The Challenge: Despair and Hope in the Conquest of Inner Space. Further Studies of the Psychoanalytic Treatment of Severely Disturbed Children: By Rudolph Ekstein, Ph.D., et al. New York: Brunner/Mazel, Inc., 1971. 354 pp.

This book is a most respectable companion to Ekstein's Children of Time and Space, of Action and Impulse1 which evolved from the Reiss-Davis Child Center's Childhood Psychosis Project. The Challenge is in five parts preceded by a Prologue that carries a plea for the continued support of treating the individual at a time when the tide of community psychiatry rides high.

Part One considers diagnostic issues and questions whether the medical dichotomy of diagnosis and treatment should be maintained in our work; the Reiss-Davis staff advises (they are not the first to do so of course) that therapy should be contained within the diagnostic assessment procedure. Parts Two and Three consist essentially of clinical case material with discussions of treatment rationale and technique as well as points of theory. Dr. Ekstein's chapters on his patient, Teresa Esperanza, are most sensitive, instructive, and sound. Part Four draws attention to what may too often pass unnoticed except when one is knee-deep in the therapeutic work itself: 'the need for a working alliance with … support systems', including particularly casework and parenting systems. Part Five, entitled Research Issues, consists of various research considerations that arise from the Project, a source with a multitude of research possibilities and problems.

The central theme of The Challenge is Ekstein's concern with and inquiries into the characteristics and therapeutic capabilities of the psychoanalytic treatment of severely disturbed (psychotic and markedly borderline) children and adolescents. This book is principally a clinical casebook, displaying the notable sensitivity of Dr. Ekstein and some of his contributors and shedding new light on questions of diagnosis and treatment, on pathologic function and development, and on questions of clinical theory. It is an excellent source of recorded clinical data; indeed the technique of reporting highly detailed hours—as Geleerd