In opening his well-researched account of the woes of psychoanalytic institutes, Douglas Kirsner quotes Freud's comment to Dora, ‘What is your part in this?’ Kirsner directly applies Freud's intuition—‘A string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content’ (p. 1)—to institutional psychoanalysis itself. As for a poor patient treated to relentless interpretations, we are confronted in this book with a paranoia-inducing barrage of criticisms of self-seeking power-play among analysts. Given that assault on our professional amour-propre, we might be forgiven for thinking this another in the long and tedious line of Freud-bashers.

However, I ploughed on to the end, noting with increasing interest that all criticisms were to be found in the words of psychoanalysts themselves. Kirsner decided some ten years ago to investigate the ‘decline’ of psychoanalysis. He chose four prominent American psychoanalytic institutes, and he interviewed more than a hundred