Abstract
Published by the Royal College of Psychiatrists, this book is designed primarily for the UK psychiatry trainee. It presents an overview of the therapies in which they are expected to develop competency, namely systemic, cognitive–behavioural and dynamic. Divided into 12 chapters, the book focuses on these modalities as practised in the NHS. This explains why a chapter dedicated to cognitive analytic therapy is included while interpersonal therapy and dialectical behaviour therapy are omitted. Six of the 14 authors are based in Scotland, including the editors; hence the generous allocation to the ideas of Ronald Fairbairn in the chapters on psychodynamic theories.
The opening chapter on assessment in psychotherapy addresses the subject from a predominantly clinical perspective, of necessity because of the paucity of research in this area. It contained relevant and useful ideas, but in a format that failed to cohere into a user-friendly whole. This deficit was redressed to a degree at the end of the chapter with a basic algorithm to guide the overall assessment process and tables summarizing factors to consider in assessment.
The two chapters on psychodynamic theories assume basic background knowledge, enabling the authors to construct a relatively comprehensive overview and useful guide toward more detailed study. The framework is standard, with the emphasis on contemporary Freudian, Kleinian, British object relations, ego psychology, attachment and Kohutian self psychology theories. The familiar is attractively embellished by the coherent integration of the work of a dozen or so lesser known writers. Subheadings highlight the recurring theme of integration, both of different theoretical positions, for example, ‘Bion's theory as a bridge to object relations theory and self psychology’, and of theory with practice, for example ‘Hartmann's ego psychology, cognitive–behavioural therapy and cognitive analytic therapy’.
There are chapters on group therapy, family therapy and systemic practice, individual psychoanalytical therapy with children and adolescents, psychodynamic therapy with individuals, behavioural and cognitive theories, and behavioural and cognitive therapies. The authors appear to be predominantly clinicians rather than academics, which probably accounts for these chapters being very readable and having a strong clinical feel, which is augmented by the liberal use of case vignettes. The group therapy chapter focuses on work in small outpatient groups using the group-analytic model, but reference is also made to other theoretical models. The chapter on family therapy and systemic practice explored the territory from the perspective of the two metaphors, process and narrative. The chapter on behavioural and cognitive therapies emphasizes the former at the expense of the latter, with surprising priority given to different conditions. There is only one paragraph on post-traumatic stress disorder (PTSD), under the subheading ‘New developments …’, with substantially more space being given to the treatment of tics and of alternative sexual practices – a reflection of Scottish realities and a dearth of Vietnam veterans? Cognitive therapy for non-chronic depression is also given scant attention. The chapters on group therapy and family therapy and systemic practice include sections on outcome research.
The chapter by Jan Scott dedicated to cognitive therapy for severe mental disorders describes the application of this approach to chronic depression, bipolar disorders and schizophrenia. More relevant to the general psychiatrist, it outlines the adaptations of the basic cognitive therapy model this work requires, highlights the ways it may be incorporated into overall patient management, and briefly reviews the outcome research.
Rounding out the collection is a chapter on research by Anthony Bateman. In keeping with the overall style of the book, the comprehensive review is bypassed in favour of a more focused approach. He explores the ongoing tension between outcome (quantification of change) and process (quantification of meaning) research, with an emphasis on the methodologies of the latter, including Luborsky and Crits-Christoph's core conflictual relationship theme method and research using the Adult Attachment Interview.
The book succeeds in its primary aim to be a useful starting point for UK psychiatry trainees. The omission of interpersonal and dialectical behaviour therapies, and the scant coverage of therapy for such common disorders as non-chronic depression and simple and complex PTSD lessen its value to Australian trainees. These deficiencies also detract from its secondary aim of being relevant to psychiatrists in other specialties interested in updating their knowledge of psychotherapy. Apart from the chapters on cognitive therapy for severe mental disorders and the more recent research findings, there is little I did not encounter in my psychotherapy training in the UK more than 10 years ago. The most unfortunate omission is the lack of any reference to the exciting developments in cognitive and affective neuroscience occurring in those past 10 years that have done much to enrich our understanding of the neurophysiology relevant to emotional development and psychotherapy process.