“Clinical moments,” as defined in this book, are those therapeutic encounters that challenge the analyst’s capacity to make snap judgments about how to respond to a patient at particularly delicate times. Richard Tuch and Lynn S. Kuttnauer‘s edited collection Conundrums and Predicaments in Psychotherapy and Psychoanalysis (Routledge, 2018), presents twelve such moments, each one written by a different analyst, with twenty-five experts who share their ways of thinking about the conundrums and predicaments facing the clinician. The objective of the book is not to teach clinicians about how to rise to the occasion, but rather to illustrate multiple perspectives and approaches and thereby investigate theoretical and technical questions about therapeutic action: How can we best promote change and healing in our patients’ lives?

Each clinical moment is introduced by an editor’s introduction and a “moment in context” which serves as a kind of literature review for the particular issue described. The expert commentators represent most of the prominent schools, including Bionian, Contemporary Freudian, Ego Psychology, French Psychoanalysis, Interpersonalist, Kleinian, Lacanian, Relational, and Self-Psychology. Commentators include Salman Akhtar, Anne Alvarez, Fred Busch, Andrea Celenza, Jay Greenberg, and Theodore Jacobs, among many others. Some of the chapters are particularly provocative and surprising such as the one presented by Lynn Kuttnauer about her patient, an Orthodox Jew who turns to her Rabbi for help in a moment of great need. The commentators for this moment include Rosemary Balsam who provides a compelling feminist perspective and Rach Blass, who argues strongly for a classically intrapsychic, Kleinian approach to the material. This chapter, and the book as a whole, serves as a stimulating and pleasurable exploration into comparative psychoanalysis and a challenge to hone one’s own beliefs and commitments about what one is doing as a psychoanalytic psychotherapist.



Philip Lance, Ph.D. is a clinical psychologist and psychotherapist with a private practice in Los Angeles. He is candidate at The Psychoanalytic Center of California. He can be reached at PhilipJLance@gmail.com.
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