BOOK REVIEWS

Cognitive Therapy: Basics and and reducing the risk of relapse. In each chap-
Beyond ter, the most important points are highlighted
by placing them in a gray tinted box. This
By Judith S. Beck format makes it very easy to capture the essence
New York, Guilford Press, 1995,338 pages, of the author’s message. For example, in chapter
ISBN 0-89862-847-4, $35.00 3, “Structure of the First Therapy Session,” 10
specific methods are identified for structuring
Reviewed by Jesse H Wright, MD., Ph.D. cognitive therapy. Each of these techniques is

J udith
the field
Beck has
of psychotherapy
provided a great
by writing
service
a step-
to
then described

be
Behaviorally
forewarned
in detail.

that
oriented
this book
therapists
is focused
should
pri-
by-step guidebook for learning and practicing marily on cognitive conceptualizations and
cognitive therapy. techniques. Although the author demonstrates
Cognitive Therapy: Basics and Beyond is how behavioral procedures such as activity
packed with useful information that should scheduling, graded task assignments, and re-
help both novice and experienced therapists laxation can be incorporated into cognitive
become better clinicians. In the tradition of therapy, cognitive intentions are described in
Anna Freud, the author has distilled and ex- considerably more detail throughout the vol-
tended the groundbreaking work of a famous ume. Even those therapists who prefer a be-
father. She has been remarkably successful in havioral approach to treatment could benefit
explaining the methods of cognitive therapy from reading Dr. Beck’s observations on the
originated by Aaron T Beck and has added structure and process of cognitive therapy. Her
her own astute observations on how to be- description of methods for increasing home-
come an accomplished cognitive therapist. work compliance, solving difficult therapy
Simply put, this is the best book available problems, and teaching patients to be their
for learning how to do cognitive therapy. Basic own therapists should be of interest to all
principles are clearly presented and illustrated clinicians.
with dialogue from typical therapy sessions. The majority of Cognitive Therapy: Basics
These illustrations should be especially useful and Beyond is devoted fundamentals to theof
to clinicians because they give a richly detailed this form of treatment. Thus, it should be most
picture of how to present cognitive therapy useful for students and therapists who do not
concepts and move successfully through the have an extensive background in cognitive
stages of treatment. Unlike other books on therapy. For these individuals, the book will be
cognitive therapy, this volume is specifically an invaluable resource for assimilating the
directed at teaching therapy techniques. The wisdom of a master cognitive therapist. Expe-
historical background, theoretical issues, and rienced clinicians may wish to focus on the
research effort of this treatment approach are more challenging discussions of procedures
not covered in depth. Instead, the author gets for modifying core beliefs and handling the
directly to the point: how to perform cognitive problematic aspects of therapy. The author’s
therapy. insights on these later therapy topics are both
All of the basic procedures of cognitive pragmatic and highly creative. Her sugges-
therapy are included. The book begins with a tions for use of a Core Belief Worksheet and
cognitive conceptualization for treatment and restructuring early memories offer innovative
then proceeds to instruct the reader on meth- solutions for changing deeply held maladap-
ods of structuring therapy, working with auto- tive beliefs.
matic thoughts, modifying underlying beliefs, Cognitive Therapy: Basics and Beyond is so
implementing homework assignments, using full of valuable material that it may overload
advanced cognitive and behavioral techniques, the reader who tries to digest the information

