Book reviews

Peter E. Hodgkinson and Michael Stewart (1998) A Handbook of Post-Disaster Psychosocial Aftercare, 2nd edn, London: Routledge, $15.99 (pb)

Caroline Garland (ed.) (1998) Understanding Trauma: A Psychoanalytic Approach, London: Duckworth, Tavistock Clinic Series, $14.95 (pb)

Claudio Neri (1998) Group, preface by Parthenope Bion Talamo, foreword by Malcolm Pines, London: Jessica Kingsley, $16.95

Robert L. Perkinson (1997) Chemical Dependency Counseling: A Practical Guide, London: Sage, $24

Mary Turner (1998) Talking with Children and Young People about Death and Dying: A Workbook, illustrated by Bob Thomas, London: Jessica Kingsley, $17.95

Jan Wiener and Mannie Sher (1998) Counselling and Psychotherapy in Primary Health Care: A Psychodynamic Approach, London: Macmillan, $11.99 (pb)

Melanie Hart and James Loader (eds) (1998) Generations: Poems between Fathers, Mothers, Daughters, Sons, London: Penguin, $14.99

David Kennard and Neil Small (eds) (1997) Living Together, London: Quartet, $9.00

Sally Skaife and Val Huet (1998) Art Psychotherapy Groups: Between Pictures and Words, London: Routledge, $47.50 (hb), $15.99 (pb)     

Relational Psychoanalysis Potential Usefulness with Black South African Clients

The aim of this article is to suggest that relational psychoanalysis may be a useful approach for working with clients from indigenous African cultures. In particular, the article considers the utility of relational psychoanalysis to understanding and enacting the therapeutic relationship with clients from an indigenous African cultural background. The notion of “we” self from the perspective of African cultures is a case in point for possible compatibility between relational psychoanalysis and black clients who come from background that place a high value on communal or “we” selves. An integrative therapy that combines African worldviews and relational psychoanalysis is possible.     

Time and again: Intermittent Brief Dynamic Therapy

Abstract

The author notes that in many of the settings in which Brief Therapy takes place that a client may return after the ending for a further series of sessions. Time-limited therapy has placed an emphasis upon the termination phase of the therapy and linked this to the process of individuation and separation. Such an approach, as articulated by Mann (1973 Mann, J. 1973. Time-limited psychotherapy, Cambridge, MA: Harvard University Press.  [Google Scholar]), which draws conceptually from the work of Winnicott (1965 Winnicott, D. W. 1965. The maturational processes and the facilitating environment, London: Hogarth Press.  [Google Scholar]) and the notion that the infant achieves unit status from the original undifferentiated merger with the mother, is not easily compatible with Intermittent Brief Dynamic Therapy. The work of attachment theorists and Stern (1985 Stern, D. N. 1985. The interpersonal world of the infant, New York: Basic Books.  [Google Scholar]) provide an alternative basis upon which to conceive of the development of the infant. While emphasizing the importance of attending to affects at points of separation and ending, as is evidenced in the work of Della Selva (2004 Della, Selva P. C. 2004. Intensive short-term dynamic psychotherapy, London: Karnac.  [Google Scholar]), such a framework is more readily compatible with the development of Intermittent Therapy, and with the realities of the settings in which much brief work takes place. The author also comments upon the flexibility inherent in Winnicott's own practice of brief consultations, and the implications of this for the development of Intermittent Brief Dynamic Therapy. The paper includes a case study that illustrates this debate and which provides evidence for the therapeutic potency of a form of Brief Dynamic Intermittent Therapy where a dynamic focus maintains a structuring pattern to the narrative over a sequence of several periods of Brief Therapy, spread over a number of years.     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: a controlled investigation

Correcting patients' faulty beliefs concerning social evaluative threats is the hallmark of cognitive-behavioral treatment of social anxiety disorder. The current study examined the efficacy of two videotape feedback procedures as adjuncts to exposure-based treatment. Participants suffering from social phobia (N=77) were randomly assigned to one of four conditions: (a) credible placebo treatment (PLA); (b) exposure + no feedback (EXP); (c) exposure + videotape feedback of performance (PER); or (d) exposure + videotape feedback of audience responses (AUD). Contrary to prediction, the videotape feedback procedures did not enhance the effects of exposure-based treatment. Clinical and theoretical implications are discussed.     

