Edited by Joel Sadavoy and Molyn Leszcz

Madison, CT, International Universities Press, Inc., 1987. 366 pp.

As emphasized early in this book, the elderly will represent nearly 20 percent of the U.S. population in the twenty-first century. This fact underscores the importance of a work for physicians, therapists, and health workers which focuses on issues specific to clients who are 65 and older. Editors Sadavoy and Leszcz have put together a series of essays by some of the pioneers in geriatric psychiatry (e.g., George Pollack, Jerome Grunes, Martin Berezin, Ralph Kahana, and others), each of whom has brought an expertise to different aspects of psychotherapeutic care. The essays are well-written, interesting, and full of eye-opening clinical vignettes, and the book as a whole has met its challenge of encouraging “hopefulness” in geriatric care. One problem, however, is that in presenting essays largely from a psychodynamic perspective, it lacks coherent underlying theories. Several essays, moreover, fail to distinguish the elderly patient from any other client. The overall collection, however, is pioneering and should encourage more specific studies.

The book is divided into three parts. Part I, entitled “General Psychodynamic Perspectives,” comprises essays by Pollack, Grunes, and Berezin, respectively. Each focuses on a general theme: Pollack emphasizes the wealth of psychodynamic material in therapy with the elderly and presents his own notion of a mourning-liberation process in bereavement. Grunes writes about the unique features of transference between an older client and a younger therapist and provides the concept of reverse empathy to account for the elder’s regard for the therapist. Berezin presents a wonderful introduction to clinical work, stressing the depth and vitality of the elderly. Taken together, these three essays break many stereotypes of the older client and provide a much deeper sense of age-specific therapeutic needs.

Part II, entitled “Manifestations of Psychopathology,” is the most theoretical section of the book and, as a result, the weakest. Its essays, which cover such topics as paranoia in the aged, the impact of massive psychic trauma, and character disorders, are well-organized and yet tangential to the stated goals of the general collection. The flaw seems to lie in the dearth of relevant psychodynamic theories; each essay provides concise theoretical introductions, yet never adequately adapts them for a geriatric population. In addition, no essay attempts to define the elderly. Are clients in their 60s similar to others in their 80-s and 90-s? One is left with little regard for the life cycle as a viable force past adulthood. Several of the cases presented raise interesting issues but, again, do not place them within a meaningful context. One exception in Part II is an essay by Lawrence Breslau on the Exaggerated Helplessness Syndrome. This syndrome, in which elderly patients become maladjusted to their disabilities, highlights their passivity and serves to maintain the support of primary caregivers. The psychodynamic issues here are ripe for intervention, and Breslau provides good clinical examples.

Part III, entitled “Specific Psychotherapeutic Modalities,” picks up many issues from Part I and ends with a real gem: an essay entitled “The Whole Grandfather: An Intergenerational Approach to Family Therapy” by Etta Ginsberg McEwan. The other essays focus on crisis management and short-term and group geriatric psychotherapy, and the information provided here is perhaps the most practical for readers, since it addresses the appropriate structure of therapeutic intervention. For example, Kahana’s chapter on crisis management presents a crucial skill for the intake of elderly clients. He provides a working definition for geriatric crisis, along with many useful clinical pieces. Ginsberg McEwan’s essay, coming second to last, is poignant and informative, presenting an entire case study within the context of family and intergenerational therapy. It speaks to the very intent of the book in tying together the therapeutic goals of the elderly with those of children and grandchildren. By juxtaposing these issues, Ginsberg McEwan illustrates points of common interest as well as age-specific ones.

Sadavoy and Leszcz’s collection of essays will, it is hoped, serve to encourage study along the lines of its distinguished contributors. Although several essays are a bit incongruous with the book’s focus on treating the elderly, one should not be discouraged. There has simply not been enough longitudinal work on the elderly, and the very concept, both before and after reading the book, remains a diffuse notion of “people 65 years and older.” What emerges from the book, then, is not a specific definition, but a well-rounded appreciation for the complex issues facing the elderly and the enormous potential for therapeutic intervention.