JOURNAL OF PSYCHOThERAPY PRACFICE AND RESEARCH

72 BOOK REVIEWS

too rapidly. This book will probably be of most psychoanalytic theory must continue attempts
help to those who are involved in learning to validate its assumptions and to integrate
cognitive therapy and can apply the lessons in these findings with knowledge gleaned from
a stepwise fashion. It is highly recommended other disciplines. For readers less versed in the
to any clinician who wants to learn more about literature, Buckley provides a well-written his-
how to be an effective cognitive therapist. torical overview of the taxonomy and descrip-
Judith Beck has written a classic volume that tion of defenses. The remainder of the
will be widely used as a standard text of teach- theoretical portion of this volume presents
ing cognitive therapy. numerous efforts to integrate psychoanalytic
thought with other perspectives.
Dr. Wright is Professor, Department of Psychiatry Most of the authors have adhered to simi-
and Behavioral Sciences, University of Louisville lar definitions of defense, as theoretical ab-
School of Medicine, and Medical Director, Norton stractions that describe a particular way in
Psychiatric Clinic, Louisville, KY. which the mind works, a process by which
painful thoughts, feelings, or motives are ren-
dered less potent. Finding the appropriate
Ego Defenses: Theory and level of analysis, however, was perhaps the
Measurement (Einstein Psychiatry most vexing task facing the various authors at
Publications Series No. 10) both theoretical and assessment levels. As
each level of description has its costs and
Edited by Hope R Conte and Robert Plutchik benefits, it is vital to choose a level of analysis
New York,John Wiley and Sons, 1995, appropriate for the phenomenon of interest.
340 pages, ISBN 0-471-05233-7, $52.50 Safyer and Hauser suggest that the lack of
crisp, empirical definitions of defenses and
Reviewed by Scott C. Bunce, Ph.D., and disagreement over a taxonomy have made
Philzs) Margolis, MD. research on ego defenses difficult, in part ow-
ing to difficulties in measurement. Agreement
sthe editors submit, the idea that the on an operational definition of defenses would
ind employs mechanisms that can dis- increase our ability to focus empirical work,
tort or vanquish painful thoughts or feelings is but this does not necessarily mean we should
one of the most widely accepted facets of settle on a canon. Continued work on taxo-
psychoanalytic theory. There remains, how- nomic issues has resulted in important theo-
ever, considerable debate over the precise retical developments. Safyer and Hauser, for
meaning and function of these defenses. Conte example, explore the question of whether de-
and Plutchik have outlined several important fenses can be organized into a developmental
questions in the literature: How many de- continuum according to their level of maturity
fenses are there? How shall we define them? or their degree of pathology. Their own work
Can they be arranged hierarchically by virtue suggests the predominant type of defense used
of their level of adjustment? Are defenses by individuals may be affected by age, gender,
adaptive or maladaptive, rigid or flexible? Can ego development, or cognitive level.
they be reliably and validly measured, and if Plutchik examines ego defenses within a
so, how? Ego Defenses organized in two sec- psychoevolutionary theory of emotion. He ar-
tions of seven chapters each, presents the work gues that there are eight basic emotions, and
of a number of authors who have suggested that a number of conceptual domains-per-
answers to these questions: Part I addresses sonality traits, ego defenses, and diagno-
theory, and Part II presents methods for the ses-are derivatives of these eight emotions.
measurement of defenses. One ego defense is thought to operate in re-
To remain a viable science of the mind, sponse to one basic emotion plus anxiety. The

VOLUME 6 NUMBER
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BOOK REVIEWS 73

