email page print pageAll Topic Reviews
Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
A good psychotherapist has empathy and critical acuity, with intelligence and a wish to help. Carl Rogers spoke of "non-possessive warmth" and "unconditional positive regard." That Louis Breger has all this, nuanced in his own way, is evident to his patients, and now to his readers. This follow-up survey is unique and valuable. Breger's prior writing includes books on personality, Dostoevsky, Freud. This compact (150 page) memoir melds subjective and objective skills that all therapists must learn. He provides rich dialogue from former patients who answered his request for feedback, in some cases after many years. Breger might be a playwright watching, directing and editing a drama about people he knew very well, people who--mostly--changed for the better as they worked together.
Psychoanalysis is notoriously under-researched, so this is a model, a breakthrough. Some analysts would be incapable of such research due to presumptive infallibility, learned in part from Freud himself, who deserves credit for inventing a new and constructive form of human relationship, what Otto Rank called "the analytic situation," others "the Jewish confessional." The chapter titles describe Breger's approach--"Against Dogma;" "Psychoanalysis Old and New;" "Learning the Ropes;" and "When I Didn't Help."
Of 11 chapters, four present patients, while the other seven contain Breger's reflections on psychoanalysis then and now, his own upbringing (his mother was severely depressed), his personal qualities and therapeutic style. He comfortably shares inner workings and reactions--thoughts and feelings--including a wish to help and the ability to own up to mistakes. In his mid-seventies and retired from fifty years of practice and teaching, Breger contacted many former patients, explaining his interest in follow-up and evaluation of the process. Some of the 28 respondents are themselves therapists. A few had kept in contact over the years, exchanging holiday cards, sending marriage or birth announcements; Breger and his wife went to some of their weddings. He is not a classical Freudian (but neither was Freud).
"Successful therapeutic outcomes depend more on the kind of person the therapist/analyst is than his or her theory-based technique. All the same, good theories can be very useful while bad theories make it difficult, though not impossible, for even the most skillful therapists to be of much help. To come at it a different way, much depends on the match--or mismatch--between therapist and patient." (p. 31) Patients' remarks, like those of "Andrew," a therapist himself, are often eloquent and revealing:
...my memories of this therapy don't refer to clinical methodology or skill. This may be, in part because the methodology, as I recall it, was so deeply embedded in the humanness of the interaction. .... What is clear to me is that Lou's approach reflected an unusual grasp of the sometimes evanescent distinction between being too distant and too intimate. Achieving this appropriate distance is, surely, a struggle engaged in by all serious, caring, responsible therapists, but it is a struggle, nonetheless. So, in my view, as a patient and a clinician, achieving this rightness of distance reflects a particular grace."
Andrew had two prior analyses, Freudian and Kleinian. Of that history Breger, his analyst for three years, four sessions weekly, said, "...a patient is plugged into a fixed slot, his individuality ignored. There was essentially no relationship with him as a unique person..." (34-35) Reflecting on three other patients with similar experience, Breger notes that, despite the importance of free association, they "did not feel free to talk about how their analysts affected them in the sessions." (45)
Recognizing that patients who liked him were more likely to respond, Breger sought, and found, a range success and failure. "Oliver" recalls confronting him on mistakes: a "nagging" tone of voice when saying he would be ready soon. Breger responded "you're right" and apologized. Later Breger acknowledges a homophobic response to Oliver's suggestion that the two share the couch. Such failures are mended for a net plus. Deborah, who saw him weekly for three years, had come to view a behavioral approach as more effective than talk therapy: "relying on someone else to listen to you and ask questions feels like it's creating an unhealthy dependence." (106) "Karl" wrote: "working from so-called attachment theory was all you continued to want to do to draw me closer for your needs...With each major failure on your part, I began to lose confidence that you new what you were doing." (107) Breger finds some interference in other cases from his own personal characteristics, e.g. over-controlled emotion, a vulnerability to guilt feelings and excessive responsibility (too quickly yielding to the pressure of suicide/self-injury threats), and a conflict between pride and modesty.
A flexible therapist--he saw couples and families, too--and an introspective man who overcame difficult relationship problems in his own life, Breger comes to this unusual task with balanced pride and humility. A careful writer with broad scholarly pursuits, grounded in good personal relationships and realistic ideals, he provides a guide and a mirror for new and experienced therapists, their teachers and their clients. His pioneering achievement is a gift and a challenge for all of us who care about psychotherapy.
© 2012 E. James Lieberman
E. James Lieberman, M.D., Clinical Professor of Psychiatry, Emeritus, George Washington University School of Medicine