The Craft of Psychodynamic Psychotherapy (Book Review)
Author: Kaner, Angelica, and Prelinger, Ernst
Publisher: Jason Aronson
Reviewed By: Johanna Krout Tabin, Vol. XXVI, 4 (Fall 2006), pp. 70-71
Roy Schafer proclaims on the dust jacket, “This book is just what is needed at a time when we are assailed by unwarranted doubts about the uses of therapy.” Even though the book deserves a subtitle of “mentoring new clinicians,” I wish that the Division would send copies of it to all plausibly open-minded directors of graduate programs in clinical psychology.
Right from the start, Kaner and Prelinger are modest in their statements about the efficacy of psychodynamic psychotherapy. They caution new clinicians not to expect that therapy is for everybody or that it will always result in great changes in patients. Schafer’s bonus is that their tone thus invites cynics to proceed with what they have to say. Increasingly as one reads on, the material speaks splendidly for the value of psychodynamic psychotherapy.
The development of the text parallels the trajectory Kaner and Prelinger suggest in the process of therapy. One begins superficially and gradually—very gradually—deepens the discussion. The introduction contrasts psychodynamic psychotherapy with other therapies without denigrating other approaches. Being psychoanalytic, as shown by these authors, might gain universal agreement even across psychoanalytic schools:
“[They] all assume the importance of exploring the person’s intrapsychic processes with the least amount of influence by he analyst, of developing an understanding of unconscious processes operating in a person’s past and present development, of the forces involved in internal conflict, and of the centrality of the therapeutic relationship” (p. 9).
In other words, this book is basic. Kaner and Prelinger open with simple definitions of inner life and the adaptive process. Continuing the spirit of modesty and caution, they devote in this section a two page chapter to “Impediments to Individual Psychological Work,” blockages and impasses. They are not afraid to set off an important topic by labeling it as a unit apart. Consistently, however, they examine topics in a way to encourage seeing relationships. For example, therapists and patients are not separate breeds. Everyone does psychological work; it is when that is not good enough that a person turns to psychotherapy for help. Starting off the next section, the authors address what the beginning therapist should expect of themselves, with reasonable questions to help decide whether that is a good choice for oneself.
Proceeding with being a therapist, even such details as the minutiae and significance of arranging one’s office are explored. These are related to the concept of the frame. It is characteristic of the book to integrate various ideas. Various cases are introduced in a context of certain issues, reappearing later to illustrate newly introduced ideas that enrich the original understanding. Their pattern of teaching is akin to the well-established need of a therapist to accept the “surface” of early communications and try to prepare the patient for deepening of understanding. Nothing is suggested that is not explained, and just about always they leave room for other possibilities. Although the authors emphasize that being able to verbalize feelings is helpful in order to reorganize old patterns of adaptation, they pay great attention to nonverbal communication between therapist and patient. Communication of feelings is at the heart of the work. By text and example, the novice therapist can see how anxiety is the motive force behind maladaptive behavior. It becomes clear that the defense mechanisms exhibited in the behavior must first be recognized and explored to allay anxiety before the patient can be expected to deal with the content.
Other principles of psychodynamic therapy are systematically introduced, for example, the naturalness and inevitability of transference and countertransference, the necessity for working through, etc. Clinical examples, comprising perhaps as much as half the book, satisfyingly interweave with the concepts under discussion. A few quotes picked at random will demonstrate the admirable presentation of key concepts:
“Unconscious activity can only be inferred from a person’s thinking and acting” (p. 41).
“The frame then is like a portal that makes possible a ritual of entry and leave-taking. The constituents of the frame.... are constants that guide the transition from the realities of day-to-day life into a psychotherapeutic space and back again” (p. 98).
“The word transference literally means ‘carryover’ and refers to the patient’s unconsciously carrying experiences and feelings deriving from earlier relationships to newer ones” (p. 103).
“Besides the therapist’s overall intelligence and skill, her ability and willingness to learn from the patient are important ingredients of the match” (p. 124).
“Interpretations are giving a patient something new” (p. 267).
In the earlier part of the book, the language is in the third person. By the last third of the book, the authors’ remarks are to you, the new therapist. This is the product of not only much clinical experience and theoretical knowledge, but also the result of much teaching experience. Their teaching covers every subject that a budding therapist might need. It deals with the most practical concerns of setting up a practice and takes the reader into the therapy room for learning what it is that a therapist actually does. The whole book models empathy.
By way of a small criticism, I will suggest an annoying but amusing feminist solution to the old-fashioned practice of using the male pronoun in a general sense. For much of the text, therapists are female and patients (unless specifically named) are male. Using collective pronouns (we, they) or the neutral third person choice still characteristic in European languages seems better. With-it colloquialisms, such as a patient’s “MO,” sometimes seem unnecessary, although they probably accomplish their purpose of seeming friendly to the newest generation to read the book. It also seems unnecessary to tell in one of the few references to Freud that he introduced the concept of free association.
The latter attributes, however, enhance the selection of this book for an ideal syllabus for graduate students. It should hold a prime place for the first year people. In their second year, Nancy McWilliams’ Psychoanalytic Psychotherapy: A Practitioner’s Guide, with a more extensive and formal presentation of psychoanalytic concepts and the sharing of her own early case experiences should enhance their growing sophistication. This might also be the time for Sophie Lovinger’s Child Psychotherapy: From Initial Contact to Termination. In the third year, Marilyn Charles’s Learning from Experience: A Guidebook for Clinicians could be studied. These four books, incidentally all by Division 39 members, could guarantee the highest quality of background for those joining the ranks of our colleagues. The Kaner and Prelinger volume will be dog-eared by that time. But I am sure everyone will keep his or her copies. It is the sort of volume to which one returns with greater and greater appreciation as one gains experience.
Charles, M. (2004). Learning from experience: A guidebook for clinicians. Hillsdale, New Jersey: Analytic Press.
Lovinger, S. (1998). Child psychotherapy: From initial contact to termination. New York: Jason Aronson.
McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner’s guide. New York: Guilford Press.
Johanna Krout Tabin
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