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Book Review   |    
Norman A. Clemens
Psychiatric Services 2006; doi:
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edited by Glen O. Gabbard, Judith S. Beck, and Jeremy Holmes; Oxford and New York, Oxford University Press, 2005, 552 pages, $98.50

Dr. Clemens is clinical professor of psychiatry at Case Western Reserve University, Cleveland, Ohio.

Aiming to be a definitive, comprehensive textbook of psychotherapy, this tome covers the sweep of significant psychotherapies extant today. It contains 43 chapters by authors from both sides of the Atlantic, and many of them are prominent in their particular fields. The editors take on the challenge of doing justice to each modality of psychotherapy while integrating their perspectives in certain ways and making the presentations clinically relevant.

The organization of the book is felicitous. It starts with a section on the major modalities of treatment—psychoanalytic and psychodynamic, which are regrettably not distinguished from each other; cognitive and behavioral therapies; and interpersonal individual therapies, followed by group, family, couples, and art interventions. The final chapter in the section makes a strong try at integrating the various psychotherapeutic methods while defining elements that are common to all. Every effort is made to present the evidence base, and frequent citations refer the reader to voluminous bibliographies. There is no overall index of references listed by author, and the general index is inconsistent in tracking major authors named in the text.

The second section addresses psychotherapy for numerous axis I psychiatric disorders. From here on, most chapters are coauthored by proponents of multiple therapies, especially psychodynamic and cognitive-behavioral. This usually results in subsections on one school and then the other, which is followed by some effort at an integrated discussion with conclusions at the end of each chapter.

Section III describes psychotherapy for personality disorders, which necessitates weaving together the therapeutic management of presenting symptoms and behavior with the long-term effort to modify the underlying personality structure. For example, the chapter on borderline personality disorder does a creditable job of portraying cognitive, behavioral, dialectic-behavioral, and psychoanalytic perspectives and then addresses general management issues that challenge all approaches.

Section IV divides the field in yet another direction, psychotherapy across the life cycle. The chapters on children and adolescents fill in more of the developmental perspective. Chapters on psychotherapy during the reproductive years and psychotherapy with older adults complete the spectrum.

Section V presents issues in specific populations: medical patients, issues of gender and sexual orientation, and cross-cultural psychotherapy. The final section on special topics addresses a number of important subjects. An especially provocative chapter explores the implications of research in cognitive neuroscience for cognitive behavior therapy and psychodynamic psychotherapy. A more general chapter on research is followed by discourses on psychotherapy and medication, ethics, clinical-legal issues, and supervision of psychotherapy. Brief and time-limited therapies bring this lengthy book to a close.

This book is daunting to read. It crams an enormous amount of material into 552 pages of a coffee-table-sized, attractive volume by setting it in tiny type that is conducive to eye strain. Many pages of gray type are intermittently broken up by topic headings, but the occasional chart or table is a welcome break from the onslaught of words. The writing is clear and informative but variable in its liveliness and ease of flow. Fortunately, many authors make their points with brief clinical illustrations. Covering so much territory means that this is not the definitive text from which to learn any one psychotherapy, but it makes an excellent reference and overview.




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