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Clinical material is used to illustrate the Modern Kleinian approach to and within a patient’s defensive system and their particular transference profile. Rather than embrace the traditional concept of the working-through (WT) process, the author focuses on the analytic here-and-now of working within a patient’s unconscious phantasy world, the transference, and any pathological organizations that are relied upon. This is a more holistic and comprehensive method of working analytically, based on working within a patient’s internal object relational experience, which hopefully leads to growth and transformation. A summary of the first two analytic sessions with one patient, material from a psychotic patient in treatment for 6 months, and a higher functioning patient seen for more than a year are presented to show the utility of working in this manner with all patients regardless of their level of psychic organization.

JILL SAVEGE SCHARFF (EDITOR): Psychoanalysis Online: Mental Health, Teletherapy and Training, Karnac Books, London, 2013, 272 pp., paperback, $42.30; e-book $33.58, ISBN: 13 : 9781780491547; 10 : 1780491549Psychoanalysis Online: Mental Health, Teletherapy and Training is a useful and intriguing book edited by Jill Scharff. This is a one of the few books available that addresses how psychoanalysis and psychoanalytic psychotherapy have begun to participate in the modern age of technology. A simple but pertinent example of this technology is that I "wrote" this review using my IPhone to create an audio file that I uploaded to the "cloud" and then downloaded to my IPad for editing.While phones and e-mail have been a part of our analytic work for quite some time, this book focuses on the use of voice and video-calling (Skype and similar), computer-to-computer technology as a way of conducting psychoanalytic work. The different authors in this book do a splendid job of introducing the reader to a new way of conducting psychoanalysis through the Internet.While most psychoanalytic psychotherapists have been aware of how technology has been changing our practice (these may be subtle, small, and infrequent situations but nevertheless we're all aware of them); this type of psychoanalytic treatment is relatively new. Over the last five or 10 years, Skype and similar technologies have allowed the psychoanalytic worker to conduct ongoing regular treatments with patients, who, for variety reasons, cannot be in the office physically but are motivated to have an analytic experience. I personally have used this technology once and thought it worked well. However, I have much more experience with phone-related analytic work. Therefore, I wish the book had included more about the phone as well as the Internet. My hunch is that there are many more practitioners who have used or are using the phone to conduct analytic work than there are clinicians using the Internet. We need to be discussing those theoretical and technical issues as well.This well-written book is divided into three sections. The first one is on technology, the person, and society. The second is on clinical issues with telephone or Internet treatment, and the third section is on the implications of Internet technology for psychoanalytic training. I found the first section to be helpful in a general manner. It was interesting but not terribly captivating. The chapters discuss the theories or conceptualizations of society's internalization of technology.Turning to Section Two, my interest was piqued by the many clinical examples of transference and countertransference conflicts being translated over the Inter- net. One of the opening chapters in this section makes the point that the identity issues and psychic conflicts described in the case material are not created by technology but intensified by it. I think this is a crucial and vital idea in that the use of Internet technology for psychoanalytic treatment is in some ways a brand-new issue but at the same time it is simply another playing field for transference and countertransference. It is another psychic arena for projection and another opportunity for us to understand our patients' internal worlds from a different angle.This section also presents valuable information on the ethical and legal issues of undertaking psychotherapy or psychoanalysis on the Internet. Although this is an area needing more research, this book is groundbreaking in presenting the basics as we know them today. For example, the book points out that many therapists are licensed to practice in only one state so that it is necessary to know where the patient being treated is actually located. Also, therapists need to know to whom they are talking to online because of various ethical and legal matters regarding confidentiality, underage minors, and so forth. These and other important issues are well explained in these chapters. …