Conflict and Compromise: Therapeutic Implications edited by Scott Dowling Workshop Series of the American Psychoanalytic Association, Monograph 7. Madison, CT:  International Universities Press, 1991,  x + 238 pp., $32.50

Is it possible to develop a dynamic, psychoanalytic theory broad and deep enough to explain all possible mental activity and to

make it possible to generate technical guides to psychotherapeutic treatment? Is the “structural theory,” that is, classical conflict theory, inclusive enough, or will it be necessary to live with a theoretical and terminological grab-bag, each position applicable to one group of patients but not another?

The continuing controversy between the so-called “deficit” and “conflict” viewpoints in psychoanalytic theory and technique is the focus of this book. It possesses the advantages of providing instruction, polemical argument (at times rather heated), and clinical presentation by ten advocates of the two general points of view. Any reader of this book, especially an analyst immersed in clinical work, cannot finally close its covers without having been stimulated into thinking through or rethinking his own theoretical and clinical position, and having learned something about the actual complexity of the modern conflict-compromise viewpoint.

Jacob Arlow opens the discussion with a presentation of the core issues—conflict, trauma, and deficit—which form the basis of the controversy between the adherents of the main viewpoints represented in the book. The problem, says Arlow, is this:

The question that arises is what makes it difficult or impossible for the ego to effect adequate compromise formations of childhood instinctual conflicts. The issue is crucial insofar as treatment is concerned because every therapeutic approach must at some point interdigitate with a theory of pathogenesis (Arlow, 1981). It is at this point that the concepts of trauma and deficit begin to play significant roles in controversy. (p. 6)

Arlow's answer to the first question is that “trauma is a special vicissitude of development, seen in the context of continuing intrapsychic conflict” (p. 7). It is clear that the conflict theory of pathogenesis does not permit the ident