Pinsker H

Hillsdale (NJ): The Analytic Press; 1997. 278 pp. with index

ISBN 0-88163-274-0 (cloth)

Convincing evidence has accumulated that the supportive or nonspecific component, common to most forms of psychotherapy, is responsible for most of the change that results from psychotherapeutic interventions. This component appears to be both supportive — in that it is derived from the quality of the therapeutic relationship — and technical — in that it stems from the contract established with the patient and the use of nonspecific interventions. Specific interventions drawn from different schools of thought account for surprisingly little of the variance in outcome for most disorders, with the possible exceptions of panic and obsessive-compulsive disorders. The implications of these findings are clear. All mental health clinicians, regardless of their field, should be well versed in nonspecific interventions, and clinical training should emphasize integrated or so-called transtheoretical perspectives. Unfortunately, both practice and training tend to lag behind research. Many clinicians continue to rely on specific psychotherapeutic models, and training rarely gives nonspecific interventions the weight that they deserve, although there is some evidence that this is changing.

In this context, Dr. Pinsker’s very practical little volume is a useful addition to the growing number of texts on supportive therapy. Although one might disagree with some of the ideas and with the theoretical model that lies behind the volume, one must agree with the tone. This is the work of a sensitive and humane clinician who respects his patients. The approach emphasizes a conversational style and a responsive approach, rather than listening silently or interrogating the patient. The volume offers a model worth emulating. Anyone who adheres to the spirit of this work will not go far wrong, nor will his or her patients come to harm.

The value of this work lies in the large number of examples of the kinds of statements patients typically make and the clinician’s possible responses. The topics discussed include most of the key issues in therapy: increasing self-esteem, reducing and preventing anxiety, promoting adaptive skills, building a treatment alliance, and so on. These topics are explored through specific examples that include illustrations of helpful and less helpful responses that therapists may make. It is these examples that make this book especially helpful as an introductory text. Here is an experienced clinician talking in a common-sense way about the nuts and bolts of therapy. This makes for a style that is at times a little dull but replete with clinical wisdom. The simple practical examples will be helpful to a neophyte clinician who is learning how to conduct assessment and therapy interviews. They may also be worth a brief perusal by those who are much more experienced, who may be surprised to recognize bad habits unwittingly accumulated over the years.

The volume is not without limitations. Two issues are worthy of comment. First, some of the examples are a little sparse, and the discussion of alternative responses by the clinician is a little limited. Hence, the implications of the different possible therapist responses may not always be clear to the beginning therapist. More problematic is the theoretical perspective that runs through the volume. This is classically psychodynamic; hence, much is made of the distinction between supportive and expressive therapy. With increasing emphasis on integrated approaches, this distinction is less important. It may also be a little dated. The problem emerges on the first page when supportive therapy is differentiated from expressive therapy in terms of technical considerations. These are defined as using a conversational style, viewing the patient-therapist relationship as a real relationship that is not analysed, and supporting defences that are not maladaptive. Perhaps the important issue is not the distinction between supportive and exploratory therapy — which is important only to those who espouse the psychoanalytic tradition — but rather the degree of intrusiveness and the extent to which generic mechanisms are used to effect change. Dr. Pinsker describes these clearly, although in different terms. Consequently, it is easy to put theoretical issues to one side and concentrate on the practical component of the book. In this regard, the volume meets its goal of being a is a useful primer.

RJ Meyers, JE Smith

New York: Guilford Press; 1995. 215 p

Robert Meyers from the Centre on Alcoholism, Substance Abuse and Addictions (CASAA) and Jane Smith from the Department of Psychology, both from the University of New Mexico, have authored a pragmatic “how-to” instruction book on the Community Reinforcement Approach (CRA) to alcohol treatment. CRA is listed in the US Institute of Medicine’s report on alcohol problems as a contingency management approach designed to provide focused behavioral training to persons with chronic alcohol problems (Institute of Medicine 1990). This approach remains unfamiliar to many clinicians in the field although several grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse have been provided to enrich its research basis.

The 1 st chapter outlines the approach’s empirical pedigree dating back to the work of NH Azrin and his group in 1973. The reinforcers used were access to family, to jobs, and to friends, which were contingent on sobriety. In a series of trials, CRA procedures improved the outcome of traditional 12-step programs, monitored disulfiram compliance, and enhanced an alcohol-free recreational environment as well as the involvement of concerned others. These procedures have also been applied to the management of cocaine and heroin abusers and, more recently, to an alcohol-abusing homeless population.

