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This is a moving book. It is written in a direct style which leaves one with a feeling of having been spoken to. This involvement, the meticulous detail in which the many clinical examples are examined, and the warm compassion extended both to the patient and to the therapist provide the sort of cathartic experience usually available only in an analytic session or supervision. This impressions is enhanced by the touching autobiographical account of Rosenfeld's own development and work in relation to psychotic patients, which forms the first part of the book.
The book is divided into four further parts, the fifth comprising a summarising conclusion. A helpful historical survey of the treatment of psychotic states by psychoanalysis is added in an appendix. This device, together with the use of extensive notes at the end of many chapters, makes possible the inclusion of a lot of review material that would otherwise obscure the book's main purpose. This is the study of some of the factors which lead to theraputic impasse, arising both from pathological processes in the patient and from failures of technique in the therapist which militate against understanding and containment. Central to Rosenfeld's considerations are the axioms, first that there is a sane part in all patients, no matter how psychotic, which is trying to communicate; and second that, in contrast to Searles and Winnicott for instance, no modification of basic psychoanalytic technique is required in their treatment: interpretation suffices.
Specific contributions to therapeutic impasse are examined under sections 2, 3 and 4 of the book. Part two examines some anti-therapeutic factors in the therapist which are exemplified by clinical material in chapter 3. Here the therapist is unable to hear what the patient is communicating because of her difficulties in moving with the shifts in the transference. She has prejudices concerning what the material is about (envy and the weekend rather than her inability to h