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In this recently published book, Mark Leffert distills decades of clinical experience and 35 years of being a psychoanalytic educator, and presents his readers, in seven chapters, with his current thinking on a number of important facets of the therapeutic situation. This book builds upon his previous book Contemporary Psychoanalytic Foundations: Postmodernism, Complexity, and Neuroscience. It also anticipates his future work, which we are told in the author's biographical information, “…will center on the self, subjectivity, and the way our understanding of both is impacted by a statistical understanding of heuristics and biases.”
Leffert begins by writing about power in the therapeutic dyad. His focus is on the power that therapists wield, knowingly or unknowingly, in the therapeutic relationship. He refers to a series of lectures on “psychiatric power” (p. 6) presented by Foucault at the Collège de France in 1973 and 1974, in which Foucault discussed how psychiatric patients in the period around 1840 were treated by psychiatrist in mental asylums, with the basic idea that the goal of the treatment was to have the patient accept the reality of being mad, and therefore to submit to the doctor's treatment. Leffert describes this as the induction of a state of docility in the patient by the doctor. He postulates that all current therapies are genealogically related to this history of power relations between patients suffering from psychiatric/emotional maladies and those who treat them; and as such, “…power relations are very much alive and well in the therapy machine of the 21st century” (p. 9).
He uses three cases, one of a patient treated with an orthodox Freudian approach, one within a relational perspective, and one from his own practice, to demonstrate that there is always a difference of power between the therapist and the patient. He describes, in his own work, how he tries to do and not do, say and not say, certain things, so that the patient does not feel dom