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Mellan, S.L. (1996). The Ego at the Center of Clinical Technique, Buscb, Fred. Northvale, New Jersey, London: Jason Aronson, Inc., 1995, $40.00.. Psychoanal. Soc. Work, 3(4):97-98.

(1996). Psychoanalytic Social Work, 3(4):97-98

The Ego at the Center of Clinical Technique, Buscb, Fred. Northvale, New Jersey, London: Jason Aronson, Inc., 1995, $40.00.

Review by:
Susan L. Mellan, M.S.W., B.C.D.

Defense analysis, the analysis of the resistance in the treatment situation, was central to psychoanalysis after the publication of Inhibitions, Symptoms, and Anxiety (S. Freud, 1926). Two later books, The Ego and the Mechanisms of Defense (A. Freud, 1936) and Problems of Psychoanalytic Technique (Fenichel, 1941) continued our focus on the development of anxiety and the role of the Ego in defending against it. Before Freud developed his second theory of anxiety, resistance to remembering was viewed as a hinderance to the analytic process. Treatment focused on uncovering early memories, instinctual drives, fixations and their derivatives. In this book, Fred Busch views ego oriented work as a current-day extension of basic psychoanalytic principles.

As the book title implies, the thesis of this well written, clinically useful text is plain speaking. According to Busch, we must consider the centrality of the Ego in our work with patients as we attempt the complex process of making the unconscious, conscious. In my initial reading, I felt that this was a directive which had been made often before. I knew from experience as a therapist, that it is better to interpret “In the Neighborhood,” as Busch suggests, avoiding deeper interpretations which went over the patient's head and frequently led to further resistance rather than to useful associative material. As I continued to read his book, I became increasingly respectful of the author's careful explication of how paying attention to the ego's defensive processes can lead to lasting structural change. The Busch technique is based on the concept that threatening affects create layers of defense that must be analyzed from the surface down. This point of view evolves from Freud's second theory of anxiety. It is only by making this behavior meaningful to the patient that the defensive structure can be modified. The major purpose of a defense is to block the meaning of instinctual ly driven behavior. Busch gives an example of a patient who cannot be around people without experiencing a vague feeling of selfcons-ciousness. Busch views this feeling as the person's way of living out an exhibitionistic wish without being consciously aware of it.

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