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This book is the second volume to appear that includes papers presented at a 1991 conference in San Francisco, sponsored by Boyer Marin Lodge. It is a diverse and intriguing collection of 14 chapters, with many case examples. Much of the treatment that is described is psychoanalytically informed psychotherapy. Most of the authors are, indeed, widely recognized as master clinicians. Owing to space limitations, I shall discuss only four of the book's chapters.
Harold Searles's “The Therapist's Feelings of Unrelatedness with the Borderline Patient” is another outstanding contribution from a distinguished author. It illustrates a quality in Searles's writing that Sheldon Roth (1987) beautifully captured when he said that “reading Searles's descriptions of therapy is like watching diffusion of the unconscious across a semipermeable membrane between patient and therapist” (p. 263). In this paper, Searles emphasizes that “unconscious conflict is at the heart of all psychopathology” (p. 38). On the face of it, this may appear to be an uncontroversial statement. But what makes Searles's work extraordinary is his faithful attunement to unconscious processes, which all too often are overlooked in the abstract intricacies of contemporary psychoanalytic theory. In this chapter, for example, Searles explores borderline patients' defenses against relatedness. He finds that “this phenomenon, like so many other aspects of psychoanalytic therapy with borderline patients, is best detected and explored through the avenue of the therapist's attunement to his own feelings or absence of feelings” (p. 26). One source of borderline patients' conflicts with relatedness is the unconscious connection they make between relatedness and sexual intercourse—a connection that also existed in their mothers' unconscious and that interfered