mentation is episodic and is repaired without evidence of a breakdown. For those with borderline disorders, this fragmentation is chronic, whereas in those with narcissistic personality disorders it leads to the development of defenses against selfobject bonds. Or, as in the case of the neurotic syndromes, the fragmented self focuses on the drives of a particular developmental phase. In order to treat any of these self disorders, the authors believe that an empathic diagnosis and a therapeutic diagnosis are mandatory. Empathic diagnosis is defined as a diagnosis of the deficits of the self combined with an evaluation of those areas of the self that remain intact. In making this diagnosis the interviewer‘s major operational task is to view the world empathically through the eyes of the client. In the therapeutic diagnosis, the helping professional matches the difficulties and the strengths of the client‘s self with the appropriate therapy. The authors recommend three major psychotherapeutic modalities: supportive psychotherapy, psychoanalytic psychotherapy, and psychoanalysis. Although these therapies are well known and much practiced, Muslin and Val propose specific applications for them that deserve elaboration. When the empathic diagnosis reveals that the client‘s self is in a state of disarray, the authors recommend supportive psychotherapy. For example, the client might be in a state of disequilibrium due to either depression or fragmentation, and unable to form an alliance with the helping professional to understand the psychodynamic factors causing the distress. Supportive therapy could also be referred to as sustaining therapy because its goal is the restitution of self-equilibrium through a self-selfobject transference bond between client and therapist. Psychoanalytic psychotherapy, on the other hand, is for those clients who have a specific psychological problem and whose selves are well-organized and whose self-observing egos remain intact. The goal here is the alleviation of a specific psychological symptom, such as a phobia or social inhibition, through insight and the formation of a self-selfobject transference bond. Psychoanalysis, the authors feel, should be used with clients who are in self or characterological distress that neither insight nor the self-selfobject transference bond can alleviate. To recommend psychoanalysis the therapist must be confident that the client can form a treatment alliance with the therapist and can withstand being in a regressive state, reliving a transference neurosis without experiencing severe fragmentation. Although Muslin and Val argue forcefully for a systematic approach to treatment based on these three discrete therapies, each with its own methodology and goals, they recognize complexities and exceptions that emerge in actual practice. Consequently, they believe that the therapist must be prepared to utilize any therapeutic technique in each of the psychotherapeutic modalities. This approach makes sense because even in the practice of psychoanalysis the therapist is often called upon to use supportive techniques, and in supportive therapy, insight-oriented techniques often prove helpful. A particularly useful concept introduced by the authors is the defense transference. In this process the client unconsciously transfers onto the helping professional not only the prominent features of the disappointing and/or malevolent parent(s) but also the accompanying revival of experiences and behaviors of these primitive defenses. In the defense transference the client reenacts the past, holding back or fighting against his or her renewed involvement with the therapist as a parental figure. Overall, the authors present a clear, detailed discussion of these three therapeutic modalities and their use in the practice of self psychology. In addition, all theoretical principles are bolstered by clinical examples that clarify and strengthen the concepts being discussed and, often as not, help the reader remain interested and involved. Thus The Psychotherapy of the Serf is a good, readable source for the fundamentals of self psychology and its use in clinical practice. Richard Martin Alperin Teaneck, New Jersey
chotherapy is covered, with frequent examples of success, failure, and barriers and specific suggestions about what to do and how to do it. Blau offers some useful guidelines for approaching psychotherapy with children and adolescents. Difficult and “special” situations (for example, the psychotherapist as patient, minority patients, suicide) are examined. Termination of psychotherapy is treated as well as therapist overload and burnout. The author also includes ethical considerations as a matter of course and provides some guidance through the legal maze associated with psychotherapeutic practice. The author’s information, skill, and technique are captured in this book’s quotes, case vignettes, and insights. Blau comes across as a demanding and kindly taskmaster. He achieves his goal of outlining and explicating the tradecraft of psychotherapy in a thoughtful, forthright text. Would I buy psychotherapy from this man? Yes.
