The Therapeutic Environment: By Robert J. Langs. New York: Jason Aronson. 1979. Pp. 574.

This is the latest in a continuing series of clinical studies on Psychoanalytic Technique, the principles of which the author arrives at and validates empirically from clinical material. Each volume in this series consists of a number of clinical presentations which are examined closely and sequentially by Langs along with the participant members of a seminar group of therapists in training. The particular focus for this volume is the importance and function of the framework within which therapy takes place. This includes the physical setting, the fixed arrangements such as times and fees, the ground rules such as free association, total confidentiality, the neutrality and relative anonymity of the therapist, and the boundaries of the therapeutic relationship. It is against this backdrop of a clear definition of the optimum conditions for insight-promoting psychotherapy that we are then able to see how often this framework is under threat, in flux or in a state of chaos. We are able to see patients' responses to such issues as third parties to the treatment, a boyfriend in treatment with the same therapist, the therapist who had been seeing other members of the patient's family, the intrusive effects of insurance companies requiring reports on treatment and other violations of total confidentiality. There are also examples of the impact on the treatment where there is a loss of neutrality and anonymity, as for instance in the policy of telling clinic patients that their therapist is in training and that their treatment will be supervised. Other deviations from the interpretive mode are also examined, for instance so called supportive interventions and the use of medication as an adjunct to therapy. Langs illustrates from the patient's derivative communications that there is usually a split response to such deviations, that a patient may exploit these in the service of resistance but also how a patient will often offer unconscious supervisory efforts towards