Unusual Interventions: Alterations of the Frame, Method, and Relationship in Psychotherapy and Psychoanalysis

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Unusual Interventions: Alterations of the Frame, Method, and Relationship in Psychotherapy and Psychoanalysis edited by Salman Akhtar Karnac, London, 2011; 229 pp; £22.99

I had an imaginary conversation with the editor of this book about his very felicitous choice of a title. Inasmuch as Dr. Akhtar is a poet as well as a psychoanalyst, it should be no surprise that he would veto my own immediate thought that the book is about 'deviations' from the norm in favor of the much more appropriate 'unusual interventions.' It does take a certain effort for someone who has been taught that there is a right way to do things to realize that the very words 'right' and 'wrong' have locked us into a straitjacket of normativity (another of my favorite words).

This is a book that asks the reader to suspend propriety about the conduct of treatment and also to open one's mind about a host of taken-forgranted issues in psychotherapy and psychoanalysis. It starts, after an introductory list of the actions of some of the great names in psychoanalysis (such as Freud feeding the Rat Man), with a beginning chapter on fees that cannot help but make the reader struggle with the issues raised in each and every clinical vignette. Written by Ira Brenner, it offers a series of cases that combine puzzlement along with pleasure. I loved the case of the patient who tried to have her analyst all to herself by offering ''an exorbitant annual retainer, almost three times the total amount of my total income'' (p. 11). The sheer unlikelihood of its ever happening to me allowed for a series of fantasies and, of course, this is one of the aims of this very stimulating chapter, i.e. it gets you thinking. Indeed each and every chapter of this book invites the reader to think 'out of the box' and so to wonder about the walls we have allowed to be built around us.

Speaking of walls the second chapter in the book is one by Mark Moore devoted to treatment conducted outside the office. Starting with Freud and moving on to Greenson, Moore gradually alters the settings of treatment from outside the office to hospital rooms, hotel rooms, emergency rooms and patients' homes. The reader might well struggle with the very intriguing clinical vignettes which do not easily allow one to distinguish the patients' problems from the settings. Each patient presentation is designed to confront the readers with the question of whether they might find themselves in a similar situation, i.e. ''Would I let this happen to me?'' If you have never considered seeing a patient in a video-game arcade, you might be too resistant to unusual interventions as you turn to the next chapter about alterations in time and frequency.

Frances Salo allows one to feel more at home in terms of the impact of changes in frequency, length, and timing of sessions as reflecting transference and countertransference issues. Although you may not often have taken a patient to an emergency room, you have surely been late for some sessions and almost as surely have wrestled with the subject of missed or made-up sessions. Salo takes us through the many permutations and variations of temporality, and once again we may feel on familiar ground only to be jarred out of our complacency in the next chapter. There, Akhtar writes of what many will considered out of bounds, i.e. not listening or refusing to listen to a patient.

Selective listening is a regular feature of all psychotherapy and psychoanalysis, but Akhtar puts an original twist on it with his introduction of the analyst's open declaration of a refusal to hear certain material. Akhtar has the ability to write in such a compelling fashion that the reader wants to strike up a conversation with him in order to pursue certain points. Several times in this chapter one may well agree or disagree with the author, but I advise patience as more of the book may well answer or perhaps stimulate a number of unsettling questions.

Advice is the keyword of the next chapter by Anton Kris, and I am sure that all readers have firm opinions on the subject. …