Countertransference in Couples Therapy • Marriage as a Search for Healing • Empathic Accuracy • Bipolar Disorder: A Family-Focused Treatment Approach

I have practiced, taught, and studied couples and family therapy for about 40 years. After reading Countertransference in Couples Therapy, I found myself wishing that it had been available to me when I first started on my career. It is an impressive, scholarly, and beautifully written book on an important and unjustifiably neglected topic.

The issue of countertransference is, arguably, even more important in couples therapy than in individual treatment. The patient-couple is ever alert to the danger that the therapist might favor (or disfavor), or be more identified with, one of the two partners; the wise therapist will ever be alert to the same possibility. The therapist's differential response may be a function of any combination of almost an infinity of factors and will, of necessity, determine his or her response to the couple, as well as to the outcome of the treatment.

To give one obvious example, a therapist who, all unaware, tends to behave seductively with the same-sex (or opposite-sex) member of the patient-couple, or who, conversely, disfavors the same-sex (or opposite-sex) member of the couple is a therapist who will always be in serious difficulty. The fact that the therapist is simultaneously dealing with two patients immeasurably complicates all of the problems that are associated with countertransference.

This book addresses the problem of countertransference in all of its complexity. The 18 chapters cover countertransference in cases involving parenting; rage and aggression; sexual attraction; illness; divorce; envy; and many other vital issues. The authors do a wonderful job of dealing with the material from both a theoretical and a practical, clinical point of view.

Almost all edited works have the problem of inconsistency of style. However, that is not a problem in this remarkably clearly and well-written book; it has the smoothness of expression that one associates with work by a single, experienced, and gifted author.

In this section...

Couples and family therapy are topics of books in this month's lead review, written by long-time practitioner and teacher William Vogel. Leona Bachrach discusses E. Fuller Torrey's latest book, Out of the Shadows. Later in the section, Joel Feiner wonders whether, given the unfettered flow of information in cyberspace, a book of review articles in an anachronism. Sheldon Benjamin comments on accounts of and by physicians and psychologists who experienced brain damage. The topics other books reviewed range from chronic fatigue syndrome to psychiatric genetics to writing for money in mental health.

Solomon and Siegel's Countertransference in Couples Therapy is a must-read for all therapists working with couples. I might add that its lessons are equally applicable for therapists working with families or with groups. I could not recommend it more highly; I regard it, for those in our field, as a "book of the year."

Dr. Lewis, a psychiatrist, is a distinguished teacher, researcher, and therapist whose area of specialization is marriage-family therapy. Marriage as a Search for Healing represents a cohesive, concise, thought-provoking statement of his original formulations about the theory and practice of marriage-family therapy. He has been influenced, as he writes, by "multiple perspectives… however, the theory is a derivative of psychoanalytic object relations psychology."

Lewis sees marriage as a search for a resolution of trauma that we have suffered in our families of origin, which, for any individual, results in the creation of a characteristic, repetitive pattern of interaction—a "relational structure." The resulting relational structure may be more or less adaptive, or maladaptive; it is the task of therapy to address the problems and issues that those relational structures present to the marital relationship.

The major problem that confronts any marriage, says Lewis, is how to strike a balance, for the spouses, between autonomy and intimacy. Lewis' theory is rich, and it draws on current thinking in psychology, sociology, psychiatry, and philosophy. It is well illustrated with clinical vignettes.

Most impressive, however, is that Marriage as a Search for Healing is at once profound, immensely readable, and written in plain, jargon-free, impressive English. I regard it as highly recommended reading for any mental health professional.

Empathic Accuracy, edited by William Ickes, is the kind of book that is all too rare in the sociopsychological sciences: an immensely readable, professionally highly competent tome on a topic that is inherently difficult to investigate. Do not be deceived by the soft-sounding topic: this is a book of very hard-headed theory and research, by top-notch scientists.

Ickes defines "empathic inference" as "everyday mind reading." In a neat summary, he describes the book's concern as the "evolutionary and social-developmental origins of empathic accuracy, its physiological aspects, its relation to gender and other individual difference variables, its dynamic role in the context of personal relationships, its relevance to applied domains such as clinical and counseling psychology, and its sensitivity to the processes of mental control."

The book consists of 11 chapters written by 23 authors, dealing with topics such as empathic accuracy and marital conflict resolution, empathic accuracy in a clinically relevant context, empathic accuracy in close relationships, the development of empathic accuracy, and gender differences in empathic accuracy. I found each of the chapters of interest, and all of them well balanced in their up-to-date discussions of theory and research. While I found all of the chapters rewarding, I suspect that most readers will find the chapters on the genetics and the physiological bases of psychological empathy to be especially intriguing.

I was very pleasantly surprised that the book, rare for an edited work, had a consistently even stylistic quality, almost as if it had been written by a single person.

Empathic Accuracy richly deserves to be read by workers in any of the mental health professions, as well as by workers in social and developmental psychology, sociology, family studies, and education.

In Bipolar Disorder: A Family-Focused Treatment Approach, authors Miklowitz and Goldstein present a multidisciplinary approach to the treatment of bipolar disorder that integrates family therapy and psychopharmacological intervention. Their method is creative and unique in that it is highly programmatic and yet allows for pragmatic flexibility. The treatment approach they describe cannot be simply categorized: it is nondoctrinaire, and it makes use of behavior modification as well as insight-oriented and psychoeducational techniques.

The majority of books that offer a new psychotherapeutic treatment approach usually base it entirely on clinical practice. However, this book is a result of a rigorous research program, combined with a systematically developed program of innovative clinical work that entails constant feedback from the patients and their families.

The treatment program has three phases: initial assessment; psychoeducation; and communication enhancement and problem solving, all involving the family unit. The full program involves 21 sessions spread over a nine-month period of outpatient treatment that follows the initial psychotic episode, but an abbreviated six-session treatment program is also available.

The book is beautifully written, in a style that can be fully appreciated by any trained mental health professional. It follows a format that I would strongly recommend to any author of a scientific or clinical text and that adds immeasurably to the book's readability. Each chapter begins with a section titled "Chapter Overview," which tells us exactly where the author is taking us; proceeds to the body of the chapter; and then ends with "Concluding Comments."

Bipolar Disorder: A Family-Focused Treatment Approach is richly marbled with clinical material, carefully selected to illustrate the point the authors wish to make. This is a masterful book, essential for any mental health professional who deals with patients suffering from bipolar disorder.

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