Take with a Grain of Salt: A Review of Should You Leave? A Psychiatrist Explores Intimacy and Autonomy—and the Nature of Advice by Peter D. Kramer. New York:  Scribner, 1997.  320 pp.

Peter Kramer refers to this as “the book I wanted to write—this odd hybrid of fiction, nonfiction, and self-help.” In a book that defies easy categorization, Kramer addresses the reader in the second person, as if the reader were a potential patient seeking consultation about a troubled relationship, wondering whether to stay or leave. In his role of therapist-narrator, Kramer, in a professional and moderate tone, raises important questions and controversial issues.

Should You Leave? asks: What constitutes a functional relationship? How do therapists determine “standards of relating” for their patients? Do the kind of relationships, marriages, affairs, and divorces of psychoanalytic colleagues provide any reassurance that therapists have privileged information regarding human conduct? Will a therapist favor one kind of relationship over another on the basis of scientific studies, theoretical biases, clinical experience, or strategies that have worked for the therapist? Do terms like “healthy relationships” or “dysfunctional families” ever express meanings other than the subjective values of the therapist? How do “relational values” get transmitted, not just to patients, but in the larger mental health community to therapists in training and in supervision?

Psychoanalysis has grappled with questions like these for almost a century. In an effort to distinguish psychoanalysis from advice-giving, Freud (1912) cautioned:

Young and eager psycho-analysts will no doubt be tempted to bring their own individuality freely into the discussion, in order to carry the patient

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along with them and lift him over the barriers of his own narrow personality. It might be expected that it would be quite allowable and indeed useful, with a view to overcoming the patient's existing resistances, for the doctor to afford him a glimpse of his own mental defects and conflicts and, by giving him intimate information about his own life, enable him to put himself on an equal footing. One confidence