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Book Reviews

Comprehensive Guide to cluded, as well as possible ways of tation to new formats. The book con-
Interpersonal explaining IPT concepts and issues to pa- cludes with a look at “The Future of IPT”
tients. As an IPT supervisor, I find that and an extensive discussion of the con-
Psychotherapy
clinicians new to IPT thirst for practical, duct of an IPT case that appeared in the
By Myrna M. Weissman, John C. how- to ways to conduct the therapy. Sug- 1984 IPT book.
Markowitz, and Gerald L. Klerman gested scripts were available in the 1984 Can a classic be improved? Is the
New York, Basic Books, 2000, 465 IPT book, but the addition of others en- Comprehensive Guide more than an up-
pages, ISBN 0-46509-566- 6, riches this section as a training manual. dated sum of two previously published
$55.00 The Comprehensive Guide also provides IPT books? I believe so. With the wealth
more clinical vignettes than the 1984 IPT of both research and clinical knowledge
Reviewed by Gregory A. Hinrichsen, book. Again, the vignettes provide con- possessed by Weissman and Markowitz,
Ph.D. crete examples of how specific issues are the book is indeed comprehensive. It
handled with real patients at different
adds texture and depth to the 1984 IPT
stages of the therapy. I surmise that the
book and to New Applications. Sections II
new vignettes are drawn from Marko-

T
through IV benefit from the authorship
he book Interpersonal Psychotherapy witz’s and Weissman’s own experience of
of only two individuals (in contrast to
of Depression1 was the original state- conducting IPT in the last 15 years. Some
New Applications, which was an edited
ment of interpersonal psychotherapy of of the clinical material reflects contem-
compilation), who bring a common for-
depression (IPT). As someone who has porary issues in conducting IPT in psy-
conducted IPT for several years, I have mat to these sections enriched with clini-
chotherapeutic practice, such as the
carefully read and reread the 1984 IPT psychological ramifications of HIV infec- cal examples.
book. It is a refreshingly clear, clinically tion. Section I also provides updated ef- It is notable that Weissman and
friendly outline of why and how to con- ficacy data on IPT. Markowitz included the late Gerald Kler-
duct IPT. The fact that the book has been Section II, “Adaptation of IPT for man as one of the co-authors of this book.
in print in one form or another for the Mood Disorders,” and Section III, “Ad- Clearly he was the nucleus of IPT and
last 15 years attests not only to the in- aptation of IPT for Non- Mood Disor- had a major hand in writing the 1984 IPT
creasing popularity of IPT but also to the ders,” correspond to the last two sections book. Klerman was one of those rare in-
quality of the book itself. In short, it’s a of New Applications. The variety of prob- dividuals in psychiatry who combined a
classic. Can a classic be improved? lems to which IPT has been applied tes- clinician’s sensitivity and intuition with a
Comprehensive Guide to Interpersonal tifies to the therapeutic versatility of this researcher’s hard-headed search for the
Psychotherapy is an effort to supplement modality. Problems include recurrent facts. I found the dedication of the book
the 1984 IPT book. Its authors are Myrna major depression, dysthymic disorder, particularly touching: “To Gerald L. Kler-
Weissman, one of the originators of IPT, adolescent depression, late-life depres- man, loving and wise, a mind of crystal
and John Markowitz, a leading practi- sion, bipolar disorder, depression in clarity.” And indeed, in both the 1984
tioner and researcher of IPT. The new primary care patients, depressed HIV- IPT book and the Comprehensive Guide
book is a blend of the 1984 IPT book and positive patients, and others. These sec- one finds love, wisdom, and clarity.
an updated version of New Applications of tions of the Comprehensive Guide offer
Interpersonal Psychotherapy.2 The latter was more clinical vignettes than found in New
a review of research and clinical efforts Applications and, of course, provide con- Dr. Hinrichsen is Associate Director of Psy-
to implement IPT with a wide variety of temporary summaries of research per- chology, Long Island Jewish Medical Center,
patient populations and psychiatric di- taining to each of the problem areas and Associate Professor of Psychiatry, Albert
agnoses. Is the Comprehensive Guide more discussed. Clinicians will find the re- Einstein College of Medicine, Bronx, NY.
than an updated sum of these two books? search updates brief and straightforward,
Section I, “Conducting Interper- with relevant references for those who
sonal Psychotherapy of Depression,” is wish to pursue the details. Section III also
the expanded version of the 1984 IPT contains a chapter on “Applications in
REFERENCES
book. What I best liked about this section Progress,” which gives a glimpse of novel 1. Klerman GL, Weissman MM, Rounsa-
is that the authors added information on and cutting- edge IPT interventions such ville BJ, et al: Interpersonal Psychother-
apy for Depression. New York, Basic
how to conduct IPT that will be espe- as IPT for borderline personality disor-
Books, 1984
cially useful to clinicians who are learn- der and for body dysmorphic disorder. 2. Klerman GL, Weissman MM (eds): New
ing this modality for the first time. Section IV, “IPT Resources,” re- Applications of Interpersonal Psycho-
Suggested scripts for inquiring about in- ports on the remarkable spread of IPT to therapy. Washington, DC, American
terpersonally relevant issues are in- other countries and of its flexible adap- Psychiatric Press, 1993

282 J Psychother Pract Res, 10:4, Fall 2001


BOOK REVIEWS

The Process of Group relationship patterns), and colors (various apy researchers have been struggling
Psychotherapy: Systems affects) continually shift with each new with this for decades. Certainly it will be
measuring system. As a professor who no easy task to attempt to study the ex-
for Analyzing Change ponentially more complex arena of
teaches group theory and practice to
By Ariadne P. Beck and Carol M. clinical psychology graduate students groups. Perhaps a follow-up text by Beck
Lewis and psychiatric residents, as a researcher and Lewis will demonstrate if and how
Washington, DC, American of both group process and outcome, and each measure was linked to particular pa-
Psychological Association, 2000, as a human invested in relieving human tient outcome.
496 pages, ISBN 1-55798-658- 4, suffering by promoting good mental This will no doubt take us into the
$49.95 health through legitimate treatments, I more problematic area of research de-
believe this book is the next step on our sign. Often, process measures are not at
understanding of the interplay between fault in the inability to link them to out-
Reviewed by Sally H. Barlow, Ph.D.
group research and theory. come; rather, research hypotheses are
The strengths of this text include not stated directly enough to provide the
clear descriptions from the group process framework to establish this link. In ad-