Acceptance and commitment therapy: model, processes and outcomes

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.     

A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking

The effectiveness of a deliberately limited version of Acceptance and Commitment Therapy (ACT) for chronic skin picking was evaluated in a pair of multiple baseline across participants designs. Self-monitoring of skin picking showed that four of the five participants reached near zero levels of picking by post-treatment, but these gains were not fully maintained for three of the four participants at follow-up. The findings of the self-reported skin picking were generally corroborated by ratings of photographs of the damaged areas and by ratings on a validated measure of skin picking severity. All participants rated the intervention as socially acceptable, and reductions were found on measures of anxiety, depression, and experiential avoidance for most participants as a result of the intervention. Results support the construction of more comprehensive ACT protocols for skin picking.     

Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n = 44) or standard care plus MFGT (n = 53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.     

Can Spouses Provide Knowledge of Each Other's Communication Patterns? A Study of Self‐Reports,Spouses' Reports,and Observational Coding

The purposes of this study were (1) to assess individuals' self-reports of communication and their reports about their spouses' communication in order to examine the congruence of spousal views and (2) to investigate whether each report provided unique information about observed marital interactions. These associations were evaluated in a sample of 119 longtime married couples. The Verbal Aggression and Cooperation subscales from the Conflicts and Problem-Solving Scales were used as measures of negative and positive aspects of communication. The findings indicated that self-reports of both verbal aggression and cooperation were strongly associated with the same individual's report of his or her spouse's verbal aggression and cooperation. Conversely, self-reports were only moderately associated with reports made by spouses (e.g., the husband's report of his wife's communication). Hence, within-reporter agreement was higher than between-reporter agreement about marital communication. When entered into regression models, reports made by spouses, but not self-reports, explained unique variance in observations of marital hostility and affection. There was one exception: Wife self-report of verbal aggression explained unique variance in coders' ratings of wife hostility, controlling for husband report of wife verbal aggression. Findings indicate the importance of assessing partners' views of one another's communication for the most accurate portrayal of marital interactions. Implications for research and clinical work are discussed.     

The Initial Efficacy of Stand-Alone DBT Skills Training for Treating Impulsivity Among Individuals With Alcohol and Other Substance Use Disorders

Impulsivity is considered a core feature of substance use disorders (SUDs), including personological (i.e., negative urgency, positive urgency, lack of premeditation) and neuropsychological (i.e., cognitive and motor disinhibition, impulsive choice) dimensions. Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone treatment is an effective intervention for alcohol use disorder (AUD) and other SUDs. However, there are no studies that have investigated changes in impulsivity levels during a DBT-ST program, especially testing the therapeutic effects of DBT skills. Twenty-nine patients with AUD and other SUDs were admitted to a 3-month DBT-ST program. Self-report (i.e., UPPS-P) and computerized neuropsychological (i.e., Attentional Network test; Go/No-Go task; Iowa Gambling Task) measures of impulsivity were administered at the beginning and end of the DBT-ST. Distress tolerance (DTS), mindfulness (MAAS, FFMQ) and emotion regulation (DERS) were also assessed pre- and post-intervention. The study included two age- and gender-matched control groups: (a) untreated patients with SUDs (N = 29); (b) healthy controls (HCs) (N = 29). Twenty-four (82.7%) patients concluded the DBT-ST program. Emotion-based forms of impulsivity significantly improved during the program. At the end of treatment, impulsivity levels were significantly lower than those of untreated patients with SUDs and they were not significantly different from HCs. Cognitive disinhibition significantly decreased during the treatment. The improvement in impulsivity was explained by pre- posttreatment changes in distress tolerance, mindfulness and emotion regulation. Motor disinhibition did not improve during the treatment. These findings supported the initial efficacy of the DBT-ST program for addressing different features of impulsivity among individuals with AUD and other SUDs. Future follow-up studies should demonstrate the role of impulsivity domains in long-term relapse prevention.