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In this book Giovacchini shows us how he works with difficult patients ranging on a developmental continuum from inchoate states to higher level character disorders. He tells us what happened in the sessions, what his countertransference feelings were, what motivated his interventions, and what the outcome was. Using mostly his own work, but also occasionally contributions from colleagues or supervisees, he demonstrates how the careful study and the proper management of countertransference feelings will bring about therapeutic results however disruptive the patients may be. He is not afraid to let us see occasionally a temporary misjudgment: what appears at first to be a catastrophe may turn into a triumph. The abundant, well-documented and engrossing clinical illustrations are framed by the author's theoretical concepts; technique and countertransference are inseparable.
Giovacchini's therapeutic model is based on Winnicott's: he emphasizes the roles of a soothing holding environment and nurturing interpretations. Informed by the countertransference feelings, these interpretations either of the defenses or of the motivations behind them are maturational interventions, felt as “a good feed” by the patient.
Giovacchini divides countertransference into two broad categories. He calls the first “homogeneous countertransference reactions” and the second “idiosyncratic responses.” (These roughly correspond to objective and subjective countertransference.) Both kinds fluctuate and may be mixed at various times in various degrees. Either can be disruptive or nondisruptive and, in some instances, idiosyncratic responses may be a valuable asset. In general, the more primitive the psychic organization of a patient, the more intense the countertransference will be; however, intense countertransference responses do not hinder treatment or render it impossible.