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The authors and their colleagues are engaged in a worthwhile endeavor, bringing psychoanalytically based treatment to a poor community in Philadelphia. This is a how to do it book particularly aimed at beginner practitioners and their supervisors. The volume is brief, containing in its 190 pages an introduction, technical issues which are the substance of the book, a lengthy case report, and a detailed index.
At the onset, the authors confront a problem. Why cover familiar ground unless there are identifiable characteristics of their patient population which make it substantially different from the more conventional groups offered psychoanalytically oriented therapy and that require modification of technique? At the same time the authors go to some pains to say that they are not dealing with a homogeneous mass of patients, and that individuals should not be stereotyped by their economic, class, or racial backgrounds. It is a problem that the authors do not completely resolve, but it is much to their credit that they are willing to tackle it.
An introductory chapter reviews pertinent literature. This is quite well done, grouping papers under appropriate headings such as suitability of community patients for treatment, treatment expectations, patients' experience in terms of their color, institutional racism, and therapists lack of experience and knowledge of lower-class patients. This lack of experience can probably only be corrected by working in a setting such as that described by Lager and Zwerling, for which a book, however well-intentioned and written is a frail guide.
The book devotes twenty-seven pages to beginning treatment, sixty-three pages to the middle phase, and unfortunately only four pages to termination. In this the book has the same deficiency as many other volumes on technique. Termination gets short shift. It is particularly unfortunate that this aspect of care is not more fully considered with the particular patient population with which the authors