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Publications: Book Reviews
Review of Illusion and Disillusion: Core Issues in Psychotherapy

Title: Illusion and Disillusion: Core Issues in Psychotherapy
Author: Teitelbaum, Stanley
Publisher: Jason Aronson, 2007
Reviewed By: Dolores McCarthy, Vol. XXIX, No. 1, Winter 2009, pp. 36-37

Illusion and Ubiquity: Psychotherapy and Elsewhere

Ten years ago Stanley Teitelbaum published a book on “illusion and disillusionment.” A new paperback edition has recently been issued. It as relevant today as when it was first written; in fact, given the current economic climate, perhaps it is more relevant. Many believe that current economic and social issues are due to illusions about wealth and greed that have ruptured into disillusion and cynicism. In fact, much of contemporary interest in narcissism and related phenomena is based in distortions of social reality in service of individualistic perspectives. Teitelbaum offers us a discussion of various perspectives on the all-too-human experience of heightened and dashed expectations.

In our consulting room, we regularly work with examples of illusions and disillusions. Many patients who present with anxiety and depression regarding relationships, career choices, separation from parents, mid-life crisis, marital and family issues, aging and deceased parents, and other life crises are more explicitly presenting their disappointments and disillusions in their daily lives. Generally we expect life to go a “certain way” and seek treatment when “life doesn’t go according to our plans. Other patients present with intractable defense systems are often dealing with implications of disillusionment. These are often individuals who are fearful about the illusion/disillusionment process and have developed defensive strategies in an attempt to avoid this awareness. As Teitelbaum states: 

Throughout their lives individuals maintain illusions about themselves and their world that sustain them and serve as organizing principles and the loss of these illusions in the harsh light of reality requires a psychological negotiation with the impact of disillusionment. (p. x)
Although Teitelbaum’s subtitle is “Core Issues in Psychotherapy” much of the book is not about psychotherapy per se. I would say the book is more of a psychological compendium on the themes illusion/disillusion across the life cycle, and across human experience. He begins with a consideration of the role of illusion/disillusion as a universal human experience. He introduces the topic by presenting the role of illusion/disillusion across the human life cycle, including “paradise lost” of infancy, then adolescence, mid-life crisis and concepts of immortality. Teitelbaum reminds us illusions about one’s self and one’s world are part of normal development and are necessary for emotional survival. Optimally these illusions are dismantled through a gradual, tolerable mourning process.

A later chapter takes a novel perspective, focusing on the ramifications of illusion/disillusion on popular culture, including examples in politics, theatre, music, movies and sports. He includes such historical references as Lyndon Johnson, Kennedy, Napoleon and Hitler. He even notes the disillusioned fans of the Brooklyn Dodgers when they moved to Los Angeles. He references movies such as Titanic, Lost Horizon, and Fatal Attraction, and songs such as “Over the Rainbow,” “The Land of Make Believe” (Camelot), and “I Dreamed a Dream” (Les Miserables). This chapter is highly “entertaining” and also points out the ubiquitous nature of his theme. 

The author provides a survey of psychoanalytic theorists’ view on the subject, including material from Freud, Mahler, Jacobson. Fromm, Winnicott, Kohut, and Modell. Notably absent are Melanie Klein and, arguably, Eric Erickson. Both these theorists address stage/phase development that suggests the illusion/disillusion process. Both theorists propose “developmental tasks” that should be mastered and involve a change of perspective (Klein in regard to the “breast,” Erickson in regard to psychosocial demands) with subsequent a sort of “grief” and “working through.” Including the work of these writers, and perhaps others, would enhance the historical approach of the topic. 

The bulk of the book includes chapters on the psychopathology of illusion/disillusion covering such topics of the role of defense, the power of illusion, illusion as an organizing principle, and the specific applications of depression and narcissism. He lists varieties of illusion, including necessary illusions, persistent illusions, shattered illusions, adaptive illusions, and positive illusion. Using clinical examples, he argues that psychic defenses can lead to the falsifying of inner perceptions, and thus promote illusion. In addition to this perceptive statement, Teitelbaum alludes to splitting, as the difficulty integrating positive and negative as a component of the illusion/disillusion process. He explores fantasy, idealization and grandiosity as other aspects of this process. Teitelbaum excels in this more abstract and conceptual presentation. His work brings to mind a flashlight, shedding light on all corners to the complexities of illusion/disillusion; it continues to open up this process in all its facets. 

Of particular interest to clinicians are the chapters on narcissism and depression, with topics such as narcissistic wounds, narcissistic defenses and narcissistic illusions. Regarding depression, he lists five types of depressive response, that is, illusions leading to disillusions, leading to varied reactions including acceptance of reality, denial of reality, replacement illusions, defensive hypervigilance and despair. These distinctions can guide clinical assessment and interventions. In addition, general anxiety, borderline personality disorder, antisocial personality disorder substance use disorders, even aspects of bipolar disorder, and other diagnoses. Teitelbaum’s work can be fruitfully expanded in many other diagnostic and treatment applications.

Teitelbaum concludes with a chapter on psychoanalytic psychotherapy. While this topic is quite appropriate given the subtitle of the book, I believe it is also the weakest chapter. Unfortunately the theme is discussed in generalities, where more clinical specificity would be valuable. There is a discussion of patients’ illusions about psychotherapy and therapists’ illusions about psychotherapy; he then reviews psychotherapy process, transference, and the relational aspects of patient/therapist interaction. Although he clearly states that the clinical task is to accept and mourn the loss of illusions, he does not present specifics on how this would be accomplished. The chapter begs for vignettes and session transcripts to illuminate and illustrate this process. Although the author has given brief transcripts in other chapters, such as that on depression, the chapter specifically dealing with psychotherapy needs more concrete examples of clinical technique.

This review began with a reference to macro level issues in the current world economy; it then focused on micro issues of the clinical consultation room. I believe that Teitelbaum takes an important theme and approaches it from many levels. One is tempted to say that his book is not disillusioning. Although the material was quite informative, comprehensive and even novel, I feel disappointed in the crucial area of clinical application. There is almost something formulaic about the illusion-disillusion-mourning paradigm; I would rather a more creative process. Perhaps, however, I am merely avoiding my own disillusionment.

Dolores McCarthy
New York, NY

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