Book Review
Psychotherapy 
Psychoanalytic Psychotherapy:
A Practitioner’s Guide. Nancy McWilliams. New York: The Guilford Press; 2004. 353 p. US$45.00.
Reviewer
rating*: Excellent
Review by: Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
It is a pleasure to review Dr McWilliams’ third book (1,2). It is rare to find a text that is so excellent for new practitioners and that also has enough sophisticated clinical insights to be worthwhile reading for experienced therapists. Dr McWilliams’ effective approach simulates hearing a valued senior colleague discuss important treatment issues. She has grown as an author and is more assured in her writing, which is rich in relevant references. Despite its easy readability, this is a scholarly text.
Dr McWilliams begins with a chapter describing the evolution of psychoanalysis in the US. Following it is a thoughtful, in-depth discussion of the qualities that psychoanalytic therapists value and develop in themselves. The third chapter describes the preparation the therapist needs for psychoanalytic work. While it is true that therapists do not need to be paragons of mental health and that the experience of suffering emotional troubles may make one a better therapist (3), I would add that therapists who have not found satisfactory resolutions to their major difficulties will be significantly limited in their work. However, apart from personal treatment, few situations offer more of an opportunity to continue learning about oneself than does treating others. McWilliams makes a similar point on page 70. She does not hesitate to describe personal experiences, including errors she has made, to illustrate her points, and she returns to the important topic of the need for therapists to receive personal treatment. The chapter on preparing the client is helpful to beginning therapists, in terms of how to use supervision optimally. Here there is much clinical wisdom, practically applied. McWilliams complements her own observations on how to handle difficult situations with patients with those of other clinicians.
At times, she discloses her own experiences in analysis to help readers understand what their patients may feel. Two chapters on the important subject of boundaries focus on the frame and boundary quandaries, and McWilliams offers thoughtful, pragmatic comments on important aspects of the therapeutic frame and boundaries. She also includes “things they didn’t tell me in my training program,” contrasting accidental or inevitable boundary problems with unconsciously orchestrated enactments. McWilliams acknowledges that some problems stemming from innocent boundary crossings cannot be helped and may lead to a disruption of the treatment. She is open in her involvement with her patients, including boundary crossings that may be beneficial. She goes further than some therapists would when she agrees to attend the wedding ceremony, but not the reception, of a patient. McWilliams freely acknowledges the limits of psychoanalytic work and offers helpful advice, in a warm and personal way, for avoiding ethical transgressions. She thoughtfully divides the issue of disclosure into disclosures that are inevitable, disclosure of information vital to the patient, disclosure of countertransference reactions, and disclosure of personal or biographical information. The opinions McWilliams expresses here are both sensitive and full of common sense.
A chapter on basic therapy processes emphasizes the ramifications of the power inherent in the therapist’s role. One chapter describes the treatment of a very disturbed female early in McWilliams’ career, with frank indications of what she would do differently now and with awareness of her limitations. McWilliams’ devotion to the treatment of even hostile and disturbing patients, as well as the beneficial effects of her treatment, is clear. Another chapter describes the treatment of a less disturbed individual. A chapter on ancillary lessons of psychoanalytic psychotherapy deals with emotion, development, trauma, stress, intimacy and sexuality, self-esteem, forgiveness, and compassion. Still another chapter deals with occupational hazards and gratifications. A final chapter on self-care originally and humorously divides care into care of the id, the ego, and the superego. This is an excellent and detailed chapter on the many aspects of life in which therapists can care for themselves in myriad creative ways—an often-neglected issue. In short, McWilliams has useful advice for therapists of all orientations She combines hope and realism in a manner that engenders optimism for the future of psychoanalytic therapy. She concludes this inordinately helpful book with more help, providing an annotated biography of suggested texts, arranged by subject, and meticulously referenced author and subject indices. To summarize, this is another excellent text by Dr McWilliams—her best yet—which I cannot recommend too highly to any mental health professional who performs any type of psychotherapy. In my opinion, this should be the first book on treatment read by every beginning psychotherapist, including all psychiatric residents at the start of their residency.
References
1. McWilliams N. Psychoanalytic diagnosis. New York: Guilford Press; 1994.
2. McWilliams N. Psychoanalytic case formulation. New York: Guilford Press; 1999.
3. Greenson R. Technique and practice of psychoanalysis. New York: International Universities Press; 1967.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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