Of all our cultural icons, of all
the things that should be placed into a time capsule to remember our current
society by, psychotherapy is one of those least understood by the general
public. Moreover, unlike physicians, engineers, and professionals in other
applied sciences, many practitioners of psychotherapy would even argue that
some of their colleagues misunderstand it. This disagreement over fundamental
issues in psychotherapy is Douglas Scaturo’s starting point in Clinical
Dilemmas in Psychotherapy. Scaturo surveys different schools of
psychotherapy (e.g., psychoanalytic, cognitive-behavioral, etc.) and shows that
various concepts from each approach must be integrated with concepts from other
approaches for psychotherapy to work best.

The first part (two chapters) makes
general comments about dilemmas that therapists encounter and provides
historical background, while the next part (five chapters) focuses on various
types of psychotherapy (e.g., family therapy, group psychotherapy),
highlighting the dilemmas that therapists encounter in each type of therapeutic
work. A third part (two chapters) focuses on dilemmas that flow from the
personal relationships that form between therapists and clients, and the book
ends with three chapters devoted to the dilemmas that occur when therapists
attempt to combine elements from different therapeutic approaches.

The book is clearly meant for
professional therapists, professors who train therapists, and students training
to become psychotherapists. Because of this intended audience, there is a great
deal of technical jargon, even when the material being covered is not
especially difficult. Consider Scaturo’s definition of codependence (p. 99): "Codependency
is a concept that is reflective of a mutually dependent, but complementary role
relationship among members of a family that is maintained by a homeostatic
mechanism as a response to changes made or impacted on by a given member of the
family."

Unfortunately, this combination
of jargon and tortured writing pervades the book, especially the first half.
The poor presentation is all the more lamentable because Scaturo’s wide reading
and considerable clinical experience are evident in every chapter. His
quotations from famous psychologists (who are generally clearer than Scaturo)
and his incorporation of great works of literature could make a clearer book
into a destined classic, and his discussions of actual psychotherapy clients
could be very useful to practicing therapists. Consider the second chapter,
which focuses on the evolution of different models of therapy. Scaturo offers a
thoughtful and nuanced historical narrative, but bad writing gets in the way
again, as in his discussion of the family therapy model in that chapter (p. 35,
reference citations removed):

The need to establish the independence of the family systems concept to demonstrate its viability as yet a theoretical force was understandable. Even in the past decade of psychotherapy integration, family systems treatment has tended to be confined to the integration of family therapy as a treatment modality, as opposed to family systems theory as a way of conceptualizing psychopathology and its amelioration. Nevertheless, as family therapy began to develop and evolve as a discipline in the mental health area, clinicians already solidly identified with the family systems approach were beginning to recognize the importance of empirical contributions from other levels of theoretical abstraction. These levels of theoretical abstraction have included the psychodynamic-intrapsychic level of conceptualization, the behavioral-symptomatic level, and the cognitive level of intervention.

Passages even less accessible
than this one abound, but even more regrettable is that no other book covers
all of the content found in Clinical Dilemmas in Psychotherapy.
Therefore, students who are training to be therapists and the instructors who
are training them may find the book to be a helpful resource, simply because
few others are available. However, these readers will at least have a general
background in psychology; others who are looking for a clear introduction to
psychotherapeutic approaches should look elsewhere.

© 2006 Ben Lovett

Ben
Lovett is currently a doctoral candidate in the psychology department at Syracuse University, where his research interests include learning disabilities and ADHD.
For more information, see his website: http://web.syr.edu/~bjlovett/

Categories: Psychotherapy, Ethics