This encyclopedic volume begins provocatively by detailing several “unkept promises” of family violence writings. Among the unkept promises of greatest interest to the authors is that “research will answer the difficult questions and lead to the development of efficient and effective treatments.” Throughout the book, the authors endeavor to address the research that does exist in an organized and disciplined fashion and to suggest improvements in practice. The authors focus on the commonalities among types of family violence. They first show the consistencies in the correlates of physical abuse, sexual abuse, conjugal violence, and elder abuse. Drawing on an ecological model, they sort thirty-four contributors (for example, social isolation, depression, reli giousness) into three categories: social environment, psychological environment, and family processes. References that support the authors’ claim that most correlates of one type of abuse are correlated to all types of family violence suggest the thoroughness of their investigation and support the soundness of their basic premise. However, the authors steer clear of some controversies. They report no evidence that victim characteristics are correlated with sexual abuse or conjugal violence and leave substance abuse out of their list of correlates that cut across types of family violence. They later argue that research does not indicate a causal relationship between alcohol and family violence-at least, alcohol cannot stand alone as a causal factor. This assertion is odd, given their general belief that family violence results from a combination of factors and their appropriate shunning of the search for causality. Perhaps the authors rely too heavily on the idea that alcohol abuse is an excuse for violence. However, this notion does not hold well given the many violent acts that perpetrators commit without any concern about excuses. This confusion stems in part from the authors’ occasional overgeneralizations across types of family violence. Certainly, alcohol is used as an excuse for conjugal violence. This phenomenon is much less clear, however, in physical, sexual, and elder abuse. Although this criticism may seem quibbling, it suggests the difficulty of maintaining accuracy while aiming at such a broad target. More difficult than identifying common characteristics of families at high risk for violence is the task of identifying common characteristics of interventions to serve such families. However, the section on clinical work in family violence takes an admirable shot at it. This section addresses special populations and problems (for example, interviewing the allegedly sexually abused preschool child) and the legal context for much family-violence work. However, the social service context is not discussed: that is, how do clinicians work with child welfare case managers, women’s shelter staff, and adult protective services? The clinical-intervention section does consider individual, group, and family therapies as well as concrete services and education as interventions for each of the four kinds of family violence. Although an admirable endeavor, describing such a large matrix of types of violence and types of treatment inevitably shortchanges descriptions of each kind of intervention. On the more positive side, this book casts intervention commonalities into relief. Practitioners who have generic practices, instructors who teach about various kinds of family violence, and scholars who build on the authors’ efforts to find links among acts of family violence will welcome this effort. This ambitious book by a psychologist and an attorney is an important addition to the family-violence field. It helps redress shortcomings in the field. Especially striking is that despite the fact that most interventions continue to be designed to alter individual and family characteristics, the social environment is a much more significant correlate of violence than are individual or family traits.
This encyclopedic volume begins provocatively by detailing several “unkept promises” of family violence writings. Among the unkept promises of greatest interest to the authors is that “research will answer the difficult questions and lead to the development of efficient and effective treatments.” Throughout the book, the authors endeavor to address the research that does exist in an organized and disciplined fashion and to suggest improvements in practice. The authors focus on the commonalities among types of family violence. They first show the consistencies in the correlates of physical abuse, sexual abuse, conjugal violence, and elder abuse. Drawing on an ecological model, they sort thirty-four contributors (for example, social isolation, depression, religiousness) into three categories: social environment, psychological environment, and family processes. References that support the authors’ claim that most correlates of one type of abuse are correlated to all types of family violence suggest the thoroughness of their investigation and support the soundness of their basic premise. However, the authors steer clear of some controversies. They report no evidence that victim characteristics are correlated with sexual abuse or conjugal violence and leave substance abuse out of their list of correlates that cut across types of family violence. They later argue that research does not indicate a causal relationship between alcohol and family violence-at least, alcohol cannot stand alone as a causal factor. This assertion is odd, given their general belief that family violence results from a combination of factors and their appropriate shunning of the search for causality. Perhaps the authors rely too heavily on the idea that alcohol abuse is an excuse for violence. However, this notion does not hold well given the many violent acts that perpetrators commit without any concern about excuses. This confusion stems in part from the authors’ occasional overgeneralizations across types of family violence. Certainly, alcohol is used as an excuse for conjugal violence. This phenomenon is much less clear, however, in physical, sexual, and elder abuse. Although this criticism may seem quibbling, it suggests the difficulty of maintaining accuracy while aiming at such a broad target. More difficult than identifying common characteristics of families at high risk for violence is the task of identifying common characteristics of interventions to serve such families. However, the section on clinical work in family violence takes an admirable shot at it. This section addresses special populations and problems (for example, interviewing the allegedly sexually abused preschool child) and the legal context for much family-violence work. However, the social service context is not discussed; that is, how do clinicians work with child welfare case managers, women’s shelter staff, and adult protective services? The clinical-intervention section does consider individual, group, and family therapies as well as concrete services and education as interventions for each of the four kinds of family violence. Although an admirable endeavor, describing such a large matrix of types of violence and types of treatment inevitably shortchanges descriptions of each kind of intervention. On the more positive side, this book casts intervention commonalities into relief. Practitioners who have generic practices, instructors who teach about various kinds of family violence, and scholars who build on the authors’ efforts to find links among acts of family violence will welcome this effort. This ambitious book by a psychologist and an attorney is an important addition to the family-violence field. It helps redress shortcomings in the field. Especially striking is that despite the fact that most interventions continue to be designed to alter individual and family characteristics, the social environment is a much more significant correlate of violence than are individual or family traits.
