Description
This article discusses the clinical perspectives on midlife issues, specifically the challenges and stresses of this stage of life that can lead to a sense of despair and even crisis. Goldstein focuses on those individuals who are particularly vulnerable to these challenges, citing factors such as heightened narcissistic vulnerabilities. She outlines a treatment approach that incorporates self-psychological concepts and techniques, which are seen to be most effective in helping these patients rebuild their self-esteem. The case studies Goldstein includes in her article illustrate the treatment process in detail, with examples of midlife patients in psychotherapy. This article is an excellent overview of the clinical perspectives on midlife issues and provides a practical guide for treating those who are struggling with these challenges.
What is it about the challenges and stresses of midlife that disrupts equilibrium and promotes a sense of despair, even of crisis? Why does this stage of the life cycle give rise to new mental and physical symptoms that, for some, lead to chronic unhappiness to the point of dysfunction? Of course, there are common midlife events that account for the special narcissistic vulnerabilities of this period of life, and Eda Goldstein ably reviews these events and the theoretical perspectives commonly brought to bear on them. In When the Bubble Bursts, however, Goldstein's special concern is those individuals who come to midlife with heightened narcissistic vulnerabilities that make the navigation of this stage of life more difficult still. In understanding the latter such patients and devising a treatment approach appropriate to their self" issues, Goldstein adopts a broadly self-psychological frame of reference. It is a matter, she finds again and again, of understanding how current stressors frustrate healthy self needs and trigger narcissistic vulnerabilities. Self-psychologically informed treatment, which, in Goldstein's pragmatic purview, embraces modalities that are, to varying degrees, supportive, psychodynamic, and psychoanalytic, reworks and strengthens self structures in helping patients find new ways of affirming their sense of self. Her substantive case studies, which accompany the reader through all the chapters in her study, draw on personal and supervisory experiences to illustrate crucial foci of the treatment process with a range of midlife patients in psychotherapy. It is a striking that, amid a voluminous literature on psychodynamic psychotherapy, so little attention has been paid to the narcissistic vulnerabilities of midlife and the manner in which they enter into the psychotherapy of midlife patients. Eda Goldstein remedies this glaring lacuna in the literature with a study that comprises an admirable blend of theoretical astuteness, clinical wisdom, and personal honesty. Her clinical study of midlife narcissistic pathology, bracketed by her balanced discussion of theoretical perspectives on adult development and her concluding consideration of the countertransference issues elicited by midlife patient in their midlife therapists, is an edifying and ingratiating contribution to the literatures of psychodynamic psychotherapy, self psychology, and adult development.
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