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This readable, informative and compact volume is a welcome addition to the psychoanalyst's library. It opens with a strong statement of belief in the analytic treatability of the schizophrenic patient, emphasizing the patient's terror of his or her imagined superhuman capability for destructiveness and the patient's paralyzing self-terrorization resulting from this belief. If the therapist is able to convey to the patient that he or she is not similarly terrified, the work can, and perhaps usually does, proceed toward the patient's ultimate recovery. Paradoxically, this hinges on concerted efforts by the therapist to assist the patient in becoming conscious of feelings of hatred for the therapist as transference object. This, Spotnitz emphasizes, does not mean that the therapist provokes the patient's hostility.
The stages of treatment are outlined, with emphasis on the recognition, understanding, management and mastery of resistance. Narcissistic transference and the resulting countertransference are discussed in some detail. The book concludes with a fascinating chapter of briefly stated rules with illustrative vignettes.
This is truly a second edition, not a reissue of the 1969 edition, as the author integrates into the text discussion of many of the advances made in the intervening years. The author's speaking style comes through as well. Reading his book, I feel I have made the acquaintance of a profoundly dedicated and effective clinician. He discusses the recent attempts to bridge the neuron-thought synapse as well as acknowledges the work of recent writers such as Ogden, McGlashan, Grotstein and Chasseuguet-Smirgel.
The section on narcissistic transference and oscillating transference states is especially clear and succinctly stated, a clear road map of the phases of treatment. But he says nothing about psychopharmacology and its role in the analytic treatment of such patients. The index lists pages 71 through 73 as dealing with drug therapy, yet no reference t