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During my four years of analytic training 1 held two successive full-time jobs at inner-city hospitals. This work was often stimulating and rewarding. It was also overwhelming and frustrating. My fellow clinicians and I spent much time negotiating interlocking systems that seemed designed to impede rather than support and expedite the important work we were attempting to perform. Altman's wonderfully illuminating book deals with the problems I faced. I found myself reading it and lamenting the fact that it was not available then; it would have provided the framework for understanding what I was experiencing and lent the emotional support that I and others felt the lack of so keenly.
From the first chapter, Dr. Altman leaps in where others fear to tread. He supplies poignant clinical examples of the tragedy, heartbreak and occasional joy that one experiences while working from a psychoanalytic perspective with a clientele who is often treated as hopeless by the very system designed to be of service to them. The author is keenly aware of the chasm between himself, a white, middle-class, highly educated male psychoanalyst, and his clients, who are minority poor, of limited education and mostly female. Dr. Altman seems to have bridged that divide successfully. He positions himself, in good analytic fashion, equidistant from the demands of his clients, his own desire to be useful, and the clinic's bureaucratic requirements and power struggles that often made him feel angry and powerless. He used this neutral position to negotiate the best possible outcome for his clients. In this he was not always successful, but with the