The book’s main contribution lies in the next 10 chapters. Five chapters provide detailed instruction in the CRA assessment procedure, an intriguing approach to facilitating a client’s acceptance of the need for sobriety through a contractual “time-limited sampling” period, the optimal use of disulfiram, and the planning of a treatment protocol using a quality of life scale and identification of counselling goals. The remaining chapters describe procedures to be used for behavioral skills training as well as coping strategies at work, in one’s social interactions and significant relationships, and in relapse prevention.

The highlights of the book for me were the tables appended at the end of each chapter that could be readily adapted by therapists to their own practice. The book is a good primer for those interested in developing their cognitive-behavioral skills with substance abusers. Some procedures may be more controversial or dated than others. For example, recent studies have provided mixed evidence regarding the usefulness of disulfiram (Institute of Medicine 1990). Will the use of naltrexone replace disulfiram as a preferred pharmacotherapy?

As highlighted by the Director of the Research Division at CASAA, Dr WR Miller, many of the procedures included in the original CRA trials, such as motivational preparation and early relapse prevention strategies, have become important elements in today’s treatment programs and have gained more recognition than their predecessors. Elements of the CRA have been incorporated as part of the cognitive-behavioral intervention to be tested in Project MATCH (1994), the current NIAAA-funded multisite clinical trial of patient-treatment matching.

This book’s content is suitable for a multidisciplinary team dedicated to the field of addiction and for the psychiatric resident or psychiatrist searching for ways to enhance his or her skills with this challenging population. The cost of the book is reasonable.

JM Oldham and MB Riba, editors

Washington DC: American Psychiatric Press Inc; 1995. 846 p

This book is the latest in what is becoming an extended series of reviews of psychiatry published by the American Psychiatric Association. I imagine most readers are aware of this series. It continues in the tradition of producing comprehensive yet fairly succinct summaries in 5 areas of special importance. These are: “Substance Abuse,” “Psychiatric Disorders in Women and Women’s Health Care,” “Psychiatric Genetics,” “Cross-Cultural Psychiatry,” and “Sexual Disorders.”

The topics chosen reflect the burgeoning interests of the day. For instance, substance abuse has had a major impact on the mental health of psychiatric patients, to the extent that the “typical” psychiatric patient of the 1990s is a rather different person from his or her counterpart of the 1950s. There are many reasons for this, but the abuse of substances is a major one. Substance use affects the course of major disorders, and the appearance of major disorders predicts the use of many substances.

Yet until recently, relatively little was known about substance abuse, and that which was known was not widely disseminated. There is probably still a series of connected prejudices on the issue, comprising such myths as “substance abusers are all low-class, unbeatable individuals” and “nothing can be done in any case.” In fact, a great deal of useful information is known, and patients can be successfully treated, using combinations of pharmacotherapy and psychosocial therapies.

To be sure, the “war on drugs” is still being won by the drugs. And the issue of substance abuse raises large and important questions that go well beyond the treatment of the individual patient—how should the nation’s wealth be apportioned to individual treatment, prevention, research, or criminal investigation, for example.

But the 6 chapters on substance abuse in this volume will be of immeasurable practical help to clinicians. And practical help is readily available in most of the other chapters in this book. I point particularly to the chapters on “Trans-Cultural Psychiatry.” This is a field on which one often finds superficial writings and meaningless conceptual articles that seem to forget that the individual doctor-patient interaction is still central to the game. The 3 leading articles in this section on assessment, psychotherapy, and drug therapy in the transcultural context are replete with (I thought they had disappeared forever!) case examples of what the author is talking about. This is a welcome regression.

The section on psychiatric genetics is the only one that contains information which this reviewer finds increasingly difficult to follow—the details of chromosome structure and gene chemistry. However, once you wade through a few pages of technobabble, you come to some excellent pragmatic articles on schizophrenia, agoraphobia, and bipolar illness, and a most sensitive and instructive article on genetic counselling.

The section on sexual disorders comprises 2 areas that those of us with overly linear minds probably separate too often: the areas of normal sexuality and the paraphilias. If I had to choose one must-read article from this section, it would be Seagraves’ essay on how drugs affect sexual behavior. I select this one, because its contents will bear on almost half of the patients seen by any psychiatrist in practice.

Finally, the section on women’s mental health issues is broad, useful, and relatively nonpolitical. The article on psychotropic medication is again one of the most useful for just about anyone, while the article on new reproductive technologies will appeal to the needs of those specializing in this area.

