysable and may function well in life outside analysis, yet have difficulty using the analytic method. Coen defines the syndrome as 'pathologic dependency', which involves the 'misuse of others', i.e. the use of relationships with other people to serve the patient's own defensive need to feel safe and not alone and to avoid feeling responsible for themselves and for their intrapsychic conflicts. Because these patients are so frightened of the rage and destructiveness within themselves, they seek complete submission and attachment to their object, which is idealised and perceived as omnipotent. They use the analytic situation, including the analyst's interpretations, not to gain insight and to free themselves, but rather to maintain the pathologically dependent tie to the analyst. Therefore, their analyses become stalemated.
Coen presents richly detailed, convincing illustrations of how analysing the defensive use of passivity and helplessness to obscure unconscious rage and hostility can help these patients to achieve autonomy and competence. In addition, his discussion of the importance, and the difficulty, of analysts' tolerating the patients' hostility, is pertinent and closely reasoned. Further, his portrayal of patients who have a sense of defect and victimisation demonstrates effectively the crucial role of conflict theory in understanding and helping the patients, by analysing the uses they unconsciously make of their handicaps and hardships. At the same time, the emphasis on the defensive and regressive elements distinguishes Coen's idea of 'pathologic dependency' from deficit-model concepts, such as