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Nason, J.D. (1993). Conflict and Compromise: Therapeutic Implications: Edited by Scott Dowling. Workshop Series of the American Psychoanalytic Association, Monograph 7. Madison, Connecticut: Int. Univ. Press. 1991. Pp. 238.. Int. J. Psycho-Anal., 74:190-194.

(1993). International Journal of Psycho-Analysis, 74:190-194

Conflict and Compromise: Therapeutic Implications: Edited by Scott Dowling. Workshop Series of the American Psychoanalytic Association, Monograph 7. Madison, Connecticut: Int. Univ. Press. 1991. Pp. 238.

Review by:
Jeffrey D. Nason

This is a volume which manages to be both absorbing and disappointing. Clearly intended as an exposition of the ideas of Charles Brenner and Jacob Arlow, it suggests a purpose persuasive and polemical rather than exploratory. Apparently straightforward in its opening premises (Arlow writes: 'Psychoanalysis is first and foremost a psychology of conflict', p. 3), its principal contributors elaborate Brenner's idea of the centrality to psychoanalysis of compromise formation, as, in Dale Boesky's words, 'not only our best explanation for pathogenesis … (but) also our most advantageous theory to account for clinical improvement' (p. 29). Along the way it becomes clear that their argument is with those who stress the importance of deficit in many, if not most, patients and who are dissatisfied with the implications of conflict and compromise theory for therapeutic technique.

I have tried to imagine the impression this book would produce on the reader unfamiliar with recent controversies in psychoanalysis, perhaps a curious but psychoanalytically unsophisticated scholar from a neighbouring academic field. Such a reader would probably find it difficult to decipher what this controversy is all about. All psychoanalysts, and certainly all the contributors to this book, readily acknowledge the clinical demonstrability of deficits in affect tolerance, object relatedness, and cognitive and perceptual reliability in our patients, and all accept the centrality of conflict and compromise formation in neurosogenesis.

Where then does the controversy lie? The answer involves the question of what is primary in pathogenesis. Although this may seem to be a mere matter of emphasis, its implications for the theory and technique of psychoanalytic therapy are far from trivial. Writers such as Arlow and Boesky suggest that the analyst's therapeutic attention to trauma, in the sense of the role of reality in pathogenesis, or to resultant functional deficits in the patient, can distract from optimal analytic attention to underlying intrapsychic conflict. For them it is conflict which ultimately determines both the meaning and force of trauma and the resultant form and content of apparent deficit.

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