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Book Reviews   |    
Defiance in the Family: Finding Hope in Therapy
Reviewed by William Vogel, Ph.D.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.2.219
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by David V. Keith, Gary M. Connell, and Linda C. Connell; Philadelphia, Brunner-Routledge, 2000, 224 pages, $29.95

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The authors of this text are all highly experienced clinicians. David V. Keith, M.D., is director of family therapy and professor of family medicine and pediatrics at the State University of New York at Syracuse; Gary M. Connell, Ph.D., is professor of counseling and human development at Edinboro University in Edinboro, Pennsylvania; and Linda C. Connell, M.S.W., is director of behavioral science for the family medicine residency program at Saint Vincent Health Center in Erie, Pennsylvania.

In discussing the philosophy that guides their work, the authors write, "From our perspective, colored by existential and systemic thinking, defiance is a way of protecting and preserving the inner Self (Soul), in the face of perceived threat, from being ignored, forced into a system of values it does not trust or honor, treated like an object, admired or despised, or double bound into nonexistence. Obviously, defiance has both constructive and destructive components."

The book is divided into two sections. The first is a description of the authors' theoretical, philosophical, and clinical model, and the second presents clinical applications and discussions of theoretical interventions.

In discussing their philosophy of intervention, the authors offer 13 suggestions for working with children in family therapy. Some of these will meet with general acceptance, but some are more novel ideas that may be controversial. The first suggestion is to have a cotherapist. This may strike some readers as impractical, however, especially in these economically trying times, both for private practitioners and for clinics that are struggling to survive financially.

Other suggestions underscore their unconventional approach. For example, item 5 on their list is "Choose indifference over cajolery." "Children and adolescents," they say, "tend to be apprehensive of people who need them. Bemused indifference lays down a better track for getting to children." Suggestion number 8 is "Establish a rule that adolescents have to attend, but they don't have to talk." Number 9 is "Insult adolescents, but indirectly. Paradoxically, the insult makes them feel more secure. They are terrified by seduction."

Defiance in the Family is meant for both lay readers and professionals. Although the authors wrote it "with therapists in mind, [they] hope the book will also be useful to families."

Dr. Vogel is affiliated with the department of psychiatry at UMass Memorial Health Care in Worcester, Massachusetts.

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