C linicians and researchers study the


treatment process as a way of un-
derstanding therapeutic action in group
experts regarding their particular process
measure, general descriptions, corre-
spondence to theory, and direct applica-
dition, all good researchers know that
various sources of process and outcome
must be assessed: self-report data along
psychotherapy. When Fuhriman and tion to the session. Most exciting is the with expertly rated behavioral systems.
Barlow1 reviewed the extant group pro- comparison of systems and what each re- As the next generation of research-
cess measures in group psychotherapy veals about the group process. (This is ers considers process, outcome, and
research, they noted: “Missing here are methodology, many of these important
also a possible weakness, however. There
the various perspectives on the same mo- questions will be answered. The Beck
is so much data to sift through that the
and Lewis book is a good start. For any-
ment, event, response. Most measures reader must be patient. Figures, tables,
one serious about studying group psy-
identify behaviors; few describe emo- and summary chapters help.) Such direct
chotherapy, this is a must read.
tions, and none catalogue cognitive pro- comparison allows readers to see the
cesses. The dynamic interplay of these strengths and weaknesses of the various Dr. Barlow is Professor of Psychology,
three most likely overlies the dynamic in- process measures. Brigham Young University, and Adjunct As-
terpersonal qualities of the group mem- It becomes even more evident, how- sociate Professor of Psychiatry, University of
bers. The lack of detail in various ever, why there are no real frontrunners Utah School of Medicine.
dimensions and across varying levels of in group process measurement: those
functioning surely calls for increased in- measures that reveal important informa- REFERENCE
teractional instrumentation capable of tion about emotional, cognitive, and be-
1. Fuhriman A, Barlow SH: Interaction
such measurement.” Fuhriman and Bar- havioral processes are prohibitively analysis: instrumentation and issues, in
low systematically examined a number of difficult to learn though data-dense; those Handbook of Group Research, edited by
measures addressing general utility, va- measures that leave out an important part Fuhriman A, Burlingame G. New York,
Wiley, 1994, pp 191–222
lidity and reliability, and ability to link of this triad are superficial, although easy
process to outcome. An exciting next to learn and score; and most of these
step has occurred, shedding empirical measures have not been used consis- Expressing Emotion:
light on some of the questions we raised tently in the research to sustain their vi- Myths, Realities, and
in 1994. ability in linking process to outcome. Therapeutic Strategies
The excellent text of Beck and Lewis This is, of course, de rigueur for most
allows us a peek into this process. These therapy process measures: rich detail is By Eileen Kennedy-Moore and
authors gave identical transcripts of one often sacrificed for ease of learning and Jeanne C. Watson
particular time-limited group session, scoring.
New York, Guilford Press, 1999,
365 pages; cloth, ISBN 1- 57230-
with accompanying descriptions of prior But this is not a fault of Beck and
473-1, $42.00; paper, ISBN 1-
sessions, to a number of experts on pro- Lewis. If anything, they have clearly il-
57230-694-7, $25.00
cess measures. As each representative as- luminated the needs in this particular
sessment system (or lens) allows us a field of research. Their complex handling
protean glimpse, the arrangement of al- of an admitted conundrum in group psy- Reviewed by Edward Hanin, M.D.
tering views presents us with a kaleido- chotherapy research brings us one step
scope, as changing forms (people, time,
space), patterns (repeated behaviors and
closer to establishing the link from pro-
cess to outcome. Individual psychother- I n my experience, it is somewhat rare
to find a work that is not only schol-

J Psychother Pract Res, 10:4, Fall 2001 283


Book Reviews

arly and detailed enough to satisfy ex- therapy; and expression-related interven- enhanced well-being. When ex-
perienced practitioners in the field, but tions in health psychology. One may not pression persists at the lowest levels
also so well written as to be easily under- always agree with the treatment recom- of emotional awareness, or when it
standable to those less experienced or mendations, but these are always clearly disguises genuine feelings, it is not
related to emotional insight. In
just beginning their work. In Expressing put forward so that experienced readers
these cases, emotional expression
Emotion, the authors have produced just know where they disagree and those with
may be harmful because it merely
such a work. Their writing style is clear less experience have a useful framework intensifies negative feelings and in-
and concise without the hyperbole and for the evaluation of other ideas as they terferes with functioning.
obfuscation with which some authors try come upon them.
to impress their readers. They make very Perhaps a brief quote from their
The authors do not claim all ideas
clear that both the experiencing of emo- work will give some indication of their
presented in their work as their own.
tion and the way such emotions are ex- style:
They are quite generous in giving credit
pressed to oneself and to others create a
to others whose ideas they have incor-
complex network of events and experi-
The relationship between porated. The bibliography is extensive
ences. They very quickly put to rest the
emotional expression and emo- and well researched and provides a valu-
idea, perhaps more popular among the tional insight is complex. In some able pathway for those interested in ob-
lay public than professionals, that letting cases, expression is simply a conse- taining more information on the areas
emotions “hang out” is all that is needed quence, a direct sign of emotional discussed. This work is a valuable addi-
to experience relief and psychological insight. In other cases expression is
tion to our understanding of the roles of
progress. They do not deny the possible a cause of emotional understanding
emotion in both psychopathology and
therapeutic effects of ventilation, but they through self observation, verbaliza-
tion, or social feedback. In still health and should be a valuable resource
point out that both the experiencing of
other cases, certain forms of emo- for students in all aspects of the field of
emotions and the expression of emotions
tional expression may be a sign of mental health.
are considerably more complicated than
lack of insight. For instance, when
that.
expression involves perseverative Dr. Hanin is Clinical Professor of Psychiatry,
The student is well served by defi-
attention to poorly understood New York Medical College, and Senior At-
nitions of key terms in describing emo- emotional distress, such as repeated
tions (arousal, behavior, experience, tending, St. Vincent’s Catholic Medical Cen-
expressions of ‘I feel bad,’ it indi-
expression, reflection, non-expression), ters, New York, NY.
cates a lack of emotional under-
so that it is always clear what the authors standing. Expression can also be
are talking about. In addition, the orga- used as a means of defensively
nization of the book—an overview fol- avoiding emotional awareness Beyond Individualism:
lowed by sections dealing first with through emotional substitution,
such as when anger is expressed to Toward a New
intrapersonal emotional processes, then
interpersonal processes, and finally the avoid acknowledging feelings of Understanding of Self,
implications for treatment planning—
sadness. Relationship, and
The implication of all of this is
helps the reader move from the theoreti- Experience
that when clients show deficits in
cal to the practical implications of the au- emotional insight, it is important
thors’ ideas. By Gordon Wheeler
for therapists to determine whether Hillsdale, NJ, Analytic Press, 2000,
The authors’ theoretical discussions these deficits are related to a lack
of emotion are interesting and necessary, 400 pages, ISBN 0- 88163-334-8,
of attention to inner experience, to
but for me, the most useful part of their skill deficits in emotional process-
$27.95
work is their section on the treatment im- ing, or to a motivated lack of
plications. Here they are very liberal in awareness of emotional experience. Reviewed by John Gladfelter, Ph.D,
the use of clinical examples so as to be Therapists need to assess the role CGP
most helpful to the clinician. They ad- of emotional expression or nonex-
pression in contributing to or cor-
dress expression and nonexpression as

