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Engel doesn't think highly of what he considers the unrealistic and overblown goal of inner transformation, and he scoffs at New Age notions of spiritual healing. He has harsh things to say about the "kooky therapies" of the '60s: he believes they brought dishonor and focused public skepticism on the entire field. He distrusts those who claim they can help patients change their identities as if they were shopping for clothing brands or disposable shavers.

For Engel, therapy is ultimately an exercise in learning and gradual self-improvement. He tells us that "psychotherapy works best when it leverages a patient's desire to participate more productively in the world around him, when the patient is genuinely committed to the difficult process of acquiring new, healthy skills." He even paraphrases Viktor Frankl, the psychiatrist and concentration-camp survivor who said, according to Engel, that the "common trait of all emotionally healthy people is a desire to get to work." To Frankl, even in the midst of a Nazi hell, those who had the best chance of surviving seemed to be those who could make themselves the most useful to others. This is also what Engel values: people who engage with life, even under the most trying circumstances.

What Engel is talking about is close to what the psychologist and writer Daniel Goleman means by "emotional intelligence." For other therapists and clients, it may be just a new way of saying "For goodness' sake, grow up, please!" In the end, that means "Be true to your responsibilities, delay immediate gratification, and settle into a longer view." For many patients, however, the new skills and altered beliefs necessary to change the direction of a life may be hard to learn in 12 or 20 managed-care therapy sessions. That sort of emotional education may take longer than we like it. (Believe me: I'm still working on it.) We may need constant reminders, homework, and emotional tune-ups to make and maintain real progress.

Ultimately, Engel sees therapy as being about learning to keep a sense of perspective and remaining engaged in a raucous world. That's an underlying therapeutic philosophy that a Freudian might find too utilitarian and shallow, but that Engel, the American pragmatist, heartily endorses.

Richard Handler, M.A., is a radio producer and columnist with the Canadian Broadcasting Corporation in Toronto, Canada. Contact: rhandler@sympatico.ca. Letters to the Editor aboutthis article may be sent to letters@psychnetworker.org.

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