Textbook of Psychoanalysis (Book Review)

Author:  Person, Ethel S., Arnold M. Cooper, and Glen O. Gabbard 
Publisher: American Psychiatric Publishing, 628pp., 2005
Reviewed By: Anthony F. Tasso

A Comprehensive Text

There is a rich psychoanalytic literature readily available to anyone, from the neophyte practitioner to the seasoned analyst. There are classic works and contemporary gems that fully immerse the reader in analytic history, theory, pathology, or treatment. The problem is that rarely—if ever—are these multifaceted themes available in one book, thus leaving the psychoanalytically oriented practitioner, educator, or researcher without a single go-to text that covers the breadth of the field. Subsequently, consumers are forced to devote considerable time, effort, and money to build their psychoanalytic libraries.

Textbook of Psychoanalysis (American Psychiatric Publishing) represents, at the very least, a great starting point. Edited by Ethel S. Person, Arnold M. Cooper, and Glen O. Gabbard, this massive, 600-plus page, 36-chapter book (plus a glossary) comprehensively examines the field of psychoanalysis. Divided into six sections, the internationally renowned contributors beautifully articulate not only theory and treatment, but also history, research, challenges, and trends. Textbook of Psychoanalysis provides a wealth of useful information for clinicians and educators alike—and does so in a single text.

Part I (“Core Concepts”) opens with Fred Pine’s discussion of motivation. First describing the evolutionary and biologically derived sexual and aggressive instinctual views set forth by Freud, Pine next explores non-drive motivational theories. The author explicates ego psychology’s motivational views of a conflict-free ego adapting to internal and external stimuli. He also discusses human relations’s theories concerning the motivation to recreate one’s earliest relational patterns; and self-psychology’s self-corrective motivational experiences of agency, establishing boundaries between self and others, and maintaining self-esteem. Regardless of the viewpoint, Pine concludes by firmly placing the locus of motivation in the unconscious. Next, Meissner highlights the role of the unconscious within dreams by leaning on recent neuroscientific evidence on dreams and describing how Freud’s meticulous attention to his patients’ dreams led to a rich understanding of affect, defensive maneuvers, and fantasies. Although the significance of the unconscious in psychoanalytic thinking is nothing new, Pine and Meissner provide a useful theoretical discussion and a timely empirical overview of the power of the unconscious.

Salman Akhtar and Otto Kernberg separately explore the impact of early relationships on personality. Akhtar illuminates the ways in which constitutional and cultural factors prime the internalization of significant others. Kernberg describes prominent object relational theories, including his own, and closes by discussing object relational treatment techniques such as therapeutic attention to psychic structures, internalized object relational units, therapeutic regressive processes, and proactive and counterproductive countertransference. Both Akhtar and Kernberg nicely expound on the enduring influence significant others have on shaping an individual’s psychic world.

Daniel Stern (chapter 5) examines intersubjectivity, or the dialectical interaction between therapist and patient, and outlines both theoretical and practical differences between classical analysis and intersubjectivity as follows: the objective, “third-person perspective” of the patient versus a focus on the cocreated experiences of therapist and patient; classical theory’s goal of drive discharge versus object relatedness; and linear determinism versus a nonlinear view of mental activity. Stern reframes transference and countertransference from an intersubjective viewpoint and makes a compelling argument for the ways in which such a position underlies concepts like empathy, group cohesion, and the here-and-now clinical experience. Muriel Dimen and Virginia Goldner (“Gender and Sexuality”) close Part I by tracing the ebb and flow of sexuality within psychoanalytic theories. The authors explain how masculinity-activity and femininity-passivity dichotomies were born out of Freud’s anatomically driven theorizing, and how contemporary postmodern feminist and queer theories encompass more permissive perspectives that support a fluid, socially influenced “sexual subjectivity” view, thus marking a significant departure from the prior bifurcated (male-female, heterosexual-homosexual) view of gender and sexuality.

In Part II, “Developmental Theory,” Robert Emde and Peter Fonagy (chapters 7 and 8) examine research on the criticalness of early childhood experiences and the psychoanalyst’s ability to apprehend material from the genetic point of view based upon a patient’s current functioning. Next, Linda Mayes discusses the historical chasm between clinical psychoanalysis and psychological science and explores how this formidable gap has stymied the field’s ability to be recognized as an empirically viable treatment modality. However, Mayes optimistically highlights how the recent proliferation of analytic research is inching the field toward acceptance amongst academicians (and others). Mary Target historicizes psychoanalysis’s initial trepidation (and even dismissal) of attachment theory—essentially writing off Bowlby’s work (and Bowlby himself ) as superficial, simplistic, and ultimately missing the significance of the dynamic unconscious— to the complementary relationship of today. The attachment-psychoanalysis marriage has proven to be a fruitful association, with the former lending scientific credence to clinical practice in addition to helping it reach a broader (nonclinical) audience, while the latter demonstrates the applicability of attachment theory.