G
recting a lack of emotional insight.
facilitators of emotional understanding ordon Wheeler is introducing
When emotional expression en-
and behavioral change; the therapeutic ables individuals to label and un- what he believes to be a new par-
approaches to emotional constriction in derstand their emotions, and to adigm for the field of psychotherapy
depression; vacillating expression and extract information from them, it based on the original constructs of Ge-
nonexpression in bereavement and fosters emotional insight, directs stalt psychology. He uses the conceptual
trauma; emotional expression in marital coping efforts, and should lead to framework of constructivism as a vehicle

284 J Psychother Pract Res, 10:4, Fall 2001


Book Reviews

for his approach to looking at individu- dividual as the figure and the imagined thor does. Transactional analysis and
alism and the self. This book is an am- world as the ground in a Gestalt frame- redecision therapy have acknowledged
bitious undertaking as he goes about work. This much-simplified example the role of the self, although again not as
deconstructing the idea of the individu- may give at least an incomplete picture clearly and strongly as this book. Current
alistic self, pointing to the limitations of a of the exercise. analytic thinkers will find much that is
long-held view and suggesting that much This is not an easy book to read, as provocative and much that is affirming.
of the difficulty that psychotherapy has it expects the reader to have a working Self psychologists should find in this
had in explaining human distress is re- knowledge of Kuhn’s concept of para- book a well-developed set of arguments
lated to the view of self. The author of digm, basic Gestalt psychology, and the for a point of view that will challenge, as
this book believes that the individual self development of Gestalt psychotherapy as well as support, current thinking.
as historically viewed precedes and tran- it has grown in sophistication. However,
scends relationship and social conditions this is a book well worth reading because
Dr. Gladfelter is a faculty member of the
and that interpersonal experience is it introduces in a broad panoramic way
Fielding Institute, Santa Barbara, CA.
somehow secondary and even opposed the limitations that are inherent in how
to the needs of the inner self. the psychotherapy field has viewed the
The book is written to lead the self in relation to society. Wheeler takes
reader through a set of experiential chap- one rapidly through a wide range of con-
ters presenting the notion of relational cepts that invite and challenge the reader
Group Psychotherapy for
self in a set of frameworks that develop to examine long-held beliefs about the Psychological Trauma
the concepts of the social field, contact, self in relation to the world. As the author
Edited by Robert H. Klein and Victor
shame, support, and intimacy and suggests, this means a significant shift in
L. Schermer
through these the broader human expe- the way we think about ourselves and our
New York, Guilford Press, 2000,
riences related to narrative, culture, patients. Much of what has been appear-
364 pages, ISBN 1-57230-557- 6,
health, ecology, and spirit. ing under the rubric of constructivism,
$45.00
In the first imagery exercise, the au- deconstructivism, and constructionism
thor leads the reader through experi- introduces a vehicle for understanding
Reviewed by Henry I. Spitz, M.D.,
ences of thinking, feeling, and imaging to our traditional views of self and suggests
FAPA
inform a stepwise, detailed behavioral- that a concept of relational self is well
descriptive feedback of the self. The se- worth considering.
quence of this imagery (and the author The written word has limitations,
suggests writing this down) would go “I
see/ imagine, then I feel/do, and then
you see/imagine/feel and offer a re-
and nowhere have I found that more true
than with this book; there is so much I
would have liked to discuss with the au-
I ntense interest in psychological
trauma has been central to the field of
psychotherapy since its inception. En-
sponse.” An example would be “I see thor. This is perhaps one of the problems counters with the sequelae of trauma are
shoulders hunched over, mouth sagging, that arise when experiential learning is virtually universal in any psychothera-
and then I feel sad and lonely, and then involved. There is much to agree with pist’s experience. There is, however, of-
I could do something to help you, but and disagree with—necessarily so with ten a broad gap between the ability to
you couldn’t take care of me.” This the developing of a new paradigm about identify the impact and phenomenology
would be a recursive exercise in which the self. I would also have liked a tradi- of severe psychological trauma and the
there might be a number of descriptions tional subject index for the book because ability to provide knowledgeable, effec-
resulting. In the second exercise, the there are so many ideas that call for fur- tive treatment. The information provided
reader explores the experience of creat- ther thought and comparison. in this text represents an attempt to close
ing outer and inner social supports in re- Although the thinking of this book the gap.
lation to the experiences of the first step may seem radical, the Zeitgeist of the While the term trauma has found its
and encounters shame as a result of the field of psychotherapy has shown that way into the everyday parlance of mental
individualistic model many operate from. many elements being offered here have health practitioners, it is used loosely and
In the third step, the reader explores actually been around for some time. often does not mean the same thing to all
the shame and asks what one would need Some senior Gestalt therapists will find people. One key contribution of this
from another person to enable one to talk much that is already congruent with their book is that it takes the time to clearly
about it. This step would begin explora- thinking. Group psychotherapists have define what does and does not constitute
tions concerning intimacy. These exer- long been talking about and considering psychological trauma and its specific psy-
cises, the author suggests, would enable a view of the self that is relational, al- chological manifestations. The book is di-
one to understand the nature of the in- though perhaps not as clearly as this au- vided into two sections: “Concepts,

