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Book Reviews   |    
Beginnings: The Art and Science of Planning Psychotherapy
Reviewed by E. James Lieberman, M.D., M.P.H.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.8.1173
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by Mary Jo Peebles-Kleiger; Hillsdale, New Jersey, Analytic Press, 2002, 344 pages, $49.95

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The title of this important book seems to understate the book's importance to all therapists—it is not just for beginners, but for anyone who wants a broad and deep survey of what we do to help patients and how to do it better. The author writes clearly, with a broad foundation, giving case illustrations that reveal her humanity as well as her authority, and provides some precious pearls—for example, "Allowing the unpredictable to emerge is the art; learning from the unpredictable is the science."

Mary Jo Peebles-Kleiger, Ph.D., is a psychoanalyst in Bethesda, Maryland, who spent nearly 20 years at the Menninger Clinic. She is board certified in clinical psychology and hypnosis. Beginnings: The Art and Science of Planning Psychotherapy is divided into 22 chapters, some with summary tables and charts. Starting with diagnosis and history taking, the author devotes the middle section to two main issues—the concept of underlying disturbance, and enhancing the ability to form an alliance. The former comprises deficit, characterologic dysfunction, conflict, and trauma; the latter includes reality testing, reasoning, emotional regulation, relatedness, and conscience. A chapter is devoted to each of these elements. The book closes with chapters on the psychological costs of change, the patient's learning style, expectations, and priorities and modalities.

The author balances structure with openness, control with spontaneity, and clinical observation with genuine openness to the patient's point of view. Transference exists, but so does focus: "Gone is the notion of a pure transference uncontaminated by the therapist's influence. Instead, interaction between patient and therapist is now considered to be a co-creation of the patient's inner world resonating with the analyst's inner world" (29). The author's understanding of and respect for a variety of theories and modalities finds expression in a summary table of theoretical schools, an acceptance of multiple hypotheses, and a commitment to "disciplined subjectivity."

Evidently the author's experience with family therapy is limited. Although she gives an example of its use as an adjunct, she does not see it as a major modality. And the simple (uninterpreted) family genogram as an aid in selective history taking is not mentioned. It is useful in teaching residents and medical students; it provides graphic help in recalling family data and in making concise case presentations.

This is a volume full of ideas, clinical examples, splendid organization, integration of theory, citation of relevant research, and wisdom. For example, "provocation is a sign that the other person is threatened." And, to a dithering patient, "I can see that you're having trouble responding to me right now. Can you tell me more about what is happening?" The bibliography contains some 450 references, and the name index runs to seven pages, whereas the subject index seems a little thin at five pages. In all, the book's organic integrity and its combination of humility and optimism that come with mature experience make it an exemplary companion for therapists of any background in any stage of their career.

Dr. Lieberman is clinical professor of psychiatry and behavioral sciences at George Washington University School of Medicine in Washington, D.C.




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