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Sandra Buechler is a gifted writer and an experienced psychoanalyst whose engaging style draws the reader into her book. Utilizing excerpts from short stories, she illustrates specific characterological coping styles, such as schizoid relating and paranoid processing, and then discusses treatment for these. Her therapy uses a relational model; it is the relationship itself that produces change. She asks, “Who does the clinician need to be in order to help someone with this coping style?… the personhood of the clinician is a key factor in treatment” (pp. 2–3).
She focuses “on the way people grapple with their troubles… I try to get at the heart of what it means to cope with life using paranoid… defensive patterns” (p. 2). As each characterological style produces emotional reactions in clinicians, self-awareness and utilization of intersubjectivity are essential to her therapy. In treating obsessives, one's “own obsessive devices” may be activated, “… perfecting theories about the patient, while real life goes by” (p. 93). Stimulated by the fictional characters, she sometimes speculates as to how she might treat them, but focuses more often on her own clinical experiences rather than the treatment complexities presented by those characters.
An excellent illustration of applying treatment to a fictional character is her discussion of Bessie, a “terrified old woman” in I. B. Singer's “The Key” (1999). Bessie, a widow, living alone, perceives the world as threatening. In a major crisis, Bessie's key is broken by “evil forces,” and she is “locked out of her sanctuary.” She catastrophizes the worst outcomes, exemplifying “the fearful expectations that form a component of paranoid dysfunction” (p. 28).
Buechler would focus treatment on Bessie's “sorrow,” realizing her multiple age-related losses; “her greatest loss is Sam” (her deceased husband). Helping her mourn Sam, Buechler writes, “I would… sit with her, as she remembers herself with Sam” (p. 43).However, “at some point,