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Fred Busch has written a splendid book. His thinking is clear, and this important contribution is well articulated. By his sharing with us a good deal of rich and experience-near clinical material, his work becomes very much alive and immediately engages the reader. The clarity of this concise volume is largely related to Busch's writing style and how the author has structured his work to permit his exposition to unfold.
Busch starts his book by underscoring his major thesis and then lucidly and emphatically goes about substantiating his propositions. He notes that, by focusing on one aspect of psychic functioning and clinical technique, he hopes to emphasize an aspect of theory and practice that has gone underdeveloped and neglected. He cautions us, however, that by his so focusing his discussion, other aspects of clinical understanding will be put to the side and thereby overshadowed in this study.
Busch's central proposition is that “we must place more emphasis on the role of the ego in our understanding and interventions in the therapeutic setting” (p. 5). He notes that, despite disclaimers by many clinicians, Freud's early topographic model of the mind remains alive in the thinking of many practitioners, and this causes considerable confusion in clinical work. The view of psychic functioning related to the topographical model lends itself to seeing the primary task in analytic treatment as “overcoming” the resistance in an effort to make conscious that which is unconscious. This perspective of the analytic objectives carries with it the hazard of overlooking the centrality of ego functioning and in a very profound way influences the way we proceed in our therapeutic endeavors. The author notes:
[W]hat is bypassed with the Topographic model as a clinical exemplar are the detailed ways by which the ego defends against awareness of, while
Page 74simultaneously gratifying, unconscious fantasies: how defenses undertaken early in life as a means of adaptation to a frightening