Beyond Medication contains many impressive case descriptions in which psychotherapists discuss their treatment of individuals with psychotic disorders. Various chapters show how the authors have put great amounts of time and effort into treatments for, sometimes, relatively small improvements. Two chapters are written by former patients and there is also a chapter discussing a survey of patients' experiences of drug treatment.
The overriding aim of Beyond Medication is to argue against the dominant position of pharmacological treatment of psychotic disorders. The wide range of topics could be a weakness of the book, however. A reader interested in subjective experiences of pharmacotherapy will not necessarily be also interested in technical aspects of psychodynamic treatment.
In the main part of the book psychotherapists describe establishing and maintaining therapeutic alliances with difficult-to-engage patients. Various departures from more traditional psychoanalytic techniques are presented. For example, in a chapter about engagement it is described how a patient is accompanied to a museum by the therapist and also how the therapist reads the Bible to a patient at their request. In the UK, a befriender and not a psychotherapist would perform these tasks, were they to take place at all. To those without analytic training it remains unclear what the authors suggest the curative psychodynamic elements in the therapy process might be, let alone how one could apply those techniques.
It is mentioned in the book that if psychoanalytic treatment of a patient with a psychotic disorder is successful, other clinicians tend to express doubts about the original diagnosis. It is not discussed or empirically investigated to what extent the original diagnoses of successfully treated patients actually might warrant revision. The argument in favour of psychodynamic psychotherapy for psychosis would be much stronger if it could be shown, on the basis of independent blind reviews of assessment reports, that the original diagnosis was probably correct.
Beyond Medication encourages readers to reflect upon the dominant position of pharmacological treatment of psychotic disorders. However, it does not offer empirical evidence for the psychological treatments described that in any case appear to be too complex to be applied solely with the help of this book.
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