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Book Review   |    
Sarah Guzofski
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.5.582
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by Theodore Millon and Seth Grossman; Hoboken, New Jersey, John Wiley and Sons, 2007, 288 pages, $49.95 softcover

Dr. Guzofski is a psychiatry resident at the University of Massachusetts Medical School, Worcester.

The authors open Resolving Difficult Clinical Situations with the question "Would it not be a great step forward in our field if diagnosis or psychological assessment . . . actually pointed clearly to what a clinician should do in therapy?" This book, the first of three volumes by these authors, begins with the authors' critique of the usual approach to psychotherapy, describing the limitations of applying a single school of psychotherapy to every patient without considering the whole person. They propose personalized psychotherapy as an alternative. Personalized psychotherapy focuses on each patient's unique personality attributes and considers how these contribute to the clinical picture before determination of which treatment methods to apply. The text features examples of how taking a systematic look at the patient's personality traits, characteristic behavior, and intrapsychic mechanisms and content will guide understanding of the individual patient and his or her symptoms.

The second half of the book includes chapters on the personalized therapy of five different categories of axis I—related symptoms: mood-related, acute, posttraumatic, and general anxiety syndromes; anxiety-related psychological syndromes; anxiety-related physical syndromes; and cognitive dysfunction. The chapters are filled with detailed, vivid case examples that illustrate how a given syndrome, such as dysthymia, is expressed within the context of a given personality. A brief formulation of the case is offered, with a focus on the adaptive and maladaptive role of those specific personality traits. A treatment approach, including reference to specific schools and therapeutic techniques, is described along with the desired outcome. For example, a case of an individual with anxiety disorder and with shy or avoidant personality traits describes his successful treatment as built upon a progression from relaxation training to interpersonal and cognitive-behavioral techniques. This is contrasted to the presentation and treatment of the same syndrome in an individual with a conscientious or compulsive personality.

Both authors are leading experts in the areas of personality assessments. Theodore Millon is a leading expert in the area of personality and personality disorders and is currently the dean and scientific director of the Institute for Advanced Studies in Personality and Psychopathology. Seth Grossman has written extensively in the area of personality, often collaborating with Millon. The have authored two additional books in this series: Overcoming Resistant Personality Disorders and Moderating Severe Personality Disorders.

Resolving Difficult Clinical Situations is a valuable tool for therapists at any stage of experience who want to take a broad look at how to apply psychotherapy in a more individualized manner with personality features clearly in mind. The case illustrations, formulations, and treatment guidelines are sufficiently detailed to provide a starting point for shaping your own work as a therapist and references guide the reader to more detailed instruction. The initial, theoretical part of the book that describes the utility and basis of personalized psychotherapy is dense reading at times, particularly for people less familiar with personality assessment, but it does provide a strong argument and theoretical framework for the utility of this intervention.




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