Abstract
The subtitle of this volume, ‘putting psychotherapy at the centre of treatment’, conveys the underlying polemic of the editors. They have gathered together a variety of contributions from authors with a wide range of backgrounds and interests. The different chapters essentially offer a brief exposition of a particular approach, some explanation of the underlying theory or thinking and some presentation of outcome research and evaluation. The approaches or interventions described include cognitivebehavioural treatment, psychosocial treatments including family interventions, one chapter on psychoanalytic therapy that draws on self psychology concepts and a description of Scandinavian models of integrating various treatment strategies.
Overall I think that the book does point out quite well that it is possible to usefully offer patients suffering from a psychotic illness something more than medication and a friendly chat. The brevity of the chapters does mean that they only provide an introduction to a particular issue although interesting questions are raised, often indirectly.
Chapter five presents a discussion of the Thorn training project in the UK and the follow through into its practice. The Thorn training project aimed to equip nurse case-managers with skills in problem-centered case management, family work and psychological interventions in psychosis. Actual utilisation of these skills was disappointing related in part to lack of structural, management and clinical support.
The chapters from the Scandinavian workers highlight the necessity of developing institutional structures, in the best sense of the term, that support and integrate this kind of work over time. The Finnish model of treatment described by Alanen gives an insight into what is possible but also what this takes. They emphasise the need for ongoing training and reflection that contributes to the evolution of a service. It seems a world away from what is available in Australia. A comment by Alanen is worth noting ‘An increasingly difficult problem is the lack of psychotherapeutic knowledge and skills of psychiatrists. The new training programmes do not properly prepare psychiatrists in psychodynamic and systemic understanding. At worst, this leads to a split between the doctors and other staff… There is often the temptation to raise the barricades against the medical establishment, but in such cases the potential development is at risk of dissolving into futile and endless struggles’ (p.262). This is a comment relevant to the struggle to prevent training in family and individual therapy from falling into disarray.
The book provides a useful overview to the area of psychological treatments in psychosis that would be of interest to someone in the later stages of training or to psychiatrists treating psychotic illness. It represents a contribution to and a presentation of the issues that need to be debated as part of the ongoing evolution of treatment approaches for this group of patients.