Comprehensive Guide to
explaining IPT concepts and issues to pa- cludes with a look at “The Future of IPT” Psychotherapy
tients. As an IPT supervisor, I find that clinicians new to IPT thirst for practical, how- to ways to conduct the therapy. Sug- gested scripts were available in the 1984 Comprehensive Guide more than an up- riches this section as a training manual.
The Comprehensive Guide also provides more clinical vignettes than the 1984 IPT Reviewed by Gregory A. Hinrichsen, crete examples of how specific issues are stages of the therapy. I surmise that the book and to New Applications. Sections II he book Interpersonal Psychotherapy witz’s and Weissman’s own experience of of Depression1 was the original state- conducting IPT in the last 15 years. Some New Applications, which was an edited of the clinical material reflects contem- mat to these sections enriched with clini- psychological ramifications of HIV infec- book. It is a refreshingly clear, clinically tion. Section I also provides updated ef- duct IPT. The fact that the book has been man as one of the co-authors of this book.
Mood Disorders,” and Section III, “Ad- last 15 years attests not only to the in- creasing popularity of IPT but also to the ders,” correspond to the last two sections quality of the book itself. In short, it’s a of New Applications. The variety of prob- 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 facts. I found the dedication of the book particularly touching: “To Gerald L. Kler- IPT book and the Comprehensive Guide 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- chology, Long Island Jewish Medical Center, and Associate Professor of Psychiatry, Albert agnoses. Is the Comprehensive Guide more Einstein College of Medicine, Bronx, NY. search updates brief and straightforward, wish to pursue the details. Section III also book. What I best liked about this section Progress,” which gives a glimpse of novel ville BJ, et al: Interpersonal Psychother- apy for Depression. New York, BasicBooks, 1984 cially useful to clinicians who are learn- der and for body dysmorphic disorder.
ing this modality for the first time.
Suggested scripts for inquiring about in- other countries and of its flexible adap- The Process of Group
relationship patterns), and colors (various Psychotherapy: Systems
with this for decades. Certainly it will be for Analyzing Change
and psychiatric residents, as a researcher each measure was linked to particular pa- believe this book is the next step on our Reviewed by Sally H. Barlow, Ph.D. fault in the inability to link them to out- not stated directly enough to provide theframework to establish this link. In ad- clear descriptions from the group process experts regarding their particular process tion to the session. Most exciting is the with expertly rated behavioral systems.
research, they noted: “Missing here are Dr. Barlow is Professor of Psychology, three most likely overlies the dynamic in- Brigham Young University, and Adjunct As- sociate Professor of Psychiatry, University of functioning surely calls for increased in- difficult to learn though data-dense; those measures that leave out an important part lidity and reliability, and ability to link of this triad are superficial, although easy Expressing Emotion:
tently in the research to sustain their vi- Myths, Realities, and
ability in linking process to outcome.
Therapeutic Strategies
allows us a peek into this process. These authors gave identical transcripts of one often sacrificed for ease of learning and Lewis. If anything, they have clearly il- cess measures. As each representative as- field of research. Their complex handling closer to establishing the link from pro- therapy; and expression-related interven- perienced practitioners in the field, but also so well written as to be easily under- disguises genuine feelings, it is notrelated to emotional insight. In just beginning their work. In Expressing Emotion, the authors have produced just such a work. Their writing style is clear for the evaluation of other ideas as they presented in their work as their own.
pressed to oneself and to others create a lay public than professionals, that letting emotions “hang out” is all that is needed tion to our understanding of the roles of therapeutic effects of ventilation, but they for students in all aspects of the field of lack of insight. For instance, whenexpression involves perseverative Dr. Hanin is Clinical Professor of Psychiatry, New York Medical College, and Senior At- tending, St. Vincent’s Catholic Medical Cen- expressions of ‘I feel bad,’ it indi- so that it is always clear what the authors are talking about. In addition, the orga- Beyond Individualism:
Toward a New
Understanding of Self,
Relationship, and
cal to the practical implications of the au- of emotion are interesting and necessary, but for me, the most useful part of their work is their section on the treatment im- plications. Here they are very liberal in Reviewed by John Gladfelter, Ph.D, of emotional expression or nonex-pression in contributing to or cor- recting a lack of emotional insight.
