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Book Reviews |
Key Words: Books Reviewed
The highly complex process of psychotherapy can be viewed as consisting of two major parts: the relationship and the technique. The relationship part is hard to define, even harder to grasp clinically, and difficult to study empirically. Although there are different schools of psychotherapy, few would disagree that a good therapeutic relationship is a necessary condition for the favorable outcome of psychotherapy. The central focus of this book is, in the authors' words, "what that relationship consists of, how it develops during treatment, how it varies for different systems of psychotherapy, how it operates in and affects treatment." As they have acknowledged, the book is an extension of the theoretical formulations on psychotherapy relationship originally developed by Gelso and Carter.1,2 The focus is on individual psychotherapy, although the discussions and the propositions can be generalizable to other formats like group or family work.
In today's world of evidenced-based treatments and, in the absence of evidence, expert opinions, the authors have done a fairly good job of combining theory and practice with research. They start by defining a successful psychotherapy relationship and discuss how such a relationship is defined in four major schools of psychotherapy: psychoanalytic, cognitive-behavioral, humanistic-existential, and feminist. In each of these sections, the authors draw upon both the literature and their own clinical experience.
The first half of the book is focused on the components of the psychotherapy relationship: 1) the working alliance, 2) the "unrealistic" relationship in psychotherapy (transference and countertransference), and 3) the "real" relationship. The authors see all psychotherapy relationships as consisting of these three components. After introducing the three components at length, the authors examine and explore how each of them operates in different types and schools of psychotherapy. They further discuss the interaction of these components with each other and with therapists' techniques as the therapy progresses. Throughout, they discuss how the propositions are informed by theory, practice, and research.
This first section prepares the reader to delve into the second half of the book, in which the authors discuss and analyze the conceptualizations of psychotherapy relationship in the four major theoretical clusters. With each, they approach this on four dimensions: 1) whether the relationship is seen as central or otherwise ("as an end in itself or as a means to an end"); 2) whether the relationship is seen as curative in itself; 3) the relative emphases on "real" relationship versus transference and countertransference; and 4) the therapist's conceptualization and use of power in the relationship.
A particular strength lies in the effort to bring in findings from research, when it exists. In the first section of the book the authors review the available empirical research findings on the definition of psychotherapy relationship, the importance of working alliance to treatment outcome, and the area of transference configuration. Along with the evidence, they present their own views, developed from their practice and supervision of psychotherapy, and provide case material to clarify certain points. This dual emphasis on science and practice is, I think, the real strength of this book.
An area where Gelso and Hayes's book seems to differ from most others on psychotherapy is in the authors' presentation of feminist therapy as one of the four main clusters of psychotherapy. They do raise the question of whether feminist therapy is a unique theoretical approach to clinical work or a system that possesses tenets of its own but also shares attributes with other approaches and hence can be combined with them. After discussing related aspects, the authors conclude that feminist therapy "constitutes a singular approach to therapy that nonetheless may be integrated with other distinct theoretical systems." This conclusion seems less than strongly supportive of their including feminist therapy as one of the four major clusters of psychotherapy. It also appears to be an all-accommodating conclusion, which is, perhaps, more reflective of the field than of one particular book or opinion.
Overall, the book seems theoretically balanced and fair; there is no apparent leaning toward one cluster of psychotherapy or antagonism toward others. The authors' expressed hope in writing this book was "to benefit both science and practice in the field of psychotherapy." I think they certainly have done that.
Footnotes
Dr. Saeed is Associate Professor and Chairman of the Department of Psychiatry and Behavioral Medicine at the University of Illinois College of Medicine at Peoria, IL.
References
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