Reaching Across Boundaries of Culture and Class: Widening the Scope of Psychotherapy

In a sense, the authors of Reaching Across Boundaries of Culture and Class put psychoanalysis itself on the couch. In the first section of the book, the authors diagnose psychoanalysis, the patient, as suffering from various forms of pathology, such as ethnocentrism, elitism, and classism. Péez Foster argues that analysis has made itself irrelevant to the poor and to people from other cultures because of the tendency of many analysts to idealize their own values and the patients who share them and to reject the values of poor non-Westerners.

In each of the chapters they provide, Moskowitz and Mario Rendon bring to light the many forces that have shaped psychoanalysis, regarded as the patient. The authors paint a portrait of the "patient" in infancy as a radical critic of and rebel against society, an identity borrowed from the patient's outsider father. They examine how significant events in the patient's life, such as emigration to the United States and collisions with other powerful entities, such as the American medical establishment and the managed care movement, changed psychoanalysis. Good analysts that they are, the authors see the metamorphosis of psychoanalysis from rebel to reactionary as being overdetermined—the result of many causes.

In the second section of the book, the authors give the patient a prescription for a cure. The chapters deal with the treatment of poor patients, African Americans, and blue-collar workers from psychoanalytically informed perspectives free of ethnocentrism, classism, and elitism. The final part of the book deals with other interesting and important issues, such as the significance skin color has for some patients and considerations for treating bilingual patients.

This book will not be all things to all people. Readers searching for the firm theoretical underpinnings of this type of therapy will probably be disappointed and should instead consult a work like Neil Altman's The Analyst in the Inner City (1). This flaw aside, however, the editors are to be lauded for putting together an important collection of papers on the treatment of poor and minority patients. Clinicians who work with these populations in public clinics and other settings may find its message—that it is possible, desirable, and honorable to conduct psychodynamic psychotherapy with these populations—especially heartening.

The editors should also be complimented for advocating honesty by analysts both in their clinical work and about their participation in the psychoanalytic movement. The book argues for a fuller recognition of the impact that the analyst's own motivations, values, and history have on the therapeutic interaction. According to the authors, psychoanalysis has suffered from various forms of pathology, but the treatment is at hand, and the prognosis is good.

Dr. Lagomasino is affiliated with the department of outpatient psychiatry at Cambridge (Mass.) Hospital.