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It is an honour to review this important book, which makes a major contribution to the psychoanalytic treatment of very ill psychiatric patients and to ego-psychology.
The book begins with an introduction, which gives an overview and places the book within the context of the history of, and current issues in, the psychoanalytic treatment of very ill psychiatric patients. The next chapter describes Wurmser's views on defence and superego analysis. There are then three chapters with verbatim case material illustrating and elaborating Wurmser's technique, focusing especially on superego pathology. The last two chapters address and illustrate issues of two clinical problems affecting this group of patients: global affects and the problem of the repetition compulsion.
The writing is dense. Wurmser's scholarship is broad and deep. This rich book reads like a seminar with one of our most erudite teachers. It is a pleasure to read if you find such books pleasurable. I find them extremely pleasurable because they satisfy one's need for theory, for clinical examples, for help with technique and for the literary elaborations and allusions that deepen one's understanding, dazzle one's associations and maintain one's excitement.
The case material is wonderful and unusual in its rich detail and in what it shows of the specific, verbatim process. Wurmser is among those brave few who dare to reveal to our collegial scrutiny exactly what they do. His work is incisive, articulate, precise and humane. He is open about his errors as well as his successes, the countertransference as well as the transference. This is case material in relation to which one can have no doubt about what is being done. Because the case material demonstrates new clinical technique with this group of cases, and because it illustrates new clinical theory, the case material is crucial and enlightening as well as interesting.
The major clinical contribution of this book is its focus on superego pathology in very ill