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Book Review   |    
Sarah Guzofski
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.9.1346
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by Nancy A. Bridges, L.I.C.S.W., B.C.D.; Lanham, Maryland, Rowman and Littlefield Publishing Group, 2005, 196 pages, $40

Dr. Guzofski is a psychiatry resident at the University of Massachusetts Medical School, Worcester.

In Moving Beyond the Comfort Zone in Psychotherapy, Nancy Bridges challenges the reader to think about the less comfortable corners of psychotherapy, such as self-disclosure, sexual and angry feelings, unusual requests, and self-revelation. By basing her discussion on a blend of relational intersubjective theories and developmental research, her goal is to help the reader face the difficult moments in therapy, when traditional boundaries are tested. To illustrate how she negotiates such situations, Ms. Bridges presents scripts from her own work.

Ms. Bridges begins this book with her view of the therapeutic relationship. Her view is based both on a traditional stance that the relationship itself and the feelings produced and confronted within that relationship are the keys to producing change. Her view is also based on the more developmental model of the therapeutic process occurring as the therapist and patient "fit together," a trial-and-error approach to setting up a new relationship. She dedicates the remainder of the book to discussing potentially uncomfortable moments that fall outside of routine discourse and describes these as the most likely to produce change.

In a chapter about intense affect, she discusses sexual and aggressive feelings and acknowledges that these tend to be particularly unsettling to many therapists. She reminds the reader that these affective states can be a way to express or defend against many other painful emotions, to recreate other past experiences, or to avoid unfamiliar positive feelings. She shares several transcripts, for example, about how she and a patient addressed his sexual fantasies about her and helped him create more meaningful relationships with other women in his life. She also discusses exceptional requests in therapy, such as gift giving, requests for physical contact, or invitations to personal events. Using her own examples of each of these scenarios, Ms. Bridges illustrates her collaborative approach, beginning from the stance of "Let's talk about this and what it means to you." Chapters on self-revelation and using supervision follow a similar format, with both theoretical and practical discussion of some commonly challenging scenarios.

As a beginning trainee in psychotherapy, I found that this book met the author's goal of helping the reader conceptualize some very difficult issues in psychotherapy. The transcriptions of the therapist-patient interaction make it much easier for me to imagine how to work through these difficult situations with a patient, which makes me feel much more prepared. Ms. Bridges has chosen to address some of the traditionally uncomfortable boundary issues in psychotherapy, and she has done so in a well-written book that clearly conveys her empathetic approach as well as her willingness to take risks with and for her patients with the goal of their own progress. I imagine this book would be helpful to others who wonder or worry about how to be helpful to patients in these times when therapy reaches points when the boundaries are challenged.

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