Susan Kavaler-Adler is the founder and executive director of the Object Relations Institute for Psychotherapy and Psychoanalysis in New York and the author of several books and many papers in the area of British and American object relations theory and therapy. In the book under review, the author presents in her Introduction, Chapter One, and Conclusion the revised version of Kleinian theory, integrated with concepts of Fairbairn, Winnicott and Mahler, that informs her view of the therapeutic process as one of “developmental mourning.” It is through facing up to and mourning one’s destructiveness (arising in Kavaler-Adler’s view not from innate aggression but from trauma broadly defined) and one’s consequent regrets, all in the context of a therapeutic holding environment, that one is able to liberate oneself from one’s defensive and maladaptive “false self” (Winnicott), one’s “antilibidinal ego” or “internal saboteur” (Fairbairn), and from Freud’s and Klein’s sadistic superego. Having clearly outlined her theoretical framework, the author illustrates it through a series of richly described case studies which, to my mind, succeed in demonstrating in clinical detail her theory in practice and its therapeutic power in work with patients suffering from diverse levels and types of psychopathology.

Kavaler-Adler’s perspective is very similar to my own as outlined inThe Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience (London: Karnac, 2013). Whereas I speak more about guilt than regret, the two are really inseparable as one cannot genuinely face and learn how to bear one’s guilt without at the same time experiencing regret about the damage one has done to others and to oneself. Kavaler-Adler and I agree with Melanie Klein that consciously integrating one’s guilt and regret, working through the depressive position and moving toward reparation, is the path toward recovery. But because I have a narrower concept of mourning than Kavaler-Adler’s, restricting it to working through losses, including those resulting from our destructiveness, I do not conceptualize genuinely facing guilt and regret as mourning per se. Though certainly sobering and humbling, moving into and working through the depressive position relieves one from painful alienation, shame and superego torment and promotes reconciliation with conscience. I suspect some patients on the verge of the depressive position who intensely and extensively experience mournfulness and what Kavaler-Adler calls “the grief of regret” may be using these persecutory states as a delaying tactic, a defence against genuine progress through getting on with the work of repentance and reparation.

While many deplore the fragmented state of contemporary psychoanalysis, I see the fragments as pieces of a wonderfully complex puzzle that we are gradually beginning to be able to piece together and which will constitute the higher, dialectical synthesis of the existing partial perspectives. In this connection it is relevant to note Kavaler-Adler’s (2014) latest title, The Klein-Winnicott Dialectic: Transformative New Metapsychology and Interactive Clinical Theory. Analysts who have immersed themselves in Freud, Klein, Fairbairn, Winnicott, Mahler, Kohut and others appear to be breaking out of their theoretical tunnels, overcoming tunnel-vision and glimpsing and beginning to delineate an overarching framework for psychoanalysis. In this connection a recent posting by Arnold Richards to the Clio’s Psyche psychohistory list-serve (June 23rd, 2014) is of interest: “A worldwide conceptual survey by the IPA shows that the number one and number two concepts were transference/countertransference and projective identification,” a finding he feels “supports the view that there is a new conceptual consensus with a Kleinian take.” Kavaler-Adler is an important contributor to this emerging synthesis.

In working out her object relational synthesis, Kavaler-Adler felt it necessary to offer a critique of Klein’s acceptance of Freud’s concept of the death drive because, without denying the potential role of innate temperamental differences and mismatches between infants and their carers, she views significant psychopathology as arising not from universal biological forces but from traumatic deprivation, frustration, impingement and abuse. While I share her rejection of the concept of a literal death instinct (though this term is employed in such radically different ways by different authors that it is only in specific contexts that one can hope to know what they might mean by it), Kavaler-Adler fails to draw attention to the fact that on almost every page where Klein mentions projection of the death instinct to account for the inevitable persecutory anxiety of even the most sensitively cared-for infant, she at the same time offers an alternate, and to me far more acceptable explanation: namely that given its cognitive limitations the infant is bound to misinterpret every frustration as an attack and, hence, that the absent good breast is felt as a present bad attacking breast. In “The Origins of Transference,” Klein (1952) writes: “These persecutory feelings from inner sources are intensified by painful external experiences, for, from the earliest days onwards, frustration and discomfort arouse in the infant the feeling that he is being attacked by hostile forces. Therefore the sensations experienced by the infant at birth and the difficulties of adapting himself to entirely new conditions give rise to persecutory anxiety. The comfort and care given after birth, particularly the first feeding experiences, are felt to come from good forces” (p. 433).

