Can a book barely more than 100 pages long make an impact for its profundity? Samuel Greenberg’s slim volume should be essential reading for all training directors and chairs of psychiatric departments throughout the country. By studying this book, the product of an obviously seasoned and astute clinician, the teachers of the next generation of psychiatrists will learn that “in therapy we treat the whole person, not one divided into Axes I–V” (p. x). As a psychoanalyst and a psychiatrist, I have been troubled because this message has been given too rarely, or without any emotional substance to the utterance of the words, to medical students and psychiatry residents.
The book, pragmatic in its approach, is divided into chapters that could form the basis of an ongoing seminar over 1 or 2 years, including case presentations by both the instructor and the students. In this volume of basic psychotherapy, Greenberg essentially presents a way of conceptualizing and organizing the treatment of a patient, regardless of whether psychopharmacological interventions are used or not. He begins his discussion (p. 6) with the formal definition of psychotherapy by Hans Strupp: “Psychotherapy is an interpersonal process designed to bring about modification of feelings, cognition, attitudes, and/or behavior which have proved troublesome to the person seeking help from a trained professional.” Studying this book will make it clear that the interpersonal process is central for all interactions between psychiatrist and patient.
An outline of the chapters in the book will give the reader a flavor of Greenberg’s approach: “Initial Interview,” “Life History,” “Early Phases of Treatment,” “Interpretation and Insight,” “Use of Dreams,” “Therapist-Patient Relationship: Transference, Countertransference, and the Working Alliance,” “Conducting Therapy,” “Anxiety and Depression,” “Termination.” There are four additional chapters on suicidal patients, combining medication and psychotherapy, sex with patients, and how to become a better therapist.
For psychiatry residents, who are accustomed to the concept of structured interviews, Greenberg’s notions that there is no standard manner of conducting an initial interview (p. 10) and that one has to be aware of the hidden meanings revealed in the first session (pp. 13–14) may be refreshing ideas inspiring some of them to listen to their patients rather than merely trying to fit them into DSM categories.
Greenberg stresses the centrality of collaboration with the patient as the therapist gradually understands the patient’s life history over the course of therapy. He provides very nice demonstrations of the concepts of transference and countertransference and teaches novices that they cannot assume they know what the patient means from the manifest content of what the patient says. The therapists’ meaning of the words may be very different from the patient’s meaning of the words. The message, in short, is that therapists have to try to understand their patient’s words—what they mean to the patient at that particular moment in time. A welcome message in this age of quick stereotypic diagnostic workups.
