Psychotherapy has been in the spotlight over the past few years, in part because of questions about its evidence base. This has led to careful characterisation of different psychotherapies, many of which have been studied in great detail, especially with regard to process of treatment and outcome. These include cognitive-behavioural therapy, psychoanalytic therapy, interpersonal therapy and psychodynamic—interpersonal therapy. Despite the advances in knowledge about each psychotherapy, we still have limited evidence that specific interventions themselves actually effect change. This is disappointing as it would be useful to identify interventions which have specific effects. It is possible that the identification of therapies into brand names according to the types of interventions used is erroneous and that we need a wider classificatory system. One possibility is to aggregate therapies into those that are relational/interpersonal and those that are cognitive/behavioural. Within such a schema there is no doubt that John Birtchnell's psychotherapy would be relational/inter-personal and he has labelled it as such. This book is about his theory and its implementation.

The author is quite specific about the types of relating that occur in interpersonal interactions. In fact, he states that all relationships involve either getting closer to or more distant from and becoming upper or lower to someone. While this sounds overly simplistic he makes a good case for trying to understand interactions as centred around these four poles which are axes of proximity and power.

Chapter 1 sets the scene for the reader who is not familiar with the theory. With the use of circumflex diagrams, positive and negative ways of relating are explained. The following chapters develop the theory of proximity and power and show how it is translated into practice. Perhaps in order to ensure that his points are clearly understood the author contrasts his therapy with other therapies throughout the book. In doing so, he tends to take a swipe at them occasionally. For example, analytic therapy is described as placing the patient as lower and the therapist as upper. Similarly cognitive—behavioural therapy is stated to be ‘unapologetically’ upper and the most distant therapy, although these statements are qualified. Other therapies are brought into the frame and discussed in a similar way.

My difficulty was in seeing how a practitioner's interventions within the frame of this ‘new interpersonal’ therapy differ much from the interventions made in other interpersonal therapies, even though the therapist is neither upper nor lower, neither close nor distant. It seems to me that any good therapy requires the therapist to move around such poles, although the problem is that the patient tends to place the therapist in different places at different times. I concluded, rightly or wrongly, that the real point is that this therapy makes the therapist think about what he or she is doing in relation to the other in terms of upper and lower and closeness or distance. This can then be used to inform interventions as well as helping the therapist and patient identify where each of them is on the axes at any given moment.

The author recognises the importance of deliberate or conscious actions and unconscious decision-making. He re-frames these concepts according to an outer brain and inner brain, respectively. Others have done the same, particularly since it is widely accepted that many of our actions and decisions occur outside awareness. Again, I was unconvinced that the new formulation added very much although it carries less baggage than the conscious and unconscious of psychoanalytic theory. But we already have many other formulations of the same phenomena, such as cognitive and experiential learning which has a great deal of experimental cognitive psychology behind it. I am not sure that we need more. The clinical discussion of the inner and outer brain in a psychotherapy session sounded like a normal session with exploratory and emphatic remarks.

The final part of the book emphasises the importance of not just constructing a theory and sitting back and enjoying it. The author has developed questionnaires that may be used for measuring ‘relating’ and ‘inter-relating’. These will interest those readers who recognise the importance of an empirical base for psychotherapy. The author should be congratulated for his painstaking work in developing a theory, putting it into practice, and producing meaningful measurement. This is a formidable attempt to produce an evidence-based psychotherapy. Its basis will be of interest to all psychotherapists, relational or not. It will appeal especially to psychiatrists and psychotherapists who take an interpersonal approach to their work. The book is easy to read, well structured, and demonstrates the author's wide knowledge of different psychotherapies. It is a pity that it is so expensive and I suspect that the price will mean that it is only available in a few libraries.