BOOK REVIEW: The Art of the Obvious

Developing Insight for Psychotherapy and Everyday Life.

Bruno Bettelheim and Alvin A. Rosenfeld. Thames & Hudson £16.95.

In 1977 Bruno Bettelheim was asked by the psychiatrist, Alvin Rosenfeld, to join him in conducting seminars for trainee psychotherapists at Stanford University. These were to continue for the next six years and became so popular that they attracted established psychotherapists as well as trainees. From more than one hundred tran­scripts extensively reworked and edited, the authors produced five representative sessions in which they and the participants address a variety of issues: building a patient’s trust, finding empathy for a violent, destructive child, treating the elderly, avoiding preconceptions and prejudices about a client which might impede therapy, treating the elderly and assessing the achievements and limitations of a psycho­therapeutic approach.

At the beginning of the seminars, the selected therapist presented the particular problem he or she was encountering. Bettelheim and Rosenfeld would listen care­fully and would then proceed to dismantle the therapist’s prejudices and preconcep­tions, challenging them at every turn (often to the irritation of the therapist) eventually turning the problem on its head and throwing a whole new light on its construction. Forty pages are devoted to each case history. This allows for an intriguing and valuable unravelling of the complexities in the case and of the people involved – the clients, the observers, (in some cases) the researchers, the families, the therapist – all caught up in their own belief systems, their own values and their own prejudices.

Most psychotherapists who attended these seminars were later to admit that Bettelheim had had a profound influence on their professional careers and had, in some cases, changed the direction of their lives. He liked confrontation. ‘When I teach psychoanalytic thinking’ he wrote, ‘I go out of my way to be difficult for the first few sessions, so that on the average fifteen to twenty percent of the students leave the class. I’m convinced that they are better off and that I am better off too. It entails considerable personal hardships to become a psychoanalyst, and you’re better off not to go into the field if you can’t deal with them.’

This is Bettelheim’s last book. He died, by his own hand, in 1990, aged eighty-six. He was a controversial figure, famous for his treatment of autism. He disliked the behavioural approach to therapy and was never afraid to admit that even the most skilled therapists had their limits in what they could achieve. There is a compass­ionate and excellent account of his life at the beginning of the book written by Alvin Rosenfeld.

This book is a practical and useful exploration of psychotherapy, that alchemy of intuition and technique that Bettleheim called ‘the art of the obvious’.

Mavis Arnold