Long-Term Psychodynamic Psychotherapy: A Basic Text (2nd edn), Glen Gabbard, American Psychiatric Publishing, 2010, US$65.00 pb (incl. DVD), 233 pp. ISBN 9781585623853

Gabbard addresses the trainee psychotherapist: ‘If they have innate talent, most beginning psychotherapists can establish rapport and listen empathically to the patient's story. Then they begin to ask themselves two basic questions: what do I say, and what do I do?’ (p. 71). I was gripped. These can sometimes seem like forbidden questions, yet they are often asked in (and outside of) psychotherapy supervision groups.

This text explains the nuts and bolts of what to say and do, as well as the theoretical background, while conveying a flexible approach that does not read like a list of rules. Gabbard adds a neuropsychological perspective to certain parts of the text, which is interesting (particularly in the chapter on dreams) without digressing too much. His approach to psychodynamic psychotherapy is clear and practical, and he is very good at explaining complex concepts. His explanation of projective identification is the clearest I have seen - he uses diagrams to help illustrate the steps involved in this process. He even pokes fun at a common myth in this area, saying that ‘projective identification relies on interpersonal pressure or “ nudging”, rather than a mystical or supernatural exchange of psychic content’ (p. 152).

The DVD with clinical vignettes is new to this second edition. The British viewer will easily get over the slight American cultural bias and can find the vignettes an extremely useful resource. The clips are integrated with the text and have accompanying commentary. Gabbard sees patients in various predicaments, including a passive patient who wants the therapist to solve his problems and a woman with borderline personality disorder who explodes at the end of a session but ‘forgets’ about what happened at the next appointment. I found it extremely useful to see Gabbard working clinically and how he tried to make sense of things with the patient.

I liked how the text crosses over in terms of language and explanation into areas usually associated with other therapies. For example, in discussing the diminution of transference anxieties with time Gabbard uses the model of exposure, explaining that the patient ‘habituates to the anxiety with repeated visits to the therapist, who does not react in the way that the patient anticipates [and this helps the patient] differentiate belief from fact’ (p. 111).

Unlike some books about therapies, Gabbard does not make psychodynamic psychotherapy seem easy - the vignettes do not always go amazingly well and people drop out of therapy in this book, and this is reassuring. This ‘basic’ text about psychodynamic psychotherapy is highly readable, yet not dumbed down. I recommend it to trainees and others working in this area.