the role of the self, although again not as clearly and strongly as this book. Current alistic self, pointing to the limitations of a provocative and much that is affirming.
for a point of view that will challenge, as this book believes that the individual self as historically viewed precedes and tran- scends relationship and social conditions this is a book well worth reading because Dr. Gladfelter is a faculty member of the Fielding Institute, Santa Barbara, CA. self in relation to society. Wheeler takes reader through a set of experiential chap- Group Psychotherapy for
cepts that invite and challenge the reader Psychological Trauma
the concepts of the social field, contact, self in relation to the world. As the author suggests, this means a significant shift in ences of thinking, feeling, and imaging to our traditional views of self and suggests that a concept of relational self is well descriptive feedback of the self. The se- suggests writing this down) would go “I thor. This is perhaps one of the problems pist’s experience. There is, however, of- the self. I would also have liked a tradi- tional subject index for the book because there are so many ideas that call for fur- in this text represents an attempt to close ing outer and inner social supports in re- lation to the experiences of the first step While the term trauma has found its individualistic model many operate from.
health practitioners, it is used loosely and often does not mean the same thing to all from another person to enable one to talk much that is already congruent with their book is that it takes the time to clearly psychological trauma and its specific psy- a view of the self that is relational, al- chological manifestations. The book is di- though perhaps not as clearly as this au- Theories, and Strategies” and “Special Dr. Spitz is Clinical Professor of Psychiatry and Director of Group Therapy Training, Co- lumbia University College of Physicians and trauma literature, an analysis of the im- which describes group therapies for vari- ous subsets within the trauma spectrum.
Scientific Foundations of
point of view, and a rationale for the ad- Cognitive Theory and
medical illness, the impact of trauma and Therapy of Depression
theoretical material into language that is disaster, political torture and ethnic per- secution, dissociative disorders, and se- book’s journey from theory to practice in a chapter that explicates the “nuts and points for this part of the book. Although highlight issues of screening and evalua- Reviewed by Michael E. Thase, M.D. mention for the model it offers of a lead- clear on boundary issues, and for the em- in discussing their prior traumatic expe- one-dimensional identity as “survivor” and clarity of exposition apparent in this used to address the broad range of issues view of the many faces of dissociative de- point that practitioners need to move be- with detailed evaluations of the literature yond a global view that all trauma and its specific theoretical position, the “group- 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 still serves as a good review of the work chapter clearly explicates the unique as- cate this orientation to group dynamics.
ond section of the book will be invaluable follows is particularly noteworthy. It is a contradictory data. Nevertheless, it pro- thoughtful, sensitive, and clinically wise terested in conducting groups for individ- presentation of the critical dimension of groups. The use of their personal “field 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 a rapidly emerging field and is likely to by Dr. Judith Beck, Cognitive Therapy: Ba- pressive for both its honesty and the ease sics and Beyond, which was published in with which clinicians will be able to rec- chapter focus the reader’s attention and after all, expert cognitive therapists.
go public with his problem—particularly 4. Scott AIF, Freeman CPL: Edinburgh Pri- since it is a problem that occurs both psy- copyediting is not infallible (e.g., influ- outcome, patient satisfaction, and cost af- ential early behaviorist Charles Ferster is referred to as “Fester” in both the text al: A component analysis of cognitive-be- and the reference list), typographical er- havioral treatment for depression. J Con- 6. Markowitz JC, Kocsis JH, Fishman B, et to the problem to add to the methods that appointed that the authors did not devote at least one chapter to reviewing the com- these authors’ approach is that it is “in- parative outcome research studies of CT.
lem is viewed in terms of its individual, aspects of the scientific foundation of CT interactional, and intergenerational com- for nearly 25 years.1 This is a shortcom- ponents. In addition, the individual com- ing, particularly in view of work linking early evidence of CT’s superiority (over other therapies) to strong allegiance ef- authors also imply that almost every sex- Erectile Dysfunction:
these factors and that the most effective treatment approach is to be sophisticated Integrating Couple
“neutral”3,4 or even potentially “alle- giance-disadvantaged”5–7 conditions. Ul- Therapy, Sex Therapy, and
timately, the most pragmatic benefit of an Medical Treatment
erectile dysfunction via medication: oral psychopathology is the ability to translate during benefits for our patients. In this medicine found in MUSE and Caverject.
regard, it is not yet clear that the elabo- ily in the area of the psychological treat-ment of this problem, and they give very Dr. Thase is Professor of Psychiatry, Univer- Thisbriefvolumegivesagoodsum- specific recommendations as to how to sity of Pittsburgh School of Medicine, Pitts- “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.
