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Book Reviews |
Key Words: Books Reviewed
This volume performs an enormous service for all clinicians who treat traumatized patients or are involved with individuals who have suffered traumas. It is comprehensive, exhaustively researched, and carefully edited. Although it clearly is in the tradition of cognitive-behavioral therapy (CBT) and is best used as such, it makes ample reference to historical and descriptive literature and to contemporary psychodynamically oriented clinicians, such as van der Kolk, Herman, and Lindy. Perhaps of greatest use, it explores a number of topics of special interest to those who treat traumatized patients and offers detailed treatment recommendations for highly specific situations.
The book is divided into three sections: Theory and Empirical Foundations, Treatment Domains, and Trauma across the Lifespan. Although the second section is by far the largest and the most likely to be of use to the average practitioner, the first section offers excellent reviews of approaches to behavioral formulation (Naugle and Follette) and of current outcome literature (Blake and Sonnenberg). The third section addresses applications of basic CBT trauma strategies to children (O'Donohue et al.) and to older adults (Hyer and Woods).
The meat and potatoes of this volume is in the second section, where a number of authors explore war trauma, sexual trauma (including revictimization), trauma-related guilt and anger, dissociation, comorbid substance abuse, the impact of traumatic experiences on couples, and other related topics. Some of these chapters are both specific and ingenious—for instance Wagner and Linehan's reworking of psychodynamic approaches to dissociation into a behavioral formulation, which meets current CBT standards of rigor and operationalization while not disconnecting from previous work in this area. Kubany has contributed an excellent chapter on dysfunctional cognitions of guilt and how to approach them. And Cloitre describes her approach to sexual revictimization in hair-raising but exquisitely sensitive and clinically useful terms.
A clinician not trained in CBT will be able to pick up on a number of basic cognitive-behavioral strategies in this book that will serve as organizing principles for further exploration. Themes such as hierarchical approach to fear stimuli, interpersonal effectiveness training, the importance of behavioral analysis as a guide to treatment, and decisions about imaginal versus in vivo exposure appear frequently enough that a motivated non–behaviorally trained reader will absorb many basic principles of cognitive-behavioral formulation and treatment planning almost without effort by simply reading this book carefully. Such a reader will also note the frequency with which some more typically dynamic concepts, such as alexithymia, are referenced, so that the book will not feel like foreign territory.
In fact, if there is one major problem with this volume, it is repetition. The chapters by Walser and Hayes on acceptance and by Kohlenberg and Tsai on healing within the therapeutic relationship, although fine works on their own, overlap with a number of others in the volume. There also is a tendency to describe therapies as if each is a brand new, separate modality (e.g., Kohlenberg and Tsai's "functional analytic psychotherapy," Compton and Follette's descriptions of "traditional behavioral couple therapy" and "integrative couple therapy," and Walser and Hayes's "acceptance and commitment therapy." When added to the better known dialectical behavior therapy and eye movement desensitization and reprocessing, these create the impression that cognitive-behavior therapy is merely a collection of idiosyncratic techniques that are proprietary to their creators; this mystifies, rather than illuminates, the principles informing the very methods that are so well described elsewhere in this volume.
One other critique is a small one concerning a portion of a dialogue that some readers may find disturbing. Kohlenberg and Tsai describe patient–therapist dialogue in great detail. In general, this is helpful; but at one point the therapist asks the patient to "take in my love for you" (p. 318). Although probably not absolutely contraindicated, such statements would be found overly stimulating or boundary-confusing by many clinicians and patients, particularly given the overlap between some patients described in this book and those with borderline personality disorder.
But in general this is an extremely well-written volume that is grounded in theory and outcome research and also immediately translatable into clinical practice. The detail in which protocols and interventions are described adds significantly to its worth. Clinicians and academicians whose work involves community mental health, forensics, or disempowered populations of any kind will find it invaluable, as will anyone who speculates on the nature of catastrophe, misfortune, and evil.
Footnotes
Dr. Goisman is Director, Outpatient Training and Research, Massachusetts Mental Health Center, and Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA.
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