Transformations. Countertransference During the Psychoanalytic Treatment of Incest Real and Imagined: Elaine V. Siegel, Hillsdale, NJ/London: The Analytic Press, 1996. 193 pp.

In Transformations, Elaine V. Siegel presents several case histories which revolve around the uncovering of patients' repressed memories of sexual abuse by one or more close family members. Siegel reports

that, each time an analysand came close to reporting such memories, Siegel herself experienced certain physical sensations: heart pounding, breathlessness, and a feeling of constriction in her stomach. She calls these physical sensations “somatic counter-transferences,” which she came to regard as valuable guides in the treatment of this group of patients. Siegel considers her own physical sensations, occurring as her analytic inquiry led her patients to recall their past experiences of incest, to be repetitions of feelings that she first experienced as a young child. At that earlier time, Siegel had innocently asked her family about some neighborhood children and was made to feel frightened and guilty because those children were thought to be “mating” with other members of their families.

Siegel's formulation brings together a number of issues in an interesting and thought-provoking way. Particularly impressive is the consistency and predictability of the sequence of the patients' reports of incestuous experiences, following Siegel's experience of her own physical reactions.

Siegel's inclusion of her personal notes about her emotional and physical reactions, recorded shortly after the sessions, is helpful. However, the complexity of the material, and especially the central role of the analyst's use of her subjectivity, is such that readers will inevitably react to this book on the basis of their own psychoanalytic orientations and personal experiences. For this reason, it would have been useful for Siegel to have included some detailed process material, particularly her observations of what it was in her patients' verbalizations and behavior within the sessions that provoked her reactions.

In a number of passages from Siegel's notes, what stands out about her react