They comment on the common pitfallsencountered in dealing with couples and doctorates in psychology, have collabo-rated in writing a very readable book that ment and the psychological treatment.
The illness they are approaching is erec- giances: a “wild card” in comparisons of 3. Elkin I, Shea MT, Watkins JT, et al: Na- the few deficiencies in this slender vol- ume: most of the references are to the se- gives to the first responder: an easy way to conceptualize patients’ problems and differentiation. Cognitive therapy is also ual. He is on the faculty of the Baltimore- scattered in many places in the book. The ment. The next four chapters cover issues authors have been very sensitive in show- ing that its use is not invariably a simple tient. The degree of therapist’s expressed positive response and that it affects all as- a Clinical Professor of Psychiatry at the pects of the relationship of the couple.
changed her husband into “an animal.” erage of therapeutic alliance and the role these deal with the resistances of the cou- differs from the first in the addition of a 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- ficult patients. Recounting confrontations narratives. At times his short descriptions treatment of erectile dysfunction in par- create such a vivid picture that chuckles and outright laughter are unavoidable.
ogy, as well as sophistication in the area of couple and family therapy. It is an ex- that the feared situations, if encountered, cellent introduction to the topic for any- flow from beginning to end along the line peutically. A brief chapter on termination is included for the sake of completeness.
Dr. Whitman is Emeritus Professor of Psychi- before seeing their first patient. His first atry, University of Cincinnati College of Med- chapters are the equivalent of “Airway, stress its importance but meant for noth- therapy. This section gives the main ele- A Primer for Beginning
Psychotherapy, 2nd edition
neurotic, narcissistic, borderline, or psy- there is never time to get bored with one both for entering therapy. His directness this book will have the tools illustrated for tions for entering the field is unexpected but well employed. In light of this initial ings— and thus will be already far ahead Thisvolumegivestopsychotherapy triage,hethendiscussesthebasiclifesup- oftherapistswithmoreexperiencewho 2) to self–other configuration (mode 3) rate conceptualizations, this book is also be used to explore clinical choices the an- the variety of relational concepts pervad- used throughout the book in each clinical ing the recent analytic literature is best therapist will come away feeling more se- cure in his or her ability to conduct ther- selves to different interwoven dimensions apy and will be better able to do so. This worth, and others and then offers clinical through a month of introductory lectures.
Dr. McDonald (Major USAF, MC FS) is Ad- tool for fine tuning the clinical exchange.
ministrative Chief Resident of the Wright State University Psychiatry Program, Dayton, of the underpinnings of current relational logical ideas, attachment theory, and psy- emphasis on the significance of the exter- nal object spoke to an early awareness of Relationality: From
the inevitability of intersubjectivity. The bairn’s work, seeing him as offering, for 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
Perspective Book Series,
placed great importance on the relational experience. Mitchell captures Loewald’s “language transcends the distinction be- earliest days of life.” He contrasts Loe- ity, tackles the thorny issues of expres- relationship. This chapter focuses on the analyst’s “inevitable participation in the Loewald’s contribution and his impact on process” and is the most clinically prac- ItwaswithconsiderablesadnessthatI currentrelationalthinkingispresentedin ticalinitsstraightforwardlookatthean- alyst’s position vis-a`-vis the patient. He vignettes offered in each chapter are clar- minder of what he has offered us over the ifying in that they capture Mitchell’s re- past 20 years and a sad awareness that we theoretical contribution not only of Loe- 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- erarchy,” he offers a relational frame- work, a “heuristic device for locating, it offers a brief look at the far-ranging ex- kinds of explorations of different dimen- ploration that has been so characteristic sions of relationality,” which reflects or- of Mitchell’s thinking. If there is a com- plaint to be made, it is simply that at least some of these chapters call for further ex- pansion. This is particularly the case for be an effort to awaken a field that the au- themselves about the basic processes that go on between therapists and clients.
examples are self-revealing and useful in and discuss the issues of the field, Langs has divided this book into four parts. In expand and clarify the relational field is talize our thinking about psychotherapy.
ideas will be expanded by others, just as about scientific inquiry. Here Langs per- stract issue. In a manner that rings true, structures he has observed. Here he grap- he writes: “the universal dread. . . . of a 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- 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 serves on the faculty. She is on the faculty of close, Langs returns briefly to try to put the Group Training Program of the Washing- ton School of Psychiatry. Her private practice of closely related assertions about the na- ing of emotionally charged information.
