Integration in Psychotherapy: Models and Methods

This short book is edited by two of the currently best-known UK psychotherapists, who have a deserved reputation for writing clearly and persuasively about psychotherapy. Both have been chairs of the Psychotherapy Faculty of the Royal College of Psychiatrists, and both are resolutely medical psychotherapists. Holmes is psychodynamic in orientation, and Bateman is a member of the British Psychoanalytic Society. In their introduction they summarize the importance of integration in psychotherapy: the shift in emphasis from keeping the treatment consistent with the modality to making it appropriate to the condition; the emphasis on short-term effectiveness, which has undermined the preeminence of psychoanalytic therapies; and outcome research which suggests that it is the quality of therapeutic relationship that affects outcome, and not the modality specific interventions. However, it is obvious that the authors are not temperamentally committed to outcome-driven therapy. They have not therefore set out to write about how the different insights into psychotherapy provided by different approaches might be synthesized. Instead they have sought to capture what they call ‘‘. an essential ‘moment’ (both in the temporal and the dynamic sense) in the evolution of psychological therapies’’ (p. 10). This book will therefore have limited utility to anyone looking for such a synthesis. It is also limited in its outlook by the selection of contributors, all but two of whom have UK addresses and 10 out of 13 of whom are medical practitioners. Having said that, each of the chapters does have the virtues as well as the limitations that one associates with the work of UK medical psychotherapists. The chapters are all well-written with a clear exposition of the underlying theory, and plenty of acknowledgement of its practical implications. There are plenty of references, and this should satisfy psychiatry trainees. However, there is no integration between the different chapters. The authors have not been asked to use similar headings, and so the chapters are not comparable. Each of the authors believes strongly in his or her approach, and tends not to be critical or self-reflective about them. This is less of a problem for established approaches, like therapeutic communities, which have already accumulated their own critiques (although these do not figure strongly here) as it is for new approaches that are still dazzling by their promise, such as dialectical behaviour therapy. Inevitably with a book like this, there are specific niggles. Margison, in summarizing the evidence supportive of Hobson’s conversational therapy, mentions Guthrie’s successful application of it to irritable bowel syndrome, but does not mention that the benefit has been less substantial in larger replication studies, suggesting that it may have been Guthrie herself whose abilities conferred the benefit rather than the therapeutic modality that she was using. It is also disappointing in the therapeutic community chapter not to find reference to August Aichhorn, but only to Homer Lane. In the same chapter, the curt reference to Camphill Villages as ‘silent’, ‘unmarked’, and ‘inexpensive’ indicates the distance that there is between consultant psychotherapists and consultants in learning disability, who deal with Camphill Villages and other therapeutic communities in the learning disability field all the time. The book is probably best taken as a group of individual essays summarizing particular approaches. The approaches are chosen to be those that already have official recognition in the UK health service, and have been singled out by the Faculty of the UK Royal College of Psychiatrists as of particular interest to trainees. Humanistic approaches, such as existential therapy and gestalt, although equally integrative and more familiar in other parts of the world than CAT, are not represented. All of the chapters will be a useful starting off point for each of their approaches. Inevitably, the ones on CAT and DBT are likely to be of particular interest, because these are currently up and coming approaches. What the book does not provide*/and the editors did not set out to provide*/is any progress on getting rid of the dross, and keeping the gold, of psychotherapy.