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Book Review   |    
How to Practice Brief Psychodynamic Psychotherapy: The Core Conflictual Relationship Theme Method
Robert Andre Kimmich, M.D.
Psychiatric Services 1999; doi:
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by Howard E. Book, M.D., D.Psych.; Washington, D.C., American Psychological Association, 1998, 181 pages, $39.95

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This slim volume should be read by every professional who practices psychotherapy. The importance of the work lies in its intimate style and inside view of the psychotherapeutic dyad. One feels as if in the presence of a wise and skilled psychiatrist who is talking about his work to a fellow colleague, the reader. Dr. Book does not preach or harangue, but elucidates the therapeutic interchange. Although the author calls his book a manual, its strength lies in his clarification of why treatment in his hands proceeds the way it does.

Dr. Book is an associate professor of psychiatry at the University of Toronto Faculty of Medicine and is also in private practice. He has specialized in developing and teaching brief psychodynamic psychotherapy. His text is intended as a practical, step-by-step manual for teaching therapists of various disciplines the core conflictual relationship theme (CCRT) method of brief psychotherapy developed by Lester Luborsky, Ph.D., and others.

The introductory chapter consists of 18 pages of an outstanding summary of principles of psychodynamic psychotherapy. It can apply to any school of dynamic therapy. It takes an expert to boil down so much important material into a readable and concise form. Readers should not skip this section.

The CCRT method is set forth in detail in part 1. The author states the goals as follows: "Brief psychodynamic psychotherapy has as its goals symptom relief and limited, though significant, character change attained through a finite number of sessions." He goes on to say, "As with all dynamic psychotherapies, including long-term psychotherapy and psychoanalysis, the practice of brief psychodynamic psychotherapy requires the therapist to blend expressive and supportive activities."

Dr. Book explains that patients need to be suited to the method, with adequate ego strength and verbal ability, and must able to work within the weekly, 16-session format specified for CCRT. The 16-session limit is not carved in granite but provides the chronological and technical context. The author discusses when and how to deviate from the time limit.

A major component of the method is to choose one specific, important, repetitive conflictual relationship problem on which to focus treatment. The therapist conceptualizes this problem after a thorough evaluation and formulation.

Part 1 also deals with developing the focus of the CCRT, or the theme of the brief psychodynamic therapy. Even though the details are common sense to an experienced therapist, it is fascinating to follow Dr. Book's treatment examples as they unfold. They are complete with commentary, including discussion of transference and countertransference and repetition compulsion. I was a little put off by the codification of conflict components—for instance, RO for response from the other, RE for relationship episode, W for wish, and RS for response from the staff—but one catches on. The ideas are quite useful.

Part 2 is the engaging verbatim transcription of a course of therapy with one of the author's patients. Dr. Book treats us to his own running commentary to the transcription, in an engrossing discussion of the technical hows and whys. It is hard to put this excellent book down.

How to Practice Brief Psychodynamic Psychotherapy will be interesting reading for the trained and accomplished psychotherapist, but also of great value to the advanced trainee who has some basic knowledge of psychodynamic concepts. Another audience for this fine exposition would be psychiatric residency training directors or other advanced professionals in psychotherapy training programs.

Dr. Book does a masterful job of meeting the objectives of this work and certainly demonstrates his own skill in the process. Useful references are also supplied. Even though he sets out to provide a manual on brief psychodynamic psychotherapy, he succeeds more broadly in emphasizing skills needed for psychotherapy of any duration.

Dr. Kimmich is in the private practice of psychiatry in San Francisco and is a member of the American Psychiatric Association's commission on psychotherapy by psychiatrists.

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