It is clinical work with the most difficult patients - those with severe narcissistic, sadomasochistic, and borderline disorders - that poses the greatest challenge to the therapist's guiding assumptions about clinical process; indeed, such work often leads therapists to question beliefs and expectations that formerly seemed self-evident. In Getting from Here to There: Analytic Love, Analytic Process, Sheldon Bach elaborates the holistic vision that guides him in work with just such patients. He dwells especially on the "attentive presence" through which the analyst effects a "meeting" with patients that invites the latter's trust in the analyst and in the therapeutic process. And he writes of the love - of patient for analyst and of analyst for patient - that grows out of this mutual trust and sustains the therapeutic process.
For Bach, analytic therapy aims at understanding the person as a mind-body unity that manifests particular states of consciousness. This holistic vision of treatment sustains a flexible clinical orientation that enables the analyst to "meet" states of consciousness in order to bring them into a system of which the analyst forms a part. Bach thoughtfully explores the clinical issues that enter into this taxing process, among them the establishment and maintenance of basic trust; the patient's or therapist's presence in the other's mind; and the shifts in agency between patient and therapist. And he describes at length the frequently exhausting, even demoralizing, transference-countertransference struggles that enter into this type of analytic work.
Throughout, Bach is guided by the conviction that work with extremely challenging patients promotes the psychological growth and increased self-knowledge of patient and analyst alike. And he is admirably clear that the "mutual living through" of such treatments nurtures a kind of love between patient and analyst. Getting from Here to There not only records the clinical lessons learned by an unusually gifted analyst; it also chronicles the movement of psychoanalysis itself from the dissection of love into component parts to a synthetic grasp of its vital role in psychoanalytically informed treatment.
