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Complexity of the self: A developmental approach to psychopathology and therapy
268
Book Rm’ews
complex, and admittedly evolving, judicial and legislative concepts. The authors make a conscious effort to ensure that what they describe from the perspective of the legal world is presented in as concrete and practical a manner as possible. Their judicious use of recent case law examples is especially impressive and serves to make the book lively reading. Recently a number of cherished traditions within the mental health community have experienced significant upheavals and society’s very definition of “mental illness” and its assumptions about psychotherapy have undergone considerable transition. To a very real extent, this has been the result of conflicts within our field (often the outgrowth of underlying differences between the behavioral vs. medical model orientations) being addressed by those most familiar with our legal heritage-for above all else, we are a nation of laws and individual constitutional protections. Yet, all too often, those active within the mental health community do not understand that their clinical practices, and ultimately their professional destiny, is being significantly shaped by those outside the mental health community. The authors have organized their book into two distinct sections, “The Psychotherapist in the Office and in Court,” and “Specific Disorders and the Psychotherapist.” The first section covers such topics as malpractice and professional liability, criminal responsibility and the insanity defense, prediction of dangerousness, family law, and the psychotherapist as a witness in court. These are evolving areas of the law and have very significant consequences for the practitioner. The authors state that “ . . . though the major focus of this book is on pragmatic questions confronting the practicing therapist, we will advocate potential reforms and discuss theoretical and philosophical issues that may motivate therapists to influence policy decisions in the future.” This they do very well! The second section “walks the therapist through” the consequences for his or her client if any one of a number of specific diagnoses become relevant for the court. Topics covered include schizophrenia, sexual deviations, suicide, mental retardation, substance abuse, and child abuse. Again, the extent to which the legal and therapeutic communities view the client (patient) in very different ways becomes strikingly evident and should be of considerable concern to those who are involved in the day-to-day practice of psychotherapy. This is an excellent book which is highly appropriate for psychotherapists, graduate students, and those genuinely interested in the future of mental health. It will undoubtedly cause some of our colleagues to rethink their earlier decision not to attend law school. PATRICK
H. DELEON
U s. senatt?staff
Complexity of the Self: A Developmental Approach to Psychopathology Therapy. By V. F. Guidano. New York: The Guilford Press. pp. 248.
and
This book represents perhaps the most ambitious attempt to date to apply a cognitive developmental approach to the study of psychopathology. It also exemplifies theory construction in the grand and integrative sense, which has not been seen since the days of Dollard and Miller and George Kelly. Like all such largescale attempts, it both succeeds and fails, but the reader is enriched even by the failures.
Book Reviews
269
The book is divided into three sections: theoretical principles, developmental and organizational models, and a systems/process-oriented psychopathology. The first section is heavily based on John Bowlby’s attachment theory and evolutionary epistemology (the evolution of knowledge and knowing systems) and their implications for the development of personal identity. This section has a heavy biological flavor; in fact, Guidano states that knowledge is a biological as well as a psychological process. The biological orientation pervades the entire book, leading to a more deterministic flavor than one is accustomed to in cognitive psychotherapy. The second section presents a cognitive developmental model. Two key concepts are important here which recur throughout the book. The first is that of opponent process regulation, in which the boundaries of meaning are created by an identity structure that is explicated by opposite (opponent) processes. The second key concept is the distinction between tacit and explicit self-knowledge, which comes amazingly close to the traditional distinction between unconscious and conscious thought processes without the motivational component. Guidano also describes the “personal cognitive organization” (“P.C. Org.“) which refers to the progressive organization of personal knowing processes which simultaneously is able to undergo modification and still maintain a sense of oneness and continuity. The third section is an attempt to apply the foregoing ideas to the identification of the cognitive organization behind each of four common psychological disorders: depression, agoraphobia, eating disorders, and obsessions. Like all attempts at large-scale theory construction, this book has both strengths and weaknesses. Its attempt to integrate insights from a wide variety of theoretical positions, while underlying it all with a thorough grounding in attachment theory is truly impressive. Yet, the reader is left with a distinct impression that the author is overgeneralizing and leaving out significant individual variations within each clinical disorder. In addition, the articulation between the earlier theoretical chapters and the later clinical chapters is incomplete, resulting in the feeling of two somewhat disparate sections rather than a unified whole. Complexity of the Self is truly a landmark book which is destined to have a profound impact on the field of cognitive psychotherapy. It is not an easy book to read, but definitely merits a close examination by all therapists interested in cognitive developmental processes. I look forward to cognitive developmental descriptions of other clinical disorders, such as anxiety. E. THOMAS Kent State University
DOWD
Book Rm’ews
complex, and admittedly evolving, judicial and legislative concepts. The authors make a conscious effort to ensure that what they describe from the perspective of the legal world is presented in as concrete and practical a manner as possible. Their judicious use of recent case law examples is especially impressive and serves to make the book lively reading. Recently a number of cherished traditions within the mental health community have experienced significant upheavals and society’s very definition of “mental illness” and its assumptions about psychotherapy have undergone considerable transition. To a very real extent, this has been the result of conflicts within our field (often the outgrowth of underlying differences between the behavioral vs. medical model orientations) being addressed by those most familiar with our legal heritage-for above all else, we are a nation of laws and individual constitutional protections. Yet, all too often, those active within the mental health community do not understand that their clinical practices, and ultimately their professional destiny, is being significantly shaped by those outside the mental health community. The authors have organized their book into two distinct sections, “The Psychotherapist in the Office and in Court,” and “Specific Disorders and the Psychotherapist.” The first section covers such topics as malpractice and professional liability, criminal responsibility and the insanity defense, prediction of dangerousness, family law, and the psychotherapist as a witness in court. These are evolving areas of the law and have very significant consequences for the practitioner. The authors state that “ . . . though the major focus of this book is on pragmatic questions confronting the practicing therapist, we will advocate potential reforms and discuss theoretical and philosophical issues that may motivate therapists to influence policy decisions in the future.” This they do very well! The second section “walks the therapist through” the consequences for his or her client if any one of a number of specific diagnoses become relevant for the court. Topics covered include schizophrenia, sexual deviations, suicide, mental retardation, substance abuse, and child abuse. Again, the extent to which the legal and therapeutic communities view the client (patient) in very different ways becomes strikingly evident and should be of considerable concern to those who are involved in the day-to-day practice of psychotherapy. This is an excellent book which is highly appropriate for psychotherapists, graduate students, and those genuinely interested in the future of mental health. It will undoubtedly cause some of our colleagues to rethink their earlier decision not to attend law school. PATRICK
H. DELEON
U s. senatt?staff
Complexity of the Self: A Developmental Approach to Psychopathology Therapy. By V. F. Guidano. New York: The Guilford Press. pp. 248.
and
This book represents perhaps the most ambitious attempt to date to apply a cognitive developmental approach to the study of psychopathology. It also exemplifies theory construction in the grand and integrative sense, which has not been seen since the days of Dollard and Miller and George Kelly. Like all such largescale attempts, it both succeeds and fails, but the reader is enriched even by the failures.
Book Reviews
269
The book is divided into three sections: theoretical principles, developmental and organizational models, and a systems/process-oriented psychopathology. The first section is heavily based on John Bowlby’s attachment theory and evolutionary epistemology (the evolution of knowledge and knowing systems) and their implications for the development of personal identity. This section has a heavy biological flavor; in fact, Guidano states that knowledge is a biological as well as a psychological process. The biological orientation pervades the entire book, leading to a more deterministic flavor than one is accustomed to in cognitive psychotherapy. The second section presents a cognitive developmental model. Two key concepts are important here which recur throughout the book. The first is that of opponent process regulation, in which the boundaries of meaning are created by an identity structure that is explicated by opposite (opponent) processes. The second key concept is the distinction between tacit and explicit self-knowledge, which comes amazingly close to the traditional distinction between unconscious and conscious thought processes without the motivational component. Guidano also describes the “personal cognitive organization” (“P.C. Org.“) which refers to the progressive organization of personal knowing processes which simultaneously is able to undergo modification and still maintain a sense of oneness and continuity. The third section is an attempt to apply the foregoing ideas to the identification of the cognitive organization behind each of four common psychological disorders: depression, agoraphobia, eating disorders, and obsessions. Like all attempts at large-scale theory construction, this book has both strengths and weaknesses. Its attempt to integrate insights from a wide variety of theoretical positions, while underlying it all with a thorough grounding in attachment theory is truly impressive. Yet, the reader is left with a distinct impression that the author is overgeneralizing and leaving out significant individual variations within each clinical disorder. In addition, the articulation between the earlier theoretical chapters and the later clinical chapters is incomplete, resulting in the feeling of two somewhat disparate sections rather than a unified whole. Complexity of the Self is truly a landmark book which is destined to have a profound impact on the field of cognitive psychotherapy. It is not an easy book to read, but definitely merits a close examination by all therapists interested in cognitive developmental processes. I look forward to cognitive developmental descriptions of other clinical disorders, such as anxiety. E. THOMAS Kent State University
DOWD