Abstract
The release of a practical therapist manual on psychological intervention for first-episode psychosis in 2002 was very timely, and the fact that the authors of this book are leading clinical researchers in this field should continue to ensure that it is eagerly received. The manual is brief – just 61 pages – and most segments are sketched rather than described in detail. Both experienced therapists and graduate trainees will find the manual useful, although the former will find aspects too introductory, and the latter will often wish for more detailed instructions. There are some technique ‘gems’: the application of a timeline graph to the understanding of the disorder and self-concept changes, and drawing ‘social circles’ to identify social supports and stresses are two memorable examples. The use of a modified repertory grid to assessment and treatment in psychosis is innovative, although the opportunity to use it for alternative, creative reconceptualization is not fully realized. Therapy dialogues provide concrete examples of some strategies, although an example of brief Socratic questioning is effectively repeated (cf. pp.33–34 and pp.50–51). A different example of cognitive therapy could be usefully substituted.
On first reading, I found it difficult to pin down the structure and essential features of the intervention, although chapter headings do provide guidance. The sense of vagueness was partly because COPE is intended to be flexible, individualized and negotiated, partly because the description of some aspects is in general terms and partly because many key points (including the overall therapy agenda) are tucked away in unmarked paragraphs. Even after more careful reading, I think greater specification is needed in several places. The introductory segments could describe underpinning concepts and strategies in a little more detail. Recommended decision rules on inclusion of elements and on their approximate length could be outlined without compromising the need for individual tailoring (albeit with acknowledgement that many of these recommendations may still rely solely on more than clinical impressions to support them). Some important sections could be expanded, or at least, advice on where to find further information could be given – examples would be additional therapy aids and other adaptations to deal with thought disorder during sessions, risks and limitations of symptom monitoring and potential roles for relatives in reinforcing gains. Complex and critical problems for the person, including the balancing of reengagement versus moderation of stress and deciding to terminate medication also need more discussion, as do plans and support strategies for risk periods that may result from these decisions. Given that the authors anticipate that clinicians may want to refer to the manual for advice on specific issues, it would be good to see more subheadings and a subject index to aid rapid searching.
I hope we will see a future edition of this manual that addresses at least some of these issues more fully. However, the brevity and coverage of the current manual are considerable strengths, and I amsure that many therapists are finding this manual a valuable addition to their office desk.