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Fosshage and Munschauer have done us an important service in tackling the demanding and possibly sometimes aversive task of writing about such a demanding and sometimes aversive patient. The “deeply intractable nihilism” of someone like Jack tends to work its way into the analyst's unconscious willy-nilly, leaving him or her in need of a reliable, thoughtful vantage point (through obtaining consultation, or via reading a paper such as this) to help put the experience in perspective—to detoxify it, as it were. The authors have provided a very experience-near and bold account of the twists and turns of a difficult treatment, one that allows the reader to “feel the pain” of both therapist and patient over the course of a rough therapeutic road. In introducing their contribution, Fosshage and Munschauer call for more discussion in our literature of unusual treatment situations that challenge our accepted notions of the proper conduct of an analytically oriented treatment. The authors themselves offer such material with the requisite candor, honesty, and detail to foster our careful scrutiny and consideration.
The chapter is written from a theoretical position based in self-psychological thinking, but incorporates a close appreciation of the analyst's co-participation and subjectivity. Among the thought-provoking concepts emanating from the authors' viewpoint is the notion of a continuum of relational needs from self and selfobject needs to concerns about self-with-the-other (or “intersubjectivity”), to concerns for the other (or “caretaking”). The authors maintain that facilitative interaction requires that the analyst respond in reciprocal fashion. The analyst should be able to meet a patient's self needs with