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The Clinical Exchange is a thoroughly contemporary psychoanalytic book. It repays close attention and multiple readings because of its diversity and depth. Ambitious in its scope, it can be read as a pragmatic clinical work in its main emphasis, and such an experience for the reader would itself justify a reading. However, implicit in this work are multiple layers of theoretical discourse and ideational interplay, so that the book can also be read as a more general essay on how psychoanalysis heals. Its axiomatic emphasis on the vicissitudes of self-experience is complex, as it refers to the self of the patient in dynamic interplay with that of the analyst—with each influencing the other. The text concerns itself with the potentially curative aspects of the dynamic interrelationship of two selves, in which organizing aspects of the patient's subjectivity are enlarged and diversified creatively through interplay with the self of the analyst. While the focus is on the healing of the patient, the authors demonstrate how attention to motivational states in both the patient and the analyst contribute to the patient's clinical improvement. The book's clinical theory is therefore fundamentally relational in its emphasis, and is a clinical elaboration of object relations theory. The research is also developmental in its emphasis and it draws on relevant data from child and infant research. It also draws its explanatory models from current biological and neurophysiological research. Finally The Clinical Exchange anticipates some objections to the path the authors have taken and discusses these in the conclusion. This method is reminiscent of Freud's style of Socratic discourse, and adds a touching historical flavor to an already monumental undertaking.
The first discussion describes a large specimen of an analysis conducted by one of its authors. This clinical specimen is cross-sectional in that it describes portions of sessions occurring at intervals over a period of years.