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Therapeutic action is a subject always close to the heart of psychoanalysts, psychodynamic psychotherapists, patients, and all of us who hope to develop, improve and get better. However, therapeutic action is challenging in its elusiveness and has at its centre a great paradox. Therapeutic intent often interferes with therapeutic action and theories about therapeutic action often promote a limited perspective. In 1909 Freud wrote in a letter to Jung, ‘To salve my conscience I often tell myself: Above all, don’t try to cure, just learn and earn some money! These are the most useful conscious aims’ (p. 288. In The Letters of Sigmund Freud, ed. E. L. Freud. London: Hogarth Press, 1961, Letter No. 145.) About twenty years ago I was sitting with twenty-five other new psychiatric residents when Elvin Semrad (a training and supervising analyst and Clinical Director of the Massachusetts Mental Health Center) told us, ‘I do not want any of you curing patients’. As I recall, the room grew hushed. Semrad continued, ‘Just investigate, investigate, investigate’.
Lifson describes the mission of the book as
the hope of elucidating a comprehensive overview and synthesis of the different models of the therapeutic action of psychodynamic psychotherapy. We believed that such an approach needed to take into consideration structural conflict, structural deficit, and relational deficit (p. xi).
An important strength of this book is that Lifson has selected accomplished theoreticians and clinicians from differing points of view. This stimulates the reader to integrate these perspectives in his or her own unique and shifting amalgam. The book is divided into three parts, the first being ‘Therapeutic Structure and Structural Change’. This section is oriented towards structural conflict, although discussions of interventions based on drive and defence are limited and discussed from an historical viewpoint. Alonso’s first chapter, ‘Toward a new understanding of neutrality’, provides a valuable h