Clinical Skills in Psychiatric Treatment, Rob Poole & Robert Higgo, Cambridge University Press, 2008, £36.00 pb, 240 pp. ISBN 9780521705707

I sincerely recommend this book, although with a few qualifications. In an era of rapid change in psychiatry with an explosion in types of therapies and models of service delivery, it takes us back to the basics which can otherwise feel lost in the detail. The key to being a good psychiatrist is in knowing how to treat patients rather than simply what to treat them with, and a book focusing on the former is therefore welcome. Clinical Skills in Psychiatric Treatment is an honest, reflective and often humorous endeavour by experienced consultant psychiatrists to help others share their wisdom and learn from their mistakes.

The book is about how to do simple things thoughtfully and effectively, starting with the underlying principles of treating patients. The discussion then moves on to the environments where treatment take place, looking at what makes for effective teamwork, and thinking about how to optimise the benefit v. risk of situations such as in-patient environments and legal compulsion. The latter part of the book focuses on common problems, risks and dilemmas in treatment, and gives practical advice on how to tackle them productively.

From the outset the book uses a style of language which is refreshingly frank and clear. Patients are called patients, not users, clients or consumers. Concepts are described which are pragmatic and meaningful, for example the authors talk about ‘getting alongside patients’ in order to understand what their illness means to them and how to help them recover. They value the importance of patients ‘taking responsibility’ for getting better rather than dwelling on whether or not they have ‘insight’ into specific delusional beliefs.

The book gives practical advice on various aspects of psychiatric treatment and this is its major strength. The points made are often refreshingly simple but their importance resonates in well-chosen case histories such as the example illustrating strategic v. reactive management of a clinical scenario. There is other good advice, for example treating patients in context and anticipating and evaluating setbacks, but the book also encourages the reader to reflect on how they practice, such as thinking about the need to move between different models of care during different phases of a patient's treatment these models being described as ‘paternalistic’ v. ‘patient as consumer’.

There are some obvious criticisms, the style can be bumptious and may be off-putting for some. The authors can be provocative (e.g. ‘second opinions are rarely helpful, except as a defensive manoeuvre’), but they give clear reasons for such statements which provide food for thought. The views expressed can be excessively polarised, for example saying out-patient clinics are outmoded may well be appropriate in assertive outreach models of care but ignores the fact that clinics remain an important component of generic community mental health teams' work. The discourse on the Mental Health Act is unfortunately out of date, and the authors may have been better steering clear of the debate, knowing that new legislation incorporating supervised community treatment was imminent.

In my view, this book should be on the reading list of psychiatric trainees. It is engaging, wise, stimulating and patient centred. It does not by any means ignore scientific developments in the field, but it puts empathy, reason and pragmatism at the core of clinical practice, and thus establishes a sound base upon which to practice good psychiatry.