Book Reviews

Deepening the Treatment

    Her work deserves to be read widely and for years to come. Seemingly indifferent to the empty war of competing “schools,” she has incorporated the best from each of them, guided not by ideological loyalty, but by what works for “deepening the treatment.” With this book she emerges as a role model for the contemporary psychoanalyst, and as an inspiration.―J. David Miller, M.D. for Psychoanalytic Books
    Jane Hall’s emphasis is on preventing treatment from remaining superficial. Her book adds an important dimension to the literature. It describes a special kind of respect for the patient and the latent meanings of the patient’s manifest utterances, and it stresses the use of the transference as a prime tool in deepening the treatment. The book is especially welcome as a balance to the proliferation of therapies that overlook the unconscious.—Gertrude Blanck, Ph.D
    Drawing on her long and thoughtful experience as a clinician supervisor, and teacher of psychoanalysis and psychoanalytic psychotherapy, Jane Hall has produced a helpful, down-to-earth, and easily readable book of guidance for those practitioners who are less experienced and less secure. Her attitude is a model of respectfulness, empathy, patience, and benign curiosity, and she uses clinical examples to demonstrate how, from the first contact with the patient, one may continuously deepen the treatment on the way to reaching significant insights. Psychoanalytic work emerges in its true light as an individualized and collaborative search for routes toward a self-fulfilling life.—Roy Schafer, Ph.D.

Roadblocks on the Journey of Psychotherapy

    This book is an excellent introduction to analytic psychotherapy. In addition to providing a clear and comprehensive understanding of the therapeutic situation, it offers an informed and insightful discussion of the barriers in both patient and therapist to doing effective psychotherapy. This approach makes this a work that is both unique and immensely valuable for all those interested in the art of psychotherapy.—Theodore Jacobs, M.D., Clinical Professor of Psychology, Albert Einstein College of Medicine; Training and Supervising Analyst, New York Psychoanalytic and the New York University Psychoanalytic Institutes.
    In this highly readable, richly informative book Jane Hall considers those inner forces in both patient and therapist that can impede the therapeutic action of psychoanalytic treatment. She emphasizes the complexity of these inner resistances and elaborates on their multiple determinants, particularly on the way in which attachment to pain inducing caretakers may block the therapeutic path. Through numerous detailed verbatim accounts of interchanges between therapist and patient, she shows how by drawing on transference and countertransference manifestations, these roadblocks may be understood and modified. Readers will appreciate Ms. Hall’s candid accounts of a few of these less than successful therapeutic journeys that she or her colleagues have traveled. “Inner Roadblocks” should prove to be a valuable resource for experienced practitioners as well as students and teachers. It offers guidance for the work at hand, while at the same time reminding us that each patient and therapist are unique and each therapeutic journey a one-of-a-kind experience in which the “benign curiosity”, openness, empathy, flexible use of theory, creativity of the analyst and the provision of a safe therapeutic environment play an important role in the treatment outcome.— Joyce Edward, CSW, BCD, Co-editor of “Fostering Healing and Growth”
    Jane Hall’s new book is a fine introduction to psychotherapeutic process by a clear writer with a gift for teaching. While a major focus is on “roadblocks” in therapy, the text and the examples range widely over all aspects of the process; and it is rich with these clinical examples. Written for the beginning therapist, the book nonetheless tackles complex issues of the practice of psychotherapy from the most traditional to the most contemporary. It is an excellent text for teacher and student alike.—Fred Pine, Ph.D. Private Practice, New York City
      The following review by Fred L. Griffin is excerpted from Journal of the American Psychoanalytic Association (2006) 54:1381-1391.

Once a journey toward self-understanding has begun, impulses to turn back may threaten the process. … Inner roadblocks on both sides of the couch impede the journey of psychoanalytic psychotherapy, and these roadblocks are what this book is about. Conscious and unconscious resistances, transference fantasies and fears, the wish to avoid anxiety—these are ubiquitous. … When the road becomes dangerous or disappears, it is the therapist who must build bridges, ford rivers, cross deserts, and brave storms, all the while keeping her fearful patient/companion from abandoning the journey [p. 1].

