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Dr. Shabad presents a perspicacious and moving account of how childhood wishes that were forced underground as a result of the traumatic reception they received at the hands of parenting adults later emerge from Hades as needs bearing the qualities of importunity, peremptoriness, and entitlement, often blended with veiled or not so veiled resentment, anger, fury, and vengefulness. He proposes an approach to the therapeutic handling of people with this type of problem, the crux of which is the acceptance and revitalization of the unconscious wishes by interpretive means. He urges caution in the application of any approach, such as self psychology, that hints of gratifying responsiveness to patients' “needs.” Shabad's paper, for me, engages the question of what is therapeutic about therapy or analysis and extends to an even more general question: how do people change and grow emotionally, whether in or out of analysis?
Much of the paper is given to a remarkably detailed and often sympathetic account of the plight, both inner and outer, of a person caught in a tangle of malignant need, a phrase I extrapolate from Balint's (1968) description of “malignant regression.” Shabad is at pains in this paper to show how it is possible to avert, in the therapeutic situation, the intransigence of such a state of need by encouraging the patient to “take responsibility for,” or reclaim ownership of, the exiled wishes. At the same time, he seems very concerned to dissociate himself from a self-psychological approach to the patient's need, as, for example, when he