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Sandra Buechler's Psychoanalytic Approaches to Problems in Living is more than just another book one might read about, purchase, skim, and then shelve. This is a volume to be kept near at hand, one to revisit when needing to clarify, at the deepest level, what the nature of our clinical work is and why we do it. An experienced clinician, as well as a wise and generous person, Buechler continues what has been, in her words, “an extended effort to come to terms with mourning, aging, uncertainty, loneliness, and other fundamental challenges” inherent in human experience (p. vii). The title is a nod to one of her clinical forebears, Harry Stack Sullivan, who characterized patients' emotional difficulties as “problems in living.”
Each chapter concerns a “human predicament” (p. 13), such as aloneness, resilience, and mourning, and in each the author considers important attitudes that inform a clinician's work, presented as dichotomies that “seem to regularly evoke contradictory advice from commentators” (p. 50). She is especially interested in attitudes about adaptation vs. protest, intense vs. modulated emotion, and the value of verbal vs. experiential communication.
If the clinician values getting along over engaging in conflict, for example, she may not acknowledge a frustrated reaction to something the patient says or does; if she is more conflict-tolerant, and has compassion for both self and patient, she may bring up an enactment for mutual exploration. Will she see intense expressions of distress as something to be moderated, or simply witnessed? Will she privilege putting every experience into words?
Buechler poses several other dichotomous attitudes—such as remembering vs. moving on, obeying vs. defying rules, avoiding shame vs. exploring it—but whatever those attitudes are, she argues, the clinician needs to have certain core orienting capacities. As she wrote in Clinical Values: Emotions That Guide Psychoanalytic Treatment (2004), and references throughout this bo