“Patricia Gianotti’s book, ‘Embracing Therapeutic Complexity, was quite different from what I expected—yet quite rewarding. Structurally, the book is very well organized and clearly and accessibly written. The reader benefits substantially from the author’s ability to convey complex ideas clearly and relatively simply in straightforward language unvarnished by jargon. Her writing is straightforward and concise, yet not spare; for instance, among her many useful metaphors, she likens case formulation to taking a good snapshot: ‘As a good photographer knows, creating a good snapshot requires knowledge of depth of field, adjusting the camera settings in a way that the lens can capture the right elements of both figure and ground.’ (p. 107). Gianotti slices up the relational psychoanalytic pie in a novel fashion that is quite useful. She shows how a relational psychodynamic understanding and method can inform and enrich virtually all approaches to psychotherapy. Although the book contains insights useful for the most sophisticated of readers, I believe its greatest value will likely be in the hands of practitioners who are untrained psychoanalytically and who feel that something vitally essential—a kind of depth, immediacy, creativity, and richness are missing from their work. Overall, I believe this capably conceived and written book provides a needed service. It helps non-analytically trained therapists find their way into relational psychoanalytic insights and enables them to contextualize their work usefully within the framework of today’s psychodynamic understandings. It might also offer sophisticated practitioners additional and useful ways to think about their work.”

Kenneth A. Frank, PhD, is an American clinical psychologist and psychoanalyst, and co-founder of the National Institute for the Psychotherapies in New York City, where he is Director of Training. A faculty member of the Columbia University College of Physicians and Surgeons from 1974 to 2009, he was Clinical Professor in Psychiatry from 1996 to 2009, and received his MA and PhD in Clinical Psychology from Columbia University. Frank has published several books and numerous other scholarly publications examining psychoanalysis, cognitive-behavior therapy, and integrative psychotherapy. In particular, Psychoanalytic participation: Action, interaction, and integration.

“Embracing Therapeutic Complexity is a book that aims to present psychodynamic principles in ways that make sense to therapists of all orientations, to show how the different perspectives in our field intersect rather than clash, how therapists of different backgrounds can learn from each other and build on each other’s innovations and insights rather than treating product differentiation as the highest value. Gianotti brings an openness to diverse ideas and a commitment to helping people change broadly and deeply, not just symptomatically, that is increasingly rare in a quick fix society. Her vision is broad and integrative, pulling together ideas and methods from a wide variety of sources, but she is particularly focused on exploring the impact of trauma. Weaving these themes together in a framework that highlights the ways human beings develop and live in relationship, and how the therapeutic effort too must be grounded in an appreciation of its fundamentally relational foundations. Gianotti offers a vision of the therapeutic process that provides new insights and refinements for the psychodynamic therapist as well as valuable enhancements and points of entry for the therapist trained in other points of view.”

Paul Wachtel, PhD, Past President, Society for the Exploration of Psychotherapy Integration (SEPI); Recipient of the Hans H. Strupp Award for Psychoanalytic Writing, Teaching, and Research; the Distinguished Psychologist Award by APA Division 29 (Psychotherapy); and the Scholarship and Research Award by Division 39. His most recent book is Cyclical Psychodynamics and the Contextual Self.

“Psychoanalysis is not now, and has not been for decades, what many psychotherapists still think it is. Analysts today are centrally concerned with relationship, from the beginning of life, and attachment processes lie at the heart of the theory. Relational psychoanalysis has done much to promote these changes, and so this literature contributes directly and naturally to the general field of psychotherapy. Dr. Gianotti performs a great service by introducing relational psychoanalytic ideas to students and independent professionals who are interested in these ideas, but don’t know how to find their way into them. She makes this introduction in the most practical way, presenting the material in a way that is sensitive to the changing realities of clinical practice, and to practitioners’ uncertainty and worry about 'losing their way.' The book is full of clinical material and will be of interest both to those looking for a route of access into today’s psychodynamic thinking and to psychoanalysts interested in contextualizing their work within the broader field of psychotherapy.”

Donnel Stern, PhD, Author, The Infinity of the Unsaid: Unformulated Experience, Language, and the Nonverbal

“Finally, a panacea to the incompetence of manualized and technique-based approaches to treatment! This book is destined to become an invaluable training guide for developing solid psychotherapeutic integration skills that address the complexity and psychodynamic nuances of the contemporary patient. Dr. Gianotti's approach should be taught to every student of psychotherapy.”

Jon Mills, PsyD, PhD, ABPP, Diplomate, American Board of Professional Psychology; Board Certified in Clinical Psychology & Psychoanalysis; Fellow, American Academy of Clinical Psychology; Fellow, American Board & Academy of Psychoanalysis

“Dr. Gianotti has written a sophisticated, nuanced, scientifically based book that takes psychotherapy into the 21st century. This excellent volume provides practical guidance for new practitioners but has so much depth that even experienced therapists will return to it time and again when confronted with difficult situations that inevitably arise with complex patients. Kudos to Dr. Gianotti for integrating neuroscience, psychoanalysis, and evidence-based therapeutic techniques.”

Barbara Ziv, MD, Adjunct Clinical Professor of Psychiatry, Temple University Medical School; Forensic Psychiatry expert for the prosecution in the Bill Cosby and Harvey Weinstein trials

“A ‘must read’ for student therapists and senior clinicians alike, Dr. Gianotti takes the rich cacophony of contemporary psychodynamic theory and creates her own unique synthesis. Clear, concise, and jargon-free, these concepts are now ready to be put to use in the clinical encounter. Her approach to psychodynamic formulation and understanding psychopathology are not pathologizing. Instead, Dr. Gianotti emphasizes how symptoms evolve and serve to protect and stabilize a fragile self. In addition she outlines specific clinical interventions, with abundant examples, that show how her psychodynamically-informed approach can help a therapist engage even those patients most resistant to change. This book is a great resource.”

Rafael D. Ornstein, MD, Instructor in Psychiatry, Harvard Medical School

“With this book, Patricia Gianotti offers a remedy for what ails current psychotherapies. Under pressure for quick fixes and inundated with modalities, today’s therapists get lost and de-skilled. Gianotti suggests they ground themselves in certain complexities all therapies share, and she shows them how. She offers elegant big-picture maps that capture the interplay of self-expressive and shame-protective forces in patients’ psychologies. She explains 'loyalty contracts' that block therapeutic progress. She argues for rigorous case conceptualization that includes patients’ developmental and cultural contexts. A master clinician and teacher, Gianotti demonstrates how to drop down through language to right-brain moment-to-moment therapeutic presence, how to navigate psychic splits with delicate compassion, and how to finesse the power of transference for change. This is not a text on learning how to be a skillful relational psychodynamic practitioner, though it will serve that purpose well. As Gianotti intends, it invites all practitioners into a big tent of understanding what they’re doing, offering relief from confusion and self-doubt. With contextual understanding of their patients’ suffering and permission to slow the process down, therapists can re-discover the healing connection that underpins all helpful interventions.”

Patricia DeYoung, MSW, PhD, Author, Relational Psychotherapy: A Primer and Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma