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by Stefan G. Hofmann and Martha C. Tompson (Editors)
Guilford Press, 2002
Review by Colin A Holmes, Ph.D. on Jul 8th 2004

Treating Chronic and Severe Mental Disorders

This is a well-researched, carefully edited and very useful technical handbook for clinicians, researchers and students providing psychological treatment to those individuals with chronic and severe mental disorders. The editors have successfully drawn together a fine international team of writers, mostly psychologists and psychiatrists, to create a text that nevertheless sustains unity of style and conveys a sense of shared purpose. The chapters nicely balance theory and research, whilst maintaining an unequivocal focus on practice, and it is hard to fault.

The explicit focus is on psychosocial treatment of the 'difficult' mental disorders, i.e. the major psychoses, substance abuse and personality disorder, and to have extended the brief, in terms of either the range of disorders or interventions covered, would have involved sacrifice of depth and detail. A chapter on the treatment of individuals with dual or multiple diagnoses would have been justified, however, since we now know that clinicians should expect such clients rather than view them as exceptions. This could perhaps have been at the expense of the chapter on 'marital discord and coexisting depression'. The book is divided into four sections – schizophrenia, mood disorders, substance abuse disorders and severe personality disorders – comprising four or five short chapters, each devoted to a specific type of intervention. These include CBT, DBT, family therapies, social skills training, individual psychotherapy, couples therapy, and motivational interviewing.

Some of the chapters stand out as models of clarity and helpfulness. The excellent account of motivational interviewing, for example, is a precise, step-by-step description, illustrated by verbatim extracts from sessions, and supported by research studies. The chapter on dialectical behavior therapy for personality disorder is coauthored by Marsha Linehan and, as one would expect, is also paradigm of clarity and completeness (it could have been subtitled "All you ever wanted to know about DBT but were too afraid to ask"!). I think this is technical writing at its very best.

Familiarity with the conceptual apparatuses of contemporary psychiatry and clinical psychology is assumed, along with knowledge of the etiological factors and clinical features of mental disorders. The qualities required of the therapist, and the attitudinal and values issues that therapy raises are mostly set aside, and the emphasis placed strictly on the clinical application of, and empirical support for, the treatments employed. In short, this is a 'what to do' and 'how to do it' book! Most of the chapters draw on case studies and give verbatim accounts of therapy, and there are some very convenient tabulations of the finer details. The role of pharmacological treatment is briefly noted in relation to most of the psychosocial techniques described, although knowledge of pharmacotherapy is assumed. The evidential support for each treatment is generally presented in a way that draws attention to the strengths and shortcomings of the research. Consequently, the referencing for each chapter is copious, appears comprehensive, and is as recent as can reasonably be expected in a text.

The interventions described refer to diverse settings, and the text would be useful for psychologists, psychiatrists and other mental health specialists, working in community or institutional settings. It would be valuable to novice clinicians developing their skills under expert supervision, as well as in providing established clinicians with an evidence base for their practice. In my view, it is the best text of its kind currently available, and I recommend it without reservation.


© 2004 Colin A Holmes


Dr Colin A Holmes, Professor, School of Nursing Sciences, James Cook University, Townsville, Queensland, Australia

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