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Judy Eekhoff has provided us with a personal exploration into the difficult and sometimes impossible psychotherapy of patients with primitive mental disorders. I say personal as each of us interested in working with these patients must find our own way of working. How can we make contact? What theoretical language do we find useful? How do we deal with the relentlessness of countertransference pressure and enactment? How do we find at-one-ment with terror, death and negativity? These are the questions that Eekhoff takes up and addresses in her own journey, her own way of working. But this is not a textbook; it cannot and should not be. What is useful about such a book is that it is one possible path to creative ideas on how to think about and work with such patients. Each of us would take a different way based on our personal countertransference, personal way of listening and unique mix of theory. Grotstein (2009) calls this “sharing personal recipes” (5). I will try to show in this review where my sensibilities and those of Eekhoff may overlap in some general principles. We can learn much from one another's creativity and innovation.
What is this book not? It does not present a unified theory. Eekhoff draws heavily on the theories of trauma, the theoretical writing of Bion and, to a lesser degree, theories from Ferenczi, Klein, Winnicott, Bleger, Meltzer, Grotstein and others. First, I suggest we have three different languages here, a psychiatric trauma language, and two distinct psychoanalytic languages: Freudian and Kleinian/Bionian. These languages are not compatible, although it is possible to form bridges among them. In the book, these different languages and concepts derived from them are not delineated and it is up to the reader to know their origins. I think this book would only be useful if someone already had a working knowledge of Klein and Bion, and a familiarity with recent work on unrepresented states; it would be hard to follow without such knowledge.