J Psychother Pract Res, 10:4, Fall 2001 285


Book Reviews

Theories, and Strategies” and “Special sonal vulnerabilities evoked by members Dr. Spitz is Clinical Professor of Psychiatry
Populations and Trauma Groups.” of psychotherapy groups for trauma. and Director of Group Therapy Training, Co-
In the first chapter, Klein and The countertransference chapter at lumbia University College of Physicians and
Schermer set the stage by providing a the end of Section I serves as a natural Surgeons, New York, NY.
thorough overview of the relevant bridge to the second half of the text,
trauma literature, an analysis of the im- which describes group therapies for vari-
pact of trauma from an object relations ous subsets within the trauma spectrum.
point of view, and a rationale for the ad- Entities including posttraumatic stress
Scientific Foundations of
vantages of specialized psychotherapy disorder, sexual and physical abuse, Cognitive Theory and
groups. Their scholarly yet very reader- medical illness, the impact of trauma and Therapy of Depression
friendly style condenses a great deal of loss on children, community reactions to
theoretical material into language that is disaster, political torture and ethnic per-
By David A. Clark, Aaron T. Beck,
clear and clinically relevant. secution, dissociative disorders, and se-
and Brad A. Alford
Goodman and Weiss begin the verely psychiatrically impaired and/or
New York, John Wiley and Sons,
book’s journey from theory to practice in substance-abusing patients are the focal
1999, 494 pages, ISBN 0- 47118-
a chapter that explicates the “nuts and points for this part of the book. Although
970-7, $85.00
bolts” of the trauma group model. They all of these chapters are very strong,
highlight issues of screening and evalua- Chapter 7, by Buchele, deserves special Reviewed by Michael E. Thase, M.D.
tion of prospective group members, the mention for the model it offers of a lead-
advantages of homogeneous group com- ership style that is highly empathic but
position, stages of group development,
and the key issue of how to control the
pace of self-disclosure by group members
clear on boundary issues, and for the em-
phasis she places on the need for trau-
matized individuals to move beyond a
A lthough there are dozens of books
on cognitive therapy of depres-
sion, a majority are edited volumes and
in discussing their prior traumatic expe- one-dimensional identity as “survivor” relatively few are distinguished by the
riences. Hageman and Wohl amplify the and to improve the overall quality of comprehensive mastery of the material
themes from the first two chapters and their lives. and clarity of exposition apparent in this
provide a more in- depth study of disso- By devoting eight chapters to the book by Clark, Beck, and Alford. This
ciative states and of defenses employed creative ways in which groups are being volume offers a relatively up-to-date
by traumatized individuals. Their broad used to address the broad range of issues (circa 1999) and scholarly review of the
view of the many faces of dissociative de- emanating from traumatic experiences, phenomenology of depressive disorders
fenses includes behavior, affect, sensa- Klein and Schermer make the essential from the cognitive perspective, along
tion, and knowledge as potential avenues point that practitioners need to move be- with detailed evaluations of the literature
for dissociation in trauma victims. yond a global view that all trauma and its pertaining to the key hypotheses of the
Chapter 4, by Ganzarain, is well consequences are the same. Thinking cognitive model of depression.
written but narrow in scope. He takes a only about similarities can present the The book is well written, but it is not
specific theoretical position, the “group- temptation to adopt formulaic and non- for the cognitive therapy neophyte. It is
as-a-whole” model, and applies it to work specific treatment plans, thereby risking rather lengthy and detailed. Moreover, as
with trauma patients. There is not much unsuccessful outcome and avoiding might be expected, the discussions of
new information in this chapter, but it countertransference sensitivities. Each criticisms of the cognitive model are
still serves as a good review of the work chapter clearly explicates the unique as- somewhat partisan, and the authors con-
of Bion, Hopper, and others who advo- pects of how groups are tailored to meet sistently present the cognitive model as
cate this orientation to group dynamics. the needs of their membership. This sec- dynamic and organic (as opposed to
The chapter by Ziegler and McEvoy that ond section of the book will be invaluable static) in response to new and at times
follows is particularly noteworthy. It is a to new and seasoned group therapists in- contradictory data. Nevertheless, it pro-
thoughtful, sensitive, and clinically wise terested in conducting groups for individ- vides a valuable source companion to the
presentation of the critical dimension of uals who have undergone a severe classic but outdated treatment manual
countertransference reactions in trauma psychological trauma. originally published in 1979 by Dr. Beck
groups. The use of their personal “field This is not merely just another good and colleagues (Cognitive Therapy of De-
journals” describing their ongoing reac- book. It is an invaluable contribution to pression) and the excellent how-to book
tions as leaders of trauma groups is im- a rapidly emerging field and is likely to by Dr. Judith Beck, Cognitive Therapy: Ba-
pressive for both its honesty and the ease be the cornerstone text in the field of sics and Beyond, which was published in
with which clinicians will be able to rec- group psychotherapy and psychological 1995.
ognize their own blind spots and per- trauma for some time to come. Subheads, periodic summaries, and

286 J Psychother Pract Res, 10:4, Fall 2001


Book Reviews

statements of key points within each tional Institute of Mental Health Treat- who are 70. Of course a very important
chapter focus the reader’s attention and ment of Depression Collaborative development for this malady is that for-
Research Program: general effectiveness
enhance comprehension; the authors are, and treatments. Arch Gen Psychiatry mer Sen. Robert Dole had the courage to
after all, expert cognitive therapists. 1989; 46:971–982 go public with his problem—particularly
There is a minimum of redundancy 4. Scott AIF, Freeman CPL: Edinburgh Pri- since it is a problem that occurs both psy-
across the 11 chapters, and although the mary Care Depression Study: treatment chologically and physically in various
copyediting is not infallible (e.g., influ- outcome, patient satisfaction, and cost af- combinations.
ter 16 weeks. BMJ 1992; 304:883–887
ential early behaviorist Charles Ferster is 5. Jacobson NS, Dobson KS, Truax PA, et The field is rapidly changing, led in
referred to as “Fester” in both the text al: A component analysis of cognitive-be- particular by the discovery of the drug
and the reference list), typographical er- havioral treatment for depression. J Con- Viagra (sildenafil), which provides one
rors are few. sult Clin Psychol 1996; 64:295–304 more, usually quite acceptable, approach
As a treatment researcher, I was dis- 6. Markowitz JC, Kocsis JH, Fishman B, et to the problem to add to the methods that
al: Treatment of depressive symptoms in
appointed that the authors did not devote human immunodeficiency virus–positive are already in vogue. The advantage of
at least one chapter to reviewing the com- patients. Arch Gen Psychiatry 1998; these authors’ approach is that it is “in-
parative outcome research studies of CT. 55:452–457 tersystemic,” meaning that every prob-
Outcomes data has been one of the key 7. Ravindran AV, Anisman H, Merali Z, et lem is viewed in terms of its individual,
aspects of the scientific foundation of CT al: Treatment of primary dysthymia with interactional, and intergenerational com-
group cognitive therapy and pharmaco-
for nearly 25 years.1 This is a shortcom- therapy: clinical symptoms and func- ponents. In addition, the individual com-
ing, particularly in view of work linking tional impairments. Am J Psychiatry ponent is seen as including both the
early evidence of CT’s superiority (over 1999; 156:1608–1617 medical and psychological factors. The
other therapies) to strong allegiance ef- authors also imply that almost every sex-
fects2 and the increasing number ual problem of this sort involves all of
of studies in which CT has not these factors and that the most effective
Erectile Dysfunction:
performed so well under more treatment approach is to be sophisticated
“neutral”3,4 or even potentially “alle- Integrating Couple in addressing them all.
giance-disadvantaged”5–7 conditions. Ul- Therapy, Sex Therapy, and Weeks and Gambescia mention the
timately, the most pragmatic benefit of an Medical Treatment three most common methods of treating
elegant, scientifically strong model of erectile dysfunction via medication: oral
psychopathology is the ability to translate By Gerald R. Weeks and Nancy (Viagra), transurethral (MUSE), and in-
such knowledge into greater or more en- Gambescia jection (Caverject). Alprostadil is the
during benefits for our patients. In this New York and London, W. W. medicine found in MUSE and Caverject.
regard, it is not yet clear that the elabo- Norton, 2000, 201 pages, ISBN 0- Other mechanical medical treatments
rate suprastructure of schema theory ac- 39370-330-4, $30.00 such as vacuum pumps are mentioned
tually adds such benefits relative to but only briefly described.
simpler behavioral5 or interpersonal6 Reviewed by Roy Whitman, M.D. The authors’ contribution is primar-
models of intervention. ily in the area of the psychological treat-
ment of this problem, and they give very
Dr. Thase is Professor of Psychiatry, Univer-
sity of Pittsburgh School of Medicine, Pitts-
burgh, PA.
T his brief volume gives a good sum-
mary of the current status of both
sex therapy in general and the treatment
specific recommendations as to how to
“reframe” the problem, develop a thera-
peutic alliance with the couple, and deal
of erectile dysfunction in particular. Drs. with the therapy in an incremental way.
Weeks and Gambescia, who both hold They comment on the common pitfalls
doctorates in psychology, have collabo- encountered in dealing with couples and
REFERENCES
rated in writing a very readable book that also the fundamental problems involved
1. Rush AJ, Beck AT, Kovacs M, et al: combines seamlessly the medical treat- in doing sex therapy (of any type), in-
Comparative efficacy of cognitive ther-
ment and the psychological treatment. cluding communication difficulties, dif-
apy and pharmacotherapy in the treat-
ment of depressed outpatients. Cognitive The illness they are approaching is erec- ferences in expectations, and dealing
Therapy Research 1977; 1:17–37 tile dysfunction, a much more prevalent with unresolved anger and conflict.
2. Luborsky L, Diguer L, Seligman DA, et disease than we had expected. There is a vast literature on sex ther-
al: The researcher’s own therapy alle- They give startling figures for this apy, including works by Masters and
giances: a “wild card” in comparisons of
treatment efficacy. Clinical Psychology problem: the prevalence rate for men Johnson, Helen Singer Kaplan, and nu-
Science and Practice 1999; 6:95–106 who are 40 years of age is 39%, and it merous other therapists. That is one of
3. Elkin I, Shea MT, Watkins JT, et al: Na- dramatically increases to 67% for men the few deficiencies in this slender vol-

