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This book describes the author's experience in practising psychoanalysis with patients demonstrating a wide degree of pathology. He acknowledges his debt to Stone (1954), who long ago advocated this extension of the psychoanalytic method. Rothstein clearly advocates that analysts should immerse themselves more deeply in analytic practice. His challenge is clearly and repeatedly stated to the reader: with the increasing questions about the viability of psychoanalysis as a science or clinical practice, how does an analyst at whatever stage of his career respond to the question of involvement? Can analysts continue to practise analysis maintaining the conviction that it is the best treatment for a wide variety of emotional conditions?
Throughout, he offers rich theoretical and clinical perspectives that will inspire analysts of different persuasions to re-explore their own emotional involvement and commitment to the task of conducting clinical analysis. Several points are central in his argument: in choosing patients for analysis, we should focus less on our initial diagnostic or prognostic questions and more on the feeling that we may have about whether or not we can help the patient with their psychological conflicts at this time. An undue focus on diagnostic questions or analysability often hides countertransference attitudes. In making the recommendation for treatment, we should convey an attitude of optimism about the psychoanalytic method as the treatment of choice for the patient. This does not imply that every patient is suitable for or ultimately wants analysis, but only that a suitably long trial of analysis will determine whether this is the appropriate treatment. Ideal patients are intelligent, relatively compliant, co-operative individuals who can express their transferences in words. The author stresses that other kinds of patients can also be suitable if the analyst is able to introduce modifications in technique. This includes defiant, uncooperative, ena