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Crucial Choices, Crucial Changes

by Stefan De Schill
Prometheus Books, 2001
Review by Louis S. Berger, Ph.D. on Aug 1st 2001

This is a bad book which I found highly irritating. To support this judgment fully would require a lengthy article if not an entire book, and the work merits neither such space nor effort. Accordingly, I will limit myself to a few remarks about what seem to me its most grievous faults.

It is a large book (548 pages), but its themes are few: psychotherapy is in a terrible state; dreams and feelings should be the therapist's main concern; and, a certain kind of group therapy is the answer to making effective quality treatment available to the large population that needs help but is presently being served either poorly or not at all. These themes are repeated relentlessly.

The book claims originality ("we present much useful clinical material not found elsewhere" [30]) and a foundation in research. Regarding the former, the old adage "what is good is not new, and what is new is not good" applies; and, de Schill offer no real support (and, indirectly, some evidence against the latter claim (e.g., the time-frame of his "research" on group therapy).

I cannot identify a readership for this book. On the one hand, as de Schill says, it is not intended as a scholarly work (31, 97). For example, most of it is a highly repetitious and motley rehash of old literature; citations of sources often are missing; key relevant critical literature is not mentioned; the book is sprinkled with strange anecdotes--e.g., about the Grand Duke Nikolai Nikolajewitch's selection of his guards (265--re selection of therapy candidates); and, to professionals the bulk of the criticism will be familiar and old. On the other hand, I cannot see well-educated nontherapist readers or other lay persons wanting to wade through such a bulky book that is tediously repetitious, haphazardly organized, self-aggrandizing, full of sarcasm, and rigidly dogmatic.

The sarcasm in the book is particularly odious. For example, de Schill calls Erik Erikson "a vociferous purist and self-proclaimed saint" (135), says of Irving Yalom that "we are glad to learn [that he] can do much better" (than Freud) (161), and condemns certain "acclaimed theorizers," saying (concerning the milling crowd of their admirers) that "it is true that 'the higher the monkey climbs, the more you see his rear" (401). He makes comparable inappropriate, unprofessional remarks about numerous other well known therapists, including Kohut, French, Karasu, Shengold, and Grotjahn; and, he notes generally that other therapist's views of dreams "betray utter ignorance," are "irresponsible," and deserve to be answered with "harshness" (98-99). de Schill has no doubts about the absolute truth of his knowledge and judgements.

Here is a partial list of further grievous faults. de Schill idly and stridently criticizes (and misquotes) Freud on the interpretation and use of dreams in therapy, offering his own dogma instead (e.g., 149, 193, 196, 215, 229-233; having criticized orthodoxy in psychoanalysis in numerous publications, I do not automatically take exception to well-conceived critiques of Freud, but in this instance I see no reason for giving preference to de Schill's poor arguments and alternative dogma based on his own experience); de Schill's few original proposals include a bizarre recommendation to "creat[e] a three-dimensional representation of the unconscious [dynamics]" which, he claims, is a necessity in psychotherapy (439-453); he acknowledges a key shortcoming of group therapy, namely, that one must give up using free association (which some of us see as indispensable in analytic therapy--e.g. Barratt, 1993, 1994; Thompson, 2000, 2001; Bollas, 1999; Berger, 1991, 1996), but dismisses the issue in two brief sentences (510-511).

I close by noting that the lack of credibility brought about by this book's many and significant technical and stylistic faults is augmented by certain puzzling inconsistencies and evasions concerning the book's lineage: (1) Its publication date is given as 2000, but a 1994 review is cited on page 10 of the book's companion volume (de Schill and Lebovici, 1999[?]). (2) That companion book is given as a 1997 publication in a publisher's mailing and in de Schill's list of references (520), but subsequently he (530) cites a 1994 review. (3) de Schill's book has two long "introductions," by Robert Stoller and John Gedo. The author says that these were written in response to his invitation to write introductions, but there are grounds for questioning this claim; Stoller died in 1992, and Gedo's "introduction" is an (unacknowledged) reprint of chapter 12 in Gedo, 1984. And finally, (4) Part II, "The quest for affordable and effective psychotherapy" (471-520), reprinted from de Schill and Lebovici, 1997, acknowledges that it was "written in cooperation with Denise LaHullier," but there is no information about the nature or extent of their respective contributions and collaboration; unfortunately, instances of such absences of information about substantial cited materials are scattered throughout. I can see no redeeming virtue in this strange work.

REFERENCES

Barratt, B.B. 1993. Psychoanalysis and the Postmodern Impulse: Knowing and Being since Freud's Psychology. Baltimore, MD: Johns Hopkins University Press.

____________. 1994. Critical notes on the psychoanalyst's theorizing. Journal of the American Psychoanalytic Association 42:697-725.

Berger, L.S. 1991. Substance Abuse as Symptom: A Psychoanalytic Critique of Treatment Approaches and the Cultural Beliefs that Sustain them. Hillsdale, NJ: Analytic Press.

Berger L,S. 1996. Toward a non-Cartesian psychotherapeutic framework. Philosophy, Psychiatry, & Psychology 3: 169-184.

Bollas, C. 1999. The Mystery of Things. New York: Routledge.

de Schill, S., & Lebovici, S. (Eds.), 1997 [?]. The Challenge for Psychoanalysis and Psychotherapy: Solutions for the Future. London: Jessica Kingsley.

Thompson, M.G. 2000. 'Free association:' A technical principle or model for psychoanalytic education? Psychologist Psychoanalyst 20: 1-13.

Thompson, M.G. 2001. The enigma of honesty: The fundamental rule of psychoanalysis. Free Associations 47: 1-45.

