East Asian Arch Psychiatry 2012;22:34

BOOK REVIEW

When talking about psychodynamic psychotherapy, one could easily associate it with Freud and his theories on unconsciousness and ego. Yet to most young trainees in psychiatry, little is known about how this form of psychotherapy is conducted after decades of development. Do we still need a couch that the patient will be lying on, and to talk about whatever comes into his or her mind? Do we still attempt to interpret how one’s Oedipal complex is unresolved? This clinical manual is a useful guide for psychotherapists or trainees in psychiatry who are interested in knowing how psychodynamic psychotherapy is conducted. Born as a syllabus for psychiatry residents in the New York State Psychiatric Institute, the primary aim of this book is not to delve deeply into the theoretical issues, which might be too complex to comprehend for beginners. Rather, it is set out as a blueprint for clinicians to use as a reference when they are beginning to practise this form of psychotherapy.

The book is divided into 7 parts. The authors first gave a brief and concise introduction to the principles and theories of psychodynamic psychotherapy, explaining how it is believed to work. It is then followed by how the therapist should choose and evaluate patients, in which different forms of ego functions and defences were taught, so that we could make formulations for individual patients and tailor-make the therapy. The third part goes back to more technical issues that are common to many forms of psychotherapy like setting boundaries, establishing a therapeutic alliance, logistic issues for the sessions, and so forth. Having discussed the basic concepts, part 4 focuses on the techniques of listening, reflecting and intervening in the course of psychodynamic psychotherapy. These could help the therapist assess the level of defence and ego function, so as to choose an appropriate intervention. With these techniques on hand, the manual then goes on to talk about their application into elements in psychodynamic psychotherapy such as resistance, transference, and dreams. Part 6 demonstrates how, by using all these skills on the different elements in the therapy, one could eventually bring about changes and target problems such as interpersonal difficulties, poor self-esteem, and weakened ego functions. The last part of the book focuses on specific issues related to the termination of therapy that a therapist should become familiar with.

Written as a manual, the language used is straightforward and simple. It is organised in a way that resembles a school textbook. Each chapter begins with a list of key concepts that help the readers to focus. Interspersed between theories are numerous examples, in the format of case vignettes consisting of dialogues between the patient and the therapist. As the dialogues are based on case scenarios, they allow readers to have credence about the ideas being discussed. The materials in the book therefore have a fine balance between theoretical materials and practical guidance, of which the latter could be most helpful to beginners lacking clinical experiences in psychotherapy. Towards the end of most chapters are case studies for brainstorming and exercising. Not only does this help to reinforce the concepts, it invites the readers to actively learn by applying knowledge into virtual practice.

The way which our mind functions is comparable to that of water running down a hill. As the water runs, it carves out a path of its own on the earth. The collection of tracks forms into a system, which is likely to be followed when water comes again, as there is less resistance where tracks have already been formed and used. When we were young our mind was pretty much like a hill, devoid of such tracks. Our upbringing, early experiences of relating with one and other are the water that shaped our mind and formed the habitual patterns that we use throughout the rest of our lives. Some of these patterns, however, could become problematic when they are maladaptive and jeopardise our relationships, and self-esteem. It is often hard for us to change these habitual ways of being, as it is always easier to go back to the old rather than exploring new ones. Yet what is even more difficult is to acknowledge the existence of such patterns. Often the hill is overgrown by bushes and trees, and these tracks and the system become invisible. In other words, they are out of our consciousness. It is the aim of psychodynamic psychotherapy to identify these defective tracts, bring them into awareness, and assist patients to adopt new ways of being. For anyone who is interested in stepping into the realm of psychodynamic psychotherapy, this manual would be a great companion for the journey.

Oscar Wong, MBChB (email: oscarwongwh@gmail.com)
Department of Psychiatry Tai Po Hospital
Tai Po, New Territories
Hong Kong SAR, China