- Email: [email protected]
A Guide to Treatments That Work.
Clinical Psychology Review, Vol. 20, No. 1, pp. 137–143, 2000 Copyright © 2000 Elsevier Science Ltd Printed in the USA. All rights reserved 0272-7358/00/$–see front matter
BOOK REVIEWS A Guide to Treatments That Work. Edited by Peter E. Nathan and Jack M. Gorman; Foreword and Afterword by Martin P. Seligman. New York: Oxford University Press, 1998. 594 pp. $75.00. This thorough and rigorous volume provides a rich reference for both the researcher and the practitioner on a critical topic: mental health treatments that work. Although it is not an official American Psychological Association (APA) document, it emanates from a Division 12 (Clinical Psychology) task force established during APA President Martin Seligman’s presidency of that division. Seligman clearly and forcefully states that the book is not intended to establish clinical standards or guidelines—APA endorsed or otherwise. Nonetheless, one could argue that it is inevitably a step in that direction. In fact, the ultimate goal of this laudable effort is to someday be “able to specify which psychotherapy delivered by which psychotherapist is most effective for which person in which treatment setting” (p. 12). Whether this is a worthy goal that will dramatically improve care, or a sell-out to the rising tide of managed care, is currently a matter of heated debate. Indeed, Seligman notes that the sensitivity of the topic almost doomed the publication. It also necessitated an unusual section on disclaimers and caveats designed to limit the liability that could result from selecting treatment and expecting improvement based on the book’s findings (p. vii). Seligman states convincingly that “we should not shape the research to justify what we already do in practice, but rather we should shape what we do in practice to conform to what is discovered in research on therapy” (p. v). For it is indeed critical that mental health providers embrace the need to scientifically demonstrate service efficacy, lest they be left behind in the healthcare revolution in which we find ourselves (see Barlow, 1996; Kelly, 1997; Pallack, 1995). This book provides an excellent first step in that direction. It provides a research-based discussion of what treatments work for 17 of the major DSM-IV disorders. The scope of the discussion varies by disorder depending on availability of research, and nine of the most common disorders have two chapters devoted to them, one on pharmacological treatments and one on psychosocial treatments. Each chapter summarizes the scientific literature, background information, and future trends for the treatment discussed. For example, the chapter on psychosocial treatments for schizophrenia begins with an overview of the disorder, briefly discussing topics such as diagnosis, etiology, cost, and prevalence. The authors then review the major treatments available, and present the results of outcome studies for each. The chapter concludes with a discussion of future directions for research and practice. Additionally, most of the chapters include an in-depth evaluation of outcome research design and methodology, and detail the data on which their conclusions are based. For example, the chapter on psychopharmacological treatment for post-traumatic stress disorder reviews clinical drug trials in a table that clearly lays out selected studies and includes data on duration of treatment, global improvement, number of responders, etc. The references drawn on for each chapter are impressive, both in 137
138
Book Reviews
quality and in quantity. Selected studies are classified according to a six-level rating of scientific validity, and many chapters list over a hundred references. In sum, this impressive work will serve both the researcher and the practitioner as a ready reference for what is currently known about treatments that work. Seligman correctly notes that this is but a small step towards what must be accomplished. There is a need for creative new treatments to be developed, and then subjected to comprehensive and cumulative outcome research. This book may represent but a small step in that direction, but it is huge in significance.
REFERENCES Barlow, D. H. (1996). Health care policy, psychotherapy research, and the future of psychotherapy. American Psychologist, 51, 1050–1058. Kelly, T. A. (1997). A wake-up call: The experience of a mental health commissioner in times of change. Professional Psychology: Research and Practice, 28, 317–322. Pallack, M. S. (1995). Managed care and outcomes-based standards in the health care revolution. In S. C. Hayes, V. M. Follette, R. M. Dawes, & K. E. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations (pp. 73–77). Reno, NV: Context Press.
