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Boesky, D. (1994). Psychoanalysis: Clinical Theory and Practice: By Jacob A. Arlow, M.D. Madison, CT: International Universities Press, Inc., 1991. 444 pp.. Psychoanal Q., 63:349-357.

(1994). Psychoanalytic Quarterly, 63:349-357

Psychoanalysis: Clinical Theory and Practice: By Jacob A. Arlow, M.D. Madison, CT: International Universities Press, Inc., 1991. 444 pp.

Review by:
Dale Boesky

This is a remarkable volume. In his classic paper, "Unconscious Fantasy and Disturbances of Conscious Experience" (Chapter 10), Arlow stated quietly: "It is my impression that a clearer understanding of the functioning of the mind may be achieved from examining the role that certain aspects of unconscious fantasy play in mental life" (p. 158). This volume testifies to the validity of that claim. The classic core theoretic papers in this book are actually a potential text of clinical theory based on the modern structural hypothesis. In fact, these core papers with suitable emendation would constitute a unique syllabus for a seminar on modern structural theory.

One can see Arlow's methodology slowly emerging as one reads on. He has chosen the unconscious fantasy as the clinical and theoretic unit for his explication of structural theory. He has from the outset studied the vicissitudes of the dynamic equilibrium between the wish and defense as these are manifested in unconscious fantasies. He demonstrates repeatedly that the unconscious fantasy actively establishes the mental set against which the data of sensory registration are selectively perceived, inhibited, transformed, or disregarded. He provides a wealth of persuasively documented clinical illustrations of his views about focusing on unconscious fantasy as the herald of crucially important dynamic shifts in the associations of the patient throughout the course of a psychoanalytic treatment. What makes his mordant clinical examples so valuable is that they offer such coherent, lucid, and persuasive illustrations of his theoretic views.

It should be emphasized that it is one thing to say that all analysts listen differently and quite another to say that all analysts listen with equal care to everything that the patient says. Arlow's papers are a forceful argument for meticulous attention to the patient's associations. This alone is a topic which deserves further research because our literature and meetings demonstrate abundantly that many analysts are in disagreement about the value of very close readings of their patient's associations.

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