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Giovacchini's most recent book offers us a summary statement of his work over the past twenty plus years. He treats the most difficult patients with whom we as psychoanalysts contend. They occupy the severest end of the character disorder spectrum, exhibiting what appear to be developmental arrest and structural distortions. To provide any sense of a therapeutic climate, one must make major alterations in the psychoanalytic setting.
Peter Giovacchini is to be commended for attempting to bring these patients within the domain of psychoanalytic acceptability. Like Kernberg, he has been a pioneer in this endeavor, although not as rigorous, perhaps, in linking his clinical observations to theory. He has followed a deficit model in addition to the more classic conflict-oriented one. He shows superior, even at times remarkable, clinical skills, courage, sensitivity, candor, and compassion. He obviously knows his way around the borderline-psychotic territory. In common with most analysts, he works out of a private office, without the support of a hospital setting or a team approach that utilizes other mental health colleagues.
His style is clear and easy to read. At times, he writes in an almost folksy manner, expounding major theoretical positions without feeling the necessity to justify them with supporting data. It is as if he is addressing his comments to a wider audience of mental health workers who are being inspired and directed to join him in adopting an analytic perspective, since that is the only way these patients can truly be helped.
Giovacchini describes a "psychoanalytic paradox" in which the classic setting, operationally guided by the principles of neutrality and abstinence so well suited for the unfolding of the transference neurosis, acts as a traumatic event for the patients he is describing, since it approximates closely the environment created by the unavailable, non-responsive mother. Further, in narrowing our focus to an exclusive interest in