Psychotherapy

Review by

Paul M Cameron, MD
Ottawa,Ontario

The editors of this multiauthored text state that their purpose is to review the scientific underpinnings of psychoanalysis, to review the progress made, and to assess the results of psychoanalysis.

This 40-chapter book does meet these objectives for the informed reader. The editors have chosen to focus on mainstream American psychoanalysis, emphasizing the theoretical viewpoints of ego psychology, Mahler’s developmental psychology, and object relations. Conversely, self-psychology and intersubjectivity are hardly mentioned—a shortcoming of the book.

The authors are, however, a very impressive group of well-published and erudite psychoanalysts: Harold Blum, Jacob Arlow, Otto Kernberg, Robert Wallerstein, James McLaughlin, Dale Boesky, Leo Stone, Owen Renik, and our Canadian scholar Charles Hanly. Pulver has written a fine overview of technique, documenting the fact that “different patients require different approaches.” His review of the basic concepts of psychoanalytic method demonstrates the technique’s evolution. Blum and Goodman’s chapter on countertransference is very clear. As they state, “unconscious countertransference, whether positive or negative or both is the factor that is most likely to impede analytic work.”

They point out various markers that countertransference exists and interferes or is a problem. Arlow writes about the role of unconscious fantasy in facilitating empathic attunement with the patient, noting that analysts may remember their patients’ previous dreams or fantasies at certain times or may have fantasies stimulated that are held in common with the patient. Such moments can help formulate effective interpretations.

Trossman’s chapter on dream mechanisms and dream interpretations is quite basic and clear. Renik and Grossman’s following chapter, “Working With Dreams,” shares examples of how dreams may inform both the analyst and the patient about the transference in the working alliance. Moore has written a worthwhile review of narcissism that incorporates the work of many authors, such as Kohut, Kernberg, and Rothstein. Kernberg has provided a basic review of psychoanalytic object relations theories. Overall, this book is clear and quite understandable by a psychiatrist or psychotherapist who does not have formal psychoanalytic training. It is pleasant to read and fairly priced.

Review by

Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta

The third edition of this by now very well-accepted textbook closely follows the format of the DSM-IV edition. Section 1, “Basic Principles and Treatment Approaches in Dynamic Psychiatry,” includes the basic priciples and

theoretical basis of dynamic psychiatry and psychodynamic assessment of patients, along with 3 chapters on treatment. The treatment chapters discuss individual, group, family, and marital psychotherapy, along with pharmacotherapy and dynamically informed hospital and partial-hospital treatment. Section 2, “Dynamic Approaches to Axis I Disorders,” comprises 7 chapters on symptomatic conditions, while Section 3, “Dynamic Approaches to Axis II Disorders,” has 6 chapters on personality disorders, 4 of which deal with Cluster B disorders individually.

This clearly written book has few typographical errors. As is common with textbooks, the style is drier than one sometimes finds in less comprehensive works, which makes a book of this length a little more of a challenge to read from cover to cover. Nevertheless, this is compensated for by the above-mentioned comprehensiveness, the concise and lucid writing, and the material’s relevance. The author has done a marvellous job of applying psychodynamic theory to the practice of general psychiatry. The chapter on basic principles is an excellent introduction to dynamic psychiatry, focusing on subjective experience, the unconscious, psychic determinism, transference and countertransference, resistance, and the mind and brain in psychiatry. Gabbard employs the felicitous metaphor of a cave to illustrate some of the basic principles. He incorporates neuroscientific evidence that learning, including the learning that occurs in psychotherapy, affects brain microstructure. He might, however, have more accurately stated that it is all people and not just “all patients (who) carry within them a host of different mental representations of themselves and others.”