Psychotherapy: Lives Intersecting

by Louis Breger

In the best therapeutic tradition, Louis Breger describes contemporary theories and research in the field of analytic psychotherapy. Through the framework of his personal experiences as a scholar, researcher, and therapist, he focuses on his relationships with patients over the span of his fifty-year career. He records their reactions, in their own words, to their experience with psychotherapy many years after its conclusion. The author surveyed over thirty former patients to see if their progress, begun in therapy, had continued, expanded, or regressed. They were asked to highlight what they remembered as being most helpful, therapeutic, or curative in their treatment. The book is a unique long-term follow-up demonstrating the effectiveness of modern analytic psychotherapy. Breger primarily deals with the connections between therapist and patient. This is a professional memoir of the life of the psychotherapist dealing with trials as a young practitioner, lessons learned, and personal reflections on the choices, including mistakes, made along the way. Young therapists, and those who are in or considering psychotherapy, will find it helpful to have access to this self-reflective approach. Extracts from the patients are extensive and informative, giving the reader the opportunity to see therapy from their perspectives. The book also centers on the development of the therapist over his career span. Breger acknowledges that his understanding of patient care has improved over time in the eyes of his patients. In a larger sense, the book contains lessons for all psychotherapists. This is an important, unique, and innovative work. *Click here for an interview with the author. *Click here for an interview with the author on KQED's Forum with Michael Krasny

Genres: Psychology

154 pages, ebook

First published January 1, 2011

Reviews

[Deb · Rating 5 out of 5]

**What makes for good therapy anyway?**

What factors make for good therapy? Is it the therapist’s training, experience, expertise, and style; the client’s circumstances, abilities, personality, and effort; the therapeutic relationship; or perhaps a combination of all of these factors (with a dash or two of luck thrown in there as well)?

And, what factors determine whether the therapeutic effects endure once the therapy has ended?

Author/psychoanalyst Louis Berger attempts to answer these questions in this book:
“While most previous work has been centered on analyst or therapist reports, I will turn this around and devote a great deal of attention to what my former patients have to say about their therapy. Among other things, I was curious to see how their lives had gone after the conclusion of our work together: whether the progress they made endured, regressed, or expanded. I conducted an informal study of over thirty of these patients, asking them to describe what they remembered as being most helpful/therapeutic/curative in our work together…I also asked them to report what was not helpful, what they remembered as nontherapeutic.”
(p. 6)

I found the book to be an effective mix of first-person reflections from the patients and author, supplemented by the author’s account of his own personal and professional development. It reads like a detective story that ultimately uncovers essential clues as to what makes for good therapy:

“It is clear that the relationship between the patients and myself was at the heart of these successful outcomes, though it took different forms with each individual. Experiencing my attention and affection, admitting and repairing mistakes, catharsis, insight gained from collaboratively constructed interpretations, self-disclosure, humor, flexible fees, and openness to concomitant forms of treatment, all played their roles.” (p. 100)

The patients’ own words also capture the essence of what therapy is all about. Here’s an example:
“Therapy is a wonderful, flawed, limited, potentially limitless process like life itself…it gives us wonderful tools to glimpse beneath the surface layer of our existence, to pause, to check ourselves, to understand our behavior, to grow from the insight and experience—and repeat them all again, hopefully with more understanding.” (p. 76)

The book is a fun and fascinating read, providing perspectives from both sides of the couch. The writing is honest, straight-forward, and non-defensive (sorry, it’s hard to take off my own therapist hat it seems), and offers helpful insights for therapy clients as well as all levels of clinicians.

[Sunday · Rating 5 out of 5]

This book is brilliant and I would recommend it both for therapists and those who are considering undergoing therapy. Admirers of Nancy McWilliams' therapeutic approach should find it a particularly enjoyable read.
Breger details his development as a psychoanalytic therapist, his idealization of Freud followed by his disillusionment with some of the ideas Freud espoused e.g., on psychosexual stages, the oedipal conflict and penis envy. Breger rejected the rigid rules of classical psychoanalysis in favour of an approach that was not all-knowing; it was collaborative, warm, attentive and attuned to the unique needs of each patient. He candidly shares both positive and negative feedback elicited from patients regarding their perception of their psychoanalysis with him. In doing this he is able to provide valuable insights into what worked and what did not work in therapy.
We might not agree with all of Breger's approach, e.g., ongoing relationships with patients after therapy is terminated; however I think most would agree that a key factor in positive therapeutic outcome is the therapy relationship and Breger's book provides clear lessons in this.