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The Thinking Heart is Anne Alvarez's second sole-authored book. It is a sequel to her moving first book, Live Company, in which she showed how a therapeutic technique that directly invited engagement from a severely autistic boy, insisting upon relatedness and meaning even if they appeared absent, offered a route to liveliness and feeling. In this second book she draws on what is now 50 years of clinical experience with very disturbed children to present a continuum with three main types of psychoanalytic intervention situated along it, each suitable for different types of patients or for different stages of therapeutic work.
The Thinking Heart is characterised by an engaging and informal writing style and a high level of integration between psychoanalytic theory and practice, in the form of sustained and detailed clinical observation. Alvarez is good at bringing disparate elements together: she applies psychoanalytic ideas to a variety of challenging and relatively unchartered clinical situations, her approach exemplifies the integration of intelligence and emotional experience communicated by the book's title (it is drawn from Donne's poem ‘The Blossom’), and she weaves both poetry and recent findings in neuroscience into her clinical discussions. However, she does tend to open up more areas for exploration than she manages to cover in any systematic way, and I sometimes found myself wanting her to narrow her focus a little in order to follow through an argument or a line of enquiry.
The use of full clinical excerpts is unusual nowadays when authors are so conscious of the need to protect patients' identity and/or to gain consent from patients or their guardians. This book is a forcible reminder of what is lost from psychoanalytic discussion when clinical material is not included, or only appears in a truncated or elliptical form. Generally Alvarez gives detailed accounts of interactions during therapy with little background information, presumably to ensure patient