The Technique and Practice of Psychoanalysis (Book Review)

Author:  Sugarman, A., R. A. Nemiroff and D. P. Greenson (Editors)
Publisher: Madison, CT: International Universities Press, 1992
Reviewed By: Jeffrey H. Golland, Summer 2001, pp. 64-65

When I began psychoanalytic training, Ralph Greenson’s technique text was new. Greenson was himself already very well known for his scholarly contributions as well as for being analyst to Hollywood stars and the putative model for “Captain Newman, M.D.,” a World War II psychiatrist portrayed in the film version by Gregory Peck.

Volume One of The Technique and Practice of Psychoanalysis (1967) was a most welcome contribution. Prior to its issue only two works could claim the status of texts in the field of psychoanalytic technique. Glover’s volume (1955) was an updating of lecture notes compiled originally in 1928 before the maturing of the structural theory. Fenichel, Greenson’s own analyst, had written a brilliant monograph on technique in 1941. Each work provided a compendium of technical wisdom in the absence of a text by Freud.

Greenson set himself the task of creating a state of the art text arranged in a highly organized and teachable format with numbered sections and subsections. He went to press with the first volume (covering the central issues of resistance, transference, the working alliance, and the psychoanalytic situation) when his ambition to cover treatment issues sequentially (beginnings, interpretation, etc…) would have resulted in too long a delay in publication. His second volume was outlined, with some chapters begun or completed, when illness intervened. We waited a quarter century for its posthumous publication.

Greenson’s Volume One did not disappoint. It evoked contradictory feelings, however, in this beginning candidate. On the one hand, the clarity of exposition and the at-the-time unprecedented (and still rare) open discussion of clinical details in a thoroughly engaging personal style led to the distinct (albeit naïve) feeling that this humane and exquisitely individualized technique could, in fact, be learned by following a text. On the other hand, the definitive and confident nature of Greenson’s formulations was awesome, suggesting, perhaps, that only someone of his unique talents could master psychoanalytic technique.

Personal development as a psychoanalyst as well as professional change in the field over the decades since Volume One have made it plain that psychoanalytic technique cannot be learned from a text. Supervision, clinical experience, and peer group study provide an individual analyst with skills that may continue to develop toward a personal but very incomplete sense of mastery as each analysand presents new challenges. The pluralism of theory characterizing recent decades has, pending a new integration, stayed the hand of any Greenson successor in attempting to provide a technique text. Etchegoyen’s massive tome (1991) tantalized with its title, but, with its Kleinian-based theory, it disappointed textbook seekers, at least in North America.

Then, in 1992, there appears Volume Two!

Lovingly and painstakingly put together by Greenson’s son and two editorial collaborators, under the auspices of the San Diego Psychoanalytic Society and Institute, an organization whose birth was assisted by Greenson, Volume Two appears from the same publisher and with the same title, cover, and typeface as its predecessor. The editors invited nineteen contributors, most of them well known from prior writing, to address the topics in Greenson’s outline. A section on goals was added as were some additional topics of interest to the invitees. Also included are Greenson’s introduction and the four chapters he had written. Except for a chapter by the Shanes (from a self-psychological perspective) and one by Brandchaft (a critique of the working alliance concept from the intersubjective point of view), each a former student of Greenson, the book takes as its orientation modern conflict theory. Its authors, mostly psychiatrists, were trained at and/or belong to institutes of the American Psychoanalytic Association.

In his introduction and chapters on beginnings, acting out, countertransference, and termination, Greenson treats the reader, as in the first volume, to beautifully expressed, experience-rich and thoughtful ideas, anecdotes, and examples (but without the subsection numeration). It was a pleasure to be again in his company across decades. In his familiar authoritative tone, Greenson reminds us, nonetheless, that every case is different, and specific technical recommendations are always unpredictable in their effect.

Each of Greenson’s chapters is followed by at least one contemporary paper on the same topic. This is felicitous editing, involving both update and critique. Daniel Greenson writes on assessment of analyzability and provides useful caveats against poor assessment. Haig Koshkarian makes good suggestions on managing acting out and he deals well with related countertransference issues. Morton and Estelle Shane render a cogent critique of Greenson’s assumptions about the reality perspective from which transference and countertransference are understood. Sanford Izner postulates a useful differentiation between countertransference and counterdefense. Jack Novick offers compelling, transcript-like material from the terminal phase of treatment of an “interminable” analysis, demonstrating the importance of the phase and its issues.

Analytic goals are discussed by Robert Wallerstein, then jointly by Edward Weinshel and Owen Renik. Each essay, rich and informative in its own way, shows that agreement on the aims of psychoanalysis, if it ever existed, is largely absent today, even from within a common theoretical orientation. As chapters 3 and 4, these papers also serve notice that Volume Two is not a coherent single-voiced text. Although mostly organized as Greenson had outlined, topics such as interpretation (S. Levy and L. Inderbitzen, A. Skolnikoff), abstinence (P. Dewald), reconstruction (R. Tyson), dreams, (A. Grinstein), and working through (S. Wilson, S. Izner) are presented in papers that would be readily published individually by our best journals. Intellectual (and sometimes emotional) connection to Ralph Greenson seems the thread holding them together. Such is even more the case with the closing papers by Rudolph Eckstein and by Vann Spruiell. These are significant contributions to technique with widening scope patients and include, as was always the case with Greenson, detailed clinical material and innovative ideas.

Comprised, then, of excellent papers better described as a festschrift then as a text, Volume Two may disappoint readers who still wait and hope for a textbook. Such a wish was likely always a vain one (and one eschewed by Freud), psychoanalysis being in its essence an idiographic domain. The current phase of theoretical pluralism makes a definitive text even less likely. Volume Two will not disappoint serious readers from any psychoanalytic persuasion, however. The quality of the papers and their continued relevance almost a decade after publication, the detailed clinical material, and the special opportunity to experience previously unpublished writing from Ralph Greenson give this book lasting value.

Festschrifts rarely serve as vehicles for influential contributions to the literature. Most authors prefer to submit their best work to the guaranteed readership of major journals. This book may be a happy exception, in that eight years after publication it was reissued in paperback. While its physical resemblance to Volume One and its title may be something of a marketing ploy, that seems a small indiscretion in the service of our continuing education.

Etchegoyan, H. (1991). The Fundamentals of Psychoanalytic Technique. London, Karnac.
Fenichel, O. (1941). Problems of Psychoanalytic Technique. Albany: Psychoanalytic Quarterly.
Glover, E. (1955). The Technique of Psychoanalysis. New York: International Universities Press.
Greenson, R. (1967). The Technique and Practice of Psychoanalysis. Vol. 1. New York: International Universities Press.

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