scope of Plutchik’s attempt to integrate various experiences and wishes and 2) to inhibit the
levels of description is laudable. However, the acts related to the wishes.
specificity and precision of dynamic descrip- Benjamin begins her chapter by suggest-
tion may be lost in his effort to gain systemic ing that defenses need not offer protection
clarity. It is probably too simplistic to describe from forbidden impulses, yet she reintroduces
eight basic defenses as linked to eight basic motivation as the realization of wishes or the
emotions. Defenses are dynamic processes, avoidance of fears; hence, motivation plays
usually defined by the process with which they a central role in her theory. Benjamin ex-
neutralize the offensive material. The same tends defensive theory by operationalizing
mechanism could operate on any number of psychoanalytic hypotheses within an interper-
emotions, cognitions, or desires. sonal context, asserting that defenses can at
The Horowitz and Stinson chapter implic- times be adaptive, primarily when they pre-
itly acknowledges the complexity inherent in serve interpersonal relationships. This is not
research on unconscious mental processes. By inconsistent with Freud; defenses allow us to
taking a microanalytic approach to case mate- operate in a social world with interpersonal
rial, their techniques exemplify important constraints.
methodological considerations for defense Slavin and Grief invoke evolutionary the-
analysis. They have shown how Freud’s de- ory to help decide the argument between clas-
scription of the interaction between conscious sic psychoanalytic views and object relational
and unconscious processes might be ex- views of what gets repressed and why. As prod-
plained in light of recent cognitive science ucts of evolution through inclusive fitness,
models of the mind. Within a parallel distrib- parents necessarily have self-interests that
uted processing account of the mind, control compete with the interests of their offspring,
processes are thought to determine which of and children must negotiate the parental world
many levels of unconscious processes will be to survive. Because reproductive success relies
allowed to become conscious, thereby allow- on continuation of the genome, it is in the
ing image distortions in the individual’s person children’s best interest to repress competitive
schemas. They do not, however, articulate the parts of the self necessary for future reproduc-
motivational aspects of their theory well. Con- tion. Reproductive success requires investment
trol processes are proposed to modify thoughts in both selfish interests and the social interests
and communication to avoid unwanted states characteristic of object relational views.
of emotion, but the role of defenses vis-#{224}-vis Methods of measurement should neces-
motivation is not examined. This is trouble- sarily derive from theoretical hypotheses
some because there has been some conflation concerning the variable of interest. The over-
of emotion and motivation, particularly in the determined nature of psychoanalytic concep-
literature on emotion. The role of a defense is tualizations of intra- and interpersonal
often either to keep a given desire or motive processes makes the assessment of defensive
unconscious or to prevent acting on that desire processes difficult, labor-intensive at best.
when the consequences are too dire. This is Three approaches to the measurement of de-
underscored in Dahl’s chapter, where he inte- fense mechanisms are presented in this vol-
grates defenses with an information feedback ume: self-report inventories, projective
theory of emotion. Dahl sees emotions as one methods, and scales for rating clinical mate-
of the primary systems we have for surviving rial. The development, reliabilities, and va-
in a dangerous world, facilitating communica- lidities are described for three self-report
tion and the recognition of the intentions of instruments, the Life Style Index (Conte and
other members of our own species. Defenses are Apter), the Defense Style Questionnaire
thought to serve two primary functions in this (Bond), and the Defense Mechanism Inventory
theory: 1) to restrict awareness of emotional (Ihilevich and Gleser). Although self-report

