Urology in General Practice

A contribution to theoretical thinking about psychoanalytic technique by a leading psychoanalyst such as Karl Menninger is noteworthy. From this point of view alone, this book commends itself to anyone utilizing psychoanalytic principles and practices in his work, anyone interested in the philosophical and practical impact of psychoanalysis on society today, or one whose contact with psychoanalysis may have been only from the vantage point of the couch. In addition, Dr. Menninger brings to this highly complex subject his characteristically clear, concise style devoid of oversimplification. In fact, by organizing the material to follow the temporal sequence of psychoanalytic treatment, from initial patient-doctor contact to termination, much of the crisis and suspense inherent in the experience itself is conveyed and the book's readability enhanced. Dr. Menninger conceptualizes the psychoanalytic "contract" as a special form of two-party contract in our society. Starting from the model of the contract between grocer and customer where money is exchanged for a product, he progresses through contracts based on the performance of a service to the specialized service contract of a "qualified, authorized, prepared, willing psychoanalyst" who "suspends judgment and interprets" in relation to a "sick patient" who "cooperates, communicates self observation and pays [money]" (Fig. 5, page 28). The ensuing process experienced by the patient in the working out of this contract is described by Dr. Menninger as a psychic regression. This regression is stimulated by factors in the treatment situation, not the least of which is the parsimony of intervention on the part of the analyst. It is precisely the reversal of this process of regression and the patient's finding of new and more adequate goals that constitutes the healing portion of the psychoanalysis. Dr. Menninger indicates that this reversal is partly aided by the analyst's interpretations and other interventions but unfortunately does not attempt a real theoretical formulation of why the regression does in fact undergo reversal. This concept of the analytic process as a regression is distinct from the more classical formulation of the process as primarily the development of transference neurosis and the resolution of this transference neurosis; the author makes an attempt to clarify the distinction. In addition, he discusses such basic phenomena as patient resistance, analyst countertransference, and the nature of interpretation. There are also interesting discussions throughout the book of practical technical issues such as the rationale for charging a fee, criteria for terminating the contract, and the appropriate timing and types of interpretation used by the analyst. This book, the first from this author in several years, is thus of interest to the general reader but virtually a must for the serious student of psychiatry.