Louis S. Berger's career has straddled clinical psychology, engineering and applied physics, and music. His major interest is in clinical psychoanalysis and related philosophical issues. Dr. Berger's publications include 3 books (Introductory Statistics, 1981; Psychoanalytic Theory and Clinical Relevance, 1985; Substance Abuse as Symptom, 1991) and several dozen journal articles and book reviews. A manuscript comparing praxial and technologically based psychotherapies is being completed.

We have received the following reply concering Louis Berger's review. The reply is by Monroe W. Spero, M.D., Chairman of the Professional Board at the American Mental Health Foundation. The author of the book, Stefan de Schill, is director of research for the AMHF.

I regret to say that this is a most inaccurate book review. To anyone who has read the book, Berger's comments are off the mark. It is evident that he spent much effort to create a case.

Berger makes numerous non-factual statements in his review.

One has to wonder about Berger's motives for attacking Crucial. It is obvious that the work struck a raw nerve in Berger. Why?

To cite a few sentences from Professor Fabian Schupper's review of this book:

"What a welcome breath of fresh air….Dr. de Schill's work stands as a much-needed expert correction to the mountain of highly speculative and unanchored theory building in the field of psychoanalysis and psychotherapy. On the basis of numerous cogent examples, he demonstrates the need for an expert clinical approach as the indispensable tool for understanding the unique psychological makeup of the individual. This stands in marked contrast to the facile practice of generalizing broad 'theory' to every patient, regardless of his or her individuality in structure and dynamics. I don't know of any analyst more capable of understanding and formulating very complex concepts in a clear and cogent manner."

Berger's anger appears to be related to two circumstances.

1. He is the author of a number of writings on psychoanalytic theory. See the description of his latest book Psychoanalytic Theory and Relevance: What Makes a Theory Consequential for Practice? by The Analytic Press: "Berger grapples with the nature of 'consequential' theorizing, i.e., theorizing that is relevant to what transpires in clinical praxis. By examining psychoanalysis as a genre of 'state process formalism' - the standard form of scientific theory - he demonstrates why contemporary theorizing inevitably fails to explain crucial aspects of practice. Then, drawing on theories of affect, the nature of first-language acquisition, and the philosophical aspects of free will and determinism, he offers pragmatic recommendations for arriving at a theory more relevant to practice."

2. de Schill, in Crucial, severely criticizes the ever-increasing use of easy-to-learn and easy-to-practice but inadequate treatment methods in psychotherapy and psychoanalysis. He discusses in detail a great number of writings by professionals promoting such approaches. Berger, however, aligns himself with many of these authors, giving their names, and defending them by censuring de Schill for his criticism of them. All these therapists, even though well-known, according to de Schill's analysis of their work evidence little competence. In his book, de Schill extensively describes the talents he states a psychotherapist must possess and what skills he or she needs to acquire.

To answer Berger's inaccuracies would take many pages. Thus, we will select significant examples.

Berger claims that the themes of the book are few, namely three. Not at all: the book covers basic and essential issues of psychotherapy, often using writings in psychotherapy as illustration. Furthermore, considerable attention is given to improved methods for selecting trainees and the need for creation of a new specialized professional curriculum for psychotherapists. In the same paragraph. Berger indicates that de Schill claims that a certain form of group therapy is the "answer to the large population that needs help." de Schill never makes such a claim. He merely indicates that the American Mental Health Foundation over a number of decades can help a considerable number of patients, including many who previously would not have been considered for group treatment. The major part of the book, however, is devoted to the discussion of topics of relevance to individual therapy as well as to groups.

Berger states that an underlying theme is "what is good is not new, and what is new is not good." One finds it difficult to discover a basis for such an assertion.

Quoting Berger: "de Schill notes generally that other therapists' views of dreams 'betray utter ignorance,' are 'irresponsible,' and deserve to be answered with 'harshness.' (emphasis added). This is another one of Berger's misrepresentations. He gives the impression that de Schill's comments refer to all therapists using dreams therapeutically. The fact, however, is that de Schill speaks in the highest terms of a number of very important therapists who work with dreams. The three quotes of de Schill cited above by Berger are in no way general but specifically apply merely to five neurobiologists who declare that dreams do not have any meaning and thus no value in psychotherapeutic work. Since these professionals hold important university positions, these assertions have considerable influence on students.

Later, Berger speaks about "evasions" - but where are they? Dr. de Schill is straightforward in his opinions and writings, and to the point in his comments.

Then the reviewer questions de Schill's statement that the two introductory chapters were obtained in response to Dr. de Schill's invitations to these authors. Berger appears to imply that de Schill has lifted the chapters from some other books. The truth, however, is that both these authors have made special efforts to tailor their chapters to this work. I herewith send copies of their letters to the editor of Metapsychology.

And so it goes.

Berger's tirade is an indication of the reaction experienced by many who feel criticized by de Schill's book. His comments are in stark contrast to the many laudatory reviews by outstanding authorities, some of which are reprinted on the dust jacket. On the other hand, it is quite apparent that Berger fails to comprehend the scope and the essence of de Schill's book.

And a last statement: a reviewer is entitled to express his or her opinion but not to misrepresent the contents of a book.

January 8, 2002

Monroe W. Spero, M.D., Chairman, Professional Board, American Mental Health Foundation

April 4, 2002

Louis Berger has declined the opportunity to respond to Monroe Spero's letter, but he stands by his original review of Crucial Choices, Crucial Changes. In support of his review he directs readers to another review by Scott Wetzler, Ph.D., in the American Journal of Psychiatry, 159(3):509-10.

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