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Beyond Medication: Therapeutic Engagement and the Recovery from Psychosis. Edited by D. Garfield and D. Mackler. (Pp. 216; £19.99; ISBN: 9780415463874.) Routledge: London, 2008.

Published online by Cambridge University Press:  21 April 2010

SHERRY KIT WA CHAN
Affiliation:
(Email: kwsherry@hku.hk)
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Abstract

Type
Book Review
Copyright
Copyright © Cambridge University Press 2010

This book is one of the ISPS (The International Society for the Psychological Treatments of the Schizophrenias and Other Psychosis) series of books, with the aim of demonstrating how psychotherapy, particularly psychodynamic psychotherapy, works in the process of engagement and recovery of people with psychotic symptoms. It challenges the medical model and advocates that the establishment of a therapeutic relationship should be at the centre of the treatment process and is the most important element in recovery, even more so than pharmacological treatment.

The book is divided into three parts, each with several chapters contributed by clinicians from various settings. Most interestingly it includes the voice of those who have had first-hand experiences.

Part One focuses on the engagement of patients by emphasizing the use of different psychotherapy techniques, such as pre-therapy (technique of reflection), to ‘contact’ and strengthen the inner self of the patients. Disturbance of self was understood as one of the core psychodynamic explanations of psychotic symptoms by most authors of this book. One chapter within this part, which I found both interesting and useful, explores the crucial differences of therapeutic alliance in comparison with other forms of relationship established in clinical settings.

Part Two uses extensive case vignettes to illustrate how the changes can be brought about with the psychodynamic psychotherapy techniques employed on patients with various conditions and in different clinical settings. The description of both the analysis and the therapeutic process of each case are impressively detailed. This part demonstrates that psychotherapy can substantially improve the sense of well-being, the relationship of the patients both with others and with themselves, and the quality of life of patients. However, what is not clear throughout is the definition of psychosis. Many of the case vignettes involve patients with ill-defined psychotic symptoms, therefore the generalizability to patients with specific disorders may be in question. In fact various conditions and needs of the patient do require emphasis on the differential roles of various treatment modalities including pharmacological treatment.

Part Three is a unique part of the book where it records the experiences of those who suffered from psychosis and had been helped by psychodynamic psychotherapy. The recovery stories of both Catherine Penney and Joanne Greenberg are particularly touching. The first-hand account of patients and subjective experience of treatment is especially important and often a missing element in the description of other treatment approaches.

An interesting narrative approach has been adopted throughout the book to illustrate the understanding of psychosis from the perspective of psychodynamic psychotherapy and the ways that it could provide help to some patients. It is a powerful way to convey what could be a complex message to the reader. This book will surely be an interesting read for experienced clinicians to better understand the therapeutic effect of psychodynamic psychotherapy in some disturbed patients.