J Psychother Pract Res, 10:4, Fall 2001 287


Book Reviews

ume: most of the references are to the se- gives to the first responder: an easy way therapy from analytic to supportive—
nior author’s own work rather than to to conceptualize patients’ problems and using the degree of interpreted
other authors. This makes it somewhat start immediate treatment. Dr. Goldstein transference and insight as a measure of
repetitious and narrow. is well qualified to provide such a man- differentiation. Cognitive therapy is also
References to Viagra and its use are ual. He is on the faculty of the Baltimore- given attention as an alternative treat-
scattered in many places in the book. The Washington Institute for Psychoanalysis, ment. The next four chapters cover issues
authors have been very sensitive in show- where he is director of their Adult Psy- to be pondered before meeting the pa-
ing that its use is not invariably a simple chotherapy Training Program. He is also tient. The degree of therapist’s expressed
positive response and that it affects all as- a Clinical Professor of Psychiatry at the emotion, office arrangement, initial
pects of the relationship of the couple. Georgetown University Medical Center phone contact, and the contract with the
For example, one woman had a negative and currently practices psychotherapy patient are all discussed, leading to a
reaction because she felt the drug and psychoanalysis. He is extensively more in-depth question-and-answer cov-
changed her husband into “an animal.” published and has taught many the art of erage of therapeutic alliance and the role
Numerous clinical examples are given; psychotherapy. of transference.
these deal with the resistances of the cou- This book is the second edition and Following a brief lesson on basic
ple rather than with total outcome. Most differs from the first in the addition of a strategies, Goldstein leads the students
of these resistances are familiar to any chapter describing newer schools of psy- through several techniques of psycho-
psychotherapist, such as forgetting ap- chotherapy. The update allows the nov- therapeutic intervention. Along the way
pointments, being late, not doing their ice to understand how the approach he gives the beginning therapist a candid
“homework”. (the mutual sensate focus illustrated fits within the context of the look at some of his early follies and dif-
exercises that couples do that speed up contemporary schools. The concise, ficult patients. Recounting confrontations
the treatment). easy-to-follow format uses a question- with racism, sexism, and attacks of in-
I recommend this book heartily as a and-answer style. The most pertinent competence, he demonstrates his per-
concise summary of where the field of concepts and terms used are described in sonal trials without resorting to long
sex therapy is in general and of current an appendix on ego functions. narratives. At times his short descriptions
treatment of erectile dysfunction in par- The layout is all business. The au- create such a vivid picture that chuckles
ticular. It requires some background in thor wastes no words in explaining the and outright laughter are unavoidable.
psychology, especially sexual psychol- basic questions of psychotherapy, and he The examples capture the worst fears of
ogy, as well as sophistication in the area covers more topics and in greater depth beginning therapists and make it clear
of couple and family therapy. It is an ex- than one would have thought possible in that the feared situations, if encountered,
cellent introduction to the topic for any- a book of this size. Fourteen chapters can be overcome and dealt with thera-
one who works in this field. flow from beginning to end along the line peutically. A brief chapter on termination
of questions most therapists should have is included for the sake of completeness.
Dr. Whitman is Emeritus Professor of Psychi- before seeing their first patient. His first It is only three pages—long enough to
atry, University of Cincinnati College of Med- chapters are the equivalent of “Airway, stress its importance but meant for noth-
icine, Cincinnati, OH. Breathing and Circulation” for psycho- ing more. Finally, contemporary strate-
therapy. This section gives the main ele- gies, from the Relational School to Self
ments of what needs to be done Psychology, are discussed. The novice
immediately to size up the debilities of will find the appendix on ego functions
A Primer for Beginning patients and quickly categorize them by very helpful.
Psychotherapy, 2nd edition ego strength assessment into a normal- In the question-and-answer format,
neurotic, narcissistic, borderline, or psy- there is never time to get bored with one
By William N. Goldstein
chotic organization. topic. This book, though, in no way re-
New York, Brunner/Mazel, 2001,
In these early chapters Goldstein sembles a mere series of bullet state-
138 pages, ISBN 1- 58391-074-3,
gives a description of the varied back- ments. The author writes engagingly,
$19.95
grounds of patients and therapists and with seriousness as well as humor;
raises questions of the motivations of throughout, his voice is both wise and
Reviewed by Kent D. McDonald, both for entering therapy. His directness concise. The beginning therapist reading
M.D in addressing some therapists’ motiva- this book will have the tools illustrated for
tions for entering the field is unexpected making the four basic diagnostic group-
but well employed. In light of this initial ings— and thus will be already far ahead