JOURNAL OF PSYCHOTHERAPY PRACTICE AND RESEARCH

74 BooK REVIEWS

inventories are convenient, and can offer pre- be difficult for a rater, having identified a
dictive validity, they have serious limitations particular defense, to avoid “observing” clus-
for use in assessing dynamic defenses. Bond is ters of related defenses. Bauer and Rockland
appropriately cautious about the conclusions have attempted to cope with this observer bias
that can be drawn from self-report measures in their Inventory of Defense-Related Behav-
of defenses. Self-report is subject to the moti- iors by rating specified behaviors, rather than
vations and openness of the subjects at the abstract “processes,” as present or absent in
time of their response, and at best, taps con- clinical material. However, defense mecha-
scious derivations of unconscious intrapsychic nisms are abstractions, reflected in numerous
processes. Thus, high test-retest reliabilities behaviors, whereas any behavioral assessment
probably reflect trait-like defensive styles, or instrument is limited by its taxonomy. This
the propensity to use particular defenses, difference may result in the low interrater reli-
rather than defenses per se. This limits their abilities found for several defense mechanisms.
use to a particular range of psychodynamic Ego defenses represent complex, dy-
hypotheses: those concerning character styles. namic intrapsychic phenomena that must be
These instruments can be useful as long as understood within a larger dynamic system of
their limitations are acknowledged. personality. This complexity contributes to a
Two chapters address the assessment of feeling that many of the authors could not do
defenses with projective measures, which pur- justice to the intricacies of their theories within
portedly allow the direct assessment of de- the spatial limits of these chapters. Most of the
fenses because the ambiguous stimuli are chapters describe published work, however,
thought to evoke actual defensive responses. and are well-referenced, so the motivated
The Defense Mechanism Profile Uohnson and reader can follow up on interesting concepts.
Gold), a projective sentence completion in- Overall, it is encouraging to see both theoreti-
strument, avoids a forced-choice format that cal and empirical work on psychoanalytic con-
might elicit responses that are neither accurate cepts. To remain a viable science of the mind
nor representative. The projective task helps and of clinical services, psychoanalysis must
establish ecological validity, but it is still vul- continue its dialectic within the field while
nerable to self-report biases-that is: Do the integrating the best that other disciplines have to
subject’s reports reflect actual situational re- offer. This book is a step in the right direction.
sponses? Ritzler nicely summarizes and co-
gently critiques several methods for assessing Dr. Margolis is Professor of Psychiatry, and Dr.
defenses by use of the Rorschach. His discus- Bunce is a postdoctoral fellow in psychology, Uni-
sion exemplifies the complexity of defense versity ofMichigan Medical Center, Ann Arbor, MI.
measurement that contributes to the low valid-
ity and reliability plaguing projective research.
He appropriately emphasizes the need to vali- Psychotherapy in the Age of
date existing schooling systems with behav- Accountability
ioral or clinical observations of defenses.
The last two chapters exemplify the meth- By Lynn D.Johnson
odological rigors necessary to capture a rela- New York and London, WW. Norton, 1995,
tively unconscious intrapsychic process. Perry 257 pages, ISBN 0-393-70209-X, $29.00
and Kardos review the Defense Mechanism
Rating Scales (DMSR), one of two rating sys- Reviewed by Marcia Krafi Goin, MD.
tems in this volume that rely on extensive
analysis of case material. The DMSR allows L ynn D.Johnson
of a long-time case
writes
management
with the authority
reviewer
for good ecological validity and internal
reliability, but falls prey to observer bias: it can for one of the largest employee assistance

VOLUME 6 NUMBER!
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BOOK REVIEWS 75

programs. He knows the needs and attitudes process.” The setting of time limits, Mann’s
of the managed care administrators and has focal therapy, and Alexander’s corrective
myriad opinions about the accountability of emotional experience all represent our col-
therapists across the country. His book informs leagues’ concern with time and their efforts to
the reader about a model of treatment that he shorten the process. With the advent of behav-
believes achieves therapeutic success while ioral and cognitive therapy, clinicians hoped
working within the confines of a managed that treatment based on learning theory would
care system. achieve this goal. We have learned that certain
The first of the book’s three sections, “An problems do respond more readily to behav-
Integrative Approach,” describes Johnson’s ioral intervention and that certain patients are
therapeutic technique, which makes use of able to make productive use of homework
aspects of behavioral, psychoanalytic, Gestalt, assignments and other practical techniques.
T-group, and other models of brief psychother- Some patients can respond to these tech-
apy. Johnson believes that his technique niques, but not all patients are alike. Although
achieves focused quality care in the shortest the author states that his focused technique can
possible time. The second section, “Support- be used even with the most severely mentally
ive Concepts,” deals with the matter of time in ill patients, his section on the severely trauma-
psychotherapy (how much time is really nec- tized patient does not bear this out. In this
essary, time-limited and time-sensitive psy- section he states that the therapist is not the
chotherapy, and other issues) and with patient’s protector and “If the patient cannot
motivation and compliance. The final section, remain safe, she must reach out to crisis agen-
“Specific Applications,” discusses the applica- cies or emergency rooms.” A therapist cannot
tion of time-sensitive, accountable, and effec- say this to a patient without completely abdi-
tive treatment in working with traumatized cating professional responsibility. Besides
patients, adolescents, and those with alcohol abandoning responsibility, Johnson is relying
and drug abuse problems. on a system of care (crisis agencies and emer-
It is implied throughout the book that the gency rooms) that is rapidly disappearing.
restrictions placed on therapists by managed It has become all too common for treat-
care will in fact benefit patients. The author ment planning to be dictated by faceless re-
envisions that the demands of managed care viewers rendering clinical judgments through
will provide an impetus for therapists to work checklists on computer screens. Despite the
faster to enable patients to get better within the limits set on treatment duration by managed
delineated time limits. This view conveys the care, it is the professionals who still bear the
idea that for the most part therapists are self- heavy burden of ultimate responsibility for
serving miscreants who will dawdle along un- their patients’ well-being--morally, ethically,
concerned about patient care until prodded and legally. This cardinal principle is not taken
into action by the almighty dollar. In my years into account in this book.
of supervising the training of hundreds of psy- Despite my misgivings, I believe this is a
chiatric residents I have found the opposite to book worth reading. The treatment examples
be true. Most therapists are humane and com- are instructive and thought provoking, and
passionate professionals working to find the they include treatment techniques that may be
most effective way to help their patients. helpful for certain patients. Primarily, it is a
Clinicians have long searched for speedier useful handbook for understanding the atti-
resolution of their patients’ problems. From tudes of managed care employees. Although
the beginning of the development of psycho- neither fun nor conceptually provocative, the
analytic therapy, as Freud wrote in Analysis book will help you grasp reviewers’ perspec-
Terminable and Interminable, attempts have tives and will educate you as to what they want
been made to “hasten the time-consuming to know and how you are accountable to them.

