Reviewer Jon Mills
As the title suggests, this book is an introduction to the key concepts of the object relations and self-psychology movements intended to reach an audience unfamiliar with the history of psychoanalysis. As a result, it is an excellent elementary textbook, particularly for those who are unaware of the interface between self and other within theoretical and clinical practice, and more specifically, graduate students in clinical and counselling psychology, as well as clinical social work. The advantages this introductory book has over others is that it is written for a lay audience that is uninitiated in the history of psychoanalysis and psychodynamic psychotherapy, hence it does not presuppose any familiarity with the field let alone the finer distinctions within clinical theory. It is written in plain, accessible, and non-technical language, which makes the concepts easy to grasp without losing complexity of the constructs and clinical phenomena under review. For these reasons, it is a welcome companion to graduate level courses on psychodynamic theory and therapy, psycho-diagnostics, case formulation, psychopathology, and supervisory practicum seminars.
In an effort to avoid technical, esoteric jargon, this book potentially appeals to many students in psychology and the mental health fields by attempting to offer an integrated framework of theory and practice that engages developmental psychoanalytic models within the current emphasis on DSM terminology born from those traditions. In a direct challenge to contemporary models that focus on diagnosis and disease within the so-called scientific realism of pathology and cure, Weber and Downing are careful to stipulate that actual clinical practice entails both conceptual and methodological diversity that is tailored to fit the unique dynamics of the patient’s developmental history, life narrative, psychological vulnerabilities, the therapeutic dyad and treatment frame, and intervention techniques employed by the therapist. Rather than view a person as a thing or scientific object with a medical disorder that needs a surgical procedure in order to return to a state of normalcy, the human being is seen on a developmental trajectory of health and maladjustment within an interpersonal world affecting self-structure, creativity, suffering, and functionality. Not only do these processes transpire within individuals seeking out psychological treatment, they are normative and operative within the relational parameters of therapy. That is why clinical theory must be conceived as non-static and variable from person to person, and why therapeutic efficacy must consider what is useful for each unique patient who has a different story requiring a different treatment approach.
Weber and Downing organize their book around making it accessible to a neophyte first introduced to the field of clinical practice; and that is why it has pedagogical appeal to teaching graduate students about how to think psychodynamically and how that might translate into what is actually said and done in the consulting room. In fact, the reader gets a feeling of the therapeutic encounter by the many scenarios presented in the book, from verbalizations made in therapy to common experiences any clinician has faced, as well as how the clinical encounter is conceptualized from psychodynamic perspectives compared to contemporary approaches that focus on cognitive-behavioural interventions. Beginning with the legacy of Freud, readers are quickly introduced to the value of object relations and self-psychological theory that shed light on the value of relatedness within modern developmental theory and clinical practice. Here the basic tenets of a model of mind and unconscious mental functioning, basic problems in adjustment and the development of psychopathology (in relation to the DSM-IV), and the nature of change and the change process in psychotherapy are emphasized.
Many different developmental models that have direct relevance to clinical technique are discussed in a cursory fashion, including Mahler, Jacobson, Kernberg, Fairbairn, Winnicott, Kohut, and Gunderson, just to name a few, as well as how these parallel developmental processes play out in transference phenomena, countertransference, and therapeutic interventions. We are shown how patients are conceptualized in terms of their developmental organizations, and how they appear on a continuum of symptomatic profiles, differentiating the normative neurotic or less disturbed person from the personality disordered, such as narcissistic and borderline conditions, to the psychotic, with concrete prescriptions and basic treatment strategies for dealing with each classification of patient. Here the emphasis is not on diagnosis, but on how to think theoretically and clinically in a coherent and pragmatic manner that serves as an orienting principle guiding therapeutic practice.
Much of this primer is focused on educating the novice on how to think critically about clinical theory and practice. It is a welcome addition to the literature in a time when current mental health training models are saturated with politically driven ideologies, and following so-called evidence-based practice wed to simplistic notions of human nature, brain-based reductionism, and cookie-cutter technical principles that are embarrassingly simple and therapeutically shallow. Recommended reading for those teaching the next generation of clinicians.
Jon Mills, Psy.D., Ph.D., C.Psych., ABPP is a psychologist, philosopher, and psychoanalyst. He is Professor of Psychology & Psychoanalysis at the Adler Graduate Professional School in Toronto, Fellow and Past-President of the Section on Psychoanalytic and Psychodynamic Psychology of the Canadian Psychological Association, Editor of two international book series, and author or editor of over one hundred publications including twelve books. In 2006 & 2011, he was recognized with a Gradiva Award for his scholarship from the Association for the Advancement of Psychoanalysis in New York City.