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Clinical Exploration in Primitive States of Being

An extraordinary depiction of one analyst's efforts to receive and respond to the vivid impressions of her patients raw and sometimes even unmentalized experiences as they are highlighted in the transference-countertransference connection. Mitrani attempts to feel, suffer, mentally transform, and finally, verbally construct for and with the patient possible meanings for those immediate versions of life’s earliest experiences as they are re-enacted in the therapeutic relationship. She uses insights from this therapeutic work to contribute to the psychoanalytic theory of technique. In these eleven essays, Dr. Mitrani masterfully integrates the work of Klein, Winnicott, Bion, and Tustin as she leads us on an expedition through primitive emotional territories. She clears the way toward detecting and understanding the survival function of certain pathological maneuvers deployed by patients when confronted by unthinkable anxieties. In her vivid accounts of numerous clinical cases, she provides and demonstrates the tools needed to effect a transformation of unmentalized experiences within the context of the therapeutic relationship.

Harold N. Boris, author of Envy, Sleights of Mind, and Passions of the Mind




A Post-Kleinian Approach to the Treatment of Primitive Mental States

…In the midst of my writing this review, life's events pulled me away from completing the task. This was fortunate because I would otherwise have underestimated the value of Mitrani's book to me, the sure test being its staying power in awareness, the ability to change the reader. Which is to say, this book has legs, and it has remained with me. I would not have predicted this; it seemed repetitive in its clinical approaches, and after a while quite predictable—I knew what was coming. But in my subsequent supervising of difficult cases and in my musings about my own work, I find I am regularly citing Mitrani's Kleinian, post-Kleinian and Tustinian clinical conceptions... Mitrani brings them to life and value: the depressive and paranoid-schizoid positions; the role of envy, jealousy, reparation; container and contained; Tustin's supervisory notions of keeping on; adhesive relations; many more. These are useful maps that guide us—and contain us—in our impossible work. They capture common clinical experience, they get it right, and I am grateful.

Alfred Marguilles- J. of American Psychoanalysis, 2002



Psychoanalytic Technique and Theory

The Author continues her contributions as a passionate and enriching source advancing the progress of psychoanalysis. Her profound and movingly written clinical reports enlarge appreciation of developmental depths, ever rooting analytic theory in clinical experience. Extending the thinking of earlier pioneers such as Klein, Bion, Bick, and Tustin, she shows how experience of patients with elemental difficulties advances understanding of very early conflictual issues and of clinical technique in a way that applies to all psychoanalytic patients. And she does it all in writing that is a delight to read. 

Warren S. Poland, M.D., author of Melting the Darkness, and 'Intimacy and Separateness in Psychoanalysis

Dr Mitrani's book provides that rare opportunity to listen in on psychoanalytic thinking and practice at its most exquisitely sensitive to the inner life of both patient and analyst as they attempt to talk with one another about the most fundamental truths of the patient's experience. The book builds upon the work of Freud, Klein, Bion, and Tustin, but goes well beyond that body of work to offer a conception of analytic theory and technique that is uniquely Mitrani's. It is a pleasure to learn from this very fine teacher.'- 

Thomas H. Ogden, author of This Art of Psychoanalysis and Projective Identification and Psychotherapeutic Technique



A Memorial Tribute to Frances Tustin

This remarkable tribute consists of a collection of invaluable papers on subjects close to Tustin's heart that touch on questions at the very core of the human experience. Those who know her work will welcome the opportunity to deepen their understanding of her seminal contributions to psychoanalysis on such issues as psychic autism, hopelessness, despair, awe, ecstasy, and isolation. For those unfamiliar with the thinking of Frances Tustin on regressed and primitive mental states, the book constitutes a found treasure. 

Theodore J. Jacobs, M.D, New York

Frances Tustin was a phenomenon in the field of psychoanalytical psychotherapeutic research with children, and particularly with autistic children. Her independence from organized schools and their prescribed thinking made her an observer of peculiar freedom and therapeutic effectiveness. I appreciate what the editors have done to establish Frances Tustin's position in our history.

Donald Meltzer, M.D., Oxford, UK

Tustin influenced not only those interested in the specific problems of autistic states but also those who shared an intuition that autism could play the role of a new paradigm for the study of the mind. Yet Tustin's thinking did not achieve a recognition comparable to that of her masters and inspirators―Winnicott and Bion. This book corrects that unjust fate. The contributors widen the scope of her work, witnessing its richness, fecundity, and depth, and establishing connections with other contemporary conceptions. Never was a tribute so sincere, so justified, and so thoughtful. 

André Green M.D. Paris, France

The contributors of Frances Tustin constitute perhaps the most significant step forward in our understanding of primitive mental states since the work of Klein, Bion, and Winnicott. This truly superb collection of clinically alive papers by twenty-one notable analytic thinkers from around the globe is certain to become a classic. 

Joyce McDougall, Ed.D., Paris, France



Frances Tustin is an icon within British Object-Relations psychoanalysis. It is good to have in this book, a sustained tribute to her ideas and to their significant and enduring contribution. Her tradition of learning fundamental truths from autistic conditions remains lively, productive and inspiring. Her work sustains one of the founding principles of Object-Relations work – that the depth of psychoanalytic ideas is enhanced by rigorous work with children. As that long-held view ― going back to the innovative work of Anna Freud and Melanie Klein ― has weakened over time, granting a more exclusive place to work with adults, it is important to have this book to redress that imbalance. This excellent collection, the collaboration of Theodore and Judith Mitrani, draws us back to the fundamental questions about working with another mind. How can one conceive of the object relations of a mind that can barely sustain the possibility of relating to others? It is commonplace to regard psychoanalysis as a body of knowledge derived from what goes wrong, but what can be learned about a mind that has gone so radically and despairingly wrong? It is evident from the wide range of papers presented here, that indeed much can be learned from the work with children, contributing that which is not accessible in the work with adults alone. This book is a celebration of clinical and therapeutic confidence from those who have actually persevered in the presence of severe autism, those who have managed to form a joint venture with their suffering young patients, both large and small. 

 Bob Hinshelwood, Professor, Centre for Psychoanalytic Studies, University of Essex

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