occurred as well as the child’s resultant fears of abandonment and loss of control. The most significant lesson in these sessions is the application of this knowledge to current relationships and problemsolving ability. The exercises use probing questions that help participants to explore their own barriers. In the closing session. the author emphasizes that although healing can begin through knowledge, additional treatment may be necessary. She briefly describes the disease of codependency, which is not yet a diagnostic category and an issue of some controversy among professionals. In her attempt to explain the role of the therapist, Tainey again tends to be directive in saying that a therapist may need to tell clients what they have experienced and felt as children. An experienced therapist would probably more gently assist the adult child of an alcoholic to tell his or her story in the time and manner that would best facilitate healing and constructive change. The manual encourages participants to pursue experiential and insight-oriented therapy in group as well as individual modalities. A brief explanation of each is presented. Also, a very helpful closing minilecture describes the format and processes of the selfhelp groups Adult Children of Alcoholics (ACOA) and AI-Anon. Adult Children of Alcoholics is a good primer for those seeking fundamental knowledge about the effects of alcoholism on families. It encourages group involvement to dispel the adult child’s sense of isolation and to provide a structured, supportive atmosphere for learning new information. It can, however, be useful in settings other than Family Life Education workshops. The manual may be a helpful resource in classroom work. Church discussion groups could benefit from its direction. Private therapists may want to use particular topics or assignments to explore the significant impact of parental alcoholism on a client. The inclusion of Adult Children of Alcoholics in the Workshop Models for Family Life Education series recognizes the serious impact of alcoholism on the family. The book offers an educational format that reaches beyond those people who seek therapy only after a serious crisis; perhaps, in some cases, this type of educational approach will serve to prevent a serious crisis. Families in our society must stop reacting to alcoholic behavior and begin to adopt healthier life-styles. This manual provides the directions to get started.
to predict alcoholic relapse patterns. Alcoholics who are high in private self-consciousness and who have experienced events indicative of personal failure are likely to relapse. Alcoholics who are highly selfconscious and experience events indicative of personal success are least likely to relapse. And alcoholics who are low in private self-consciousness fall between these two extremes. Steven Berglas contributes a chapter on the selfhandicapping model, which is derived from the premise that one initiates failure in a present situation to protect a positive self-image derived from a previous successful experience. Such a tactic stems from feelings of low self-worth. The alcohol abuser uses alcohol as a fool-proof justification for substandard performances. Treatment centers on assuring the client of competency in a future interaction. Interestingly, women do not use alcohol to preserve a self-image. Berglas attributes this to the negative societal image of women drinkers. The final chapter, by Thomas E. Shipley, Jr., discusses opponent process theory. This theory is primarily concerned with understanding the transition from normal to addictive drinking. Alcohol is assumed to be reinforcing. The critical juncture is the experience of self-dosing to relieve the discomfort of withdrawal symptoms. Shipley discusses the difficulties of using a drug to alleviate withdrawal symptoms, which is the practice in most detoxification programs. He states that prognosis is dependent upon a strong motive to maintain abstinence. Also, he attributes the positive feelings at the beginning of therapy as being important in treatment, due perhaps to the relief of chronic stress and to the transference phenomena occurring in the early stage of therapy. Blane and Leonard, in their conclusion to this important and needed book, point out that “more research is necessary to develop potential intervention techniques, to determine the efficacy of these techniques, and to identify the individuals most appropriate to these techniques.” In Psychological Theories of Drinking and Alcoholism, they have laid the groundwork for such research. The book is informative and well structured, discussing several psychological theories of alcoholism in a way useful for both practitioners and researchers. It serves as a useful reminder that for enhanced treatment, knowledge of theory is necessary; for the researcher, application of theory in the practice setting is essential.
The author discusses the results of a study designed to determine the relationship of professional experience as a social worker with attitude toward serving as a qualified examiner. Findings indicated that workers with extensive experience had more positive attitudes toward the role.
