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Firestein, S.K. (1982). The Therapeutic Environment: By Robert Langs, M.D. New York: Jason Aronson, 1979. 574 pp.. Psychoanal Q., 51:145-149.

(1982). Psychoanalytic Quarterly, 51:145-149

The Therapeutic Environment: By Robert Langs, M.D. New York: Jason Aronson, 1979. 574 pp.

Review by:
Stephen K. Firestein

In his preface Robert Langs defines the therapeutic environment as "the ground rules, framework, hold, and setting of the psychotherapeutic and analytic situations" (p. ix). He quickly stakes out his essential thesis that "the frame itself is undoubtedly the single most fundamental component of the analytic and therapeutic interactions," and claims that patients will respond to alterations in the therapeutic environment with strong reactions that are very predictable. He states further that his experience has been that presentation of this demonstrable sequence to therapists and analysts tends to elicit highly emotional reactions, which in part seem to him to reflect countertransference phenomena.

It is this contradiction between patients' responses and therapists' reactions to alterations in the framework that Langs is addressing in the body of this lengthy volume.

Langs's approach involves application of previously described methods of listening to the patient's associations and an attempt to validate hypotheses generated by those verbalizations. These methods focus upon the manner in which the therapist manages and regulates the interaction with the patient. The meaning for the patient of the various elements in the therapeutic environment are examined through reactions to deviations in the essential elements of that environment, including the physiotemporal features and the human aspects. The reactions are viewed in terms of conscious and unconscious derivatives communicated by the patient, especially what Langs labels "Type Two Derivatives." By this latter designation Langs intends validating inferences from the patient's manifest statements that can be related to a "specific adaptive context"—that is, to a specific item in the therapeutic environment to which the patient is responding. Langs states that influences disturbing the secure, silent framework for the treatment are common. He places an emphasis upon therapeutic work focused upon such disturbances which he feels become frequently critical for the effectiveness of the treatment. He includes more than correct interpretations in his definition of this therapeutic work.


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