The clinical exchange

In this lucid, practical sequel to the same authors' Self and Motivational Systems (TAP, 1992), Lichtenberg, Lachmann, and Fosshage offer ten principles of technique to guide the clinical exchange. These principles, which pertain equally to psychoanalysis and exploratory psychotherapy, integrate the findings of self psychology with recent developmental research that has refined our understanding of the self as a center of experience and motivation. The authors adumbrate these principles by presenting extensive process notes from a single analysis ("the case of Nancy") and exploring the successes and failures of the treating analyst's interventions alongside their technical guidelines. These process notes cover a week of analytic work every other year over an eight-year period. These data alone make The Clinical Exchange a valuable addition to the very limited casebook literature. More specifically, the use of process notes illustrates the technical implications of the theory of five motivational systems set forth by Lichtenberg in Psychoanalysis and Motivation (TAP, 1989). Drawing on the case of Nancy and on other clinical experiences, the authors demonstrate how their ten principles of technique provide a valuable framework for attending to a wide range of motivations, including deficit-related and conflict-related motivations. More specifically, the authors show how these principles lead to fundamental revisions in the theory and technical management of affects, transference, and dreams, and to the understanding of modes of therapeutic action.