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“How Much Does the Therapist at Work Need to Feel?” asks Stanley Coen in this book's chapter 7, which bears that title. A great deal, he answers: he or she must be able to experience passions—both of love and hate—in order to explore them in the treatment. Several clinical vignettes detail the author's struggles with intense feelings, as well as his satisfaction when he succeeds in resonating with his patients. For example, he was surprised to find himself hating a patient, Ms. X (pp. 15-21). Presentation to a “peer supervision group” (p. 20) helped him understand that her surface presentation of love had been so gratifying that he had been complicit in camouflaging her underlying rage and hatred. Another patient (Prof. J, pp. 21-27) evoked hatred with his tenacious resistance to experiencing the neediness that he hid behind a facade of rigid rage and entitlement. Colleagues at Austen Riggs, used to working with hospitalized patients, helped alleviate the author's pessimism (p. 24).
As noted in the preface, Affect Intolerance in Patient and Analyst is the product of many years of work, which “incorporates, in thoroughly revised form, material previously published elsewhere” (p. v). It is comprised of eleven chapters and divided into three parts. Part 1 is entitled “What Makes Affect Intolerable for the Patient and Therapist?” Part 2 is “What Is the Therapist's Role in Helping the Patient Develop Affect Tolerance?” And part 3: “Helping Therapists' Affect Tolerance through Talking and Writing about Our Work.” Illustrative clinical vignettes accompany such subtopics as “Barriers to Love,” “How to … Bear the Unbearable,” “Managing Rage and Hate,” “Perverse Defenses,” and “The Wish to Regress.” Many of the chapters might be read individually.
Somewhat incongruous with the title of part 3, its third chapter addresses the application of child development research to adult treatment, while the fourth discusses two papers by Erik Erikson. Although these two chapters are intere