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Book Review

Clinical Handbook of Couple Therapy, 4th ed

Robert T. Spalding, MD, DFAPA

Published: October 15, 2009

Clinical Handbook of Couple Therapy, 4th ed.

edited by Alan S. Gurman, PhD. Guilford Press, New York, NY, 2008, 736 pages, $85.00.

Gurman’s 4th edition of Clinical Handbook of Couple Therapy is comprehensive, up-to-date, and clearly the definitive reference book in this field. His introduction, a history of couple therapy, is a pleasure to read and is sprinkled with witty and wise aphorisms. It begins with a brief summation of the pioneering work of Jay Haley, who saw marital conflict as resulting from issues of power and control. Haley also formulated the "first law of human relations" that states "when one individual indicates a change in relationship to another, the other will respond in such a way as to diminish the change" (pp 7,8).

The first section of the book presents a review of schools of thought in couple therapy. Each is presented in a similar format (background, theory, and role of the therapist) and allows the reader to speed through to the "how to" section and case illustrations. The discussions start with the cognitive-behavioral couple therapy (CBCT), a common sense, skills training, quid pro quo approach to couple therapy and probably the most frequently used model in counseling centers today.

The next chapter deals with an integrative approach to BCT that is appropriate for those couples who would be poorly served by traditional BCT. It involves the concept of "acceptance," in which destructive reactions to acknowledged, irreconcilable differences are avoided.

The family systems theory appears to be alive and well and has a broad appeal, probably because of its nonthreatening nature. Its concepts of triangles, differentiation of self, and, certainly, the genogram have been adapted in many approaches. Murray Bowen, originator of the family systems theory, although antimethod and antitechnique, cannot avoid some aspect of this theory being a method.

The richness and complexity of the object relations theory is well explained in the Handbook, with its ties to psychoanalysis and the unconscious. The theory’s description of the use of dreams in couple therapy is intriguing.

Two chapters focus on the role of emotions in contrast to cognitive-behavioral couple therapy or family systems therapy. This emotionally-focused therapy, as well as a therapy developed by Dr John Gottman, requires more strategic planning because of potentials for both destructive and healing results. Gottman’s theory is discussed as dealing in a similar way with "irreconcilable differences," calling them "gridlocked conflict," and stressing the need to avoid the negative "Four Horsemen of the Apocalypse" reactions, which are criticism, defensiveness, contempt, and stonewalling.

Another school of thought, narrative therapy, will appeal to therapists with a literary inclination (eg, rewriting and enriching one’s life story). This deals with the notion that meaning is constituted through the stories we tell and hear concerning our lives.

Another school discussed, solution-focused couple therapy, has Bowenian overtones and is described as "a way of thinking and being, not a set of clinical operations" (p 259). The emphasis is on building solutions rather than increasing insight. In it, the role of the therapist is that of consultant, similar to the therapist’s role in family systems theory.

In the 2 final chapters, an attempt is made to integrate these different theories. The editor’s final attempt is nothing less than heroic. It is also a refreshing perspective on the various schools that can run the danger of having cult-like features. Gurman highlights the importance of eclecticism and emphasizes integration as the dominant trend in the field.

Section 2 interestingly discusses special populations and problems, such as treatment of affairs, borderline personalities, depression, divorce, alcohol and drug abuse, sexual dysfunction, and more. The chapter "Couple Therapy and Medical Issues: Working With Couples Facing Illness" is a particularly helpful chapter.

The practicing psychiatrist can garner many practical points from the Clinical Handbook of Couple Therapy. Although it is a reference book in which one can find specific information, one can also browse through such topics as empathy, communication, intimacy, and curative factors. Even though most of the recent work in couple therapy has been done by psychologists, almost all of the early pioneering work was done by psychiatrists. Psychiatrists of any persuasion will find an abundance of valuable pearls in this reference.

Robert T. Spalding, MD, DFAPA

Author affiliation: Private practice, Chattanooga, Tennessee. Financial disclosure: None reported.


© Copyright 2009 Physicians Postgraduate Press, Inc.

Volume: 70

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