His presentation is dense and detailed.
Psychotherapy and Science
He offers lists of numbered postulates.
his postulates or conclusions. Some of his names such as the “perception-analyzing points, though, seem unlikely to stand the 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” cal basis of the denial of death. This may and describes his personal tribulations as iar with literature on the social construc- psychotherapy is unlikely to survive as a apy transcripts and then subject the data distinct discipline without the “develop- 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 of theory-building and the testing of as- quently accept or reject what he purports, actively lending energy to the interaction.
sets out to describe to us the quest he has writes: “It is my fervent hope that this need for science.” For myself, it was the case that Langs’ work helped to revitalize of this finding, including ones that draw writing about Langs’ theories and his un- Dr. Lysaker is a clinical psychologist and Langs’ thoughts are nonetheless exciting Assistant Professor of Clinical Psychology, Indiana University School of Medicine, best one for introducing the clinician to the practice of group psychotherapy” and 1. Hermans HJM: Voicing the self: from in- formation processing to dialogical inter- junior colleagues.” Does that advice still the disintegration of dialogical self-struc- Systems Approach to Forming a Group.
The new title speaks to its reformulation.
A series of chapters in the second edition Strategy for Research and Analysis. NewYork, Teachers College Press, 2001 First, there have been refinements in the- ory and the infusion of intersubjectivity, Psychodynamic Group
conceive of affect as the underpinning of Psychotherapy, 3rd edition
group process. Throughout the text, clini- swer is, yes, as well as can be expected.
at times the text is so rich in theory that clinicians who know little theory may get 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 Since the first edition in 1984, this groundedinthetheoryandtechniqueof nicians can approach the same clinical foremost in the field. It is the only non- chotherapy. Certainly, Yalom’s textbook1 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 which events at one level affect another.
text adequately addresses the use of med- ication. There is a small section on com- the group as an organic entity and to his insistence that the therapist take a less in- trusive role, so as to become the group’s conductor (as in music) rather than its di- events, and the group’s history affect the “quick fix” over the use of psychotherapy process; and the relationship of affect to content and process—all the while inter- vening at a level that is near to experi- but functions within a sociocultural con- viewer stated that “this volume remains Factors is extremely rich in theory. How- a textbook nonpareil,” and that “it is the ever, the level of sophistication is so high that it might leave some novices behind.
In contrast, a later chapter on The Diffi- to the advisability of engaging with man- clear way and makes it clinically relevant.
difficulty with any of this. They can use or sampled for relevant chapters. Illustra- tive case vignettes are scattered through- underpinnings, and its complexities.
skip that earlier chapter and not be dis- whether, in their experience, using these their level of understanding. This volume scales helps secure support for treatment.
time, will come to appreciate its sophis- tions” format, describes current devel- tication, and will find fresh insight in its 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- of excellence so that now reading the vol- dant, the Strategic Guide admirably fulfills Dr. Kibel is in private practice in Valhalla, 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. chapter clarifies insurers’ conception of world of managed mental health care.
sis on functional impairment and the lack siderations on the part of care reviewers.
Psychodynamic Practice in
cians is also relegated by default to other a Managed Care
works. Its strength is greatest for the ther- Environment: A Strategic
Guide for Clinicians
the fray; and for such it is highly recom- plans in the concise, “atheoretical,” func- tional language likely to win approval of Dr. Feldman practices in Mentor, OH, as part of University Mednet and is Clinical Assistant Professor of Psychiatry at Case Western Re- Sperlingandcolleagueshavewritten orate dynamic formulations are serve University School of Medicine, Cleve- aged care the “just sufficient informa-

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