Like many North American analysts, Kavaler-Adler appears to have bought into the idea that Klein ignored or minimized the role of the real parenting in health and pathology, perhaps influenced as so many have been by John Bowlby’s slanderous claims in this regard (see references and discussion in Carveth, 2013, chapter 9). In actuality, Klein constantly stressed the crucial importance of good, loving care-taking, for only this can hope to offset the inevitable rage and paranoia resulting from frustration, both that which is basic and unavoidable and the surplus frustration arising from parental failure in varying degrees. In “Mourning and its Relation to Manic-Depressive States,” Klein (1940) writes:

All the enjoyments which the baby lives through in relation to his mother are so many proofs to him that the loved object inside as well as outside is not injured, is not turned into a vengeful person. The increase of love and trust, and the diminishing of fears through happy experiences, help the baby step by step to overcome his depression and feeling of loss (mourning). They enable him to test his inner reality by means of outer reality. Through being loved and through the enjoyment and comfort he has in relation to people his confidence in his own as well as in other people’s goodness becomes strengthened, his hope that his ‘good’ objects and his own ego can be saved and preserved increases, at the same time as his ambivalence and acute fears of internal destruction diminish. … Unpleasant experiences and the lack of enjoyable ones, in the young child, especially lack of happy and close contact with loved people, increase ambivalence, diminish trust and hope and confirm anxieties about inner annihilation and external persecution; moreover they slow down and perhaps permanently check the beneficial processes through which in the long run inner security is achieved (p. 128).

For the reasons indicated, Klein’s references to the concept of the death drive are redundant and can safely be ignored since she always provided another and far more acceptable explanation of the same set of facts. Since Klein considered the parent’s provision of loving experiences as crucial for development, it cannot be said that she sought to get them off the hook, as it were, blaming pathology entirely on the child’s drives and phantasies. Hence, there is no need for Kavaler-Adler’s speculative psychoanalysis of Klein’s alleged motives for doing so (such as that she needed to engage in a Fairbairnian “moral defence” of her mother by blaming herself and the drives and phantasies of children in general ) for, in reality, she never denied the role of the real caretakers in development in the first place.

Despite some differences with Kavaler-Adler in the ways indicated above, I believe her work represents a major and important contribution to the integrative psychoanalytic theory that is beginning to emerge after decades of fragmentation of our field into an array of partial and noninteracting perspectives. One of her book’s major strengths is its many detailed and extensive case studies that will prove invaluable to students and colleagues seeking a practical, clinically grounded understanding of her approach.

Expertly using psychobiography to mine for insight, Dr. Susan Kavaler-Adler illuminates the subterranean psyches of two giants of the British Psychoanalytic Institute: Melanie Klein and Donald W. Winnicott. Adding phenomenological and clinical perspectives, Kavaler-Adler reveals forces shaping their groundbreaking psychoanalytic theories, and, poignantly, the intrapsychic ceiling that Klein hit in developing hers – preventing Klein, like Moses, from reaching the Promised Land.

Kavaler-Adler integrates Klein and Winnicott’s views by moderating a gratifying objective discourse – a dialectic – that Klein and Winnicott were not able to sustain themselves. Kavaler-Adler herself stands on their shoulders to reach greater insights and add her own theories to the field.

In the first half of the 20th century, the institute’s relationship-based, object relations theorists, such as Klein, debated the more instinct-based (and medically trained) Freudians. Klein identified developmental stages different from Freud’s: first the infant’s “paranoid-schizoid position” from which the world appears split into all-good and all-bad parts, and later, if all goes well, a “depressive position”— from which one can enter into satisfying relationships, experiencing both autonomy and compassion for others.

