|Basic InformationMore InformationLatest NewsQuestions and AnswersVideosLinksBook Reviews| Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing Stories101 Things I Wish I'd Known When I Started Using HypnosisA Primer for Beginning PsychotherapyA Therapist's Guide to Understanding Common Medical ProblemsACT With LoveAlready FreeAssessment and Treatment of Childhood Problems, Second EditionBad TherapyBefore ForgivingBeing a Brain-Wise TherapistBiofeedback for the BrainBody PsychotherapyBody SenseBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBreaking ApartBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheChoosing an Online TherapistClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCompassion and Healing in Medicine and SocietyConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsCouch FictionCounseling with Choice TheoryCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDecoding the Ethics CodeDepression 101Depression in ContextDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTDoing ItE-TherapyEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveEssays on Philosophical CounselingEthics in Psychotherapy and CounselingEveryday Mind ReadingExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFlourishingFlying ColorsGod & TherapyHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHealing the Heart and Mind with MindfulnessHealing the Soul in the Age of the BrainHeinz KohutHow to Give Her Absolute PleasureHow to Go to TherapyIf Only I Had KnownIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt’s Your HourLearning from Our MistakesLetters to a Young TherapistLogotherapy and Existential AnalysisLove's ExecutionerMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessOf Two MindsOn the CouchOne Nation Under TherapyOur Inner WorldOvercoming Destructive Beliefs, Feelings, and BehaviorsPhilosophical CounselingPhilosophical MidwiferyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPlato, Not Prozac!Psychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRecovery OptionsRent Two Films and Let's Talk in the MorningSaving the Modern SoulSecond-order Change in PsychotherapySelf MattersSelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSexual Orientation and Psychodynamic PsychotherapyStrangers to OurselvesTaking America Off DrugsTales of PsychotherapyThe Art of HypnosisThe Case Formulation Approach to Cognitive-Behavior TherapyThe Crucible of ExperienceThe Education of Mrs. BemisThe Fall Of An IconThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New PsychoanalysisThe Philosopher's Autobiography The Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe UnsayableThe Wing of MadnessTheory and Practice of Brief TherapyTherapyTheraScribe 4.0Thinking about ThinkingThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTreating Attachment DisordersWhat the Buddha FeltWhat Works for Whom? Second EditionWhy Psychoanalysis?Yoga Therapy
by Louis Breger
Transaction Publishers, 2012
Review by E. James Lieberman, M.D. on Oct 30th 2012
A good psychotherapist has empathy and critical acuity, with intelligence and a wish to help. Carl Rogers spoke of "non-possessive warmth" and "unconditional positive regard." That Louis Breger has all this, nuanced in his own way, is evident to his patients, and now to his readers. This follow-up survey is unique and valuable. Breger's prior writing includes books on personality, Dostoevsky, Freud. This compact (150 page) memoir melds subjective and objective skills that all therapists must learn. He provides rich dialogue from former patients who answered his request for feedback, in some cases after many years. Breger might be a playwright watching, directing and editing a drama about people he knew very well, people who--mostly--changed for the better as they worked together.
Psychoanalysis is notoriously under-researched, so this is a model, a breakthrough. Some analysts would be incapable of such research due to presumptive infallibility, learned in part from Freud himself, who deserves credit for inventing a new and constructive form of human relationship, what Otto Rank called "the analytic situation," others "the Jewish confessional." The chapter titles describe Breger's approach--"Against Dogma;" "Psychoanalysis Old and New;" "Learning the Ropes;" and "When I Didn't Help."
Of 11 chapters, four present patients, while the other seven contain Breger's reflections on psychoanalysis then and now, his own upbringing (his mother was severely depressed), his personal qualities and therapeutic style. He comfortably shares inner workings and reactions--thoughts and feelings--including a wish to help and the ability to own up to mistakes. In his mid-seventies and retired from fifty years of practice and teaching, Breger contacted many former patients, explaining his interest in follow-up and evaluation of the process. Some of the 28 respondents are themselves therapists. A few had kept in contact over the years, exchanging holiday cards, sending marriage or birth announcements; Breger and his wife went to some of their weddings. He is not a classical Freudian (but neither was Freud).
"Successful therapeutic outcomes depend more on the kind of person the therapist/analyst is than his or her theory-based technique. All the same, good theories can be very useful while bad theories make it difficult, though not impossible, for even the most skillful therapists to be of much help. To come at it a different way, much depends on the match--or mismatch--between therapist and patient." (p. 31) Patients' remarks, like those of "Andrew," a therapist himself, are often eloquent and revealing:
...my memories of this therapy don't refer to clinical methodology or skill. This may be, in part because the methodology, as I recall it, was so deeply embedded in the humanness of the interaction. .... What is clear to me is that Lou's approach reflected an unusual grasp of the sometimes evanescent distinction between being too distant and too intimate. Achieving this appropriate distance is, surely, a struggle engaged in by all serious, caring, responsible therapists, but it is a struggle, nonetheless. So, in my view, as a patient and a clinician, achieving this rightness of distance reflects a particular grace."
Andrew had two prior analyses, Freudian and Kleinian. Of that history Breger, his analyst for three years, four sessions weekly, said, "...a patient is plugged into a fixed slot, his individuality ignored. There was essentially no relationship with him as a unique person..." (34-35) Reflecting on three other patients with similar experience, Breger notes that, despite the importance of free association, they "did not feel free to talk about how their analysts affected them in the sessions." (45)
Recognizing that patients who liked him were more likely to respond, Breger sought, and found, a range success and failure. "Oliver" recalls confronting him on mistakes: a "nagging" tone of voice when saying he would be ready soon. Breger responded "you're right" and apologized. Later Breger acknowledges a homophobic response to Oliver's suggestion that the two share the couch. Such failures are mended for a net plus. Deborah, who saw him weekly for three years, had come to view a behavioral approach as more effective than talk therapy: "relying on someone else to listen to you and ask questions feels like it's creating an unhealthy dependence." (106) "Karl" wrote: "working from so-called attachment theory was all you continued to want to do to draw me closer for your needs...With each major failure on your part, I began to lose confidence that you new what you were doing." (107) Breger finds some interference in other cases from his own personal characteristics, e.g. over-controlled emotion, a vulnerability to guilt feelings and excessive responsibility (too quickly yielding to the pressure of suicide/self-injury threats), and a conflict between pride and modesty.
A flexible therapist--he saw couples and families, too--and an introspective man who overcame difficult relationship problems in his own life, Breger comes to this unusual task with balanced pride and humility. A careful writer with broad scholarly pursuits, grounded in good personal relationships and realistic ideals, he provides a guide and a mirror for new and experienced therapists, their teachers and their clients. His pioneering achievement is a gift and a challenge for all of us who care about psychotherapy.
© 2012 E. James Lieberman
E. James Lieberman, M.D., Clinical Professor of Psychiatry, Emeritus, George Washington University School of Medicine