Through case examples, this book illuminates the elusive and shadowed terrain of primitive strivings for the lost connection with mother at the earliest developmental level and how this searching is manifested in life and in the consulting room. It provides the professional with guidelines to identify how the terror of human contact and relating is at the root of the organizing (psychotic) level and the pockets of disorganized material that may be present, under stress, in highly functioning persons. It introduces the fact that the fight, flight or freezing reactions to early contact dysjunctions with the primary caretaker register somatically and that in treatment they need to be met at this preverbal level. Hedges discusses how these organizing responses appear in the relationship with the therapist. Every conscientious, empathic clinician can relate to the experience of working to connect with someone who at the very moment of conjunctions seems to disappear.

The author provides a window to understanding and dealing with conditions that have historically eluded treatment. The case examples illustrate how to track the moments of connection and disconnection that occur in the therapeutic relationship. The primary therapeutic focus is to eventually engage the client in monitoring these moments of contact and rupture. Attention is paid more to the structure of the therapeutic relationship that to the literal content of what the patient says.

Countertransference feelings and sensations stirred in the listener serve as cues to the client’s efforts for contact and its inevitable rupture. However, these are not interpreted. With such patients the therapist needs to tolerate experiencing some of his or her own organizing material. The case studies bring alive the struggles in working with the organizing, presymbiotic experience. In a refreshing fashion, the emphasis is placed on the strivings for human connectedness rather than on pathology, and on the primitive puzzling blocks to interpersonal relatedness.