The Anatomy of Psychotherapy: By Lawrence Friedman. Hillsdale, N.J.: Analytic Press, 1988, xiv + 601 pp., $59.95.

Readers who are familiar with Friedman's extensive, provocative, and incisive contributions to the psychoanalytic literature over the past two decades will not be surprised that, in The Anatomy of Psychotherapy, he has successfully welded many of his previous contributions into a coherent and creative whole that is pioneering. For Friedman, stress is the sine qua non of the psychotherapeutic endeavor, a fact which is not accurately reflected in psychotherapy literature. "Therapists function in a sea of trouble, and they talk as though they don't" (p. 6). Theories are born out of the therapist's inevitable experiences of stress. They function to hide those stresses and comfort the therapist. The intimate relation between the therapist's experience of stress and theory is Friedman's central theme.

Therapy always involves not only the patient and the therapist, but also the theory, which "sits (or hides) in the therapist's mind" (p. 9). Careful study of theory can tell therapists more than they might want to know about their stresses and desires. In addition, theory not only describes the treatment process, but it is an essential tool in that process. The author develops his theme by juxtaposing descriptions of "mundane practice" (p. 93) and selected aspects of theory, including its structure and how it has evolved.

In Part I ("Theory and Practice: The Trouble with Psychotherapy"), the therapist's discomfort is described. The concept of the therapeutic alliance is examined in order to illustrate how the therapist's experience of stress is reflected in the theory of therapy and how the development of a specific theoretical concept (therapeutic alliance) helps the therapist (or analyst) cope with the stress of an ambiguous situation: the analyst's responses must be relevant to the patient's needs and wishes, but the analyst must also avoid colluding with the patient's neurosis in order to be able to help the patient change.

In Part II ("Practice Observed"), Fried