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The Little Psychotherapy Book: Object Relations in Practice
Reviewed by Lynne Fenton, M.D.
Am J Psychiatry 2011;168:102-102. doi:10.1176/appi.ajp.2010.10081132
View Author and Article Information
Aurora, Colo.

Book review accepted for publication August 2010.

The author reports no financial relationships with commercial interests.

Accepted August , 2010.

Copyright © American Psychiatric Association

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This is a wonderfully practical and accessible book on conducting psychotherapy from an object relations perspective. Written for beginning therapists (and more advanced therapists new to object relations), it explains basic concepts clearly and with minimal jargon, getting quickly to the meat of what to say. "Little" describes not only the 26 short, quick-read chapters, but also the encouraging nature of the instruction, approachable and friendly to students of psychotherapy.

A basic premise of object relations theory is that humans are motivated by a desire to connect with others. Rather than considering people to be primarily driven by libido and aggression, object relations considers the desire to bond with real and imagined others ("objects") to be the prime motivation throughout life. Early relationships are internalized and played out in adult relationships, including the patient-therapist relationship. Using an object relations perspective, therapists strive to understand the patient's ways of relating in order to improve the quality of his or her current relationships and relieve related symptoms and suffering.

The first three chapters explain the basics of object relations theory, defining important terms and flagging them with bold type. The remainder of the book is devoted to specific guidance on conducting therapy, using a single fictitious patient to illustrate concepts. Common topics, such as projective identification, neediness, and verbal attacks on the therapist, are discussed, and specific interventions are suggested. The author engages readers, asking them to consider the patient's point of view and to think about what they would say next. Key points are clearly marked, such as in the chapter on projective identification: "The concepts in this chapter are probably some of the most important….So please read the chapter carefully" (p. 59).

Many of the presented techniques and ways of thinking about patients are potentially helpful not only for object relations psychotherapy but for any type of psychodynamic psychotherapy. For example, the author's advice regarding timing and number of interpretations, how to "roll with the attack," and his acronym COST (concrete, others, self, therapist) for the four levels of meaning are widely useful across patients and types of therapy. The final two chapters suggest ways of using an object relations perspective with other types of psychotherapy and in inpatient as well as outpatient settings.

Being a brief text, the complex history and theory of object relations is necessarily simplified. This is particularly fortunate because the complexity of much of the writing on this subject might be daunting and discouraging to beginning therapists. However, although a suggested reading list is included, I would have enjoyed an appendix outlining the major contributors to object relations theory (Fairbairn, Klein, Winnicott, Guntrip—to name a few) with a guide to their most important writings.

The Little Psychotherapy Book is a useful text for all students of psychotherapy who want to learn the basics of object relations theory and how to incorporate this approach into their treatments. For many, if not most, patients, understanding their struggles by considering how they experience and strive for bonds with others is a most helpful approach.

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