JOURNAL OF PSYCHOTHERAPY PRACTICE AND RESEARCH

76 BooK REVIEWS

Dr. Goin is Clinical Professor of Psychiatry, Uni- Nace’s effort to identify and explain the
versity of Southern California School of Medicine, interplay between these forces is both the
Los Angeles, CA. strength and one of the main weaknesses of his
book. His dissecting of the variables that
influence and contribute to addiction is very
Achievement and Addiction: helpful in familiarizing the reader with the
A Guide to the Treatment of special set of circumstances that confront the
Professionals addicted professional. Consequently, his in-
sights provide a useful perspective on the ways
By Edgar P. Nace that these influences can make diagnosis and
New York, Brunner/Mazel, 1995,264 pages, treatment more difficult for this population.
ISBN 0-87630-735-5, $32.95 On the other hand, Nace comes precariously
close to furthering the belief that an addicted
Reviewed by PhilzJ. Flores, Ph.D. professional is unique, special, or different
from other addicts or alcoholics. Successful
E dgar
about
Nace
a subgroup
has written an
of addicted
important
patients
book
that
treatment of addiction,
ning, requires that more
especially
emphasis
in the begin-
be placed
can sometimes be overlooked and neglected. on the similarities among those who are ad-
He begins his book by confronting the stereo- dicted than on the differences that may exist.
types that are occasionally held about alcohol- Nace, to his credit, addresses this issue later in
ics, addicts, and substance abusers. He then his book when he writes about the different
explores ways in which many of these assump- strategic approaches to treatment for early-
tions and typical images do not fit when at- stage and later-stage patients. However, one
tempts are made to understand or explain why book cannot be all things to everyone, and
highly successful, intelligent, motivated, and Nace’s intent is clearly to identify the ways in
achievement-oriented professionals succumb which the addicted professional is different. As
to a disorder that remains baffling to a large he cautions, he is using the term “different”
portion of the general population. Even conservatively and does not want it to suggest
though the general public’s attitude about ad- that this is an elite group. He goes on to present
dictions is changing as the problem grows and convincing evidence that the alcoholic’s and
more accurate information is made available, addict’s inclination to believe he or she is
it is still a confusing disorder to many profes- unique or special contributes not only to the
sionals in the treatment community. Nace’s disorder, but also to recovery.
explanations of the phenomena of addiction Throughout, Nace does a commendable
take on added significance because he does job of integrating the theoretical and the prac-
not permit himself to escape into stereotypes tical. In Chapter 4 he presents many useful
about its causes. For instance, although he pays recommendations and clearly written sug-
homage to the disease concept of addiction, he gestions on intervention, diagnosis, and
avoids the pat answer that addiction is just a evaluation. He provides many nuts-and-bolts
disease. He recognizes that a number of vari- suggestions about what to do, how to do it, and
ables influence the addiction process. Genetics, when. His theoretical perspective encompasses
personality, social influences, peer pressure, both the disease concept and the most current
availability of the drug or substance, interper- positions within psychodynamic theory.
sonal psychodynamics, subtle interactions of Drawing on the world of Kohut, Khantzian,
grandiose defenses with shameful affect, and and Kurtz, he admirably integrates two differ-
neurological/biochemical influences all com- ent theoretical perspectives, showing how the
bine to produce a predictable but complicated disease concept and psychodynamic theory
process that is called addiction. can complement each other. For example, he

