When the Bubble Bursts ─ Clinical Perspectives on Midlife Issues

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.

Eda Goldstein presents a study that comprises an admirable blend of theoretical astuteness, clinical wisdom, and personal honesty. Her clinical study of midlife narcissistic pathology is bracketed by her balanced discussion of theoretical perspectives on adult development and her concluding consideration of the countertransference issues elicited by midlife patients in midlife therapists. When the Bubble Bursts is an edifying contribution to the literatures of psychodynamic psychotherapy, self psychology, and adult development.

Eda Goldstein, D.S.W., is Professor and Director of the Post Master's Certificate Program in Clinical Practice of the Ehrenkrantz School of Social Work of New York University. Among her many publications is Lesbian Identity and Contemporary Psychotherapy (Analytic Press, 2003), which she co-authored with Lois Horowitz.