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The analyst in the city: race, class, and culture through a psychoanalytic lens (second edition), by Neil Altman, New York, Analytic Press, 2009, 370 pp., £24.95 (paperback), £65.00 (hardback)
This book is in its second edition and deservedly so; it tackles crucial but often neglected issues central to clinical practice. Altman is a relational psychoanalyst and the reader is left in no doubt about his allegiance to his theoretical background, but he also integrates a wide range of theoretical perspectives including the work of Klein, Bion and Winnicott. At the heart of the book is his exploration of a process whereby a denigrated or disowned category of ‘other’ is created; he argues for a shift away from viewing a patient's issues about race or class as simply intrapsychic to a more complex approach whereby the social, racial and cultural context is understood as having a significant impact on both therapist and patient. Using clinical vignettes from his community work in the Bronx of New York, Altman repeatedly illustrates his argument that any meaningful consideration of what happens between patient and analyst must involve full engagement with the influences of class, race and culture on the therapeutic dyad.
The book is organised into four sections; the first part describes Altman's experiences in a public clinic and grapples with the realities of life for poorer communities. He considers a range of dilemmas for the psychoanalytic practitioner in this setting, including missed appointments, the pressure of good attendance figures and time-limited treatment. The following gives a flavour of his thinking:
Many psychoanalytic authors have shown how resistance can generally be reformulated as transference (eg. Schafer 1992) or as adaptive behaviour from the patient's point of view. Similarly, from a cultural point of view, what might appear resistant is often capable of being formulated as a culturally syntonic behaviour. Many ethnic groups have jokes about their own