VOLUME 6 NUMBER
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BOOK REVIEWS 77

illustrates how Kurtz’s writings about addic- Dr. Flores is in private practice and is Adjunct
tion and shame complement Kohut’s and Clinical Associate, Department of Psychology,
Khantzian’s views on the relation of shame to Georgia State University, and Adjunct Clinical
narcissism. He draws parallels between Supervisor, Department of Psychiatry, Emory Uni-
Kurtz’s perspective on addiction as an attempt versity, Atlanta, GA.
to combat shame and Khantzian’s self-medi-
cation hypothesis, which defines addiction as
an attempt at self-repair that fails. Eye Movement Desensitization and
The book does have an unacknowledged Reprocessing:Principles, Processes,
bias. Although I personally hold to and agree and Procedures
with most of his recommendations on treat-
ment, he fails to speak to the chasm that exists By Francine Shapiro, Ph.D.
between the majority of the addiction treat- New York, Guilford Press, 1995, 398 pages,
ment community and the small but powerful ISBN 0-89862-960-8, $42.00
community of researchers, educators, and
treatment professionals who are strongly op- Reviewed by T/wmas D. Geracioti,Jr., MD.
posed to 12-step abstinence-based models and
disease-concept-oriented approaches. Al- In this book, Francine Shapiro details the
though the majority of treatment personnel clinical procedures and theoretical princi-
who work with addiction would find Nace’s ples of eye movement desensitization and re-
perspectives and recommendations useful, processing (EMDR). Recently, EMDR has
helpful, and complimentary, there are grow- been gaining popular acceptance as an effec-
ing numbers of more academically and behav- tive treatment for posttraumatic stress disorder
iorally oriented individuals who would (PTSD), among other putative indications,
vehemently disagree with Nace’s position on although awareness of the technique within
addiction. It is not necessary that Nace address academic medical centers remains dim. Pre-
this controversy, but it would have been help- liminary research on the clinical efficacy of
ful to at least acknowledge it. EMDR, cited by Shapiro, is highly encourag-
Despite a few oversights, the book is an ing, but additional well-designed studies are
excellent one by an author who obviously needed to validate its usefulness and to explore
understands the addictive process thor- its effects. This book is timely insofar as it
oughly. It reflects the insights of someone provides the uninitiated with a comprehensive
whose interest is not merely passing or purely introduction to EMDR by its creator.
academic. Dr. Nace has obviously worked Shapiro traces the origins ofEMDR to her
extensively with this population on a personal days as a graduate student in 1987, when-
and intimate level. This is a clearly written while walking in the park-she noted that her
and concisely organized book that makes ju- own rhythmic eye movements seemed to be
dicious use of clinical examples to help illus- associated with the immediate disappearance
trate what could otherwise be dull, abstract, of some disturbing thoughts. When later re-
and ponderous reading. His cleverly pre- called, these thoughts “were not as upsetting
sented examples help his material come alive or as valid as before.” Indeed, the central
on the page. Nace’s book will be helpful to the procedure in EMDR involves using the fingers
beginning student of addiction, the seasoned to lead the client in back-and-forth eye move-
practitioner who wishes to expand his or her ments while he or she holds “targeted” prob-
understanding of this disorder, and the expe- lematic images in consciousness. Shapiro
rienced addiction specialist who wishes to claims that repeated sets of directed eye
know more about this segment of the addicted movements activate the brain’s “informa-
population. tion-processing system” and facilitate the