Kavaler-Adler shows us how Klein’s unconscious psychological defenses kept her from seeing her mother’s ostensible narcissism, blinding her to theoretical possibilities and closing her mind. They also led Klein to resist Winnicott’s discoveries – and reject him. Klein’s own psychoanalysis might have dismantled her defenses, but she chose only abbreviated exposure to that side of the couch. Her need to deny her mother’s true nature kept Klein from realizing the shortcomings of upholding an outmoded death instinct theory, or from appreciating the value of developmental mourning of object loss, which Kavaler-Adler explores and widely writes about.

But Winnicott had a different experience with a different – a schizoid rather than narcissistic – mother, which informed his own work on relational mirroring and development. Without Klein’s internal roadblocks, he could see the paths ahead more clearly. And as a pediatrician, making first-hand observations of child and mother interactions, he could correctly identify that the infant was affected by real-life interactions with a real-life mother, beyond the mental-only constructs theorized by Klein. He could see aggression stemming from infants being mismatched, through the luck of the draw, with mothers not attuned to their developmental needs. Aggression was no longer an inborn, free-floating biological drive independent of external relationship; his theories did not have to protect an idealized, narcissistic, blameless mother.

In retrospect, Klein was a bridge between Freudian thought and a fuller expression of a non-drive-based object relations theory realized by Winnicott. And now Kavaler-Adler continues building on the past. With this brilliant work, she enriches our understanding of object relations theory, of psychobiography as a research method, and of her own work in developmental mourning. She shows us that the depressive position can encompass empathy, creativity, and even deep regret that spurs healthy mourning of object loss. The work is an example of how to synergize the best of what has gone before, to plant seeds for the next field of insights in a promised land.

– Barbara E. Berger

For more than four decades, Dr. Susan Kavaler-Adler’s clinical practice and academic writing have focused on faithfully integrating British object relations psychoanalysis into the current mainstream American psychoanalytic tradition. More so, as a clinician, writer, and Founder , Executive Director, Senior Faculty, Training Analyst, and Senior Supervisor of the Object Relations Institute for Psychotherapy and Psychoanalysis ( ORI), Dr. Kavaler- Adler gives voice to some of the most challenging psychological complexes found in contemporary psychoanalytic treatment. Areas that are explored and uncovered in Dr. Kavaler-Adler’s clinical practice and academic writing include the fear of success, paralyzing inhibitions of the Real Self, the demon lover complex that affects many women’s creative lives, the theme of creative compulsion versus free motivation, the importance of developmental mourning in the opening of erotic desire and spirituality, and much more. Unique to Dr. Kavaler-Adler’s clinical approach is her creative reliance on both autobiographical and biographical work as reflected by the psychoanalytic exploration of the lives and work of such literary luminaries as Charlotte Bronte, Emily Dickinson, Anais Nin, Sylvia Plath, and Edith Sitwell (please see bibliography included). As a prolific author, with over seventy articles and six books, Dr. Kavaler- Adler’s provides unique psychoanalytic insights into the profound mental anguish and creative achievements of these writers. Dr. Kavaler-Adler’s well-known books entitled The Compulsion to Create: Women Writers and Their Demon Lovers (Routledge, 1993, 2000), The Creative Mystique: From Red Shoes Frenzy to Love and Creativity (Routledge, 1996), Mourning, Spirituality and Psychic Change (Routledge, 2003), The Anatomy of Regret (2013), and The Klein-Winnicott Dialectic (2014) achieved not only a National Gradiva Award from the National Association for the Advancement of Psychoanalysis but a further 16 awards on psychoanalytic writing. Dr. Kavaler-Adler can indeed be viewed as a pioneer in object relations psychoanalysis, as well as a seasoned clinician and creative voice in the separation-individuation themes explored in contemporary feminine psychology.