T his volume gives to psychotherapy


what a basic life support manual
triage, he then discusses the basic life sup-
port measures—the spectrum of psycho-
of therapists with more experience who
may suffer from lack of direction. For

288 J Psychother Pract Res, 10:4, Fall 2001


Book Reviews

those already in the field who may be In the preface, Mitchell sets the stage (mode 1) to affective-permeability (mode
having trouble making quick and accu- for the exploration of the many ways in 2) to self–other configuration (mode 3)
rate conceptualizations, this book is also which psychoanalysis occurs. His idea is and intersubjectivity (mode 4), that can
helpful. The framework set forth pro- “[that] human minds interact with each be used to explore clinical choices the an-
vides a way to organize further readings other in many different ways, and that alyst makes. These four modes are then
on various topics in psychotherapy, mak- the variety of relational concepts pervad- used throughout the book in each clinical
ing a complex and growing field more ing the recent analytic literature is best example in a way that clarifies the work
manageable. Any new or inexperienced understood not as representing compet- of particular clinicians.
therapist will come away feeling more se- ing theories, but as addressing them- In chapter 4, “Attachment Theory
cure in his or her ability to conduct ther- selves to different interwoven dimensions and Relationality,” Mitchell weaves in
apy and will be better able to do so. This of relationality.” the works of Bowlby, Stern, Main, Ains-
is a three-evening book that conveys the In chapters 1 and 2, he begins by worth, and others and then offers clinical
practical information often not gathered exploring the contributions of Hans Loe- examples of attachment and modes 2, 3,
through a month of introductory lectures. wald, whom he describes as writing from and 4. These examples help to solidify
within traditional drive theory language the idea of mode and offer a potential
Dr. McDonald (Major USAF, MC FS) is Ad- while subtly shifting the meaning of the tool for fine tuning the clinical exchange.
ministrative Chief Resident of the Wright terms. In his work, he recognized some He reaches for a convergence of psycho-
State University Psychiatry Program, Dayton, of the underpinnings of current relational logical ideas, attachment theory, and psy-
OH. thinking in psychoanalysis. Loewald’s choanalytic theory. The prospect is
emphasis on the significance of the exter- stimulating.
nal object spoke to an early awareness of Mitchell goes on to explore Fair-
the inevitability of intersubjectivity. The bairn’s work, seeing him as offering, for
Relationality: From
importance of the analytic relationship his time, a rather radical view of relation-
Attachment to for the curative effect was a sophisticated ality that is now seen as quite significant.
Intersubjectivity (Relational shift away from drive theory in that it His explication of Fairbairn’s work is
Perspective Book Series, placed great importance on the relational both interesting and thought-provoking
Vol. 20) experience. Mitchell captures Loewald’s in that he goes beyond Fairbairn and ex-
unique emphasis on language, in which plores what that author might have been
By Stephen Mitchell “language transcends the distinction be- implicitly suggesting. He offers some
Hillsdale, NJ, The Analytic Press, tween preverbal and verbal; language be- compelling clinical examples that ex-
2000, 200 pages, ISBN 0- 88163- gins to play an important role from the pand Fairbairn’s work.
322-4, $39.95 earliest days of life.” He contrasts Loe- The final chapter, on intersubjectiv-
wald with Stern and Sullivan and their ity, tackles the thorny issues of expres-
Reviewed by Rosemary Segalla, views on the impact of the movement siveness and restraint in the analytic
Ph.D. from preverbal to verbal. relationship. This chapter focuses on the
Mitchell’s grasp of the subtleties of analyst’s “inevitable participation in the
Loewald’s contribution and his impact on process” and is the most clinically prac-

I t was with considerable sadness that I


took up this last book written by Ste-
phen Mitchell. Reading it became a re-
current relational thinking is presented in
clear and concise language. The clinical
vignettes offered in each chapter are clar-
tical in its straightforward look at the an-
alyst’s position vis-à-vis the patient. He
concentrates on the strong emotions that
minder of what he has offered us over the ifying in that they capture Mitchell’s re- inevitably emerge in the analytic rela-
past 20 years and a sad awareness that we lational style as well as explicate the tionship, exploring the complexity of
will no longer have his unique and very theoretical contribution not only of Loe- love and hate in the analyst toward the
original voice available to us. It has made wald but also of Fairbairn and others. patient. His clinical examples are both re-
a critical reading of the book rather dif- In chapter 3, “An Interactional Hi- vealing and clarifying.
ficult. Who wishes to quarrel with his erarchy,” he offers a relational frame- Although this brief review does not
views when he is no longer available to work, a “heuristic device for locating, capture the rich complexity of the book,
continue the dialogue? Nonetheless, the juxtaposing, and integrating different it offers a brief look at the far-ranging ex-
review is well deserved, and despite his kinds of explorations of different dimen- ploration that has been so characteristic
absence, it is important to explore this sions of relationality,” which reflects or- of Mitchell’s thinking. If there is a com-
book as a rich addition to the expanding ganizational patterns of increasing plaint to be made, it is simply that at least
body of ideas emerging from contempo- sophistication. He suggests four modes, some of these chapters call for further ex-
rary psychoanalysis. ranging from nonreflective behavior pansion. This is particularly the case for

