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Fliegel, Z.O. (1981). Treatment of Primitive Mental States. Peter L. Giovacchini, M.D. New York, Jason Aronson, 1979, 536 pp.. Psychoanal. Rev., 68(1):149-151.

(1981). Psychoanalytic Review, 68(1):149-151


Treatment of Primitive Mental States. Peter L. Giovacchini, M.D. New York, Jason Aronson, 1979, 536 pp.

Review by:
Zenia Odes Fliegel

Peter Giovacchini is well recognized for his contributions to the treatment of the difficult patient. In his earlier papers, collected in Psychoanalysis of Character Disorders (1975), he emerged as a champion of an unmodified analytic stance vis a vis all forms of pathology. He used the term “character disorder” broadly, to encompass all configurations lying “somewhere between neurosis and psychosis” (p. 31); recognizing the considerable nosological confusion in this area, he purposely avoided more specific diagnostic categories. He made no attempt at systematization.

In Treatment of Primitive Mental States Giovacchini attempts to recast essentially the same material within the framework of a coherent theoretical system, including a developmental theory, a nosology related to it, and a general discussion of technical issues. The developmental theory centers on the evolution and internalization of early object relations; Giovacchini's intention is to achieve “a synthesis of recent ego psychological principles and various object relations theories” (p. 20). This ambitious goal is not fulfilled; rather, concepts borrowed from disparate theoretical systems form a theoretical conglomerate. Thus Giovacchini finds a close relation between the current concept of symbiosis and Winnicott's concepts of transitional phenomena and of “primary psychic creativity.” In the process, he defines the symbiotic phase as one in which “the merger … is presumably perceived by the child as consisting only of himself” (p.

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