The Personality Disorders

In the introduction Masterson states the book's aim plainly: patients considered untreatable fifty years ago can now build their own lives, yet there is still no universally accepted dynamic definition of the personality disorders. The aim is to retest the ideas Masterson put forward 25 years earlier — which have survived and which have changed. A list of questions follows: how well founded are the objections of Stern and the attachment researchers to Mahler? Is Linehan's dialectical behaviour therapy suitable for all borderline patients? What are the strengths and gaps of DSM-IV?

Chapter 1 is the book's most useful part, because the author rereads Margaret Mahler, the foundation of Masterson's own theory, with a critical eye. Between 1962 and 1968 Mahler observed 13 mothers and 21 children and divided «separation-individuation» into phases: autistic, symbiotic, differentiation, practising and the «rapprochement crisis». Masterson concedes that Mahler designed the study not to discover what actually happens but to «prove» Mahler's earlier hypothesis about childhood psychosis — rare candour about one's own theoretical base.

Next comes Daniel Stern's work. Stern showed that the infant is born with an active perceptual apparatus, is a co-creator of its own development, that there is no «autistic» or «symbiotic» phase, and that the sense of self develops in four domains — emergent, core, intersubjective and verbal. Masterson accepts these findings but points to a contradiction: if the infant perceives the mother as separate yet experiences her actions emotionally as part of itself, then emotional separateness is still lacking. The chapter continues with a summary of Bowlby and attachment theory.

The book's theoretical line is this: although Mahler's theory has been criticised as a description of normal children, it remains a workable framework for the psychotherapy of personality disorders. Masterson adds genetic predisposition and neurobiology, especially Allan Schore's work on the neurobiology of the self. The synthesis is interesting but one-sided: Masterson treats the «minimisation and denial» of the mother's role as a problem in itself and tends to judge other approaches (Kernberg, Kohut, Gunderson) by how close they come to the Masterson model.

The clinical core is a complete report of six years of therapy with a patient with closet narcissistic defences. Masterson uses it to show the difference between an oedipal conflict and a pre-oedipal «abandonment depression» and includes a 19-month follow-up. Case reports this detailed are rare in the psychoanalytic literature and valuable for younger therapists. But it is an illustration, not evidence: a single successful treatment does not demonstrate an approach's effectiveness.

The Turkish translation is the work of two translators and a scientific editor; the terminology is consistent, but the text is dense and reference markers (such as 1.20–1.25) slow the reading. Overall this is a «mature» statement of the Masterson school and a necessary reference for therapists who use the approach. Other readers would do better to start with Masterson's more accessible «The Search for the Real Self».

• A side-by-side comparison of the theories of Mahler, Stern, Bowlby and Schore
• A complete, session-by-session report of a six-year therapy
• Concrete clinical criteria for differential diagnosis