Introduction to the Technique of Psychotherapy: Practice Guidelines for Psychotherapists

While I was writing this book review, a first-year psychiatric resident walked into my office to talk about psychotherapy. His first words were, "I haven't a clue about what's going on!" How to give him a clue? If he doesn't get a clue (he will, he's an excellent resident), his career as a therapist is at risk. The beginning therapist often begins to feel ineffectual and then starts to see therapy as a vague, open-ended enterprise where few hard results are won and much valuable time is lost. The beginner is then at risk of detaching from the patient as a person and relying solely on the traditional medical model of drugs and directives.

The usual didactic approach to psychotherapy is what James Gustafson (1), citing Friere, calls the "banking" method of education. The assumption is that students passively receive "deposits" of information in the form of history and theory that they then "reinvest" in practice. Educating adults based on "banking" rarely works, and therapists, after all, are adults. A more effective model of adult education is contextual and problem based. Dr. Greenberg helps define the context that beginning therapists find themselves in by describing the lay of the land, so that they can begin to learn therapy by facing the problems of therapy.

The stated goal of his small volume is to be a "simply written book" that is "practical" and "helpful to beginners" and will teach the "fundamentals" of individual dynamic psychotherapy. The author's description that "the therapist is the guide who has been over the terrain before, while for most patients it is a new experience" is an apt analogy for this book. Dr. Greenberg is an experienced therapist, guiding the new therapist over the terrain of doing therapy. And for any beginner, it is important to have a teacher and guide with whom to identify. The author's affection for his craft, his informal tone, and his gentle but authoritative voice provide such a teacher.

The book is divided into two sections: Basic Psychotherapy, followed by Special Situations. The first section includes succinct, informative chapters covering the initial interview, the phases of therapy, the conduct of therapy, an introduction to the use of dreams, understanding and working with resistance, and transference-countertransference.

The second section serves as an introduction to the special issues of working with suicidal patients, combined medication and psychotherapy treatment, therapeutic boundaries, and continuing to learn as a therapist. The book concludes with a glossary of psychodynamic terms.

The emphasis throughout both sections is, in the author's words, that "therapists should try very hard to know what they are doing, and what they hope to accomplish." The author himself facilitates this task with a simple and direct style of writing that implicitly describes learning how to learn about the problems patients bring to therapy. The underlying themes throughout the text are that of understanding the patient, understanding oneself, understanding what is happening between the two, and responding to the patient effectively. Information, concepts, and advice are concrete and practical. Theory is kept to the necessary minimum. Case illustrations are useful and demonstrate the language and rhythms of therapy.

This book invites comparison with Colby's Primer for Psychotherapists (2), now, sadly, out of print. Introduction to the Technique of Psychotherapy is a shorter, more elementary, and up-to-date book, and so it is more easily gotten through by one who is brand new to therapy. It can also be read in one sitting and then referred to for the pearls and aphorisms it contains. The book meets its stated goals of being simple, practical, and helpful. Because of its introductory nature, its scale of resolution in mapping the terrain of psychotherapy is low. Or maybe it is better described as a landscape painting. For a more detailed map, a book such as Beitman and Yue's Learning Psychotherapy (3) is useful, but Dr. Greenberg's Introduction to the Technique of Psychotherapy is a nice place to start.

Dr. Jarvis is residency training director in the department of psychiatry at the University of Missouri-Kansas City School of Medicine in Kansas City, Missouri.