Front Matter

About the Author ix

Foreword xi

1 Introduction 1

2 Starting Psychotherapy Supervision 19

3 Establishing and Maintaining a Therapeutic Frame 33

4 Words and Silence 51

5 Finding the Focus: Content Versus Process 67

6 Developing a Sense of Self: Theory 85

7 Developing a Sense of Self: Clinical 117

8 The Oedipal Situation (Exclusion and Rivalry): Theory 137

9 The Oedipal Situation (Exclusion and Rivalry): Clinical 161

10 A Neuroscientific Perspective on Object Relations 177

11 Termination 209

Index 233

Dr. Christopher W.T. Miller is an Associate Professor in the Department of Psychiatry at the University of Maryland School of Medicine. He obtained his medical degree from the Universidade Federal de Santa Catarina, in Florianópolis, Brazil. He trained in Adult Psychiatry at the University of Maryland/Sheppard Pratt Residency Program. He completed training in Adult Psychoanalysis at the Washington Baltimore Center for Psychoanalysis. He is the Director of Psychotherapy Education for the University of Maryland/Sheppard Pratt Psychiatry Residency Program. In addition to seeing patients for psychodynamic psychotherapy and psychoanalysis, he works in the Psychiatric Emergency Services. He has published and lectured on educational frameworks for teaching psychotherapy in residency programs, the intersection between the neurosciences and psychotherapy, and psychodynamic dimensions of film and literature. He lives in Baltimore, Maryland.

FORTY YEARS AGO, I started seeing outpatients for psychotherapy. I was a third-year psychiatry resident, anxious and clueless. My only experience of psychotherapy was as a patient. It was then that I decided to add a psychotherapy book to my bedside table, alongside a novel and general nonfiction book. Every night, I read a chapter or two from one of them. Over time, I gained in experience as a therapist, and my anxiety subsided. I learned from my patients and supervisors. I kept reading. I undertook psychoanalytic training and kept reading. I became a psychotherapy supervisor, teacher, director of psychotherapy education, and director of residency training. As time rolled on, I taught several generations of psychiatry residents and psychoanalytic candidates. For 40 years, I kept reading novels, general nonfiction, and psychotherapy books with discipline and growing sophistication. I read more than 75 psychotherapy books in that time.

What is it about this book by Dr. Christopher Miller that sets it apart? Let me state three points.

First, it is an undeniable fact that this book is very well written. Dr. Miller is a gifted author and craftsman of the English language. He avoids unnecessary jargon and defines and elaborates difficult psychoanalytic concepts (such as projective identification) with admirable clarity. Theoretical points are carefully explained and then come to life with detailed clinical vignettes from his practice. This book is engaging, at times quite entertaining, and always relevant. Once you start it, you will finish it.

My second point is that this book is a rare combination of relevance, breadth, and depth. Although written for early career psychotherapists (and in particular psychiatric residents), it has much to offer a more seasoned reader. Dr. Miller speaks from the position of a clinician entering his prime, with real wisdom to share. He works in a variety of clinical settings, shoulder to shoulder with the young clinicians he trains. He has designed and refined a model curriculum on psychodynamic psychotherapy for third-year psychiatric residents that he uses to teach. This has helped him to be incisive in his thinking and writing. He supervises residents in their outpatient clinics and in the psychiatric emergency department. This has refined his mastery of the clinical material. He is up to date and expert in areas directly related to psychotherapy, such as neuroscience and sociocultural competencies. (If you question this, read Chapter 10 on the neuroscience of psychotherapy, which is a remarkable tour de force.) In addition to being contemporary, Dr. Miller is a true Renaissance man, which adds nuance and color to this book. For example, he is a self-educated Shakespeare scholar of some note. At key times, he brings in wisdom from literary sources to emphasize a clinical point. In sum, he knows his material, knows what trainees need to hear, and knows how to say it.

My third and final point involves the fundamental coherence of this psychotherapy text. It is a tremendous asset that this book has one author, presenting a single, consistent voice. Furthermore, it is grounded on one particular orientation of dynamic psychotherapy: object relations theory as developed by Melanie Klein and the modern Kleinian school. Theory, practical advice, and illustrative clinical material are integrated and reflected through the mind of one (very talented) clinician. They fit into a coherent whole. The student gets to sit on the shoulder of Dr. Miller and see how he thinks, what he feels, what he says, and how he acts with his patients in the office and in the emergency department.

In conclusion, Dr. Miller’s book is an important addition to the literature on thinking from a psychodynamic perspective, practicing psychotherapy, and teaching this science and art to trainees. It is well worth reading, digesting, and incorporating into the psychotherapy practice of any clinician. It will prove especially useful to new therapists and supervisors alike.