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Book Review: Treating Couples and Families   |    
Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives • Essential Skills in Family Therapy: From the First Interview to Termination • Burnout in Families: The Systemic Costs of Caring • The Practical Practice of Marriage and Family Therapy: Things My Training Supervisor Never Told Me
William Vogel, Ph.D.
Psychiatric Services 1999; doi:
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edited by Frank M. Dattilio; New York City, Guilford Press, 1998, 486 pages, $44 • by JoEllen Patterson, Lee Williams, Claudia Grauf-Grounds, and Larry Chamow; New York City, Guilford Press, 1998, 250 pages, $30 • edited by Charles R. Figley, Ph.D.; Boca Raton, Florida, CRC Press, 1998, 228 pages, $39.95 • by Mark Odell, Ph.D., and Charles E. Campbell, M.Ed.; Binghamton, New York, Haworth Press, 1998, 276 pages, $49.95 hardcover, $24.95 softcover

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It is, unhappily, all too rare to find a book in the family and marriage therapy field that is, at the same time, well written, instructive and enlightening, and a great deal of pleasure to read. Case Studies in Couple and Family Therapy is such a book.

The editor, Dr. Dattilio, is a family therapist who espouses a cognitive-behavioral approach. He has invited advocates of 17 different theoretical approaches to contribute a chapter to the book. Each chapter follows the same formula.

First, the authors present their particular theoretical point of view. Second, they present a case that incorporates their particular theoretical and methodological ideas. Dattilio intersperses each presentation with critiques, from the cognitive-behavioral point of view, of what is taking place. Finally, the authors of the chapter respond to Dattilio's critique.

Among the theoretical systems represented are the cognitive-behavioral, behavioral, structural, strategic, contextual, symbolic-experiential, solution-focused, transgenerational, cross- cultural, feminist, and psychoanalytic. The case presentations of the majority, but not all, of the writers are faithful to the theories and methodologies they represent; that is, their methods and narratives generally follow the system to which they declare allegiance.

Some of the chapter authors are well known; others are less so. Nevertheless, the quality of the writing is almost uniformly exceptional. It is unusual to find a book with so many authors that maintains such a high standard of excellence.

The cases are of interest and the exchange of views is instructive, and sometimes surprising. For example, to quote from Fred Sander's reply to Dattilio's critique of Sander's presentation on psychoanalytic couple therapy: "Dr. Dattilio and I apparently agree … that the psychoanalytic and cognitive-behavioral approaches are antithetical… . After reading his largely positive comments, I began to wonder whether I was more of a behaviorist and/or he more analytic than I thought!"

The book reminds me of a classic study carried out some 50 years ago in Carl Rogers' laboratory in which Rogers concluded that there is a very considerable similarity among experienced therapists of very different theoretical schools in the actual methods and techniques they employ; the differences lie less in their methods than in the ideas and language they use to characterize and describe their work.

Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives is a book well worth the purchase. I recommend it to all mental health professionals.

Essential Skills in Family Therapy is a well-written primer, designed as a text for the beginning family therapist. The book does what it sets out to do, and does it very well. The authors deal, carefully and systematically, with the principal issues that novices face. They include chapters on the challenges for beginners (managing one's own anxiety, issues of confidence, obsessing about one's clinical work); what to do before the initial interview; the initial interview; assessment; developing treatment plans; working with couples, families, and children; getting "unstuck" in therapy; and termination.

I especially appreciate the style and quality of the writing. It is collegial and never patronizing; a danger to which these authors never fall prey is that of "talking down" to the new student.

I highly recommend Essential Skills in Family Therapy as a primer for the new therapist and the new student. I have seen introductory texts I liked as well, but none I thought to be superior to this one.

Charles R. Figley, professor in a marriage and family therapy training program at Florida State University, is the editor of Burnout in Families,which is the first in a book series called Innovations in Psychology.

Dr. Figley is well known for his studies of posttraumatic stress disorder and of the effects of stress, especially the impact of stressors on families. He defines family burnout as "the breakdown of the family members' collective commitment to each other and a refusal to work together in harmony as a function of some crisis or traumatic event or series of crises or events that leave members emotionally exhausted and disillusioned."

The book consists of eight chapters by different contributors. It provides a comprehensive and exhaustive, almost encyclopedic, series of reviews of the literature covering the effects of the complete range of stressors on families as a whole and on categories of family members in particular—for example, on sons, daughters, husbands, wives, and parents. Among the stressors studied are accidents, illness, death, substance abuse, natural disasters, war, the Holocaust, concentration camp experiences, kidnapping, fatigue, rape, homicide, extramarital affairs, child abuse, spousal abuse, sexual abuse, and many others. Treatment programs are extensively discussed.

Burnout in Families is well written and scholarly. It will be valuable as a resource work for the scholar and researcher in family studies, and for clinicians who want to acquaint themselves with the impact of specific stressors on family members and on classes of family members.

The authors of The Practical Practice of Marriage and Family Therapy: Things My Training Supervisor Never Told Me present it as a manual to introduce beginning therapists to the "nuts-and-bolts sorts of problems endemic to the practice [emphasis theirs] of family therapy in the real world." It has 18 chapters dealing with every conceivable aspect of practice in the field.

The intention is to communicate to the beginner things that are essential to know but were not taught in school. However, that is what the book does not do. A major problem is that many, if not most, of the topics the authors discuss were, or should have been, taught, and thoroughly learned, in any accredited program—for example, case formulation, engaging families in therapy, case management, and dealing with value conflicts and dual-relationship issues.

A second major problem is that in the attempt to cover every conceivable aspect of practice in 276 pages, too many issues that should be dealt with in some depth are treated superficially. For example, there is a section on "firing clients," such as those who don't pay their bills. The discussion gives no indication that "firing clients" is a dangerous legal minefield that, unless very carefully done, might well involve a practitioner in a malpractice suit for abandonment. Once you have accepted a patient under your care, you are legally responsible for that person's necessary care, and you cannot terminate treatment without making provision for continuation of necessary care by someone other than yourself.

To be fair, the book is meant for the beginner. As someone who has been 40 years in the field, it is difficult for me to read Practical Practice with a beginner's eye; certainly, the acid test would be how valuable a beginner finds it.

Dr. Vogel is associate professor of psychiatry at the University of Massachusetts Medical School in Worcester.




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