In the current work, Dr. Susan Kavaler-Adler, as theorist, clinician, and integrator, sets out to articulate a long-held vision inherent in her many publications of bringing into psychoanalytic dialogue two very creative and seemingly contradictory giants in British object relations theory, i.e., the work of Melanie Klein and that of Donald W. Winnicott. The integration and contextualization of the conflicting ‘ positions’ of both Klein and Winnicott follow different but interweaving contexts, mainly the various institutional schisms within the British Psychoanalytic Society, as well as Ms. Klein’ s singular commitment to the death drive/ instinct psychology. I t i s well documented that institutionally the polarization of both Ms. Klein’ s and D. W. Winnicott’ s views had detrimental effects on not only the reading and articulation of their respective theories by all the schools falling under the umbrella of the British Psychoanalytic Society, but also foreclosed sincere collegial support within divergent theoretical and clinical domains (workable dialecticism). In the written work of Dr. Kavaler- Adler;

“Both the psychoanalytic society camp and the outside ‘revolutionaries’ of the Middle Group have seen themselves as diametrically opposed to one another, and, therefore, have often politicised their theory of clinical technique into polarised statements that have belied the profound degree to which their separate contributions could be integrated on a phenomenological basis. I have attempted to integrate their theoretical contributions to clinical practice through the use of the conceptual term ‘dialectic,’ a term that has been formerly utilized in the American scene theorising of Thomas Ogden (1986, 1994) and Sheldon Bach (1985, 1994, 2005).” (p. xiv)(italics added)

Adding to politicised views, according to Dr. Kavaler-Adler, and as mentioned, a major polarizing factor can also be found in the death instinct theorizing of Klein;

“… I have had to make the case in this volume of thinking that the major polarising factor in the contributions of the two camps has been Melanie Klein’s metapsychology of the ‘death instinct,’ rather than Klein’s clinical theory with its brilliant phenomenology. Part of making this case has been to preface my clinical illustrations of the integration of Kleinian and Winnicottian theory from their contrasting, but also complementary, dialectical perspectives with some studies of Klein’s psychobiography.” (p.xiv)

Central here, and in an essential extension of Dr. Kavaler-Adler’s previous work on biography of well-known literary figures (fleshing out the concept of developmental mourning and the demon lover complex), Dr. Kavaler-Adler brings her psychoanalytic biographical method into creative play by thoroughly and sensitively exploring the various developmental challenges both Winnicott and Klein had to endure. In chapters one to five[2], Dr. Kavaler-Adler describes the different developmental ways Klein’s autochthonous strivings fell victim to a profoundly controlling and narcissistic mother. Dr. Kavaler-Adler also argues that the mother-daughter bond may serve as a reason as to why Ms. Klein so tenaciously clung to her view of the importance of the death drive in psychic development:

“I will try to demonstrate why Klein clung to her ‘death instinct’ metapsychology. I believe that she needed that in order to psychically cling to her mother…. I believe that her resistance to giving it up is, in itself, a diagnostic sign of Klein’s poignant and evocative mourning state. Grosskurth (1986) helps her readers imagine the maternal and fraternal relationships that contributed to this state of mind in Klein.” (p. 3)

Given this endopsychic conflict and unresolved process of mourning, Ms. Klein, like that of the biblical figure Moses, remained unable to enter the promised land so evident in her own psychoanalytic vision;

“It is the story and legend of Melanie Klein, who, I believe, similar to Moses, foresaw the vivid outlines of a promised land, a psychic land, which she herself could not enter or could enter only to a partial degree.” (pp.1-2).

Dr. Kavaler Adler’s close reading of especially the work of Grosskurth (1986) supports a sensitive unfolding of Ms. Klein’s complicated relationship with not only her narcissistic mother, but also Klein’s position in her family of origin, her relationship with her siblings and father (her father-wound), choice of partners in adult life, her approach to being a psychoanalyst, and the development of her unique psychoanalytic vision. During the exploration, the reader is guided to empathically witness and relate to Klein’s painful relationship with her mother, children, husband, and colleagues (including Winnicott). For those not familiar with Dr. Kavaler-Adler’s previous writing and use of the biographical method psychoanalytically, chapter two entitled “Melanie Klein’s creative writing revealing themes in her life and theorizing,” will undoubtedly open uncharted vistas in understanding both Ms. Klein’s and Dr. Kavaler-Adler’s psychoanalytic sensibilities. I leave it to the reader to immerse themselves and come to their own imaginative conclusions as to the immense contribution of an object-relations informed biographical approach.

