The Twenty-Minute Hour: A Guide to Brief Psychotherapy for the Physician: Pietro Castelnuovo-Tedesco, M.D.,  American Psychiatric Press, Washington, D.C., 1986, $12.00.

The Twenty-Minute Hour is subtitled “A Guide to Brief Psychotherapy for the Physician.” It is directed to internists and general practitioners who are sensitive to the interrelationship of psyche and soma and who want to practice in a more holistic way. It is concise and precise.

The Twenty-Minute Hour differs from current approaches to brief psychotherapy such as those developed by Davanloo, Sifneos, Mann, Malan, and others. While these therapies have as their aim conflict resolution leading to lasting character change, Castelnuovo-Tedesco describes a supportive treatment that has symptomatic relief as its aim. The more modest goal requires less time overall but also necessitates a narrower focus within the realm of what is already conscious or preconscious. There is no attempt to delve into the deeper recesses of the unconscious and, in fact, this is to be avoided by the maintenance of a here-and-now focus. The author discourages dream work and suggests that if the patient brings in a dream, it can simply be noted that the dream suggests he is disturbed about something. What is important is that the practitioner not get beyond his depth and that no Pandora's boxes are opened.

The other brief therapies that have character change as their aim also maintain an agreed-upon focus, but they do not avoid the unconscious. In fact, insight into unconscious conflict and its genetic roots as well as into its manifestation in the transference essentially defines the work. What is to be avoided in these therapies is regression and the development of a transference neurosis. This is achieved by the immediate and consistent interpretation and dissolution of transference, the activity of the therapist, the face-to-face and once-a-week format, and the confrontation of resistances in general. The even stricter constraints of the twenty-minute hour are assumed to prevent transference, although this may often be an unwarrented assumption. Castelnuovo-Tedesco reassures that transference