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78 BOOK REVIEWS

therapeutic working-through of traumatic ex- associative memory network that had held the
perience. A typical “set” consists of at least 24 incompletely processed traumatic material.
bidirectional eye movements. Other stimuli, Shapiro believes that use of her method can
such as bilateral, alternating hand taps or “accelerate” information processing to such a
stimulation of the acoustic apparatus, are also degree that enduring symptomatic relief can
said to mobilize the information-processing often be obtained with just a few treatment
system as well as eye movements. Although sessions and, sometimes, after only a single
no in-depth exploration of the different neuro- session. She hypothesizes that the rapid, “time
nal afferents evoked by these different stimuli free” nature of EMDR-invoked accelerated
is attempted, consideration is given to the information processing might involve neuro-
possibilities that either alternating hemi- physiologic mechanisms similar to those that
spheric activation alone (in the absence of any permit elaborate sequences to be dreamed in
specific movement) or the rhythmicity of a relatively short time during REM sleep.
movement itself is of clinical importance. Although use of directed eye movements
The EMDR protocol itself consists of is reminiscent of certain mesmerizing tech-
eight “essential” phases-”cient preparation, niques, and the reported association of eye
history, and assessment,” followed by “desen- movements with cerebral activation is vaguely
sitization, installation, body scan, closure” reminiscent of neurolinguistic processing
and, finally, “reevaluation.” Shapiro asserts theory, the technique of EMDR appears
that “dysfunctional material” (images and as- novel. However, the EMDR premise that
sociated cognitions, typically trauma-related) “most psychopathologies are based on early
is “stored in its original state-specific form” life experiences” should resonate with psycho-
and is stimulated if it is held in consciousness. analytically oriented therapists, as should Dr.
Processing of this material, which had been Shapiro’s admonition to “stay out of the way
arrested, then proceeds if the information- of the client during successful processing.”
processing system is simultaneously activated Although Shapiro repeatedly prescribes for-
during sets of repeated eye movements. While mal training in EMDR prior to attempting its
traumatically engendered dysfunctional mate- use, study of this book by experienced, well-
rial is said to be held in a “neuro network” that trained psychotherapists should permit safe
operates autonomously, or is effectively cut off experimentation with many of its methods.
from other networks, similar traumatic events The book is not without flaws. It is loosely
are regarded as being linked associatively to constructed and long; elimination of frequent
the target memory or image. Once activated repetitions alone could reduce its 400 pages
in a directed manner, the patient’s capacity for without any loss of information. The focus is
“spontaneously generated recovery” report- clinical, and properly so, but treatment of
edly leads to a healthy physiological transfor- associative memory, neurocircuitry, and neu-
mation of both the nodal trauma and ral network architectures is simplistic. But in the
associated traumas, so that thoughts of the final analysis, if EMDR does pan out to be
traumas are no longer associated with pain or generally efficacious in the treatment of PTSD,
pathological reactions. Once this desensitiza- then it constitutes a major contribution to our
tion to the traumatic material and the associ- clinical armamentarium. This book is highly
ated “negative cognition” (such as “I am a recommended for anyone interested in learn-
permanently damaged”) is achieved, the next ing about or practicing the technique of EMDR
step is the “installation” of an appropriate re-
placement “positive cognition” (such as “I am Dr. Geracioti is Chief Psychiatry Service, Veterans
healthy”) that was previously agreed upon Affairs Medical Center, Cincinnati and Associate
between clinician and patient. This positive Professor of Psychiatry University of Cincinnati
cognition allegedly generalizes to the entire Medical Center, Cincinnati, OH

VOLUME 6 NUMBER!
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BOOK REVIEWS 79

