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The psychoanalytic literature has suffered for much of its history from an overabundance of passion attached to theoretical positions and a paucity of shared clinical data on which to judge them.
That fact makes this contribution from Goldberg and his associates especially welcome. It is, as the subtitle declares, a casebook, a collection of eight cases, each describing the treatment of what the group terms a “narcissistic behavior disorder,” with a minimum of theoretical elaboration. It is a good read, and it is a major step forward in the direction of showing, rather than describing, what we actually do with our patients. It should be seen as a testimony to the success of the book in showing us what is possible in clinical reporting that I conclude that it does not altogether succeed.
The book is divided into an introduction by Goldberg and a set of eight independent case presentations by members of a group formed to study perversions, delinquencies, and addictions. Although the members of the group are listed, the cases are not identified with the therapists. Each patient is a person who behaves in a socially deviant way that most people, including most therapists, would find repugnant—and that the patient, it is emphasized, also finds repugnant. In the introduction, Goldberg gives a thumbnail description of each case, providing more of an overview and assessment of the treatment than the case reporters offer. He also describes something of how the group worked with each case, including a fascinating, valuable glimpse into the personal reactions the group had to the behaviors of both patient and therapist. This is a major contribution in itself, as it illustrates how easy it is for therapists to slip into moralism and to lose sight of the psychological function of behavior of which we disapprove.
Goldberg sees the pathology in question as a kind of disavowal, which in his theoretical language is a function of the “vertical split,” in contrast to the “horizontal s