How Does Treatment Help? On the Modes of Therapeutic Action of Psychoanalytic Psychotherapy. (Workshop Series of the American Psychoanalytic Association, Monograph 4). Arnold Rothstein, (ed.). New York:  International Universities Press, 1988,  x + 232 pp.

This work is the fourth published monograph based on annual workshops for mental health professionals sponsored by the American Psychoanalytic Association since 1976. These two-day workshops were designed to “offer the entire mental health community an exposure to the expertise of Association analysts on fundamental subjects of concern to practitioners in the field” (p. ix). The three previously published monographs in this series were Models of the Mind: Their Relationships to Clinical Work, The Reconstruction of Trauma: Its Significance in Clinical Work, and The Interpretation of Dreams in Clinical Work.

This book presents individual papers by a roster of leading contemporary psychoanalysts: Basch, Furer, Gray, T Jacobs, Levenson, Loewald, Modell, P. Ornstein, Pine, H. Schlesinger, E. Schwaber, and Werman. These papers are formally discussed by Boesky, Lichtenberg, Spence, and Rothstein, with Arlow and Stone adding their comments briefly at the end. However, this prestigious group was given an almost impossible charge. The panelists were asked “to present a theoretical statement concerning mode of therapeutic action and to present clinical data to support their hypotheses.” They were also asked the following:

(1) Comment on the role of insight and other factors in the therapeutic action of therapy and explicate the relationship of these factors. (2) Are there different modes of therapeutic action for different patients? (3) How are the modes of therapeutic action of psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy similar and how are they different? (4) How do ideas and data from other than your therapeutic experience influence your conception of therapeutic action? For example, do the data of infant observation and/or particular theories of development influence your understanding? (p. 3)

The result is a mixed bag. The attempt to fulfill this assignment has produced a picture of the deep contradictions in current American psychoanalytic the