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Primitive patients induce destructive feelings and acting out in the professionals who take care of them. These processes of countertransference enactment pervade the hospital treatment of these severely disturbed patients. When processed and appropriately used, such enactments can contribute greatly to the successful treatment of these difficult patients. When not transformed into productive material, however, these countertransference enactments can destroy the therapeutic character of our treatments. The task of the hospital staff and milieu is to ensure that this material is used productively rather than becoming the catalyst for staff dissension and hostile actions against patients. Such is the message of this book.
While focused on this central theme, this book appears to consist largely of the reflections of the author on a variety of aspects of the hospital treatment of severely disturbed patients. Primary attention is focused on the countertransference enactments that occur on the wards, with much attention going to the institutional arrangements of hospitals and how they affect the ability to attend to induced feelings and actions. For some reason, the book also contains a chapter by Peter Giovacchini on “Collective Countertransference and Parallel Process,” which focuses on induced countertransference in groups of psychoanalysts. Unfortunately, the chapter has a condescending tone that detracts from the message. While it is nonetheless interesting, no attempt is made to integrate this chapter with the rest of the book.
Those familiar with the voluminous work on countertransference since Searles's pioneering works will hardly be surprised by the book's basic message. The book, however, extends the utility of this work beyond traditional analysis and psychotherapy to the