Crises and Special Problems in Psychoanalysis and Psychotherapy: By Leopold Bellak, M.D. with Peri Faithorn, M.D. New York: Brunner/Mazel, 1981. 249 pp.

Rather than classify this volume as a technical work, which may have been the author's primary intent, it can better be regarded as a collection of tactics or, as is described in the introductory pages, as containing an assortment of "suggested stratagems" for managing unusual situations that bedevil patients and therapists alike. The latter include suicidal danger, psychosis, major surgery, pregnancy, and divorce. Attention is directed not only to certain problems in the "ordinary psychotherapeutic situation," but especially to patients with more difficult disorders. Flexibility is vigorously promoted as therapists are urged to tailor the therapeutic process to special needs. The book is oriented toward clinicians interested mainly in psychoanalytic psychotherapy (including psychoanalysis proper). A cogent argument can be made, however, that Bellak's recommendations are often likely to preclude the very process he seeks to preserve and render more efficient.

Bellak emphasizes the importance of therapeutic neutrality and interpretation and recommends that one abandon neutrality only in "special circumstances." He takes this position in his introduction and then leaves no doubt about the dangers and damage he believes are created by therapeutic rigidity. Few experienced clinicians would disagree with him. But he gives insufficient attention to the cautious reservations psychoanalysts have about departing from standard technique, and serious questions can be raised about the techniques Bellak recommends in this book. Questions also can be raised about the author's selection of patients for whom he recommends analysis