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Dr. Lewis' book addresses the question of how best to train the beginning therapist in a psychiatric residence setting. He focuses particularly on the training seminars meant to introduce his students to techniques and concepts important in their initial work with patients. It is not his intention to deal with personal psychotherapeutic experience nor supervisory sessions.
The book is essentially an exposition of an eclectic approach to training. It focuses on aspects of descriptive psychiatry, psychoanalytic and existential psychotherapy, and the interpersonal school. It also draws on research from work with optimal family systems.
The author describes the scope of his book in the following way:
At the core, it addresses the issue of the balance of intimacy and detachment required to be an effective psychotherapist. It started with a central concern about the neglect of affect in psychotherapy and, as a consequence, during its early years the major focus was on empathy. This starting point has been balanced during more recent years by increased emphasis on the skills of detachment.
In addition to the central emphasis on the role of intimacy and detachment in the therapist's thinking, the author discusses in detail such topics as empathy, genuineness, self-disclosure, awareness of interaction and selected interventions.
There are a number of statements throughout the book that struck this reviewer as valid and interesting. In discussing medical education, for example, Dr. Lewis states:
A … source of difficulty for beginners is the likelihood that whatever native capacity for intimacy they possessed may have been washed out by the process of their education. They come to a psychiatric residency after eight years of careful training in detachment … It is likely that medical education not only rewards detachment, but selects its students on that basis.
In another place in the book the author, commenting about the meaning of intimacy and detachment in psychiatry and psychology