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Book Reviews   |    
Clinical Epiphanies in Marital and Family Therapy: A Practitioner's Casebook of Therapeutic Insights, Perceptions, and Breakthroughs ? Divorce, Family Structure, and the Academic Success of Children ? Living on the Razor's Edge: Solution-Oriented Brief Family Therapy With Self-Harming Adolescents
Reviewed by William Vogel, Ph.D.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.12.1636
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edited by David A. Baptiste Jr.; New York, Haworth Clinical Practice Press, 2002, 429 pages, $34.95 • by William Jeynes, Ph.D.; New York, Haworth Press, 2002, 205 pages, $24.95 • by Matthew D. Selekman; New York, W. W. Norton & Company, 2002, 223 pages, $32

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Three books on family therapy are reviewed here. The editor of the first, David A. Baptiste, is a psychologist who specializes in family and marriage and family therapy. Clinical Epiphanies in Marital and Family Therapy is, apparently, his first book—and what a book! It is unlike any other book I have reviewed in my many years as a reviewer.

According to the book's foreword, the target audience is graduate students. However, to my mind, the audience described in the preface is more correct: "There is something for every marriage and family therapist (and other therapists) in this book, regardless of his or her particular theoretical orientation to treating families or whether he or she is an advanced or beginning therapist, teacher, or student of marriage or family therapy."

An epiphany, as defined by the Random House Unabridged Dictionary, is "a sudden, intuitive perception of or insight into the reality or essential meaning of something, usually initiated by some homely, commonplace occurrence or experience." The theme of clinical epiphanies is the link among 16 case studies, contributed by a total of 20 therapists differing in age, training, experience, and theoretic identification: "most of the critical incidents occurred serendipitously, rather than as part of a treatment plan."

In each case, the therapeutic insight helped unravel some clinical puzzle or unclarity and thereby became central to the therapist's understanding of the case and to his or her ability to help the patient. Thus the book's 16 chapters read like 16 mystery stories, each of which, like any really good mystery story, is exceedingly difficult to put down until it has been read in its entirety. To add to the enjoyment, each of the "stories" is followed by two commentaries by experienced and distinguished practitioners, who offer criticism, praise, or speculation as to how they personally might have dealt with the case.

All the cases and commentaries are organized in a format suggested by Baptiste. They are uniformly well written. There is much that is unique and refreshing about Clinical Epiphanies in Marital and Family Therapy, not least of which is the self-revelatory, nondefensive style of the therapists, who, in discussing each case, share their personal anxieties, doubts, and fears. (In the first chapter, Baptiste describes how he once feared the possibility that his unconventional therapeutic moves could endanger his entire career.)

Do yourself a favor and buy this book—it's unlike any other recent publication.

The author of the second book reviewed here, William Jeynes, is a distinguished social scientist with impressive research credentials in the area of the effect of divorce and family structure on children's academic achievement.

The first two chapters of Divorce, Family Structure, and the Academic Success of Children review the literature, and the next three chapters discuss methodologic issues related to the effect of divorce on the academic achievement of children. The author's thesis is that controversial findings in this area essentially relate to generally unrecognized methodologic issues such as failure to control for socioeconomic status; results vary depending on whether socioeconomic status is considered. Jeynes argues that many variables, in addition to socioeconomic status, affect the impact of divorce on children's academic achievement, including factors that are too often ignored—for example, whether the custodial parent remarries, ethnic background, postdivorce geographic mobility, and whether the children live with a birth parent.

Some of the findings discussed in this book will raise eyebrows among some readers, such as the finding that the remarriage of the custodial parent tends to have a negative impact on the academic achievement of the children. However, this finding will be less surprising to family therapists who work with such families, who will be keenly aware of the problems that occur when children have difficulty coming to grips with their parents' divorce and will also be aware of the children's subsequent difficulty in dealing with a living situation that includes the custodial parent's new mate.

Although this book will be of interest to anyone in the family or marital therapy field, it will probably be of greatest interest to those who have a strong background in statistics and research methodology.

The third book, Living on the Razor's Edge, is a scholarly work on the diagnosis and treatment of self-harming adolescents. The book's author, Matthew D. Selekman, is a highly distinguished practitioner and scholar whose specialty is solution-oriented brief family therapy with families who have young children and adolescents.

One of the features of Selekman's book is its truly comprehensive, splendid analysis of the literature on the topic—the best I have seen. Although the author describes his work as "brief, solution oriented," he is, in fact, not constricted by any single, sharply defined theoretical focus. He uses strategies and techniques from a wide variety of sources in an effort to keep his work "brief and problem focused"; his work is, in fact, eclectic in the very best, most complimentary sense of that term. For example, his system includes "the one-person family therapy approach . . . a viable therapeutic option with older adolescents wishing to address their family or individual issues alone."

Above all, the book is scholarly in a way that many books written by therapists, describing their work, are not. The author discusses his work in the context of contemporary family therapy as a whole. He concludes with a "coda" in which he cites a review of solution-focused brief therapy by Gingerich and Eisengart, to the effect that "only five studies [were] well-controlled and showed positive treatment outcomes. Only one of those studies, however, was with adolescents." It is always refreshing to find a worker who is so aware of all that remains to be done beyond his or her own work.

Living on the Razor's Edge is wonderfully well written and valuable, and I recommend it to all mental health workers, not just those in the family therapy field. It is a model of how to describe a model.

Dr. Vogel is affiliated with UMass Memorial Health Care in Worcester, Massachusetts.

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