In contrast with the narcissistic mother so evident in Ms. Klein’s developmental struggles, Dr. Kavaler-Adler later turns her attention to the work of Winnicott and his unique adaptation to what could be considered a rather schizoid-depressed mother. It is of interest to note that both psychoanalysts suffered from strained if not absent relationships with their fathers (father-wounding). Both fathers were primarily unable to serve as guardians of psychological safety to the pre-Oedipal pressures and conflict narcissistic and schizoid-depressed mothers induce. By treating both Klein and Winnicott as psychoanalytic ‘artists,’ Dr. Kavaler-Adler allows the reader to intimately engage with the fact that no work of art can exist in isolation from the biographical past of the artist. Valuing the biographical influences of each of the psychoanalytic scholars, the life- experience of both Winnicott and Klein as theorists and practitioners become of immense importance and sheds light on their creativity, their developmental mourning, their unique area of creativity, and singular vision on what makes us truly human.

Given the depth of exploration, as well as the clarity of Dr. Kavaler-Adler’s unfolding exposition of both theorists’ conflicted childhood development, most would consider this in itself a contribution to our understanding. That is, Dr. Kavaler-Adler’s meticulous tracking of both theorists’ developmental conflicts and how developmental mourning limed their creative, if not seemingly polarized traditions of autoplastic (Klein) and alloplastic (Winnicott) theories, would in itself serve as a valuable contribution. Dr. Kavaler-Adler’s conceptualizations continually thicken the reader’s understanding of how developmental mourning failure affects the endopsychic processes evident in internal phantasy, paranoid-schizoid adaptation, the depressive/reparative position, the eternal search for good enough mothering, and the transitional world of intersubjective phenomena, and much more. Furthermore, for Dr. Kavaler- Adler as a clinician, another step is always added, i.e., bridging such an approach to the psychoanalyst’s day to day clinical chamber. Through various in-depth psychoanalytic cases, from a decade long once a week therapy, to more classic psychoanalytic cases, that is, three to more sessions per week, Dr. Kavaler-Adler clinically explores and illustrates the Klein-Winnicott dialectic and its clinical use with entrenched developmental mourning processes. Dr. Kavaler-Adler’s consulting room serves as a psychoanalytic window, enlivening the concepts evident in the Klein-Winnicott dialectic, supporting the unfolding of conflicted inner and interpersonal worlds characterized by paranoid-schizoid conflicts, the lack of transitional space and as such the emergence of sadomasochistic reactivity in the analyst, the analysts silent reworking of such failed transitional space, the impact of paranoid-schizoid conflicts on the analytic pair, and how the dialectic enables the analyst to remain psychologically available to the analysand by reaching detached and warded off states. Dr. Kavaler Adler’s use of the ‘ Klein- Winnicott dialectic’ and case material remains in itself an act of psychoanalytic creation. The psychological and developmental traumas evident in delayed developmental mourning written on by theorists such as James F. Masterson (the abandonment depression), Michael Balint (the ‘basic fault’), and Ronald Fairbairn (internal saboteur, moral defense) also all come alive in Dr. Kavaler-Adler’s work. For psychoanalysts and therapists wishing to read the application of such a dialectism in the therapeutic echo chamber, chapters six onwards allows a profound appreciation of the psychoanalytic complexities found in working within an object relations paradigm, as well as the hopeful vision that the legacies created by both Klein and Winnicott, brought forward in a non-polarized repaired dialecticism by Dr. Kavaler-Adler, can indeed deepen our psychoanalytic journey with our fellow analysands. The Klein-Winnicott Dialectic thus ultimately succeeds as both a transformative new metapsychology and interactive clinical theory. Dr. Kavaler- Adler is to be congratulated on a psychoanalytic work that is both creative and passionately written.

– Loray Daws