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Book Reviews |
Key Words: Books Reviewed
Since the first edition in 1984, this textbook has stood as one of the foremost in the field. It is the only non-edited one on psychodynamic group psychotherapy. Certainly, Yalom's textbook1 is more popular, but his is a here-and-now approach, which eschews the value of genetic insight and group dynamics and minimizes the importance of transference. These authors recognize that the group is a multidimensional system in which events at one level affect another. Therefore, the group therapist needs to pay attention simultaneously to what is happening with the individual, among members, and with the group-as-an-entity; how genetic material, current life events, and the group's history affect the process; and the relationship of affect to content and process—all the while intervening at a level that is near to experience and also facilitates the group's development. For this reason in 1995, when reviewing the second edition (published in 1993) in these pages, this reviewer stated that "this volume remains a textbook nonpareil," and that "it is the best one for introducing the clinician to the practice of group psychotherapy" and should be used "as an aid for teaching junior colleagues." Does that advice still hold? The answer is yes, but with one proviso, to be noted below.
This edition appears eight years after the second and has been expanded by 40%. What has transpired during that period of time to warrant a new edition? Three areas of change come to mind. First, there have been refinements in theory and the infusion of intersubjectivity, an offshoot of self psychology. Second, there continue to be advances in psychopharmacology. Third, managed care has become entrenched. Has this third edition addressed those changes? The answer is, yes, as well as can be expected.
The text addresses the advances in theory in a comprehensive way. In fact, at times the text is so rich in theory that clinicians who know little theory may get lost in its pages. The foregoing will indicate for whom this text is best suited. It is ideal for the clinician who is well grounded in the theory and technique of individual psychodynamic psychotherapy and wants to learn group psychotherapy. It is perfect for the group psychotherapist who wants to learn psychodynamic group psychotherapy. The novice may have some difficulty with those sections steeped in cutting-edge theory. But that allows the student to reread the text and glean its richness as he or she matures professionally.
Like the second edition, the present text adequately addresses the use of medication. There is a small section on combining group psychotherapy with pharmacotherapy. But the current preference by so many for medication as a "quick fix" over the use of psychotherapy cannot be adequately discussed in such a volume.
The text refers to the challenges, or perhaps the problems, caused by managed care. These are addressed throughout. There is no chapter on how to manage managed care, or, more simply, how to beat the system. However, a section from the second edition on Time-Limited Psychodynamic Therapy has been expanded into a full chapter.
The third edition is both a revision and an expansion of the second. The former chapter on Group Composition has been revised and reconceptualized as A Systems Approach to Forming a Group. The new title speaks to its reformulation. A series of chapters in the second edition on Special Technical Considerations has been given new identity, and thereby greater focus. The one on Expressions of Affect has been enriched so that the reader can appreciate that the authors conceive of affect as the underpinning of group process. Throughout the text, clinical examples are added and theory expanded and updated. A new chapter is included that consists of an extended clinical example with running commentaries by both authors. Through that chapter, the reader can come to appreciate how a clinician conceives of the group's process and how he or she works with the group. More important, the reader can see how two experienced clinicians can approach the same clinical situation differently.
The second chapter is about the history of group psychotherapy. The authors do a nice job of acquainting the reader with some of the seminal contributions. However, the work of Foulkes is presented on an equal footing with the work of others. Foulkes's "group analysis" is the dominant psychodynamic approach outside the United States and Canada. More attention should have been paid to his unique way of viewing the group as an organic entity and to his insistence that the therapist take a less intrusive role, so as to become the group's conductor (as in music) rather than its director. In one respect, the authors are closer to group analysis than they acknowledge. They do an excellent job of reminding the reader that the group is not merely a dynamic entity of its own, but functions within a sociocultural context that influences its processes.
An early chapter on Therapeutic Factors is extremely rich in theory. However, the level of sophistication is so high that it might leave some novices behind. In contrast, a later chapter on The Difficult Patient explains theory in a very clear way and makes it clinically relevant. Well-grounded clinicians will not have difficulty with any of this. They can use the volume to learn about the pragmatics of group psychotherapy, its conceptual underpinnings, and its complexities. Clinical novices should be advised to skip that earlier chapter and not be discouraged if some of the theory is beyond their level of understanding. This volume can be read over and over by the beginner, who will learn more from it each time, will come to appreciate its sophistication, and will find fresh insight in its pages. In short, the authors have taken the previous edition and raised its level of excellence so that now reading the volume has become a comprehensive learning experience.
FOOTNOTES
Dr. Kibel is in private practice in Valhalla, NY, where he is also Clinical Professor of Psychiatry at New York Medical College.
REFERENCES
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