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Casebook of Multimodal Therapy
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----Book Reviews---Casebook of Multimodal Therapy Edited by Arnold A. Lazarus. New York, Guiltord Press. 1985,212 pp, $20.
• The debate about the role of eclecticism in psychotherapy has been longstanding and frequently bitter. The eclectics have been accused by some of being unsystematic and unconcerned about the value of integration and consistency, and defended by others as practical and flexible. One major proponent of an eclectic orientation to treatment is Arnold Lazarus, who has caIled his approach' 'multimodal therapy" and has attempted to operationalize its use in patient care. Lazarus assumes that most patients have at least several problems that will only respond to multiple and varied techniques. He also divides personality into seven dimensions, namely behavior, affect, sensation, imagery, cognition, interpersonal relationship, and drugs (biological factors). He claims that if assessment and treatment techniques are conceptualized and then utilized in multimodal terms, patients will receive the benefits of a comprehensive approach. The evaluation aims toward the construction of a multimodal profile, which is essentially a problem-oriented approach utilizing the author's personality dimensions and a variety of widely used therapeutic techniques, of which many are cognitive-behavioral in their orientation. This volume attempts to provide more detailed direction to therapists by specifying how multimodal therapy is performed in particular clinical situations. Toward that end, the contributors have written individual chapters describing how they have treated specific patients with a variety of con-
JUNE 1987-VOL28-N06
ditions, including agoraphobia, depression, eating disorders, somatization disorders, and post-traumatic stress disorders. In addition, there is an overview chapter, and there are comments at the beginning of chapters by Lazarus and a few discussions about alternative treatments and their efficacy. For each patient, a brief history is presented, a multimodal profile constructed, and a description of treatment rationale and techniques given. Most are straightforward and sensible, and some are even imaginative. The basic message is that different approaches in treatment are worthwhile; that multiple individual, family, and group techniques are important; and that therapists must be flexible in response to their patients. While it is difficult to quarrel with these generalizations, it is not at all clear that the multimodal approach provides more valid therapeutic guidelines than other eclectic styles. In spite of the merit of the message that eclecticism is worthwhile, the level of self-congratulatory statements and self-advertising is difficult to ignore. In addition, simply stating repeatedly that multimodal therapy has comprehensive scope and systematic methodology does not mean that it is true. Throughout the book the assumption seems to be made that the specific techniques utilized are always responsible for any change in the quality or quantity of the symptoms. The reader is supposed to assume that the treatment techniques outlined resulted precisely in the desired effect, but there is little or no documentation in support of the validity of this assumption. The interpretation of what is actually happening with a given patient and the resultant treatment approach is subject to disagreement, especiaIly
without systematic data collection and foIlow-up. There are problems with the multimodal approach-especiaIly if one is somewhat skeptical. The distinction between imagery and cognition, two components of the basic "ID profile," is frequently difficult to define. It is also difficult to understand how the use of psychopharmacologic agents is a vector of personality. This is, at best, a rather slippery use of language. While fantasized or real interpersonal gain as an important determinant of behavior is sometimes acknowledged, it is also at times ignored, with little indication of the reasons for the different interpretations. Sometimes the authors do not clarify which aspects of the proposed treatment are goals and which are techniques. Nevertheless, those looking for examples of how to conceptualize patient problems and construct treatments using multiple modalities will benefit from some of the specific descriptions and discussions. Stuart A. Walt;man. M.D. Bronx. N.Y.
Depression: Basic Mechanisms, Diagnosis, and Treatment Edited by A. John Rush and Kenneth Z. Altshuler. New York, Guilford Press. 1986, 242 pp, $26.95.
• The II chapters of this multi-authored textbook are concerned primarily with the neurobiological phenomena of depression and, to a lesser extent, mania. The material is presented at varying levels of sophistication and clarity. Psychological and neuropsychological issues are not addressed, and the only chapter dealing with 331
.
----Book Reviews---Casebook of Multimodal Therapy Edited by Arnold A. Lazarus. New York, Guiltord Press. 1985,212 pp, $20.
• The debate about the role of eclecticism in psychotherapy has been longstanding and frequently bitter. The eclectics have been accused by some of being unsystematic and unconcerned about the value of integration and consistency, and defended by others as practical and flexible. One major proponent of an eclectic orientation to treatment is Arnold Lazarus, who has caIled his approach' 'multimodal therapy" and has attempted to operationalize its use in patient care. Lazarus assumes that most patients have at least several problems that will only respond to multiple and varied techniques. He also divides personality into seven dimensions, namely behavior, affect, sensation, imagery, cognition, interpersonal relationship, and drugs (biological factors). He claims that if assessment and treatment techniques are conceptualized and then utilized in multimodal terms, patients will receive the benefits of a comprehensive approach. The evaluation aims toward the construction of a multimodal profile, which is essentially a problem-oriented approach utilizing the author's personality dimensions and a variety of widely used therapeutic techniques, of which many are cognitive-behavioral in their orientation. This volume attempts to provide more detailed direction to therapists by specifying how multimodal therapy is performed in particular clinical situations. Toward that end, the contributors have written individual chapters describing how they have treated specific patients with a variety of con-
JUNE 1987-VOL28-N06
ditions, including agoraphobia, depression, eating disorders, somatization disorders, and post-traumatic stress disorders. In addition, there is an overview chapter, and there are comments at the beginning of chapters by Lazarus and a few discussions about alternative treatments and their efficacy. For each patient, a brief history is presented, a multimodal profile constructed, and a description of treatment rationale and techniques given. Most are straightforward and sensible, and some are even imaginative. The basic message is that different approaches in treatment are worthwhile; that multiple individual, family, and group techniques are important; and that therapists must be flexible in response to their patients. While it is difficult to quarrel with these generalizations, it is not at all clear that the multimodal approach provides more valid therapeutic guidelines than other eclectic styles. In spite of the merit of the message that eclecticism is worthwhile, the level of self-congratulatory statements and self-advertising is difficult to ignore. In addition, simply stating repeatedly that multimodal therapy has comprehensive scope and systematic methodology does not mean that it is true. Throughout the book the assumption seems to be made that the specific techniques utilized are always responsible for any change in the quality or quantity of the symptoms. The reader is supposed to assume that the treatment techniques outlined resulted precisely in the desired effect, but there is little or no documentation in support of the validity of this assumption. The interpretation of what is actually happening with a given patient and the resultant treatment approach is subject to disagreement, especiaIly
without systematic data collection and foIlow-up. There are problems with the multimodal approach-especiaIly if one is somewhat skeptical. The distinction between imagery and cognition, two components of the basic "ID profile," is frequently difficult to define. It is also difficult to understand how the use of psychopharmacologic agents is a vector of personality. This is, at best, a rather slippery use of language. While fantasized or real interpersonal gain as an important determinant of behavior is sometimes acknowledged, it is also at times ignored, with little indication of the reasons for the different interpretations. Sometimes the authors do not clarify which aspects of the proposed treatment are goals and which are techniques. Nevertheless, those looking for examples of how to conceptualize patient problems and construct treatments using multiple modalities will benefit from some of the specific descriptions and discussions. Stuart A. Walt;man. M.D. Bronx. N.Y.
Depression: Basic Mechanisms, Diagnosis, and Treatment Edited by A. John Rush and Kenneth Z. Altshuler. New York, Guilford Press. 1986, 242 pp, $26.95.
• The II chapters of this multi-authored textbook are concerned primarily with the neurobiological phenomena of depression and, to a lesser extent, mania. The material is presented at varying levels of sophistication and clarity. Psychological and neuropsychological issues are not addressed, and the only chapter dealing with 331