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This is a valuable book for anyone who works with patients who are experiencing breakdown. In this work Christopher Bollas describes his unique method of working analytically when a patient is at the verge of a breakdown. He believes that increasing both the intensity and the frequency of the analytic sessions can convert an impending breakdown into a breakthrough. Intensive analysis at such times can lead to a deeply transformative understanding of the meaning of the crisis. ‘Breakdown is a tragedy but when it comes—and it must come to you, you cannot force it as Winnicott did, it can be transformative’ (p. 127). Bollas contends such an event, when treated with care and attention, is an opportunity that is missed if, when facing breakdown, a patient is treated with hospitalization, intensive medication, cognitive behavioural therapy or dialectical behaviour therapy. He contends that it is possible that patients can at times even be damaged by these other interventions.
Bollas, in considering the purposive aspect of breakdown, states (p. 69):
A breakdown is a paradoxical gestalt: a moment of self-fragmentation and is, at the same time, a moment of coming together inside the self. In the end, it is formative more than it is fracturing. However, because the form of the self's truth is now asserting itself, the strategies employed formerly to deter, defer and avoid it at all costs, now start to crumble, and this alarms the ego, whose aim is to defend the self against endopsychic danger.
This is one of those moments in which the interests of the ego and those of the self are at odds. For the self, a truth is beginning to emerge in the form of an existential crisis embedded with latent meaning. For the ego, the irruption is experienced as a threat to defenses long set in place against the inevitable force of that truth ever emerging.
In the face of an impending breakdown Bollas advocates a temporary change in the frame of the analysis but not the process. He increases the in