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The book is about how a clinical psychiatrist goes about charting one's bearings and maintains one's course in clinical work; it proposes a theoretical hypothesis of how an interpersonal psychodynamics is structured. The conceptualization of this course and its charting is what has been called "A Map of the Mind."
The book is divided into three parts. The first part is on Background, covering "traveling Backwards" and "Affect and Attachment". Part II is on Data and Hypothesis and Part III, on The Centrality of the Affect. A good clinical psychiatrist does not need only a good data, a good know -how of the psychotherapeutic process, but also a capability, enabling a clinical psychiatrist to give converging direction to an interconnectedness of all these and other affective processes to enable him/her to arrive at a viable clinical formulation that is continuously accommodating to other influences as the clinician is engaged in building the right map in clinical practice.
The Introduction consists of three pages that are enough to provide support to the foregoing statement. Speaking about the First Data the author remarks " The first contact in whatever form must be used and the data from this contact must generate hypotheses as to where one is located". Relevance of the First Meeting, of the Mental Status Examination often provides clues by showing what a patient wants and accepts. The author discusses relevance of transference and safety in 6th and 7th chapters in guiding one to a more meaningful building up of hypotheses. He remarks: "Transference and safety are related (pp.77)." And in the process one can test hypotheses of transference and safety one against the another. He explicates the role of "Resistance" and Defense Mechanisms and suggests that their role in the hypotheses building process can be tested whenever the complexity of the clinical data changes.
Part III focuses on the importance of psychological and neurological centrality of the affect in the ongoing process of generating good hypotheses. Being able to take note of the changes in the affect as the interaction with the patient continues strengthens the viability of the hypotheses building, enabling thus a clinical psychiatrist to chalk out a good "mental map " of the patient's clinical functioning. Thus, author now builds the role of "History and Affect", "Affect and Primitive Affect", "Trauma and Affect", "Affect and Medication", and "Affect and Formulation" in this chain. Concluding, the author states that the rout towards a mental map begins with data and hypotheses, providing the bearings. Transference is the vehicle, Affect gives the direction. The formulation is the (mental) map.
The various concepts are discussed and explicated in Freudian framework and in reference to several case histories to bring home their implications to the clinician. It makes a good reading. However, there is a concern. Over a period of practice such Mind Maps tend to stay in a clinician's memory and whenever a similar case history is confronted in time, the clinician may have a weakness to fall back on the memories of such maps or map in deference to a case history's specific perspective.
The reviewer considers that even an identical-like data will have to be examined in a patient's specific affect-perspective, looking for nuances peculiar to this psychodynamics.
G.C. Gupta, Ph.D. Professor of Psychology (Now Retired) University of Delhi, Delhi, India Owner of "mind-in-brain" e-Group
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