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Psychoanalysis as theory and praxis has provided a new tool for clinicians treating patients with mental health challenges since Freud’s writings on the subject over 100 years ago. But while psychoanalytic theories of thinking have been usefully applied to the treatment of neurotic disorders, they have been of limited value in the treatment of more regressed patients with limit1 conditions between neurosis and psychosis such as personality disorders, addictions, post-traumatic stress disorder, autistic spectrum disorders and psychoses. Psychoanalytic technical approaches have had limited success in the above conditions since they are generally based on epistemological principles relying heavily on verbal symbolic interventions whereas the underlying dynamics of regressed patients have a more primal pre-verbal origin often not amenable to dynamic explications of unconscious phantasy. In some cases, the application of standard technique and interpretation of unconscious phantasy may lead to regression and symptomatic exacerbation.
Patients with non-neurotic internal structural dynamics often require different kinds of therapeutic approaches than patients with neurotic structure and dynamics. Whereas the latter are often amenable to verbal, archaeological approaches uncovering repressed unconscious phantasy, the former often require the introduction of parameters that may render the regressed patient more amenable to analytic therapy (Eissler 1953).
Levine provides the reader with a theoretical framework applicable to clinical work with limit cases that is both a thorough review of the literature of the field and his integrated comprehensive, technical approach. The challenge for the clinician working with these types of case is to arrive at a representation of phenomena that present themselves in the consulting room as repetitions of past unmentalized actual experiences and are acted upon without the possibility of symbolic representation since the traumatic nidus of th