The cover illustration of this book is a beautiful and dreamy Monet: The Garden Path at Giverny. A path, banked by flowers, leads to an impression of a white house. The painting's effect is a clue to the message of this book – that instilling hope and expectations of a good outcome are essential for patients to improve with psychotherapy.
The title requires some explanation. Persuasion and Healing Reference Frank1 is a book published in 1961 by the American psychiatrist and academic Jerome Frank. Its main contentions were: different psychotherapies have similar (good) outcomes; factors common to all therapies are responsible for their main effect; and instilling hope in ‘demoralised’ patients is crucially important. The text under review is a collection of stand-alone essays by multiple authors that update and reassess Frank's ideas.
The Psychotherapy of Hope is a diverse book that samples the whole spectrum of psychiatry, with essays ranging from ‘Neural substrates of psychotherapy’ to ‘Psychotherapy, religion and spirituality’. Refreshingly, the editors have gathered essays that sometimes express opposing views, for example, on the question of the importance of the unconscious or conscious mind in patients’ difficulties.
The heart of the book is psychiatry and therapy – assessing the evidence, educating about the nature of psychiatric illness and examining effective approaches for practitioners. One excellent essay argues that standard classifications of depression do not help guide what approach to take, as people who ‘ “meet criteria” may differ from one another to an extraordinary degree.’ It then proposes a clinically helpful reclassification of depression in medical patients, derived from factor analysis, which has three syndromes (grief, anhedonic depression, and demoralisation) and outlines their treatment.
Other essayists advance subtle arguments that psychotherapy is a culture-bound activity that can be looked at scientifically at a meta-level and common factors abstracted. It follows, some of the essayists argue, that therapists should focus on maximally delivering these common factors.
These approaches place importance on the therapist remaining optimistic to inspire hope, being empathic and impressing on patients expectations of good outcomes. Personally, I expect the therapy they outline might be quite hard work to sustain over a significant period of time. Rather than a therapist primarily following an internally consistent and rich system of formulating patients’ difficulties and how to address them, therapy based explicitly on common factors falls back on the need to remain hopeful, empathic, etc. Frank originally argued that these properties emerge from interactions between therapist, therapeutic rationale and the patient. If, indeed, therapeutic change is largely effected via therapists’ hope and expectation of success, would not belief in a plausible and rich psychology be a greater source of hope for therapists to draw on than having to hope in hope itself?
A section on ‘Cultural dynamic in psychotherapy’ makes the case that differing kinds of ‘therapists’ (including religious or shamanic leaders) and therapeutic approaches suit different patients. I expect the common factors therapeutic approach would appeal to some practitioners, perhaps those with a naturally ‘agnostic’ approach to psychological theories or those who do not have an existing theoretical grounding.
The various chapters engendered in me a questioning approach: what are we therapists doing, does it work, why? How culture-bound are our mental illnesses and therapies? From what the authors say, this atmosphere of curiosity is what it was like working with Jerome Frank and, as such, this book is a fitting inheritor of his legacy.
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