Efrain Bleiberg further explores developmental processes in psychopathology and asserts that Freud’s lack of direct study of children inevitably hamstrung his thesis of ascertaining childhood experiences based on adult functioning. He compares Freud’s theory with the more cogent child theorizing made by those who worked directly with kids (e.g., A. Freud, Spitz, Mahler). Bleiberg then discusses Daniel Stern, whose theory is based on rigorous infant research, and Otto Kernberg, who continuously submits his model of developmental pathology to scientific examination. The author closes by cautioning against making inferences not founded in empirical data, and makes a strong case for the need for psychological science within psychoanalysis.

Part III of Textbook of Psychoanalysis covers treatment. Paul Williams identifies the appreciation of developmental processes, defenses, and attention to meaning as germane to psychoanalytic treatment. Adrienne Harris delves into the genesis of transference and countertransference by describing how Freud’s perspicacity and willingness to suspend narcissistic gratification led to the discovery of transference; specifically, his discovery that patient reactions to him were not solely about him but also (and perhaps more so) about significant others. Harris concludes by summarizing both distinct and overlapping theoretical views of transference while never losing site of the delicate balance betweentransference and the real relationship.

Jay Greenberg investigates the role of suggestion in psychoanalytic treatment. Although Freud acknowledged the power of suggestion, he stressed interpretative techniques over suggestive methods to “assure” that material uttered by the patient is not based on the clinician’s influence. However, Greenberg illuminates the curative abilities of suggestion by turning to Glover’s concept of inexact interpretation (the curative, suggestive nature of nonprecise interpretations). Greenberg later contrasts those theorists promulgating the notion that interpretation alone is ameliorative with those focusing more on the curative properties of the therapeutic relationship. This chapter does not erroneously attempt to dichotomize this debate as an interpretative versus relational one, but rather presents this topic as a demonstration of how these mutually facilitative processes are relevant to psychodynamic psychotherapy and psychoanalysis proper. “Process, Resistance, and Interpretation” (chapter 15) and “Termination and Reanalysis” (chapter 16) describe the substitutive elements of the treatment process. Authors Samberg and Marcus explain how process—what happens during the progression of treatment—is the essence of analytically informed treatments. They also demonstrate the multifaceted aspects of resistance and interpretation with a representative clinical vignette. Martin Bergmann discusses Freud’s lack of attention to termination and reanalysis and gives the lion’s share of credit for these topics to Ferenczi, Rank, and Glover. The author states that the prospect of a “complete analysis” is more a theoretical ideal than a practical reality, and therefore the analyst and patient must come to terms with the therapeutic limitations and terminate, continue with the analysis,or discuss the possibility of a later reanalysis.

“Psychoanalysis and Psychopharmacology” draws attention to the fluctuating opinions on the use of medication in psychoanalytically informed therapies—first with the near-categorical pronouncement of medications as anathema due to their putative “superficiality” and then with the growing tendency to integrate psychotropics into psychoanalytic treatments. Judith Yanof explores psychodynamically informed therapy with children by first stressing the similarities between adult and child analysis (e.g., establishing a working alliance, creating a safe therapeutic environment, working within the therapeutic frame, meaningful interpretation). Yanof then identifies child-specific analytic processes, such as the allowing the child to express strong aggressive affect via the safe mechanism of play and providing the child the option to try different personalities, characters, and roles, all of which allow for accessibility to information-rich and affect-rich primary process material. Ernest Wallwork ends Part III by highlighting the field’s respect for the Hippocratic tradition, as evident by analysts’ adherence to respect, proactive curiosity, honesty, and treatment, which assures that the patient’s rather than clinician’s needs are met.

