I am all for talking with patients, and some of the case material is nicely framed examples of how we all resort to defensive psychological maneuvers to avoid emotional pain and conflict, but where has Dr. Steinman been? Donald Winnicott and the object relations school of dynamic therapy of psychoses have not stood the test of time (nor have they achieved any more than anecdotal support). The author need not create dialectic between handholding and intensive dynamic therapy; after all, we have learned some things since the 1930s. No wonder he says, "I am left with a questionâ¦why did these patients not get appropriate treatment?" If he read the Surgeon General's report on mental health, he would know something about the "science to practice gap" that bedevils medicine, including psychiatry, and would be considering ways to improve access and provide effective treatments to people in need, rather than proposing an intervention that at best should be coupled with the interventions we know to work, and at worst can itself produce regression, more years of dysfunction, and tragically missed opportunities to have a life.