J Psychother Pract Res, 10:4, Fall 2001 289


Book Reviews

the Loewald and Fairbairn chapters. The be an effort to awaken a field that the au- themselves about the basic processes that
book is dense with interesting ideas and thor perceives as slumbering. go on between therapists and clients.
worth a read and a reread. The clinical To both describe his own adventures Thus here more strongly than in any
examples are self-revealing and useful in and discuss the issues of the field, Langs other section of the book, the case is
their explanatory power. This effort to has divided this book into four parts. In made in vivo for how science can revi-
expand and clarify the relational field is the first he introduces basic issues and talize our thinking about psychotherapy.
very necessary, and I hope Mitchell’s talks about why our field is ambivalent In the last section, Langs speculates
ideas will be expanded by others, just as about scientific inquiry. Here Langs per- about how the forces of evolution may
he attempted to expand the ideas and in- ceives an emotional rather than an ab- have shaped the human mind into the
fluences of earlier theorists. stract issue. In a manner that rings true, structures he has observed. Here he grap-
he writes: “the universal dread. . . . of a ples with the issue of why people act in
confrontation with the most awful aspects so many absurdly self-destructive ways.
Dr. Segalla is the Director of the Institute of
of one’s relationships, self, life experi- Why do we have important knowledge
Contemporary Psychotherapy and Psycho-
ence, inner impulses and particularly, in- that is so difficult to access (knowledge
analysis, Washington, DC, where she also
evitable demise carries over to a dread of Langs calls unconscious)? Then, at the
serves on the faculty. She is on the faculty of
science.” close, Langs returns briefly to try to put
the Group Training Program of the Washing-
In the second section, Langs pres- psychotherapy into the context of the
ton School of Psychiatry. Her private practice
ents a model of the aspects of the mind mind as evolving entity.
is in Washington, DC.
that are addressed by psychotherapy, This book is ultimately a collection
those aspects or systems that make mean- of closely related assertions about the na-
ing of emotionally charged information. ture of human consciousness and psycho-
His presentation is dense and detailed. therapy. The directness of Langs’
Psychotherapy and Science He offers lists of numbered postulates. assertions is both the strength and the
By Robert Langs He describes the division of the emo- weakness of the work. His points are
Thousand Oaks, CA, Sage tional processing mind into conscious clearly made. There is no guessing about
Publications, 1999, 224 pages, and unconscious domains and uses his postulates or conclusions. Some of his
ISBN 0-76195-616-6, $82.00 (cl), names such as the “perception-analyzing points, though, seem unlikely to stand the
0-76195-615-8, $31.00 (pb) receiving system” and “output control test of time. For example, he asserts that
center” to distinguish individual compo- “the human brain is a Darwin machine”
nents of these domains. and that there is an unwavering biologi-
Reviewed by Paul Lysaker, Ph.D.
In the third and most engaging sec- cal basis of the denial of death. This may
tion, Langs takes us into his confidence be unconvincing to many readers famil-
and describes his personal tribulations as iar with literature on the social construc-

A t the outset of this book, Robert


Langs argues convincingly that
psychotherapy is unlikely to survive as a
a little more than a decade ago he at-
tempted to code a series of psychother-
apy transcripts and then subject the data
tion of narrative.3 Some of his thoughts
about the philosophy of science are also
perhaps limited by their reliance on the
distinct discipline without the “develop- to mathematical modeling. For example, early 20th century positivist view. Nev-
ment of formal science of its own.” He Langs tells us how he found in one series ertheless, this is how science moves for-
tells us that to turn away from the rigors of studies that the amount of time clients ward. Langs is courageous enough to tell
of theory-building and the testing of as- spent narrating versus intellectualizing us what he thinks, and we can conse-
sumptions that guide practice is worse increased as the therapist was quiet but quently accept or reject what he purports,
than an indulgence. From here he then actively lending energy to the interaction. thereby advancing our field. Langs
sets out to describe to us the quest he has Here Langs explains that he believes he writes: “It is my fervent hope that this
undertaken over the course of his long was measuring mental energy, and he book has aroused a restless interest and
and fruitful career to bring science to evolves a number of laws about human need for science.” For myself, it was the
bear on psychotherapy. The style of the communication. While I suggest that case that Langs’ work helped to revitalize
book is an engaging mixture of personal there are many alternative explanations and spur on just such a process.
narratives about his triumphs and disap- of this finding, including ones that draw
pointments and more formal academic from a less synthetic and mechanistic
writing about Langs’ theories and his un- view of the mind,1,2 these findings and Dr. Lysaker is a clinical psychologist and
derstanding of the key questions science Langs’ thoughts are nonetheless exciting Assistant Professor of Clinical Psychology,
has yet to address. The tone is impas- and provocative. They draw the reader Indiana University School of Medicine,
sioned and the work as a whole seems to into arguing both with Langs and with Bloomington, IN.

290 J Psychother Pract Res, 10:4, Fall 2001


Book Reviews

best one for introducing the clinician to Limited Psychodynamic Therapy has
REFERENCES the practice of group psychotherapy” and been expanded into a full chapter.
1. Hermans HJM: Voicing the self: from in- should be used “as an aid for teaching The third edition is both a revision
formation processing to dialogical inter- junior colleagues.” Does that advice still and an expansion of the second. The for-
change. Psychol Bull 1996; 119:31–50 hold? The answer is yes, but with one mer chapter on Group Composition has
2. Lysaker PH, Lysaker JT: Psychosis and
the disintegration of dialogical self-struc- proviso, to be noted below. been revised and reconceptualized as A
ture: problems posed by schizophrenia This edition appears eight years af- Systems Approach to Forming a Group.
for the maintence of dialogue. Br J Med ter the second and has been expanded by The new title speaks to its reformulation.
Psychol 2001; 74:23–33 40%. What has transpired during that pe- A series of chapters in the second edition
3. Worthham S: Narratives in Action: A riod of time to warrant a new edition? on Special Technical Considerations has
Strategy for Research and Analysis. New
York, Teachers College Press, 2001 Three areas of change come to mind. been given new identity, and thereby
First, there have been refinements in the- greater focus. The one on Expressions of
ory and the infusion of intersubjectivity, Affect has been enriched so that the
an offshoot of self psychology. Second, reader can appreciate that the authors
Psychodynamic Group there continue to be advances in psycho- conceive of affect as the underpinning of
Psychotherapy, 3rd edition pharmacology. Third, managed care has group process. Throughout the text, clini-
become entrenched. Has this third edi- cal examples are added and theory ex-
By J. Scott Rutan and Walter N. tion addressed those changes? The an- panded and updated. A new chapter is
Stone swer is, yes, as well as can be expected. included that consists of an extended
New York, Guilford Press, 2001, The text addresses the advances in clinical example with running commen-
388 pages, ISBN 1-57230-518- 5, theory in a comprehensive way. In fact, taries by both authors. Through that
$42.00 at times the text is so rich in theory that chapter, the reader can come to appre-
clinicians who know little theory may get ciate how a clinician conceives of the
Reviewed by Howard D. Kibel, M.D. lost in its pages. The foregoing will indi- group’s process and how he or she works
cate for whom this text is best suited. It with the group. More important, the
is ideal for the clinician who is well reader can see how two experienced cli-

