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by Rob Leiper with Rosemary Kent, Sage Publications, 2001, 230 pp., £65 Hardback; £20.99 (Paperback)
Unlike many medical treatments, e.g. antibiotics for a bacterial infection, psychotherapy is not a linear process of eradicating pathology. From the outset there is a resistance to the treatment that cannot be eliminated simply by choosing the appropriate modality of psychotherapy – every case has a hint of antibiotic-resistant superbug about it.
Once a treatment is in progress there is a constant shift between positions of flexibility and rigidity, the one allowing the possibility of development and change, while the other demands that nothing be allowed to disrupt the deeply ingrained patterns of thought and behaviour that have allowed the individual to survive psychically intact. This shifting is intrinsic to psychotherapy and also encapsulates the paradoxical nature of a treatment that does not simply progress but may expect setbacks within the normal course of events.
This impressive book considers what setback means in the context of psychotherapy. It is specifically not a handbook of solutions to problems in therapy, and the authors open the chapter that considers technical approaches to overcoming impasse by warning against a quick fix: ‘go back: do not start here! The thrust of the previous chapters has been to think through impasse.’ (p162)
The focus throughout is on preserving the therapeutic alliance and maintaining the ability to think with, or on behalf of, the patient about what is happening, regardless of the theoretical background to the treatment. In order to do this the authors have written a book that is a broad consideration of what psychotherapeutic work – in its many guises - entails.
The opening chapter, entitled ‘Setbacks in the developmental process’, sets the scene for this thoughtful approach: on first reading it I wondered why the authors were going to the trouble of outlin