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Book Review   |    
Psychodynamic Concepts in General Psychiatry
Lauren Jacker, M.D.
Psychiatric Services 1998; doi:
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edited by Harvey J. Schwartz, M.D., with Efrain Bleiberg, M.D., and Sidney H. Weissman, M.D.; Washington, D.C., American Psychiatric Press, 1995, 497 pages, $67.50

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Psychodynamic Concepts in General Psychiatry is an elegant reference book, quick to dispel the notion that psychodynamic concepts have limited, if any, application to general psychiatry. The book systematically debunks this myth. It is well organized, generally well written, incredibly thorough, and loaded with cogent clinical examples and vignettes. Each of the three dozen analytically trained contributors is an experienced clinician and ably shares his or her expertise.

Psychodynamic Concepts appropriately begins with the basic concepts. It briefly traces the development of psychoanalytic thought from Joseph Breuer and Sigmund Freud through the object relations and self psychology schools of thought. The basic concepts are clearly explained and smoothly lead to the conclusion that the psychodynamic model provides a useful framework for understanding human behavior and formulating an appropriate treatment plan.

The second section demonstrates the clinical usefulness of a psychodynamic understanding of patients in a wide variety of treatment settings, including a general medical hospital, an emergency room, a psychiatric ward, a community mental health clinic, and a managed care setting.

The third section is encyclopedic in its coverage of 15 clinical syndromes or types of patients, encompassing, among others, the psychotic patient, the narcissistic patient, the patient with a history of childhood sexual abuse, and the patient with bulimia. Each chapter is rich with clinical material.

The fourth section covers a few special topics, including the psychology of prescribing and taking medications. The chapter on this topic is especially helpful for today's increasingly frequent arrangement of dual therapists, the psychotherapist and the consultant psychopharmacologist.

Because the book is a product of many contributors, it does not always flow smoothly from chapter to chapter; the chapters are not equally well written, nor do they all presuppose the same degree of familiarity with psychodynamic concepts. However, the book is not meant to be read straight through. It is an invaluable reference and should be picked up by a psychiatric resident or new practitioner when he or she changes treatment settings, and by all practitioners when they are faced with a challenging patient or a treatment impasse.

Dr. Jacker is clinical assistant professor of psychiatry at Finch University of the Health Sciences and the Chicago Medical School.




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