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This book is a solid complement to Rosenfeld's earlier work, Psychotic States, which was published over 20 years ago. Throughout his career, Rosenfeld has contributed to an understanding of psychoanalytic work with difficult patients. It is published posthumously and offers Rosenfeld's final insights in the areas he long pursued. Throughout his career, Rosenfeld was steadfast in showing that psychoanalysis of psychosis proper and psychotic states in a variety of conditions is possible. In this kind of work, the analyst must be ready to work doggedly with the painful and maddeningly frustrating states psychotic demand and intractibility induce. How often one hears in supervision complaints about die dullness or negativity of a patient, as if things should be otherwise. Rosenfeld's studies stand as a bulwark against clinical naïveté. To a considerable extent, psychoanalysts work at impasse points. It is the analyst's vocation to become an artist of impasse.
Of special interest is the impact of workers like Winnicott and Kohut on Rosenfeld's systematic Kleinian viewpoint. Rosenfeld still emphasizes the vicissitudes of projective identification in transference-countertransference difficulties. However, he cautions against premature interpretations of envy, which may be experienced as assaults. The formula that idealization masks hidden aggression proves to be insensitive to the healing bond that idealization can provide. Often, envy is intensified by the analyst's attitude, especially if the analyst overvalues his or her contribution at the expense of the patient's. The patient should be helped to bear the pain that envy causes in inhibiting the capacity to love and not be put down for it.
In keeping with Rosenfeld's more positive evaluation of idealization is his emphasis on the therapist's need to let his or her natural expressiveness show, especially in the voice. An attempt to sound detached and impersonal and to denude one's bearing of natural emotionality is detrime