The book takes the reader “into the trenches” with the author as he describes his psychoanalytic work with a variety of patients with difficult and complex conditions. The reader becomes familiar with the clinical and theoretical difficulties psychoanalysts encounter in their day to day practice with such patients, especially the counter-transference reactions so common with patients who rely on rigid defense systems. While presented from a Kleinian viewpoint, the book is written in a very inclusive and flexible manner that brings together a variety of analytic thought and provides easy access to the reader unfamiliar with Kleinian theory. The book provides a wealth of in-depth clinical material including severe personality disorders, chronic depressive conditions, pathological phantasies of grief and loss, and destructive states of narcissism.

Each chapter provides a vivid look into the workings of psychoanalytic treatment in the context of the contemporary focus on understanding projective identification, enactment, acting out, and the careful and thoughtful interpretive working through of these complex clinical situations. Much of the book also addresses how to notice, learn from, and utilize these volatile moments. Indeed, once properly understood, what once was fertile ground for the analyst’s acting out can become a bridge to better translating and interpreting the patient’s core anxieties and providing a therapeutic experience of change and growth.

This volume shows the therapeutic power the modern Kleinian approach can have with patients throughout the diagnostic spectrum. By attending to the interpersonal, transactional, and intra-psychic levels of transference, counter-transference and unconscious phantasy with consistent here-and-now and in-the-moment interpretation, the Kleinian method can be therapeutically successful with severely neurotic, borderline, and narcissistic patients. By making the goal of psychoanalytic treatment the gradual establishment of analyst contact, a broader range of patients can be helped and understood.