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Irwin Hirsch's book inspires both admiration and despair. Perhaps Hirsch intends equal measure of each kind of response. His book inspires admiration because he describes with shocking directness, and a kind of courageous, on-the-ground reportorial verisimilitude, ways in which the analyst's personal needs (mostly money, time, and love) can so easily take precedence over the needs of the patient. One can only applaud this kind of honesty and nod in agreement that personal motivations can and do affect one's way of working with patients. Hirsch's contribution adds significantly to our awareness of how the analyst functions in the day-in and day-out of clinical practice.
And yet one feels despair because his directness becomes a vehicle for a kind of repetitive self-criticism, as case illustration after case illustration involves Dr. Hirsch's explicit exercise of self-interest and narcissistic preoccupation at the ostensible expense of his patients. At no time does Dr. Hirsch break through boundaries that every clinician would agree are sacrosanct. Instead, he lets us in on his private indulgences that he avers diminish the work and redound to his benefit at the expense of his patients.
An additional issue is this: Hirsch's is an atheoretical book, or at least one deeply skeptical of theory. The writing is clear and evocative, and at times quite powerful; but it stays on the descriptive level throughout. Theory is seen solely through the prism of the analyst's character, as if psychoanalytic theory-building is passé and without inherent value. Even the chapter devoted to theory is light fare and unsatisfying, as theory becomes yet another symptom of the analyst's subjectivity.