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Weiss sets forth in clear, straightforward language a prescription for psychotherapeutic diagnosis and treatment, focused on the significance of pathogenic beliefs and based on his clinical experience and systematic research on the therapeutic process. The basic theory that he proposes is that psychopathology results from pathogenic beliefs generated in the child's relationships and experiences as he confronts the adaptation to reality. In his view, such beliefs are more fundamental than fantasies. They inhibit and interfere with the pursuit of reasonable goals, disrupt problem solving and erode self-esteem. The purpose of treatment is to disconfirm these beliefs in the relationship with the therapist and enable the patient to pursue his life goals. The patient brings into the treatment an unconscious plan to cope with these beliefs. The therapist's task is to grasp the plan and respond in attitude and behavior, passing the patient's tests, with interpretive interventions that further the goal. The book is replete with many clinical examples to illustrate the process.
Although it may seem from such a bare-bones description that this is a cognitive approach with a heavy emphasis on intellectual insight, that is not the case. The effort to disconfirm pathological beliefs rests in an object relations frame of reference, with sensitive responses in attitude, affect, and interpretation. Dr. Weiss describes in his detailed clinical examples a creative integration of responses consonant with technical principles in the current literature about enactments, self psychology, object relations, etc. In that sense, it might appear to be an eclectic blend. However, the author makes clear that whatever he may have acquired from the field is secondary to the development of his own approach in clinical and research activity.
Weiss describes the therapist as an advocate for the patient rather than a neutral participant observer. The focus turns from the patient's defenses, resistances,