Psychotherapy , an Erotic Relationship : Transference and Countertransference Passions

S Greenspan’s book details a new developmental theory that attempts to unify and extend the practice of psychotherapy. Drawing on his extensive clinical work and research, he elucidates the earliest stages of human development and clarifies the impact that difficulty in these stages has on the development of personality and psychopathology. He points out that although many experienced therapists intuitively incorporate developmental principles into their own eclectic approach, few therapists apply these principles in a systematic way. Adopting a more comprehensive developmental approach, he asserts, can expand the range of patients that can be helped by psychotherapies. Therapeutic strategies can be constructed to deal with complex psychopathological problems such as the role of constitutional factors in anxiety states and affective disorders, problems in forming and maintaining relationships, and problems of severe character pathology. In his second chapter, Greenspan amplifies the basic principles of his developmental model. Most patients have characterologic difficulties and display interactive patterns related to the very early phases of character formation. Therapies that aim to help patients verbalize feelings or alter behaviors are helpful within a narrower range of patients. These therapies, however, will not prove helpful to patients with more severe pathology. This is because of the therapist’s tendency toward overor underestimation of the patient’s developmental level and overreliance on interpretive verbal techniques. For example, patients are mistakenly assumed to be able to picture and verbalize their feelings, when, in his view, they lack this highly differentiated representational system. Four basic principles of the developmental model and the six levels of early development must be used to build a developmental profile. Examples illustrate how this approach can determine the therapeutic tactics most helpful to each patient (e.g., support versus interpretation). In chapters 3 through 7 the author details the early developmental phases, giving examples of psychopathological problems that have their origins at each level. He points out the importance of constitutional, maturational, and interactional/environmental factors in the development of these problems and shows how a parent’sor therapist’smode of interaction can worsen or ameliorate the difficulties. The final three chapters focus on clinical techniques to enhance representational capacities. Greenspan says that most patients require extensive structural changes (referable to the previously unmastered levels of skills such as self-regulation, boundary definitions, and gestural communication) before they can benefit from the more traditional verbal interpretive approaches. The appendix describes his model for assessing these developmental levels. This text has many strengths. Greenspan’s descriptions of early development are rich and thought-provoking. They provide another dimension for understanding personality development and psychopathology, building on and expanding the works of Freud, Piaget, Mahler, Kernberg, Kohut, and others. His unique perspective will give many therapists pause about their overreliance on interpretive techniques that focus primarily on conflict. This book will be a welcome addition to the library of any serious student of psychotherapy. However, therapists expecting a text with simple constructs for addressing vexing clinical problems will find instead a rich and complex text that will require careful study to enable integration of these concepts in a systematic way. Overestimating the patient’s ability to experience and represent feelings unnecessarily B O O K R E V I E W S