Treatment of Primitive Mental States. Peter L. Giovacchini, M.D. New York,  Jason Aronson, 1979,  536 pp.

Peter Giovacchini is well recognized for his contributions to the treatment of the difficult patient. In his earlier papers, collected in , he emerged as a champion of an unmodified analytic stance vis a vis all forms of pathology. He used the term “character disorder” broadly, to encompass all configurations lying “somewhere between neurosis and psychosis” (p. 31); recognizing the considerable nosological confusion in this area, he purposely avoided more specific diagnostic categories. He made no attempt at systematization.

In Treatment of Primitive Mental States Giovacchini attempts to recast essentially the same material within the framework of a coherent theoretical system, including a developmental theory, a nosology related to it, and a general discussion of technical issues. The developmental theory centers on the evolution and internalization of early object relations; Giovacchini's intention is to achieve “a synthesis of recent ego psychological principles and various object relations theories” (p. 20). This ambitious goal is not fulfilled; rather, concepts borrowed from disparate theoretical systems form a theoretical conglomerate. Thus Giovacchini finds a close relation between the current concept of symbiosis and Winnicott's concepts of transitional phenomena and of “primary psychic creativity.” In the process, he defines the symbiotic phase as one in which “the merger … is presumably perceived by the child as consisting only of himself” (p. 30). At issue here is the arbitrary redefinition of a commonly used term in order to fit it into an otherwise incompatible framework. The intended synthesis with ego psychology includes too much of such linguistic borrowing out of context; this is especially evident in the indiscriminate and often anthropomorphic use of the term “self representation”; here, the carefully wrought ego-psychological distinctions between “ego,” “self,” and “self representation” are lost, and we find that the self representation can feel,