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Book Reviews |
Key Words: Books Reviewed
This volume gives to psychotherapy what a basic life support manual gives to the first responder: an easy way to conceptualize patients' problems and start immediate treatment. Dr. Goldstein is well qualified to provide such a manual. He is on the faculty of the Baltimore-Washington Institute for Psychoanalysis, where he is director of their Adult Psychotherapy Training Program. He is also a Clinical Professor of Psychiatry at the Georgetown University Medical Center and currently practices psychotherapy and psychoanalysis. He is extensively published and has taught many the art of psychotherapy.
This book is the second edition and differs from the first in the addition of a chapter describing newer schools of psychotherapy. The update allows the novice to understand how the approach illustrated fits within the context of the contemporary schools. The concise, easy-to-follow format uses a question-and-answer style. The most pertinent concepts and terms used are described in an appendix on ego functions.
The layout is all business. The author wastes no words in explaining the basic questions of psychotherapy, and he covers more topics and in greater depth than one would have thought possible in a book of this size. Fourteen chapters flow from beginning to end along the line of questions most therapists should have before seeing their first patient. His first chapters are the equivalent of "Airway, Breathing and Circulation" for psychotherapy. This section gives the main elements of what needs to be done immediately to size up the debilities of patients and quickly categorize them by ego strength assessment into a normal-neurotic, narcissistic, borderline, or psychotic organization.
In these early chapters Goldstein gives a description of the varied backgrounds of patients and therapists and raises questions of the motivations of both for entering therapy. His directness in addressing some therapists' motivations for entering the field is unexpected but well employed. In light of this initial triage, he then discusses the basic life support measures—the spectrum of psychotherapy from analytic to supportive—using the degree of interpreted transference and insight as a measure of differentiation. Cognitive therapy is also given attention as an alternative treatment. The next four chapters cover issues to be pondered before meeting the patient. The degree of therapist's expressed emotion, office arrangement, initial phone contact, and the contract with the patient are all discussed, leading to a more in-depth question-and-answer coverage of therapeutic alliance and the role of transference.
Following a brief lesson on basic strategies, Goldstein leads the students through several techniques of psychotherapeutic intervention. Along the way he gives the beginning therapist a candid look at some of his early follies and difficult patients. Recounting confrontations with racism, sexism, and attacks of incompetence, he demonstrates his personal trials without resorting to long narratives. At times his short descriptions create such a vivid picture that chuckles and outright laughter are unavoidable. The examples capture the worst fears of beginning therapists and make it clear that the feared situations, if encountered, can be overcome and dealt with therapeutically. A brief chapter on termination is included for the sake of completeness. It is only three pages—long enough to stress its importance but meant for nothing more. Finally, contemporary strategies, from the Relational School to Self Psychology, are discussed. The novice will find the appendix on ego functions very helpful.
In the question-and-answer format, there is never time to get bored with one topic. This book, though, in no way resembles a mere series of bullet statements. The author writes engagingly, with seriousness as well as humor; throughout, his voice is both wise and concise. The beginning therapist reading this book will have the tools illustrated for making the four basic diagnostic groupings—and thus will be already far ahead of therapists with more experience who may suffer from lack of direction. For those already in the field who may be having trouble making quick and accurate conceptualizations, this book is also helpful. The framework set forth provides a way to organize further readings on various topics in psychotherapy, making a complex and growing field more manageable. Any new or inexperienced therapist will come away feeling more secure in his or her ability to conduct therapy and will be better able to do so. This is a three-evening book that conveys the practical information often not gathered through a month of introductory lectures.
FOOTNOTES
Dr. McDonald (Major USAF, MC FS) is Administrative Chief Resident of the Wright State University Psychiatry Program, Dayton, OH.
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