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by Phillip R. Slavney
Johns Hopkins University Press, 2005
Review by Tony O'Brien on Dec 2nd 2005

Psychotherapy

If you are in search of a primer in psychotherapy, and your area of interest is psychiatry rather than say social work or family therapy, this little volume by Phillip Slavney may be just what you're looking for. Brief, clearly written, and succinct, Psychotherapy is a useful and accessible introduction to the field. The book is divided into four chapters. The first provides a background derived from classical literature, the second a discussion of personality types and their interaction in the practice of psychotherapy, and the third an outline of the therapeutic relationship in psychotherapy. The final chapter discusses the issue of supervision. Although not primarily an academic text, the book is well referenced, and contains a helpful index to authors and concepts.

Slavney is a Professor of psychiatry and long time practitioner of psychotherapy. His book is written in an engaging, informal style, and is replete with the sorts of examples that can only come from an extended period of experience. New practitioners are encouraged to become familiar with a range of theories and techniques, but to keep sight of the knowledge that technique alone is not sufficient for psychotherapy to be effective. Slaveny cites Frank and Frank's Persuasion and healing to demonstrate the primacy of the relationship between practitioner and patient. There are also many references to research throughout the book. The discussion emphasizes the value of evidence without insisting that every variable can be isolated and quantified. These points are summed up in the epilogue in which Slaveny advises: "Theory and technique are important, but they are less important than common sense and character."

There is a medical focus to the book that will not find favor with those who use a broader definition of psychotherapy than Slavney's 'medical psychotherapy' will allow. There is no particular reason to limit psychotherapy in this way, except of course to identify that this is how the medical discipline of psychiatry defines it. Having defined psychotherapy in this way, a particular orientation is established, and this necessarily limits the scope of the book. This is reflected particularly in the second chapter on personality, in which the American Psychiatric Association's DSM criteria for diagnosing personality disorder provides the conceptual framework. For practitioners working in psychiatry, whatever their discipline, knowledge of this framework is useful. And the general advice offered at the conclusion of the chapter is useful for practitioners of any model of psychotherapy: "Your personality will affect how you practice psychotherapy, just as it will affect how you do everything else.... Still, most awkward moments in psychotherapy will be due to the patient's traits, not yours".

Similarly, the issues covered in the chapter on the psychotherapeutic relationship will translate well across disciplines, and even across models. Characteristics of therapeutic relationships, boundaries, and general conduct of the practitioner are issues for all practitioners, although doctors are probably more likely to adhere to Slaveny's suggestions on formalities such as dress and greetings. These are also likely to be variable across different social settings. But there can be little dispute about the strong prohibition on sexual relationships between therapist and patient.

This book is a good general introduction to psychotherapy as practiced by psychiatrists. For those working in services in which the DSM criteria are used the book is especially valuable. Practitioners who take referrals from such services will also find the overview of medical thinking on psychotherapy helpful.

 

© 2005 Tony O'Brien

 

Tony O'Brien is a short story writer, and lecturer in mental health nursing at the University of Auckland, New Zealand: a.obrien@auckland.ac.nz