Abstract
I came to this book curious as to the validity of the claim made by Grotstein in the foreword that the author had been successful in integrating various strands of psychoanalytic thought, including object relations, intersubjectivity, self-psychology and what he refers to as relationism. In considering the collapse of the self and its therapeutic restoration, Kainer covers large areas of psychoanalytic theory, providing interesting case examples along the way. However, for my money, the book does not achieve the claimed integration. It lacks sufficient intellectual and academic rigour for that task. Nevertheless, it traverses interesting territory on the health and pathology of the self in the course of its 206 pages.
The Collapse of the Self and its Therapeutic Restoration is in three parts. Part 1 (‘Creating the Self’) occupies three chapters exploring the nature of identification. Kainer distinguishes between healthy and pathological identifications, an area seldom covered. The third chapter on sadomasochistic identification is particularly good, although it does not cover new ground.
Part 2 (‘Collapse of the Self’) explores narcissistic injury and its relation to paranoid-schizoid collapse; compulsive eating as an act of autistic self-soothing in a neurotic structure (an illuminating discussion); psychotic residues in a neurotic structure; and, last, a case study. This case, that of Ms G. (Chapter 7) is a salutory example of the severe, therapist-taxing problems usually associated with patients with borderline personality organization. Many diagnoses have been applied by consultants to whom Ms G. is referred for an opinion and many medications concurrently and sequentially prescribed, without beneficial effect. Ms G. responds over time to psychoanalysis, and is presented to show the ongoing need for psychoanalytic approaches in the era of neurobiology.
Part 3 (‘Therapeutic Restoration of the Self’) also covers a huge field. Its three chapters explore the role of projective identification in imaginative empathy; the implications for treatment of psychic catastrophe and the premature psychological birth of the self; and, last, an area whose title reveals the integrative endeavour: ‘Lifting the shadow of the object: reworking pathological internal object relationships and transforming self-object failures’. This latter section lacks depth of exploration and drags the reader past complex ideas and concepts, without due pause for reflection. A pity and an opportunity missed! The author attempts to cover too much in the space available. The integration of various streams of psychoanalytic thought demands more detailed analysis and exposition. Kainer simply states that integration presents problems of mixed metaphors and creative wills. Indeed. And how has Kainer dealt with these problems?
Kainer makes a significant bridge between object relations and self-psychology in her inclusion of the containment of strong affects (famously elucidated by Bion in his metaphor of the container/contained), as a selfobject need (pp.125,182) to be added to those already delineated by Kohut. This is an important conceptualization. It is an ideal place for Kainer to demonstrate her approach to the difficulties raised by the mixing of the metaphors of container/contained and self-objects. Each of these metaphors is central to the theoretical framework of its author, so her solution to the difficulties involved in constructing this bridge is crucial to the integrative endeavour.
A further plea for integration of the two theories lies in her discussion of imaginative empathy as representing the communicative use of projective identification (PI). She asks self-psychology to re-evaluate PI in this light: to reconsider its rejection of the concept, based on the original Kleinian emphasis on the evacuative function of PI. Her point is well made. Where, for example, negative therapeutic reactions are viewed as caused by death instinct phenomena in the patient, and the analyst's own functioning in the interpersonal field is not considered, the potential for permanent damage to the treatment is enormous. While Kainer acknowledges the contribution of self-psychology to this area, she does not adequately recognize the part object relations theorists have played in elucidating the communicative aspects of PI. Heimann, Balint, Bion and others have laboured over many years to balance the understanding of PI. Perhaps the question now is whether theorists from both fields can have constructive dialogue.
This attempt to integrate psychoanalytic theories lacks depth but has some redeeming features. It is useful in regard to the health and pathology of the self, particularly in the area of identification. Those readers averse to more academic texts will find it an accessible read.