Academic journal article
By Steinberg, Paul Ian
Canadian Journal of Psychiatry , Vol. 50, No. 8
Psychotherapy Psychoanalytic Psychotherapy: A Practitioner's Guide. Nancy McWilliams. New York: The Guilford Press; 2004. 353 p. US$45.00.
Reviewer rating: Excellent
It is a pleasure to review Dr McWilliams' third book (1,2). It is rare to find a text that is so excellent for new practitioners and that also has enough sophisticated clinical insights to be worthwhile reading for experienced therapists. Dr McWilliams' effective approach simulates hearing a valued senior colleague discuss important treatment issues. She has grown as an author and is more assured in her writing, which is rich in relevant references. Despite its easy readability, this is a scholarly text.
Dr McWilliams begins with a chapter describing the evolution of psychoanalysis in the US. Following it is a thoughtful, in-depth discussion of the qualities that psychoanalytic therapists value and develop in themselves. The third chapter describes the preparation the therapist needs for psychoanalytic work. While it is true that therapists do not need to be paragons of mental health and that the experience of suffering emotional troubles may make one a better therapist (3), I would add that therapists who have not found satisfactory resolutions to their major difficulties will be significantly limited in their work. However, apart from personal treatment, few situations offer more of an opportunity to continue learning about oneself than does treating others. McWilliams makes a similar point on page 70. She does not hesitate to describe personal experiences, including errors she has made, to illustrate her points, and she returns to the important topic of the need for therapists to receive personal treatment. The chapter on preparing the client is helpful to beginning therapists, in terms of how to use supervision optimally. Here there is much clinical wisdom, practically applied. McWilliams complements her own observations on how to handle difficult situations with patients with those of other clinicians.
At times, she discloses her own experiences in analysis to help readers understand what their patients may feel. Two chapters on the important subject of boundaries focus on the frame and boundary quandaries, and McWilliams offers thoughtful, pragmatic comments on important aspects of the therapeutic frame and boundaries. She also includes "things they didn't tell me in my training program," contrasting accidental or inevitable boundary problems with unconsciously orchestrated enactments. McWilliams acknowledges that some problems stemming from innocent boundary crossings cannot be helped and may lead to a disruption of the treatment. She is open in her involvement with her patients, including boundary crossings that may be beneficial. She goes further than some therapists would when she agrees to attend the wedding ceremony, but not the reception, of a patient. …