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edited by David Morgan and Stanley Ruszczynski (London, Karnac, 2007). 260 pp. £19.99 (paperback)
Glasser's (1996) seminal writing on perversion, the core complex, aggression and sadism forms a body of thinking which is extremely helpful in our work with patients. The book under review, whose authors are linked to the Portman Clinic, takes this thinking further. As such the book touches on key aspects useful for therapists working in diverse fields – which of our patients doesn't at times exhibit aspects of the core complex, sadomasochism or perversion.
The editors describe the task of the book as being to share the difficulties of working with severely perverse patients and to provide hope. Do they achieve this goal?
I think that they do on at least two levels. First, at a more technical and clinical level, the chapters are full of clinical cases which usefully capture difficult concepts. The book manages at times to capture the warp and woof of an intense clinical encounter in real time and gives some sense of how the clinician managed a difficult situation. An example of this is the chapter by Anne Horne on psychotherapy with adolescents, where the clinician retains a level of direct curiosity so necessary to push things along with perverse patients, while trying to avoid being experienced as a shaming superego. However there are many examples in other chapters as well. An example of the practical usefulness of the book is the chapter by John Woods, ‘Ethical problems treating paedophile patients' in which he sets out the agreement he established for conducting therapy with the patient. One of the agreements was that the therapist would only work with ongoing consultation. The need for supervision, for a third viewpoint, when working with these perverse patients whose ability to corrupt the truth presents very real difficulties for the clinician, is repeated by a number of authors.
Second, from a more theoretical level