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Frankel's goals are important and ambitious ones. He starts with a clinical dilemma: a patient whose situation he feels he ‘understood perfectly’ from the framework of his analytic theory, yet who is not helped by his interpretations. To come to grips with this dilemma and the questions it raises for him, Frankel decides that he must find a way to learn other theories and take them seriously, and find methods for evaluating what does and does not work and produce therapeutic change within psychoanalysis and psychoanalytic psychotherapy. He raises the familiar and troubling problem ‘of how few guidelines actually exist within the field for determining what works’ (p. xv). The book is presented as a description of the author's project to address this problem.
The methodology Frankel proposes for the project is a review of the major psychoanalytic theories in search of common psychological principles and guidelines for interventions, a review of the literature and research on child development with similar goals, and a systematic review of his own clinical data to discover what factors advance the clinical process and lead to therapeutic change. The author takes note of the formidable problems inherent in using analytic data in a way that allows us to test hypotheses and, in the preface, describes his own method in some detail. This consists of taking detailed process notes within the analytic hour, writing down everything he is aware of about the patient and himself, regardless of whether he thinks it significant at the time. (This, of course, cannot entirely circumvent the problem of selection, as we will filter out of our perceptions and awareness altogether much of what we truly do not think is significant.) He then randomly selects