Curative Factors in Dynamic Psychotherapy. Samuel Slipp (Ed.). New York:  McGraw-Hill, 1982.  397 pp.

This book addresses the important questions: What aspects of the therapeutic situation are curative? What produces change in dynamic psychotherapy? Since the book basically concerns treatment issues with the more disturbed patient population,

primarily borderline and narcissistic personalities, the treatment is referred to as dynamic psychotherapy rather than psychoanalysis. To maintain consistency, this review will use the book's terminology.

Many well known psychoanalysts such as Kohut, Wolf, Kernberg, Gill, Langs, Volkan, Bemporad, Marmor, Lidz, and Tuttman give the reader a panoramic view of the field. The introduction by the editor, Samuel Slipp, as well as the final chapter by Eagle and Wolitzky trace psychoanalytic developments leading to the current state of thinking and include summaries that help the reader master the large body of material covered in this volume.

The issues that emerge as central revolve around two major themes. One involves treatment in terms of insight versus relationship; the other involves patient pathology. The approach emphasizing relationship factors is termed “nurturant-reconstructive,” while that involving insight is termed “neutral-interpretive.” The nurturant-reconstructive approach is seen as similar to Winnicott's holding environment and Alexander's corrective emotional experience. The neutral-interpretive approach is considered classically Freudian psychoanalysis. It is considered the treatment of choice for neurotics with good tripartite structure who are basically in conflict over oedipal impulses. In contrast, the nurturant-reconstructive approach is believed to be appropriate for more disturbed patients — those that are narcissistic, borderline, schizophrenic, or depressive. These patients, in contrast to neurotics, are believed to suffer from problems involving the ego or the self. Their pathology is preoedipal, and they utilize primitive defenses such as splitting and projective identification. Since these defenses are