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Akhtar, S. (2002). Editor's Introduction: The Science and Art of Psychotherapy. J. Appl. Psychoanal. Stud., 4(3):347-348.

(2002). Journal of Applied Psychoanalytic Studies, 4(3):347-348

Introduction: Book Review and Commentary

Editor's Introduction: The Science and Art of Psychotherapy

Review by:
Salman Akhtar, M.D.

There exists a tension at the heart of our clinical enterprise. On the one hand, the conduct of psychotherapy and psychoanalysis rests upon empirically derived developmental hypotheses, objective methods of observation, agreed upon definitions of psychopathology, and the explicit goals of providing symptomatic relief to the patient. On the other hand, such work is meandering in nature, lacks certainty, draws heavily upon empathy and intuition, often catches both the partners by surprise, and frequently fails to achieve an orderly closure. We employ systematic principles of technique and yet rely upon a deeply personal engagement with another human being.

At each step in this sojourn, we are tempted by simplicity and challenged by contradictions. It is only when we bear the former and resolve the latter that we arrive at the level of paradox where our most meaningful work takes place. In earlier publications (Akhtar, 1998, 2000), I have elucidated the developmental foundations and technical implications of these ideas. More recently, Parsons (2000) has addressed the fundamental dialectical tension in the practice of psychoanalysis and psychotherapy, i.e. the tension between working according to theoretical guidelines and working spontaneously within the matrix of a deep human relationship. Parsons extends this paradox to our theories themselves, our training, and indeed our very identities as therapists and analysts. In all these realms, Parsons argues for containing the polarities of deliberateness and spontaneity, conviction and surprise, credulousness and skepticism, and discipline and freedom.

I bring all this up to set a proper context for the two books under review. They represent the two poles of the dialectics I have just highlighted. Brockman's A Map of the Mind attempts to put observation, objective data, formulation, and hypothesis generation at the center of our work and attempts to anchor these ideas in contemporary neuroscience. Knoblauch's The Musical Edge of Therapeutic Dialogue, in contrast, reflects a postmodern, relational, even improvisational, slant to clinical work.

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