S ince the first edition in 1984, this


textbook has stood as one of the
foremost in the field. It is the only non-
grounded in the theory and technique of
individual psychodynamic psychother-
apy and wants to learn group psycho-
nicians can approach the same clinical
situation differently.
The second chapter is about the his-
edited one on psychodynamic group psy- therapy. It is perfect for the group tory of group psychotherapy. The au-
chotherapy. Certainly, Yalom’s textbook1 psychotherapist who wants to learn psy- thors do a nice job of acquainting the
is more popular, but his is a here-and- chodynamic group psychotherapy. The reader with some of the seminal contri-
now approach, which eschews the value novice may have some difficulty with butions. However, the work of Foulkes is
of genetic insight and group dynamics those sections steeped in cutting- edge presented on an equal footing with the
and minimizes the importance of trans- theory. But that allows the student to re- work of others. Foulkes’s “group analy-
ference. These authors recognize that the read the text and glean its richness as he sis” is the dominant psychodynamic ap-
group is a multidimensional system in or she matures professionally. proach outside the United States and
which events at one level affect another. Like the second edition, the present Canada. More attention should have
Therefore, the group therapist needs to text adequately addresses the use of med- been paid to his unique way of viewing
pay attention simultaneously to what is ication. There is a small section on com- the group as an organic entity and to his
happening with the individual, among bining group psychotherapy with insistence that the therapist take a less in-
members, and with the group-as-an-en- pharmacotherapy. But the current pref- trusive role, so as to become the group’s
tity; how genetic material, current life erence by so many for medication as a conductor (as in music) rather than its di-
events, and the group’s history affect the “quick fix” over the use of psychotherapy rector. In one respect, the authors are
process; and the relationship of affect to cannot be adequately discussed in such a closer to group analysis than they ac-
content and process—all the while inter- volume. knowledge. They do an excellent job of
vening at a level that is near to experi- The text refers to the challenges, or reminding the reader that the group is
ence and also facilitates the group’s perhaps the problems, caused by man- not merely a dynamic entity of its own,
development. For this reason in 1995, aged care. These are addressed through- but functions within a sociocultural con-
when reviewing the second edition (pub- out. There is no chapter on how to text that influences its processes.
lished in 1993) in these pages, this re- manage managed care, or, more simply, An early chapter on Therapeutic
viewer stated that “this volume remains how to beat the system. However, a sec- Factors is extremely rich in theory. How-
a textbook nonpareil,” and that “it is the tion from the second edition on Time- ever, the level of sophistication is so high

J Psychother Pract Res, 10:4, Fall 2001 291


BOOK REVIEWS

that it might leave some novices behind. care organizations. Remaining neutral as consideration of what can and cannot be
In contrast, a later chapter on The Diffi- to the advisability of engaging with man- accomplished within the temporal con-
cult Patient explains theory in a very aged care, the authors describe how, straints of short- term treatment.
clear way and makes it clinically relevant. within constraints, it is possible to do A chapter on the use of outcome
Well- grounded clinicians will not have some meaningful work. studies provides a good overview of the
difficulty with any of this. They can use The book can be read in its entirety many scales that might be used to dem-
the volume to learn about the pragmatics or sampled for relevant chapters. Illustra- onstrate both improvement and the need
of group psychotherapy, its conceptual tive case vignettes are scattered through- for continuing work in therapy. The lim-
underpinnings, and its complexities. out. itations and ease of administering each
Clinical novices should be advised to The first of eight chapters explores instrument are summarized. Unfortu-
skip that earlier chapter and not be dis- some of the implications of making the nately, the authors do not discuss
couraged if some of the theory is beyond change to a treatment triad. A case vi- whether, in their experience, using these
their level of understanding. This volume gnette has the therapist taken off the scales helps secure support for treatment.
can be read over and over by the begin- panel of a company that had proven im- The final chapter revisits the central
ner, who will learn more from it each possible to work with in good faith. An concepts in a “frequently asked ques-
time, will come to appreciate its sophis- overview of treatment and ethical dilem- tions” format, describes current devel-
tication, and will find fresh insight in its mas follows. Such dilemmas are explored opments in managed care, and predicts
pages. In short, the authors have taken throughout the work, but there is perhaps likely aspects of its evolution. The refer-
the previous edition and raised its level too little examination of the pitfalls await- ence section includes an annotated bib-
of excellence so that now reading the vol- ing the unwary clinician who attempts to liography, an appendix with sources of
ume has become a comprehensive learn- accommodate the demands of managed rating instruments, and a glossary.
ing experience. care. Though somewhat dry and redun-
The second chapter summarizes the dant, the Strategic Guide admirably fulfills
Dr. Kibel is in private practice in Valhalla, history, structure, and agenda of man- its stated task. Readers will find lucid,
NY, where he is also Clinical Professor of Psy- aged care as these are reflected in inter- practical guidance in the difficult task of
chiatry at New York Medical College. actions with therapists. The following succeeding as effective and ethical psy-
chapter clarifies insurers’ conception of chodynamic clinicians in the brave new
medical necessity, describing the empha- world of managed mental health care.
REFERENCE sis on functional impairment and the lack As the authors of this book acknowl-
of appreciation for psychodynamic con- edge, the experienced clinician looking
1. Yalom ID: The Theory and Practice of
Group Psychotherapy, 3rd edition. New siderations on the part of care reviewers. for a more general guide to coping with
York, Basic Books, 1985 A graph dividing possible cases into managed care or getting on provider
quadrants with orthogonal dimensions of panels should look elsewhere. In-depth
functional and intrapsychic impairments consideration of the impact of managed
illustrates the points at which managed care on the psyche and culture of clini-
Psychodynamic Practice in
care may be approached for support with cians is also relegated by default to other
a Managed Care realistic expectation of success. works. Its strength is greatest for the ther-
Environment: A Strategic Perhaps best fulfilling the intention apist with a psychodynamic practice and
Guide for Clinicians announced in the title are the chapters limited experience working with man-
“Transforming Psychodynamic Concepts aged care who is contemplating entering
By Michael Sperling, Amy Sack, and into a Managed Care (Functional) Lan- the fray; and for such it is highly recom-
Charles L. Field guage” and “Documenting Psychody- mended. it may also be of value to the
New York, Guilford Press, 2000, namic Treatment in a Managed Care new therapist of any theoretical back-
166 pages, ISBN 1-57230-133- 3, Format.” These constitute a detailed ground who is learning to deal with man-
$30.00 guide to the formulation of treatment aged care.
plans in the concise, “atheoretical,” func-
Reviewed by David Feldman, M.D. tional language likely to win approval of Dr. Feldman practices in Mentor, OH, as part
managed care. The authors provide ex- of University Mednet and is Clinical Assistant
amples of treatment plans in which elab- Professor of Psychiatry at Case Western Re-

S perling and colleagues have written


a pragmatic, concise, thorough
manual for the psychodynamic clinician
orate dynamic formulations
condensed into a format that gives man-
aged care the “just sufficient informa-
are serve University School of Medicine, Cleve-
land, OH.

who is entering upon work with managed tion.” There follows a thoughtful

292 J Psychother Pract Res, 10:4, Fall 2001