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Writing a primer for beginning students of psychotherapy is clearly a very difficult task. Beginners are impressionable, want to do the right thing, and can tend to take advice as gospel in order to avoid painful levels of uncertainty. The author of such a text must be skilled at communicating basic psychoanalytic concepts along with cogent clinical examples. He must also be able to make his recommendations about therapeutic approaches with a supporting rationale, while noting possible alternatives. The author needs to be concerned about oversimplification, excessively rigid recommendations, and idiosyncratic viewpoints. While providing many instances of excellent explications of the psychotherapeutic process, Kotin does not adequately avoid these pitfalls.
An example of oversimplification is found in Chapter Two, ‘An approach to interviewing’, which discusses approaches to patients in the initial interview, emphasising that ‘one finds out the most by saying the least’. Kotin describes a vignette in which a patient answers a query ‘Tell me about yourself’ with the response ‘Well, there's not much to tell’. Kotin then states ‘Such a patient is almost certainly depressed’. It is not clear on what basis he draws this conclusion. In fact, the patient may be schizophrenic, with a paucity of thought, or have a character disorder with passive aggressive features, or any of multiple other disorders. In addition, there may be a variety of meanings or affects involved in such a statement. Unfortunately, a beginner, anxious to learn the ‘right way’, may readily interpret a patient's similar comment in accordance with Kotin's viewpoint, without further consideration.
The tendency towards oversimplification noted above is also represented in the absence of discussions of multiple psychic determinants of feelings, behaviours and fantasies. Kotin's reference to the multiple meanings of countertransference fantasies in Chapter Eleven is an exception to this tendency. Since the consid