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The stated purpose of this book is to emphasise the role of the ego in current clinical psychoanalytic technique. Busch contends that contemporary analytic technique continues to be ‘wedded’ to Freud's topographical model of the mind, and that this link to an outmoded model leads to technical errors. He makes a convincing argument that bringing the unconscious into consciousness should not be the central goal of psychoanalysis; this should be the development of ego functions, specifically the ability to observe one's own thinking and behaviour, and the ability to engage in self-analysis.
As Busch notes throughout the book, Freud did not integrate his first and second theories of anxiety, nor did he integrate his second theory of anxiety and the structural theory of the mind with clinical technique. Important contributions were made in explicating the important role of the ego in clinical technique by Reich, Fenichel, Anna Freud and a little-known British analyst, M. N. Searl. Busch devotes a chapter of the book to Searl's ‘Some queries on principles of technique’ (1936), which he considers ‘an overlooked gem’ because of her impressive grasp of the clinical application of Freud's second theory of anxiety.
Contributions by these early psychoanalysts, however, were largely ignored. The role of the ego in the working-through process of analysis is still underemphasised in comparison to the role of the drives. This ‘developmental lag’ was first described by Paul Gray (‘“Developmental lag” in the evolution of technique for psychoanalysis of neurotic conflict’, JAPA, 30: 621-56). Analysts tended to equate ego-psychology with the work of Hartmann, who promoted psychoanalysis as a general psychology. Busch speculates on additional reasons for analysts' ‘clinical stagnation’ in their approach to resistances. Uncovering secret forbidden wishes may represent a fantasised oedipal victory, as well as reflect the analyst's wish to explain meanings to the patient to defend against th