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I approached this book with enthusiasm and pleasure. It appeared to offer a lot, particularly in respect of one or two patients with whom I felt stuck. I hoped this book would enable us to get going again. And indeed there is much to be enthusiastic about. It presents a series of papers, commendably short and well written, gathered together as part of a series on The Psychotherapy Patient.
There is a good introduction by its editor. I particularly enjoyed the cautionary tale of ‘The Wolf Man’, Freud's famous patient, who remained in psychotherapy most of his life, a clear demonstration of the damaging effect of failure to terminate.
There are papers on the difficulties of establishing a therapeutic alliance in order to get started (never ending because never really beginning) by Robert Taylor, and a look at the difficulties experienced by therapists who may embark on a career in order to remain in some sense patients for ever (Judith Felton). Most papers are filled with a wealth of clinical illustrations showing much patience, forbearance and indeed endurance. There is much to admire, envy and emulate.
Nevertheless, as I read further, I became aware of an increasing sense of frustration. Despite its promise it somehow (like the therapy it describes) failed to deliver the goods. In particular it seemed to become increasingly an apologia and finally a justification for interminable therapy rather than a critical examination of the reasons for being unable to finish. Of course some patients do need very long treatment, but probably not as many need it as receive it.
There is the usual problem of diagnostic variation between the UK and USA. One excellent paper by Alan Bond on the resolution of a paranoid episode describes the patient as schizophrenic where we, I think, would tend to regard her as borderline. This difference carries some confusion and may lead to attempts at psychotherapy with patients for whom it is not really appropriate. Indeed the whole question of selec