PII S0272-7358(99)00012-4
TIMOTHY A. KELLY George Mason University SOHEE PARK The American University
Clinical Phenomenology and Cognitive Psychology. By David Fewtrell and Kieron O’Connor. New York: Routledge, 1995. xi ⫹ 212 pp. As the title suggests, the purpose of this book is to draw together the observations and concepts of phenomenology and cognitive psychology in an attempt to enhance the theoretical and clinical value of both perspectives within the context of psychopathology. The authors draw on cognitive psychology to strengthen the empirical basis of phenomenological descriptions of psychopathology. Similarly, the authors draw on phenomenology to enhance cognitive models. For the most part, the cognitive theory and therapy draws from Beck’s work. The authors point out that cognitive theorists and therapists have tended to emphasize role of verbally-mediated thoughts on emotions, and may not be giving sufficient attention to the roles of other forms thought, or to the influence of emotion on cognition. To redress this imbalance, the authors draw on the writings of clinical phenomenologists (particularly Jaspers) in order to make the case for a broader approach to cognitive theory and therapy. The book consists of 10 chapters, covering a wide range of topics. The opening chapters cover the philosophy of self-body and self-world relations, the relationships between cognition and emotion, and the problems in defining moods and emotions. Subsequent chapters examine the cognitive and phenomenological aspects of selected disorders and symptoms, including panic disorder, dizziness, depersonalization, craving, and delusions. The penultimate chapter examines positive experiences and states of enlightenment. The book concludes by discussing the common ground between phenomenology and cognitive psychology. The book primarily focuses on
BOOK REVIEWS A Guide to Treatments That Work. Edited by Peter E. Nathan and Jack M. Gorman; Foreword and Afterword by Martin P. Seligman. New York: Oxford University Press, 1998. 594 pp. $75.00. This thorough and rigorous volume provides a rich reference for both the researcher and the practitioner on a critical topic: mental health treatments that work. Although it is not an official American Psychological Association (APA) document, it emanates from a Division 12 (Clinical Psychology) task force established during APA President Martin Seligman’s presidency of that division. Seligman clearly and forcefully states that the book is not intended to establish clinical standards or guidelines—APA endorsed or otherwise. Nonetheless, one could argue that it is inevitably a step in that direction. In fact, the ultimate goal of this laudable effort is to someday be “able to specify which psychotherapy delivered by which psychotherapist is most effective for which person in which treatment setting” (p. 12). Whether this is a worthy goal that will dramatically improve care, or a sell-out to the rising tide of managed care, is currently a matter of heated debate. Indeed, Seligman notes that the sensitivity of the topic almost doomed the publication. It also necessitated an unusual section on disclaimers and caveats designed to limit the liability that could result from selecting treatment and expecting improvement based on the book’s findings (p. vii). Seligman states convincingly that “we should not shape the research to justify what we already do in practice, but rather we should shape what we do in practice to conform to what is discovered in research on therapy” (p. v). For it is indeed critical that mental health providers embrace the need to scientifically demonstrate service efficacy, lest they be left behind in the healthcare revolution in which we find ourselves (see Barlow, 1996; Kelly, 1997; Pallack, 1995). This book provides an excellent first step in that direction. It provides a research-based discussion of what treatments work for 17 of the major DSM-IV disorders. The scope of the discussion varies by disorder depending on availability of research, and nine of the most common disorders have two chapters devoted to them, one on pharmacological treatments and one on psychosocial treatments. Each chapter summarizes the scientific literature, background information, and future trends for the treatment discussed. For example, the chapter on psychosocial treatments for schizophrenia begins with an overview of the disorder, briefly discussing topics such as diagnosis, etiology, cost, and prevalence. The authors then review the major treatments available, and present the results of outcome studies for each. The chapter concludes with a discussion of future directions for research and practice. Additionally, most of the chapters include an in-depth evaluation of outcome research design and methodology, and detail the data on which their conclusions are based. For example, the chapter on psychopharmacological treatment for post-traumatic stress disorder reviews clinical drug trials in a table that clearly lays out selected studies and includes data on duration of treatment, global improvement, number of responders, etc. The references drawn on for each chapter are impressive, both in 137
138
Book Reviews
quality and in quantity. Selected studies are classified according to a six-level rating of scientific validity, and many chapters list over a hundred references. In sum, this impressive work will serve both the researcher and the practitioner as a ready reference for what is currently known about treatments that work. Seligman correctly notes that this is but a small step towards what must be accomplished. There is a need for creative new treatments to be developed, and then subjected to comprehensive and cumulative outcome research. This book may represent but a small step in that direction, but it is huge in significance.
REFERENCES Barlow, D. H. (1996). Health care policy, psychotherapy research, and the future of psychotherapy. American Psychologist, 51, 1050–1058. Kelly, T. A. (1997). A wake-up call: The experience of a mental health commissioner in times of change. Professional Psychology: Research and Practice, 28, 317–322. Pallack, M. S. (1995). Managed care and outcomes-based standards in the health care revolution. In S. C. Hayes, V. M. Follette, R. M. Dawes, & K. E. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations (pp. 73–77). Reno, NV: Context Press.
PII S0272-7358(99)00012-4
TIMOTHY A. KELLY George Mason University SOHEE PARK The American University
Clinical Phenomenology and Cognitive Psychology. By David Fewtrell and Kieron O’Connor. New York: Routledge, 1995. xi ⫹ 212 pp. As the title suggests, the purpose of this book is to draw together the observations and concepts of phenomenology and cognitive psychology in an attempt to enhance the theoretical and clinical value of both perspectives within the context of psychopathology. The authors draw on cognitive psychology to strengthen the empirical basis of phenomenological descriptions of psychopathology. Similarly, the authors draw on phenomenology to enhance cognitive models. For the most part, the cognitive theory and therapy draws from Beck’s work. The authors point out that cognitive theorists and therapists have tended to emphasize role of verbally-mediated thoughts on emotions, and may not be giving sufficient attention to the roles of other forms thought, or to the influence of emotion on cognition. To redress this imbalance, the authors draw on the writings of clinical phenomenologists (particularly Jaspers) in order to make the case for a broader approach to cognitive theory and therapy. The book consists of 10 chapters, covering a wide range of topics. The opening chapters cover the philosophy of self-body and self-world relations, the relationships between cognition and emotion, and the problems in defining moods and emotions. Subsequent chapters examine the cognitive and phenomenological aspects of selected disorders and symptoms, including panic disorder, dizziness, depersonalization, craving, and delusions. The penultimate chapter examines positive experiences and states of enlightenment. The book concludes by discussing the common ground between phenomenology and cognitive psychology. The book primarily focuses on