“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.

“Danielian and Gianotti's first book, Listening with Purpose, was an outstanding exploration of working with shame and narcissistic vulnerability. This new workbook represents a brilliantly innovative way to elaborate the clinical implications of that earlier work. The linking of the discussions and case examples in the book to videos accessible to every reader, to worksheets and other active teaching tools, makes this a book uniquely effective in conveying how the authors work and enables readers really to integrate their insights into their work.”

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

“For years, the contributions of Karen Horney, and her prescient anticipation of much in the contemporary relational point of view, have been largely unrecognized or unappreciated. With the publication of this very valuable book, that should no longer be the case. Danielian and Gianotti illuminate the role of shame, dissociation, problematic characterological solutions, and integrative, experience-near theory with admirable clarity and clinical relevance. This is a wonderful teaching tool both for beginners and seasoned practitioners.”

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; and 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.

“Listening with Purpose is a superb training manual for practitioners, students, and trainees in the field of dynamic psychotherapy. In presenting and richly illustrating an experience-near, intersubjective perspective on the therapeutic process, the authors succeed admirably in their effort to close the gap between therapeutic theory and therapeutic practice. Their emphasis on phenomenological inquiry into the interacting subjective worlds of patient and therapist, with a sensitivity to the shame-proneness and emotional vulnerabilities of both participants, will be of great value to therapists at all levels of professional experience.”

Robert Stolorow, PhD, Founding Faculty Member and Training and Supervising Analyst at the Institute of Contemporary Psychoanalysis, Los Angeles; a Founding Faculty Member at the Institute for the Psychoanalytic Study of Subjectivity, New York City; and a Clinical Professor of Psychiatry at the UCLA School of Medicine

“In this invaluable and penetrating workbook, Drs. Patricia and Jack Danielian illustrate a clinical methodology for listening and tracking the moment-to-moment unfolding of the therapeutic process that is particularly attuned to the experience of shame, dissociation, and narcissistic vulnerability. In an effort to bolster resilience, authenticity, and healing--the painful aftereffects of relational trauma--the authors provide a nuanced model complete with training videos for facilitating careful listening and empathic attunement sensitive to varying attachment styles damaged by developmental compromises. Essential reading for all mental health professionals.”

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

“Danielian and Gianotti have done it again! – yet another magnificent volume that seamlessly integrates theory and practice as it addresses both the science and the art of an in-depth psychotherapeutic process. Exquisitely penned by two master clinicians, this second opus is an elegant and sophisticated Workbook that explores, in great detail, both the nuances and the complexities of the moment-to-moment encounter between patient and therapist. Culled from their decades of immersion in the study, the practice, and the teaching of a psychotherapeutic approach that is a synergistic blend of elements that are at once self psychological, existential, humanistic, empathic, present-focused, relational, attachment-based, systemic, Horneyian, and spiritual, at the end of the day the paradigm they espouse – exemplified by their Four Quadrant Model – can probably best be described as either “Danottian” or “Gianelian.”

But however we might describe their theoretical stance, what shines through on every page of this brilliantly conceived and beautifully orchestrated manual is their non-pathologizing optimism and profound belief in the patient’s innate resilience and capacity to self-repair. Against a therapeutic backdrop of reliability, attunement, and profound respect, patient and therapist work at their intimate edge to help the patient relinquish self-sabotaging but once adaptive narcissistic defenses mobilized to compensate for feelings of vulnerability and shame; heal the psychic split between the defensively dissociated parts of the patient’s character structure and the parts that are more spontaneous, heartfelt, and healthy; emancipate the patient’s resilient core; and facilitate the emergence of an integrated, consolidated, authentic self.

No offense intended to any of my other esteemed colleagues (or to myself for that matter), but were I to be alone on a desert island with only one book, this is the book that I would want to have – and I would read and reread it many times over, each time gleaning something new and inspirational. Quite frankly, I wish I had written this extraordinary book. It is so beautifully and sensitively written and explores with such finesse all the fine points and subtleties of the therapeutic relationship that it should be required reading for therapists of all levels. And the material is so rich and layered that I found myself wanting to peruse only a few pages at a time so that I could process and integrate the wealth of information contained on each page and savor every pearl of wisdom contained therein.

This lovingly and generously crafted masterpiece is a tome that I will long cherish. But I will not keep it on my bookshelf; I will want it in plain sight on my desk by my side – to guide me and to inspire me.”

Martha Stark, MD, Faculty, Harvard Medical School, Co-Director, Center for Psychoanalytic Studies; Author, Award-winning Modes of Therapeutic Action and 5 other books on psychoanalytic theory and practice

“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

“Danielian and Gianotti offer this book as an antidote and means to stimulate growth, competency, and therapeutic optimism. In an era of rationed treatment emphasizing quick fixes, the authors provide a liberating and enabling model for internal repair and integration. Their book helpfully holds the reader to the tension of integrating 'objective theory and subjective experience of our work.’ The focus on shame and narcissistic vulnerability provides valuable insights and tools to address the range of characterologic problems and symptoms with which our patients suffer. Listening with Purpose will be of great benefit for trainees and early career clinicians as well as seasoned therapists.”

Edward J Khantzian, MD, Harvard Medical School; Associate Chief of Psychiatry Emeritus, Tewksbury Hospital.