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Somewhere around the middle of this very challenging book by Frank Lachmann (p. 186 to be exact), there is a description of a supposed analytic session in which the author tells his patient of his responding to her wish to smear phlegm, urine, and feces on him by his own wish to do the same to her. There then follows a discussion of a fantasied snowball fight that the two (patient and analyst) would have with one another. These two vignettes certainly serve to cause the reader to sit upright in his or her chair and so allow one to use the word “supposed” to characterize an analysis that might seem unorthodox to many.
In fact, “unorthodox” seems to be a fitting word for Lachmann's book, which is chock-full of cases that stir the reader and make him or her want to talk to Lachmann for either more material or some clarification or just to meet him. Having met him myself, I thought it best to strive for objectivity in a review of his book and so decided to use it as a text for psychiatric residents who were just learning psychotherapy. It turned out to be quite a success and so, as a start, I would urge anyone to consider using it in just this way. My residents were intrigued by the cases, argued vehemently over what Lachmann said or did not say, wondered over and over why he did not medicate these patients (another wonderful opportunity for discussion), and all in all were rewarded for their efforts.
The book is a wide-ranging one from an intriguing discussion of serial killers to a compelling dissection of Ibsen. The glue that binds it together is Lachmann's take on aggression and its relevance to self psychology. In truth, Lachmann goes beyond the usual explanation of aggression offered by Heinz Kohut to embrace (in Lachmann's words) “self and interactive regulation, co-constructing perturbations and the dialectic between repetition and transformation” (p. 214). In fairness to Lachmann, he does give clear definitions and clarification of all of these ideas, and he seem