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Leston Havens's concern in this evocative and humane book is with “the most perplexing and disturbing situation in all of psychotherapy” (p. 3): the patient's absence. The author, a professor of psychiatry at Harvard Medical School, identifies the ways and reasons patients absent themselves and proposes appropriate means of dealing with each through language. His theoretical concerns are supported by a wealth of case histories describing the sensitive and courageous interactions that his existential-humanistic approach demands.
The ideal patient, says Havens, is one who is “intact characterologically” (p. 4) and has the resources needed to deal with problems that surface during the transference process. Such patients are best served by the psychiatrist's silence. But they are not in the majority: in most patients, conflicts are not self-adjusting or in balance, and human situations are not subject to change. These patients need special assistance to solve the problems addressed in analysis: problems of absence and isolation, domination, and submission; of confirming and developing a presence and finding others; of managing social forces. Psychic health—the capacity to be alone with another, personal freedom or self-possession, liberation from the need to invade others or be invaded by them—must be the concern of psychotherapy, its goal to function in the personal realm as democracy does in the political: to oppose tyranny.
Language provides the means. Each school of psychiatry, Havens says, revolves around refinements of basic psychological functions and develops a language to express those functions. Descriptive or medical psychiatric work (e.g., of Kraepelin, Janet, Reich) makes use of perception: it is work