Book Review
Psychotherapy 
Treating Difficult Couples Douglas K Snyder, Mark A Whisman, editors. New York: The Guilford Press; 2003. 448 p. US$45.00.
Reviewer
rating*: Good
Review by: Leopoldo Chagoya, MD, FRCPC
Toronto, Ontario
This book provides an ample overview of the field of couple therapy. In a novel, disorder-specific approach, it focuses on important dilemmas couples face and proposes a partner-assisted form of treatment for specific disorders.
The book fulfills its purpose quite well; however, the quality of the chapters is uneven. Some of the 37 authors are concise and illuminating; others are somewhat nebulous and impractical. That said, the writers are experts in their field, and their clinical expertise shows. When they include a clinical illustration (at the end of most chapters) the reader can see they practise what they preach.
The style is clear, to the point, and easily readable. I could detect only 2 errors: a reference quoted in the text but not listed in the Bibliography (Chapter 3, p 65) and a typographical mistake where the text says “intimate” rather than “intimidate” (Chapter 14, p 340)—an important error in the context of the disorder depicted.
The layout is not innovative, but within its traditional format, the book is pleasant to read. The chapters are uniformly structured. They start with an overview of the disorder at hand, and then they elaborate on how such a disorder affects couple interaction and how couple distress affects the disorder. Next, they describe methods of couple assessment and diagnosis and include a treatment section (covering theory and technique). They end with a case illustration, a brief conclusions coda, and a rich list of references.
The chapters focus on how couples are affected by anxiety disorders, depression, bipolar dis- order, schizophrenia spectrum disorders, alcohol and other substance abuse, sexual dysfunction, physical aggression, borderline personality disorders (BPDs), paranoia, narcissistic disorder, posttraumatic stress (PTSD), childhood sexual trauma, physical illness, aging and cognitive impairment, and bereavement and complicated grief. As noted above, each chapter also elaborates on how couple dysfunction and dissatisfaction can affect the evolution of the disorders listed. The authors summarize the methods they find useful to treat these conditions, and the bibliographies invite readers to deepen their knowledge of the problem discussed.
Three chapters stand out as good theoretical and clinical rerviews: the chapter on sexual dysfunction, by Lisa G Regev, William O’Donohue, and Claudia Avina; the chapter on paranoia, by Kenneth G Terkelsen; and the chapter on bereavement and complicated grief, by Robert E Willis. All give an excellent description of the gamut of disturbances these disorders cause in couples and provide direct advice on how the therapist can help. The theory behind the interventions is spelled out neatly, and the clinical illustrations make it all come alive.
Another high-quality chapter is the one on PTSD, by Susan M Johnson and Judy Makinem. In the theoretical part, the authors define, albeit somewhat unclearly, their emotion-based approach (sometimes experts assume that the uninitiated know what they mean simply by implying it). Nevertheless, their verbatim excerpts of a session with a couple plainly illustrate what they mean to say and how effectively they work with couples where one or both parties suffer from PTSD.
The most disappointing chapter is the one on BPD, by Alan Fruzzetti and Armida R Fruzzetti. The technique and the theory behind dialectical behaviour therapy (DBT) applied to couples are not spelled out. There are tautological phrases (for example “Problem Management means resolve problems in a dialectical manner either by solving a problem…” [p 241]), and when the authors describe the phases of a treatment, they depict results (for example “The couple lets go of judgments and acquires specific emotion re-regulation skills…” [p 253]); they do not describe the process or the technique by which they achieved such results. The uninitiated will not begin to learn here how to apply DBT to couples.
The main theories and techniques presented in most chapters combine psychoeducation, communication skills training, problemsolving skills training, and cognitive-behavioural therapies. The psychodynamic approach is represented only in one chapter, the chapter on narcissistic disorder, by Jill Savege Scharff and Carl Bagnini. They unambiguously use principles of object relations theory and self-psychology tenets.
The last chapter, entitled “Understanding Psychopathology and Couple Dysfunction. Implications for Clinical Practice, Training and Research,” by the editors, is an outstanding review of couple therapy questions that research, teaching, and empirical clinical observation could answer. These authors advocate for an integrative form of couple therapy.
I recommend this text as a good review book—ideal for clinicians who want to get a vision of the world of couple therapy, good for experienced therapists who want to reexamine and question the theories and clinical rules we work by, and excellent for researchers seeking themes to investigate in the ample field of couple therapy.
*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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