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Is there any more difficult task in psychiatry than to write a book how to do psychotherapy? In his book, Developmentally Based Psychotherapy, the eminent
psychoanalyst, child psychiatrist, and infant researcher Stanley Greenspan does two things. First, he argues that the curative agent in psychodynamically oriented psychotherapy is usually not conflict resolution and development of insight, but rather the building of intrapsychic structures and abilities where developmental deficits existed before. Second, he takes each psychological developmental stage and discusses how to help patients with difficulties at that level.
The initial two chapters of the book introduce the concepts of developmentally based psychotherapy as based on six organizational levels of ego development—self-regulation, engagement with objects, intentionality, the preverbal sense of self, the ability to create and elaborate emotional ideas, and emotional thinking with ability to construct bridges between ideas. Using this paradigm, Greenspan argues that the appropriate goal of therapy for a given patient is to help him/her “progress to higher levels of structural organization and broaden the affective and thematic range and stability at that level” (p. 41). More disturbed patients are seen as needing more intense therapeutic processes, that is, to be seen more frequently. The therapist must assess the patient diagnostically in terms of his or her level of ego organization, keeping in mind that a given patient may have differing levels of capacity depending on the area of functioning. For instance, a patient may be at the representational level in terms of attachment, separation, and loss, yet be at a more primitive level when dealing with anger and aggression.
The eight chapters following this introduction address in detail treatment of patients with difficulties at each level of ego organization. Earlier levels receive one chapter each (regulatory processes, engaging and relating, boundary-defi