New Clinical Realms consists of ten diverse chapters, organized into five sections of two chapters each: ‘Unexplored Problems’, ‘Unrecognized Personalities’, ‘Uncelebrated Partners’, ‘Unfamiliar Processes’ and ‘Untapped Potentials’. The first chapter, entitled ‘Mental Pain’, begins with a review of psychoanalytic thinking about the nature of the phenomenon. Akhtar outlines the evolution of the concept in Freud's writing from drive theory (trauma due to a breach in the protective shield) to object relations (pain due to object loss) and further development by later analysts. His summary, that mental pain is a complex phenomenon with many roots (he lists seven) will not surprise many clinicians. He briefly reviews ‘defensive maneuvers’ and this leads on to one of Akhtar's