Books on psychoanalysis frequently suffer from one of two problems: they focus on psychoanalytic theory to the exclusion of discussions of practice, or they describe technique without quite evoking the consulting room or the large body of psychoanalytic theory that informs practice. These two issues reflect the difficulty practicing clinicians often face when trying to make their practices reflect their theoretical understandings, while still leaving room for the art of psychotherapy. Owen Renik has written a fabulous book that effortlessly manages to reconcile both the theoretical and the clinical strains of psychotherapeutic practice. Practical Psychoanalysis for Therapists and Clinicians reads as the honest distillation of a long career dedicated to treating patients, and it is filled with humanity, insight, compassion and considered opinions about how to best help people in distress.
Renik's book is simply organized and cogently presented. It's divided into twenty short chapters, all on topics directly related to clinical practice, e.g. Acting Out and Enactment, The Perils of Neutrality, Phobias; and, each chapter is organized around a patient vignette. Renik opens each section by discussing the issue he wants to introduce, and then proceeds to the clinical material that illustrates his thinking on the matter. The chapters close with a brief restatement of Renik's theoretical justifications, tied into his larger argument about what constitutes useful psychotherapy.
The central premise of Renik's refreshingly frank book is that psychoanalysis and psychotherapy cannot claim to be useful to patients unless they actually strive to take patient concerns and desires seriously and at face value. In his introductory chapters Renik makes clear that his project and his book revolve around providing comprehensive but rapid treatment to patients in mental distress, helping them to improve their lives, and honestly assessing his own approaches and biases at each step of the way in order to facilitate that process. Renik cautions that in order to be practical, psychoanalysis must maintain a focus on symptom relief, and he reminds us that the birth of Freudian analysis was rooted in this goal. At the same time, Renik suggests that in order to maintain any claim to scientific validity psychoanalysis cannot reify either techniques or theory, since the definition of a science is its area of focus (in this case the mind) and neither a specific set of its tools nor a particular elaboration of its current understanding.
It is a testament to the necessity of Renik's book that when he writes about symptoms he feels a justified need to remind readers: "the analyst can make important contributions [to defining the symptoms to be treated]; but it is the patient whom must have the final word, because clinical analysis doesn't work when a patient is being treated for something the patient doesn't regard as a problem--even if the analyst is convinces that it is a problem."(8) Renik's premise, supported in each chapter of his book, is that insofar as therapy cannot proceed without the investment of the patient, therapists cannot afford to dismiss patient concerns with theoretical justifications: "Ordinarily, it's more a matter of soliciting and respecting the patient's input when deciding about frequency of meetings, duration of treatment, and the like, instead of assuming that the analyst knows best about format and that the patient is "resisting" if he or she disagrees."(53)
A major theme of Renik's book, reiterated in almost every chapter and nearly all the clinical vignettes, is that psychotherapy is a collaborative process entered into by both therapist and patient. Renik suggests that clinicians should share their dilemmas, their concerns, and their thoughts about the treatment, with most of the patients that they treat. While this may not always be necessary, Renik's clinical descriptions often turn on just such a moment of collaborative sharing between him and his patient. In this respect, Renik fits the mold of a relational analyst, a clinician whose mode of working is centered around a mutual sharing of the therapeutic encounter. Renik points out that "a reticent analyst looms large," and that sharing select information about oneself does not preclude the formation of transference, it simply "helps the analyst avoid becoming in the focus of attention.".(58, emphasis in original) The clinical encounters that he details support his contention, providing many examples in which impasses in treatment are dissolved after he engages in judicious sharing with his patients.
One of the most refreshing aspects of Practical Psychoanalysis for Therapists and Patients is the insistence, throughout the book, that clinicians not lose sight of the theoretical underpinnings of their work. Renik makes many suggestions for making psychotherapy work better for most patients. In chapter after chapter he demonstrates his commitment to improving the lives of his patients. At the same time, Renik grounds his techniques in theoretical justifications, reminding us, for instance, that Freud's impetus at the birth of psychoanalysis was, indeed, symptom relief, or, again, that analytic neutrality does not preclude our wishing that patients improve their lives. Indeed, this book is valuable precisely because Renik shows how useful psychoanalytic theory, when thought through and integrated into a clinician's practice, truly is. Renik is not above recasting recent changes in psychoanalytic jargon to remind us of what is at stake when we ignore the rich history of psychoanalytic theory:
"The problem with using the [recently popular] concept of enactment to guide analytic technique is that it assumes that certain interactions between analyst and patient, enactments, express the unconscious motivations of one or the other of the participants, realize their unconscious fantasies, while other interactions[...] do not express unconscious motivations[...]do not realize their unconscious fantasies, or do so to a lesser degree That assumption is mistaken and misleading. The truth is that every interaction between analyst and patient expresses the unconscious motivation of, realizes some unconscious fantasy or other of, both participants. For an analyst to think otherwise is naïve and will lead the analyst to underestimate his or her personal participation in clinical work."(91)
Owen Renik has written a useful and timely book about psychotherapy. Without sacrificing theoretical rigor, he uses a series of clinical vignettes to discuss technique and therapeutic process. Most importantly, he uses his book to argue that a focus on symptom relief for patients is not only essential, but the only ethical grounding for any psychoanalysis that seeks to promote itself as therapeutic.
© 2007 Andrew Pollock
Andrew Pollock is a psychotherapist practicing in Baltimore, and a Director of the Baltimore Psychotherapy Institute.
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