In Jane Hall’s Roadblocks on the Journey of Psychotherapy, we hear the voice of a veteran psychotherapist and an unremitting message that it is only “the therapist’s commitment to the process and her courage as a guide” (p. 2) that makes it possible for psychotherapy to succeed in the face of powerful obstacles to change—roadblocks that are created by both patient and therapist. As in her earlier work, Deepening the Treatment, we also hear the voice of a teacher orienting her student: patients are trapped in enduring patterns of relating to self and others, patterns that are repeated within the therapy. The “single error that is most fatal to the work,” the author states, is if “the therapist gives up the wish to understand and replaces it by attempting to direct, advise, or control …” (p. 3). This is a clear message to the inexperienced and a stern reminder for the most senior therapist that the therapeutic frame must be maintained for the therapist to assist the patient in the “wish for something better” (p. 213).

Hall’s initial approach for the beginner is her discussion, in the first chapter, of transference—“both the motor and the main roadblock in psychoanalytic work” (p. 12). Although she describes a variety of transference-countertransference constellations, she chooses to highlight sadomasochistic enactments as a vehicle to demonstrate in bold relief the intensity, the depth, and the perseverance of the drama of transference as animated in the therapeutic relationship. This focus also provides a lesson for the beginning therapist about the powerful and inevitable nature of countertransference and, how—if not recognized and learned from—it may create a threat to the therapeutic process.

Work with masochistic patients almost always evokes the therapist’s anger and sadism. … Such patients are highly adept at putting themselves in the line of fire, and when the patient cannot recognize a pattern that is clear to the therapist, the therapist feels exasperated … [p. 53].

In two compelling chapters, Hall deepens even the most experienced therapist’s understanding of the nature of attachment to abuse and of the technical handling of destructive aggression—rage, hate, envy, and spite, which she describes as “the most powerful quartet of affects” (p. 162). Early on she introduces us to Mr. M, the patient she presents in depth later in the book, with whom she was drawn into the vortex of his internalized sadomasochistic self and object world: “Killing people’s hopes, including his own, was the basis of his lifestyle” (p. 58). She courageously describes the realness of her experience with this patient, the desperation she felt, and the action she finally took:

The therapist, feeling useless, punished, abused, and angry, finally issues an ultimatum. …

The therapist had to ask herself why she kept persevering, and she thought that it was some combination of not wanting to give up, pity, hatred, her own masochism, and on some level, her horror at the story of this man’s childhood. As provoked as she felt, she had invested years of time, energy, and hope in Mr. M, and seeing him depart affected her deeply [pp. 221-223].

Here we see the humanity of a therapist whose best efforts of “empathy, responsibility, and genuine benevolent curiosity” (p. 3) may end in therapeutic impasse or failure. It is helpful for all of us—young or old—to know that we are not alone in such disappointment and self-questioning.

One may criticize this book because it tends to emphasize work with this sort of patient over that with other, healthier ones. However, this is a book about roadblocks, and, as the author tells us, it is “the need to hold on to internalized sadomasochistic object relationships … [that is] the most difficult roadblock of all” (p. 213). And beyond this focus, the text provides a broad base of understanding about the psychotherapeutic situation that cannot be described within this limited space, such as discussions of the evolution of key analytic concepts and sensible counsel for the beginning therapist about setting up an office, self-disclosure, receiving gifts, the impact of the therapist’s illness, and boundaries.

In the closing chapter, “Light at the End of the Tunnel,” Hall conveys the sense of loss and the questions that remain with every patient and therapist at the end of a psychotherapeutic journey. This is a contemplation on the very nature of exploration in psychoanalytic psychotherapy—even after it is “over.” I, for one, am still haunted by the case of Mr. M.