Following on from a 1997 conference, this book aims to build bridges between professionals from different mental health disciplines who use diverse models of treatment of psychosis. The editors have put together a volume that pays wider attention to a range of psychologically based approaches, outlining the rationale for each therapy and summarising how each is conducted. In addition, they include research evidence of effectiveness of each of these therapies. In managing psychosis there certainly has been a swing from the use of biological and pharmacological treatments. The days of long-stay in-patient psychotherapy wards for managing psychosis are long gone. Psychotherapists now attempt to come together with general psychiatrists to work on themes of common interest.
In the introductory chapter the editors argue that rapprochement is needed urgently between biological and psychological approaches, as biological psychiatry and biology have not succeeded in providing answers to the aetiology, management and course of psychosis. Following from work on expressed emotion, serious attention is again being paid to cognitive therapy, group work and approaches to managing psychotic features.
The introductory chapter's effective and detailed outline of the structure of the book is followed by sections on cognitive approaches, family, group and psychosocial approaches, individual psychoanalytical approaches and early interventions using need-adapted psychological treatment modules. The final chapter is an Australian overview. Clinicians will find practical advice in the sections on cognitive and family approaches. Garety et al, for example, provide an excellent theoretical back-ground to cognitive-behavioural therapy and conceptualisation of therapy in various stages. They include a detailed discussion on building and maintaining the therapeutic relationship and describe how negative self-evaluation, anxiety and depression can be addressed. They also offer details of outcome research and talk about how cognitive—behavioural therapy can be used in acute episodes. In the acute phase the effect of cognitive therapy was most apparent for positive symptoms; at 9-month follow-up the cognitive therapy group had significantly fewer positive symptoms. An extension of this kind of approach has been used with people with early psychosis or prodromal symptoms, and four chapters here are dedicated to early intervention.
In the several chapters on compliance therapy, which involves working with the patient and the family, the authors identify various barriers to compliance. These include not only personal concerns for the patient but also issues to do with the illness and the treatment. They identify basic principles and key techniques of compliance therapy and give practical advice on dealing with some primary problems in working with families. In particular, they outline how to handle the families' anxieties and concerns. Advice is offered on the organisation of psychoeducational sessions, and evaluation and outcome are discussed.
The final chapters provide an overview of treatments for first-episode psychosis in different parts of the world. Prodromal symptoms are very difficult to identify, and to start treating them with medication that may have implications in terms of side-effects, compliance and long-term outcome is a major issue. In the chapter by Johannessen et al, for example, it is suggested that first admission for first-episode schizophrenia should be for a minimum of 1 year. Not only is this excessive: it may create problems of its own in terms of dependency and institutionalisation. It would have been helpful to have known more about the rationale for this recommendation.
Overall, the editors offer mental health professionals an extremely helpful snapshot of current psychological treatments for psychosis.
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