This book presents a model of interpretative psychotherapy that is provided through twice weekly sessions over several years. It is for people who may be able to get by, but not to fulfil themselves, in work or love. (In a UK context, they will be typical of many seen in the private sector or as training cases). The self-defeating habits responsible are attributed to avoidant, obsessive–compulsive, depressive/dependent or hysterical/histrionic personality traits. The use of descriptive personality profiles to map psychotherapeutic needs is not new, having been the organising principle of Anthony Storr's Art of Psychotherapy nearly 30 years ago. With the possible exception of some paranoid and schizoid tendencies that do not qualify as higher pathology here, the terrain has changed surprisingly little between the two books.
Of course, the present volume belongs to a different era, one where scientific credibility has become far more important. Although use of the shorthand acronym for dynamic psychotherapy for higher-level personality pathology (DPHP) encourages implicit comparison with many well-established therapies – or the treatment devised by the same group for borderline personality (transference-focused psychotherapy, or TFP) – such comparisons are misleading as ‘DPHP’, as yet, lacks clear research evidence of its efficacy. However, the care taken throughout over description, cross-referencing and illustrative vignettes will undoubtedly facilitate its use as a treatment manual in future evaluative studies. Within the traditions of psychoanalytic therapy, the model presented here is true to Kernberg's longstanding interest in internal structure as well as conflict, using a language of object relations and developmental positions indebted to classical Kleinian theory.
What the book offers is a theoretically coherent and clear guide to exploratory, transference-sensitive psychotherapy. It seems likely to be of considerable practical use to therapists (and supervisors) because of its refusal to simplify unnecessarily and its ability to convey the strategic thinking behind the guidance it provides. At times it also strays usefully beyond the boundaries of higher pathology. At its conclusion, the authors say ‘our hope is to leave the reader with a coherent way of thinking about dynamic psychotherapy’. I found they succeeded as far as is likely to be possible without discussing actual patients. The book deserves to be widely read and studied.
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