Book Review
Psychotherapy
Becoming a Therapist: What Do I Say, and Why? Suzanne Bender, Edward Messner. New York: Guilford; 2003. 232 p. US$35.00.
Reviewer
rating*: Very Good
Review by: M Eleanor Yack, MD, FRCP
Ottawa, Ontario
This book is a much-needed, timely contribution to the area of psychotherapy supervision. When medical students become psychiatric residents, practising active problem-solving skills must give way to a more receptive mode of listening and processing emotional knowledge. This can confuse and provoke anxiety in beginning psychotherapists. This book aims to provide practical guidance and support for those struggling for the first time with the complexities of psychotherapy. Dr Edward Messner is a clinical professor of psychiatry at Massachusetts General Hospital and a qualified psychoanalyst. Dr Suzanne Bender was starting her training as a psychiatric resident when the book was begun and is now a child psychiatrist. Most of the literature about psychotherapy supervision is written by supervisors. These authors share the benefits of their mutual learning from each other in their rich supervisory experience. Although the book was a collaborative effort between supervisor and trainee, the narrative voice is that of a novice therapist.
The authors stress that words are the tools of intervention in psychotherapy and that a small modification in sentence structure can transform a comment from judgemental to empathetic. To illustrate this point, they construct a fictitious patient whose treatment presents typical therapeutic dilemmas. At times they include verbatim interaction between patient and therapist, comparing clinically effective interventions and those to be avoided. The writing is engaging and lively. The authors explain psychodynamic concepts clearly and include a glossary at the end of the book. As well as being informed by psychoanalytic principles, their approach includes aspects of cognitive and behavioural therapy and psychopharmacological interventions. Thus they define their approach as integrative.
In the book’s 4 sections, the authors comprehensively cover assessment from the beginning, through the middle, and to the end stages of therapy. The first section deals with the first phone call; initiating the therapeutic alliance; and compiling a psychosocial history, formulation, and treatment plan. There is a detailed list of questions to ask in completing a psychiatric history and screening for psychiatric illness. While this may be tedious for those experienced in the discipline, it is probably useful for beginners striving to be thorough.
The second section discusses how to establish and maintain practice guidelines, collectively known as “the frame,” to create a safe environment for patient and therapist. Limits in regard to scheduling, the beginning and end of sessions, personal self-disclosure by the therapist, and confidentiality are included. The bibliography contains further references by respected authorities on this relevant topic. “Chemistry,” the third section, combines 2 topics. The first chapter discusses how to screen for substance abuse and includes a questionnaire for evaluating alcohol problems. The second chapter deals with integrating psychopharmacology and psychotherapy. It discusses the complex role psychiatrists find themselves in when they decide to prescribe psychopharmacological intervention during psychotherapy, as well as the impact of prescribing medication upon the development of the transference.
Section 4 deals with therapeutic dilemmas, including the management of impasses, empathic lapses, and transference and countertransference difficulties. In this section, sophisticated psychoanalytic concepts based on object relations theory are simplified and clearly illustrated. Novices are encouraged to recognize countertransference as a source of information and knowledge rather than as a difficulty to be suppressed. Here, the authors provide examples of how countertransference feelings shape intervention and treatment. Various approaches to termination are presented in the last chapter, and the distinction is made between mature and premature termination.
Contemporary schools of psychotherapy, such as intersubjectivity and self-psychology, which emphasize the authenticity of the therapist, might criticize a book of this nature for being too formulaic, and although the preface contains a disclaimer that it is not a “cookbook,” the book often offers word-for-word recommendations about what to say to patients and why. I believe there is a need for structure and guidance around which the “person” of the therapist can develop. This book fills a gap in clinical training for psychotherapy, offering helpful strategies for handling many issues that arise. I recommend it for all psychiatric residents and for other students of mental health disciplines. It will also be useful to supervisors and more experienced practitioners who are interested in reflecting upon their approach and in carefully considering the therapeutic impact of the words they use.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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