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Giovacchini approaches the subject of narcissism from multiple angles—theory and theorists, therapist, patient, and the creative process. The subject and organization extend or pull together the author's interest in the subject, particularly from the viewpoint of object relations, over more than four decades. Overall, it is a tour de force, and while in some places it is loosely written and in others too driven by polemics, it usually commands the reader's attention. At times, the author reviews or repeats his previous work, but this would be difficult to avoid with his longevity and prolific output (more than 200 papers and 25 books).
The guiding thread is Giovacchini's lament over the loss of the intrapsychic focus in psychoanalysis. (Intrapsychic is not synonymous with Freudian. He speaks often of unconscious motivation, though not usually of intrapsychic conflict and compromise formation. Moreover, an antipathy to “classical” analysis runs through the book.) Responsible factors are both internal and external to analysis. These include “lassical” analysts themselves (“how much their rigidity, narcissism, and iconoclastic attachment to Freud have led them on a self-destructive course” [p. 12]); similar rigidity and narcissistic investments of other schools, such as self psychology and intersubjectivity; the various inroads of biological psychiatry; and therapists who do not use the intrapsychic conflict model, instead attempting to make up for infantile deprivations and trauma.
Giovacchini is particularly interested in sicker patients, about whom he has written considerably elsewhere, and here he notes that “In patients with structural defects, narcissism plays a greater role than in the so-called psychoneuroses. In our era, Narcissus has, indeed, replaced Oedipus” (p. 22). A therapeutic armamentarium must supply the technical adaptations necessary for clinical work with structural defects in these patients, who “attempt