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Kilborne, B. (1998). Intricate Engagements. The Collaborative Basis of Therapeutic Change. By Steven A. Frankel, M.D. Northvale, NJ/London: Jason Aronson Inc., 1995. 262 pp.. Psychoanal Q., 67(2):335-338.

(1998). Psychoanalytic Quarterly, 67(2):335-338

Intricate Engagements. The Collaborative Basis of Therapeutic Change. By Steven A. Frankel, M.D. Northvale, NJ/London: Jason Aronson Inc., 1995. 262 pp.

Review by:
Benjamin Kilborne

In this book Frankel attempts to integrate ego psychology, object relations and self psychology, drive theories and deficit theories, and to propose a correspondingly inclusive explanation of psychic change.

Throughout the book, the lines between theory and practice remain tantalizingly unclear. Frankel constructively poses the questions of what constitutes a practice driven by a theory and a theory driven by a practice. Yet one begins to feel uncomfortable with Frankel's notions of theory and practice when he writes: “The therapist lives in a psychoanalytic world without definitive guidance for making choices. There are competing points of view about analytic theory and practice. However, currently there is no method for selecting among approaches” (p. 39). If there is no such “method” at all, what, pray tell, are the thousands of analysts who daily make decisions about interventions and dynamics doing? If the world is reduced to so many points of view in deference to the currents of political correctness, then it would seem that any choice of intervention is arbitrary. The only course to take is to assume that there can be truth in accretion, and that whoever can demonstrate that he or she has taken into account the greatest number of points of view will be the most “right.” But this is clearly not the way the world works. And it is not the way Frankel works either, since at the end of the chapter he advocates three ways of making clinical choices.

Frankel valiantly and creatively attempts to demonstrate what happens in his view when practice affects theory and theory, practice. In his discussions there is much to be admired: he appears to be a sensitive, respectful, and flexible clinician. Conveniently for a writer who is attempting to marry object relations with self psychology, his clinical experiences validate both theoretical models.

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