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Josephine Klein has here gathered together a collection of essays which discuss the personal development of the skills and reflections which have gone into her therapeutic practice. The essays begin with a brief section on ethical values and considerations in the field of psychotherapy, followed by a second group which offer theoretical and clinical thinking about work with patients. The final part, again very brief, would fit well into a section entitled ‘Questions for further consideration in the field of psychotherapy’. It consists of two disparate papers: one is a critique of the differences between Anglo and American psychoanalytic theory, and the other addresses the professions' thinking about the changing role of fathers in families.
The highlight of the book is an essay entitled ‘Patients not ready for interpretations’. This is a thoughtful paper, addressing very difficult issues about the assessment and referral of more disturbed patients, particularly those often designated ‘unanalysable’. Klein makes a case for taking these patients into work with psychoanalytically oriented therapists, stating:
… There are simply too many disturbed people whom we are not even trying to understand how to help. Some of these are helped by alternative methods, but there are methods and insights that psychoanalytically based practitioners have, which could be useful, if we could make up our minds to learn how to use them. (p. 98)
What struck me is Klein's insistence that clinicians should maintain an open interpretation of assessment criteria when considering patients for therapy, emphasizing the need to step outside rigid diagnostic expectations in order to approach those patients suffering more severe disturbance. Klein outlines a set of factors which she uses when assessing these questionably less-analysable patients, which begins with an attempt to discover whether the person possesses an understanding of what therapists and patients do together. This interested me as being