Part IV of Textbook of Psychoanalysis covers psychoanalytic research. First, Robert Wallerstein discusses outcome research, or those empirical studies focused on treatment improvement (or lack thereof ). Second, Wilma Bucci addresses psychoanalytic process research by describing different factors subject to scientific investigation (e.g., Core Conflictual Relationship Themes, Role Relationship Model). Third, Greenspan and Shanker explore developmental research, which coalesces psychological and biopsychological findings with anecdotal narrative clinical data aimed at elucidating pathological and healthy mental functioning. Last, Anna Ursula Dreher discusses conceptual research (e.g., examination of analytic principles) by expanding the methodological parameters of carefully controlled experimentation to more qualitative, narrative-based studies. The aggregate of these well-written research chapters accomplishes quite a bit. For one, it shows that analytic theory is indeed being investigated through differing epistemological lenses and methodological processes. It also helps to show that these interrelated, mutually facilitative research methods are shedding light on what works and what does not, punctuating the notion that evidence is paramount to authority.

Part VI explores the history of psychoanalysis. Colombo and Abend describe Freud’s introduction to hypnosis, from Charcot and Bernheim to his later collaborative work with Josef Breuer. The authors also mark Freud’s theoretical shift from childhood sexual abuse as etiologic of adult pathology to fantasy-based, unconscious processes as truly heralding psychoanalysis by demonstrating the notion that the unconscious is as potent as external reality. Stanford Gifford surveys the psychoanalytic scene in North America and attempts to explain the boom and bust of analytic acceptance. Gifford describes how the influx of European analysts during the rise of Nazism resulted in many analysts securing academic and hospital positions and ultimately altering the American analytic landscape. The author also describes psychoanalysis’ current decline, with diminishing analytic practices, academia’s dismissive view of analysis, psychiatry’s continual movement towards medicalized treatment, and a managed care environment that puts a premium on brevity rather than quality.

Chapters 26 to 28 close Part V by describing the trials and tribulations of psychoanalysis in Great Britain, France, and Latin America. David Tuckett discusses the profound influence of Ernest Jones, from rescuing many of his Jewish colleagues from Nazi Germany, to actively cultivating psychoanalysis in Britain (especially with his support for Melanie Klein), to his diligent work on the translation of Freud’s writings into English. Dominique Scarfone discusses French psychoanalysis and the enduring contributions of Jacques Lacan, while Cláudio Laks Eizirik and Mónica Siedmann de Armesto round out this section by describing the thriving South American psychoanalytic scene. Here, Textbook of Psychoanalysis nicely establishes the roots of psychoanalysis while exploring the struggles facing psychoanalysis today. This section makes clear that although the challenges facing the mental health field—and psychoanalysis in particular—are steep, they are far from insurmountable.

Part VI, the final section, addresses psychoanalysis’s relation to a multitude of disciplines. John Kerr argues that psychoanalysis’s interdisciplinary history laid the groundwork for today’s diverse theoretical modalities, while Joel Weinberger and Kenneth Levy explore psychoanalysis vis-àvis academic psychology and clinical work. They trace the ambivalence, disregard, and even vilification that many academicians harbor toward psychoanalysis, and note that the relationship between academic clinical psychology and psychoanalysis has not been much better, with the former often criticizing the latter for lacking scientific credibility and the latter claiming clinical psychology lacks the richness of analysis. However, the authors also describe the contemporary rapprochement: how the partnership between laboratory-based psychoanalytic experiments and consulting room data has slowly helped make the case for the contributions of psychoanalytic principles to academicians, while making empirical evidence palatable to psychoanalysts.

Chapters 31 to 33 link psychoanalysis to anthropology, literature, and the arts. Robert Paul describes the parallels between anthropology and psychoanalysis (e.g., the foci on determinant factors of surface behaviors) as well as the differences (e.g., primarily research compared to applied work) and credits Freud’s Totem and Taboo (1913/1955) as an early example of the merging of psychoanalysis with cultural anthropology. Berman and Handler Spitz document psychoanalysis’s well-known relationship with literature and the arts. From Freud’s attention to the impact fiction can have on people emotionally to his careful integration of literature into his theory, Textbook of Psychoanalysis demonstrates the applicability of analytic principles to the interactive processes between art and art observer in concert with the ways in which literature can facilitate therapeutic listening and clinical hypothesis testing.

The closing three chapters investigate psychoanalysis’s relationship with philosophy, politics, and neuroscience. Jonathan Lear discusses how both the Socratic method and analytic techniques rest on the assumption that the individual/patient rather than the philosopher/analyst is the holder of knowledge, while Vamik Volkan discusses the lack of attention psychoanalysis has devoted to politics. Volkan concludes with the message that an explicit partnership between the two would make substantial contributions to global issues, as well as to patient work.

