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This is a most interesting book in which the author presents some new ideas about the use of psychoanalysis particularly with those from ethnic minorities, and others on the margins of this mode of psychological treatment. Altman writes with conviction about the use of psychoanalytic therapy with low income groups and those who live on inner city estates. His writing is based on his experience of living in a split world, having a
practice in fashionable Manhattan with mainly white, wealthy patients and working in a state-supported clinic in the Bronx with largely African-American and Hispanic patients. Far from being confused by this he has been able to use his situation to appraise thinking on contemporary psychoanalysis.
I found the book stimulating and moving. The case histories are very alive and present him as a therapist with great warmth and sensitivity even in the face of the many constraints on analytic work in the US public sector. These were not the only difficulties because the Mandarins in the private sector did not seem to take the other part of his work seriously. From his tactful writing of this, one gets the impression that he was seen as idealistic and, maybe, a little misguided. Altman felt that the one part of his work informed the other. The book, he said, was written after he left his job in the Bronx.
In the United Kingdom the line between public and private psychoanalytic therapy does not ever seem to have been so clearly marked. The founding of the Tavistock Clinic in the 1920s played an important role for the development of good public access psychotherapy. The existence of a National Health Service in the UK made it more possible for mental health professionals from a variety of disciplines to train and to make their contribution in the public sector. That said, we need to be aware of the trends that have been set in the USA. Case management, cost effectiveness, simplistic efficacy research and Health Insurance funded treatment have dogged