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The subject of this book is of considerable interest, and theoretically appears to be promising. In the Introduction, the author offers the concept of a “leap.” This is a carefully considered departure from a “familiar technique” or sound therapeutic procedure in response to the unusual needs of a patient in therapy.
The author repeatedly states the need for the therapist to avoid impulsive departures from standard technique. He advocates carefully chosen creative methods to respond to the unique needs of several disturbed patients. At first he implies that these “leaps” occur infrequently, in response to patients' life threatening emergencies. As you read further and study his clinical examples, these deviations from traditional technique are the exception rather than the rule. In his review of the literature, he points to numerous precedents for major departures in technique in the work of well- known innovators such as Balint, Giovacchini, McDougall, and Searles, among others. His writing shifts from the theoretical to the clinical to illustrate actual circumstances which necessitate these departures from standard technique. Early in his career, his work with severely disturbed children prepared him in general to be more sensitive to severely disturbed patients with their unique needs.
Throughout the book, in a series of vignettes, the author repeatedly restates a therapeutic dilemma: How does the therapist permit himself to depart from the psychotherapeutic frame to encourage the seriously impaired patient to utilize the treatment and at the same time not be involved in a countertransference acting out to satisfy his own narcissistic needs? This is a ubiquitous question in the current psychoanalytic literature, particularly with interest focusing on concepts of the “intersubjective realm” and transference- countertransference interactions.
What I found disappointing was not being able to understand his specific rationale for these departures from therapeutic techni