Mark Solms closes the section, and the text, by discussing the growing field of neuropsychoanalysis. From Freud’s embracing of his neurological roots, Solms describes some of the earlier nonanalytic neuroscientific work with unintentional analytic relevance. Solms also discusses New York psychoanalyst Arnold Pfeffer—the man instrumental to the development of the current field of neuropsychoanalysis. The author explains that neuroscientific experiments are demonstrating empirical promise for analytic concepts such as the unconscious, repression, and psychic structure, and how the epistemological differences between psychoanalysis and neuroscience actually complement each other, with the latter lending a much-needed scientific viability to the former.

Textbook of Psychoanalysis is a triumphant compendium of psychoanalytic thinking. Person, Cooper, and Gabbard bring together a book that is both wide in scope and rich with information. Akin to Otto Fenichel’s (1945) The Psychoanalytic Theory of Neurosis in terms of comprehension and density, Textbook of Psychoanalysis represents a productive addition to the literature— and does so in a single book. In the introduction the editors state: “We hope we have accomplished our relatively modest goal of providing an up-to-date overview of the field concisely packaged into one volume” (p. xviii; italics added). Person, Cooper, and Gabbard have clearly reached their not-so-modest goal.

A solid strength of Textbook of Psychoanalysis is its pedagogy. With thirty- six chapters divided into six sections, the contributors cover the origins, debates, diversity, and evolution of the field. Distinguished practitioners, researchers, and theoreticians illuminate psychoanalysis in a manner well suited for analytic training programs, clinical psychology doctoral programs, advanced graduate studies, and those psychiatry programs still offering training in intensive psychotherapy. Another key aspect of Textbook of Psychoanalysis is its ability to unify the field’s diversity. With the regrettable history of differing analytic camps promoting their respective theories by disparaging others—and now with a similar theme existing within what some have turned into a clinical psychoanalysis versus scientific psychoanalysis debate—the editors offer a nice counter to such divisiveness. Textbook of Psychoanalysis represents a venue in which the disparate analytic theories comfortably coexist.

At a time when psychoanalysis is often vociferously attacked by much of academic psychology for its historical lack of emphasis on the natural science model, Textbook of Psychoanalysis serves an important purpose. With an entire section devoted to psychoanalytic research (not to mention an excellent chapter on neuropsychoanalysis), Textbook of Psychoanalysis anchors the field in science— an absolute must in today’s “evidence-based treatment” era, when practitioners can no longer rely solely on narrative or anecdotal data to support their claims of treatment efficacy. Preceding Jonathan Shedler’s (2010) celebrated American Psychologist article on the empirical support for psychodynamic treatment, Person, Cooper, and Gabbard successfully provide a solid research foundation for psychoanalytic theory and practice.

Textbook of Psychoanalysis also has its limitations. One is its appropriate audience. This text is geared toward those with at least a modicum of knowledge of psychoanalytic theory. Though many of the chapters carefully expound on psychoanalysis’s general principles, most require some basic understanding of psychoanalysis. In other words, this is not a primer. Therefore, this book is likely beyond the comprehension of most undergraduate students. Also, the text is disproportionately heavy on theory, controversies, and history compared to direct clinical work, so those looking for a primarily applied read will be left unsatisfied. An inherent limitation in such a compendium is the inability to thoroughly cover any one theoretical viewpoint or to capture nuanced theoretical differences, meaning complementary theory-specific resources are necessary to fully grasp any particular approach. An odd drawback is the physical size of the text. At over 600 pages and taller than a dictionary, Textbook of Psychoanalysis is quite cumbersome. However, this is but a petty complaint about a book that truly belongs in the libraries of analytically oriented practitioners, pedagogically astute educators, or other knowledge-seeking enthusiasts searching for a comprehensive understanding of the broad field of psychoanalysis.

References

Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: W.W. Norton & Co., Inc.

Freud, S. (1913/1955). Totem and taboo, std. ed. 13. London: Hogarth Press.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 63 (2), 98–109.

Copyright

© APA Div. 39 (Psychoanalysis). All rights reserved. Readers therefore must apply the same principles of fair use to the works in this electronic archive that they would to a published, printed archive. These works may be read online, downloaded for personal or educational use, or the URL of a document (from this server) included in another electronic document. No other distribution or mirroring of the texts is allowed. The texts themselves may not be published commercially (in print or electronic form), edited, or otherwise altered without the permission of the Division of Psychoanalysis. All other interest and rights in the works, including but not limited to the right to grant or deny permission for further reproduction of the works, the right to use material from the works in subsequent works, and the right to redistribute the works by electronic means, are retained by the Division of Psychoanalysis. Direct inquiries to the chair of the Publications Committee.