Software Review Then the clinician completes a mental status

screen, using libraries and free text. Next, the
program provides a differential of DSM-IV
TheraScribe for Windows diagnoses matching the primary problem; the
user may select or edit. Final screens elicit
By Arthur E.Jongsma,Jr., L Mark Peterson, information about prognosis, discharge crite-
and KennethJongsma ria, and provider credentials.
New York,John Wiley and Sons, 1996, $345.00 The libraries of problem definitions, goals
and objectives, and interventions are quite
Reviewed by David Bienenfeld, MD. large and generally relevant. The choices that
ship with the program seem weighted toward
T heraScribe
patients,
will help
not paperwork,”
you “spend
boasts
time
the
on
box
behavioral and popular-psychological phi-
losophies. For example, the objectives for de-
of this “computerized assistant to psychother- pression include numerous items such as
apy treatment planning.” The authors have “Identify cognitive self-talk that is engaged to
attempted to create a program that allows support depression.” Therapeutic interven-
clinicians to generate legible, organized treat- tions include writing letters to lost loved ones
ment plans, saving the clinician’s valuable and reading Hazelden self-help books. Psy-
time. It also serves as a “consultant,” providing chodynamic objectives and interventions
suggestions for diagnosis, goals, objectives, seem stuck in notions such as “anger directed
and interventions. inward.” These libraries are, however, easily
The program is organized in a sensible modified by each user. The printed report, as
fashion that is applicable to most clinical set- advertised, is quite attractive; it is sensibly
tings. The “Next” button at the bottom of most arranged and easily tailored. It is easy to assess
screens generally takes the user to where he one’s status in completing the report with just
or she is likely to want to be. A flow chart in two clicks of the mouse.
the User’s Guide maps the logical terrain. There are some annoying aspects to the
The user first identifies himself or herself by strategy of the program: inexplicably, the pro-
name and password and is then taken to the gram automatically loads the record of the
opening screen. When adding a new patient, (alphabetical) first patient. Thus, the record of
one is prompted for demographic and insur- Anna Abel is always loaded at boot-up. Two
ance data, as well as assessments completed providers may access one patient’s record, but
(e.g., Beck Depression Inventory, Luria-Nebraska only if one is identified to the program as the
Battery). “supervising provider.” In a setting where a
The next section, the largest, details the physician is prescribing medications and a
presenting problems. These problems must be counselor is providing therapy under the su-
selected from a generous list, to which the user pervision of a third person, someone is denied
may add his or her own choices. Nested within access to the record. Nesting progress notes
the Presenting Problems display are further within the Presenting Problems display is
displays regarding behavioral definitions of counterintuitive and forces the user to descend
the problems, long-term goals, short-term ob- through several layers to record a progress
jectives, therapeutic interventions, and prog- note. The Progress screen, too, is less helpfully
ress notes. Like the presenting problems, these organized than most of the others.
must be chosen from a library, which the user The program itself requires a healthy
may edit. He or she is then returned to the amount of hardware. Operating with less
main logical stream to select treatment modali- than a Pentium processor, 12MB of RAM, and
ties (such as group therapy) and treatment Windows 95 yields unacceptably slow per-
approaches (such as cognitive restructuring). formance in supporting the handsome (but

JOURNAL OF PSYCHOTHERAPY PRACTICE AND RESEARCH

80 BOOK REVIEWS

unnecessary) graphics. Installation is simple, copy treatment plan. After some hours spent
and the User’s Guide is clearly written. becoming familiar with the program, this
The biggest question left in the mind of computer-literate user found that it took con-
this reviewer is, “Why bother?” Managed care siderably longer to complete a treatment plan
organizations will insist that treatment plans with TheraScribe than it would have taken to
be completed on their own proprietary forms. fill in a comparable form by hand. Even iden-
Individual clinicians will derive no benefit tifying only one presenting problem, one must
from this program. The only setting in which navigate through at least 35 displays to com-
TheraScribe might have use is in a multi- plete the assessment. Like many works of soft-
provider group, where standardization of re- ware, TheraScribe seems like a clever idea in
cords is desirable for internal purposes. (Here, search of a purpose.
however, the inability of more than one pri-
mary provider to access records requires the
generation of hard copy.) Since the progress Dr. Bienenfeld is Associate Professor and Vice
notes are so clumsy, it seems that the one Lhainnan, Department of Psychiatry, Wright State
purpose of the program is to generate a hard- o#{252}egeofMedicine, Dayton, OH

VOLUME 6 NUMBER!
#{149} WINTER
#{149} 1997