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Book Reviews

Long-Term Psychodynamic Psychotherapy: A Basic Text, 2nd ed

Long-Term Psychodynamic Psychotherapy: A Basic Text, 2nd ed

by Glen O. Gabbard, MD. In book series: Core Competencies in Psychiatry. American Psychiatric Publishing, Inc, Washington, DC, 2010, 223 pages, $65 (paper), DVD included.

Gabbard has authored an important book. This second edition incorporates advances in the field, theoretical as well as technical issues. He offers an excellent primer for students and teachers of psychodynamic psychotherapy in regard to key concepts, the parameters of the endeavor, important definitions, and many aspects of "how to" regarding the employment of psychodynamic psychotherapy. This is a herculean accomplishment to present such a complex entity from theory to practice, with poignant vignettes to illustrate the ideas he is presenting, in 200-plus pages. And, he tackles such topics as transference, countertransference, resistance, and psychic determinism in a language that is clear, succinct, and without jargon (unless it is cogently defined). The text is augmented by a DVD with vignette illustrations of key issues he has made in his book, eg, "erotic resistance" and the "Exit Line" that pictorially presents the concepts he has put forward. This volume has been written for both novitiates in all mental health specialties as well as supervisors and training directors.

The book is a compendium of the essentials of one of the most important forms of psychotherapy practiced today and a core component of most of the psychiatric residency training programs in the United States. It covers assessment, indications, and formulations; the nuts and bolts of psychotherapy: getting started, therapeutic interventions, goals and therapeutic action, working with resistance and use of dreams and fantasies, identifying and working with countertransference, working through and termination, use of supervision, and evaluating core competencies in long-term psychodynamic psychotherapy. This vast array of essential material is presented unusually clearly, correlated with carefully articulated vignettes, and summarized to emphasize the key issues of every chapter. Each entity moves skillfully from theory (idea) to practice, showing the reader how to use the concepts in day-to-day contact with the patient. As noted above, the volume’s clarity with these complex and complicated conceptual models is in itself a display of the outstanding pedagogic skills of the author. It is a model of translational medicine: from theory to practice; from concepts to the patient’s side.

In addition, Gabbard attempts to associate psychodynamic issues with the emerging neuroscientific bases of behavior, eg, association of transference with neural circuitry. In several sections, he lets the reader know that the burgeoning neural science discoveries are also associated with the mind behaviors and activities encountered in psychodynamic psychotherapy; for example, object relationships of the past and old neural networks and how they may be altered to new forms of relating with the object(s) influenced by this form of therapy. The illustrative diagrams are very helpful in making complex models more easily understood. The book is well referenced and balanced by including the observations of other investigators—eg, Kline, Kohut, Fairburn, Winnicott, Kernberg—with regard to psychodynamic psychotherapy constructs. Similarly, as we struggle to organize DSM-5 for 2012, Gabbard emphasizes the need to understand the patient rather than just assign a diagnostic label.

The overarching premise embodied in this book, and regardless of the theoretical model of development, is that the adult is the product of important early experiences that continue to be repeated in the present with others, including the therapist. The author notes that the role of the therapeutic alliance is more important than any technique or model in producing outcomes. Mentation—the ability to self-reflect—is essential to mental health improvement. Gabbard also writes that "Psychodynamic psychotherapy patients show and maintain therapeutic gains and continue to improve after treatment. Psychodynamic psychotherapy has an ‘ extended release’ effect set in motion by the ongoing internal process of self-reflection."

An example of how Gabbard presents concepts and the knowledge necessary to practice psychodynamic psychotherapy is demonstrated in his clear and comprehensive exposition of countertransference. He clearly defines concordant transference, complementary countertransference, and countertransference enactment. This intriguing reaction in the therapist is redefined from its original Freudian position of being related to earlier experiences for the therapist to the unique interaction between patient and therapist creating thoughts and feelings in the therapist that can be used as guides to examine in the treatment setting. The importance of countertransference as a tool to enhance treatment is thoughtfully analyzed and annotated to enhance understanding by the reader.

This book is essential reading for students, residents, and those wanting to understand the infrastructure of psychodynamic psychotherapy. It is also suggested reading for teachers and practitioners to renew and clarify their understanding and to offer methods of presentation of the seminal thesis and conceptual framework of participating in the practice of long-term psychodynamic psychotherapy. Dr Gabbard is to be congratulated on his crafting of such an outstanding second edition of his essential exposition of this seminal topic in the education and practice of psychiatry.

James J. Strain, MD

jim_strain@hotmail.com

Author affiliations: Department of Psychiatry, Mount Sinai School of Medicine, New York, New York. Potential conflicts of interest: None reported.

Volume: 72

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