Psychotherapeutic Approaches to Schizophrenic Psychoses: Past, Present, and Future

Psychotherapeutic Approaches to Schizophrenic Psychoses: Past, Present, and Future

edited by Yrjö O. Alanen, MD; Manuel González de Chávez, MD; Ann-Louise S. Silver, MD; and Brian Martindale, FRCP. In book series: International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses. Routledge, East Sussex, UK, and New York, NY, 2009, 398 pages, $43.95 (paper).

The alarm bell alerting the psychiatric community to the seemingly continuous decline in the teaching and use of psychotherapy has been sounded by many over the years. From training programs to managed care systems and public health delivery systems, the shift toward reliance on and faith in psychotropic medications is evident.

This shift is particularly evident in the treatment of schizophrenia. Antipsychotic medications are the mainstay of clinical management, dominating research and clinical thought, with psychotherapeutic interventions often relegated to roles ranging from supportive adjunct to afterthought. This allocation of training and resources is doing our patients a considerable disservice, as psychotherapeutic treatments have a rich and abundant experiential and experimental evidence base in showing utility in promoting improvement in schizophrenia. Such data are so robust that it would be difficult to justify not employing psychotherapy at the forefront of one’s schizophrenia treatment plan.

That’s where this much-needed volume comes in. In its 398 pages, it presents a comprehensive and well-organized survey of the past and present developments, research, and international experience in the use of psychotherapy and psychosocial treatments in schizophrenia. Well-edited by the 4 international editors, this book was published for the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses book series. As such, it has an international focus well beyond the American and British influence that US readers are accustomed to. However, the breadth of international experience presented will be of good use to the reader.

The book is organized into 3 parts. The first is a survey of the history of psychotherapeutic treatment of schizophrenia, moving through Freud, Bleuler (and others trained under his directorship at Burghölzli, including Jung and Binswanger), and Harry Stack Sullivan. The second part traces the international development of psychotherapeutic thought and practice, from historical origins to current practice implementations in the treatment of psychosis. Not only US and British psychotherapeutic developments are surveyed, but also those of wide-ranging European countries, East Asia, and New Zealand. The third part surveys current thought, research, and techniques, including family therapy, group therapy, cognitive-behavioral therapy, early intervention, rehabilitation, and integrative approaches for treatment of schizophrenia.

The editors should be lauded for compiling an excellent anthology of articles by numerous international experts, providing a wonderfully comprehensive view of the history, methodology, and implementation of psychotherapeutic interventions for schizophrenia. The primary goals of realizing the importance of an integrated treatment program and the use of various psychological modalities to provide a more humanistic approach for treatment of patients with schizophrenia have been well conveyed.

This book will be of greatest value to any clinician with interest in the implementation of a schizophrenia treatment program (with a compelling case contained within these pages that psychotherapy should figure prominently within such a program), although a more general audience of clinicians who treat psychotic disorders would gain a valuable appreciation for the richness of therapeutic approaches that have been developed and tested. Indeed, we recommend this book highly to pull clinicians from the increasing tilt toward exclusive reliance on psychopharmacology and instead nudge them toward a rich array of effective, humane, and integrative therapeutic approaches.

Michael Makhinson, MD, PhD

John Tsuang, MD

johntsuang@yahoo.com

Author affiliations: David Geffen School of Medicine, University of California at Los Angeles. Potential conflicts of interest: None reported.

doi:10.4088/JCP.10bk06696

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