To be sure, there are a couple of articles in this American collection that are relatively less relevant for Canadian readers, such as the description of the US federal government’s response to women’s issues, and what seems to me to be the excessive overconcern about an infinitesimal number of transracial adoptions in the United States. But the bulk of this book contains information that will be needed by most psychiatrists.

One must be warned that this is not a book one simply sits down and reads from cover to cover; only the reviewer has that chore. Rather, the way to use this book is as an encyclopedia, turning to the areas of interest and need when necessary.

I have been reading this series for many years, and have become accustomed to the high quality of the content and style of presentation by all its authors. What I particularly admire is that the editors have succeeded in almost eliminating duplication from this multiauthored collection, a feat that I would have guessed to be impossible.

This book, and its 13 predecessors, should be readily accessible to every psychiatrist in practice. Its material is minimally dated—some reference is made to articles published as late as 1993, and I have found from experience that this book tends to remain relevant even when it gets a bit out of date. To cite only one specific example, if you look back at Robert Post’s summary of the treatment of refractory mood disorders in 1990, you will still have an excellent approach to the subject, although several new drugs have been introduced since then.

To some extent, books are going out of style in North America. The Review of Psychiatry remains a stubborn example of a medium that refuses to die. It should be on the shelf of every psychiatrist, but shouldn’t stay on that shelf for too long at a time.

PW Corrigan and RP Liberman, editors

New York NY: Springer Publishing Company; 1994.244 p

Corrigan and Liberman have pulled together an assorted collection of clinical reports on the application of behavior therapy techniques to patients in psychiatric hospitals and a few other settings. These settings include Liberman’s research unit at Camarillo, a forensic unit at Fulton State Hospital in Missouri, a unit at the Albuquerque VA Medical Center, a psychiatric hospital in Munich, Germany, an adolescent ward at a private California hospital, a behavioral medicine unit at the University Health Sciences Center in St Louis, the Therapeutic Contracting Program from McLean Hospital Harvard Medical School, a ward in a state hospital in New York City, and a unit at Tinley Park Mental Health Center in suburban Chicago.

There are also chapters, more general in focus, on implementing and maintaining programs and on selling them in the “Health Care Marketplace”. Most of the programs are token economics or variants thereof.

This book is well on the way toward anachronism. Focusing as it does on the impersonal and manipulative aspects of rewarding people for desired behaviors, it is very much out of step with the current increasing value being placed on patients’ rights and on patients’ active participation in their own treatment programs.

The accounts of programs tend to be anecdotal or didactic rather than research-oriented or scientific and, in that respect, there is really nothing here that supersedes Paul and Lentz’s (1977) definitive study of almost 20 years ago. However, the book can provide at least some food for thought for those working with long-hospitalized, chronic patients. These patients are now a highly selected group, since bed closures and fiscal restraints, and mental health reform have led us to discharge, and try to maintain outside the hospital, all but the very sickest patients. This group of patients provides an interesting challenge to those few remaining professionals

who work with them. Thus, besides making us aware that there is still a group of die-hards doing behavior therapy and even running token economies, albeit with increasing difficulty, Corrigan and Liberman’s book can make us aware of a few methods that can supplement the meagre, available therapy armamentarium for such patients. We must remember to use them in a more collaborative and less high-handed way, however.

JL Cummings and MR Trimble

Washington DC: American Psychiatry Press Inc; 1995.275 p

Psychiatry is heading, willy-nilly, down the subspecialty route. Child, geriatric and forensic psychiatry are already recognized as subspecialties, and others such as psychotherapy and consultation-liaison psychiatry are following closely. Unfortunately, subspecialization is progressing in a disorganized manner, and this leads related subdisciplines such as neuropsychiatry and consultation-liaison psychiatry to evolve in parallel. Often, little effort is made to cohere or even to collaborate.

The authors of this small volume define neuropsychiatry and behavioral neurology as “clinical disciplines devoted to understanding and treating behavioral disturbances associated with brain dysfunction” (p 1). This definition seems restrictive and appears to rule out, by definition, the psychosocial aspects of neurological practice. Therefore, neuropsychiatry, according to these authors, does not follow the biopsychosocial model. The first author is a professor of psychiatry and neurology at the University of California at Los Angeles (UCLA) School of Medicine, and the second is a professor of behavioral neurology at the Institute of Neurology, London, England.

Initial chapters are devoted to assessment, neurobiology and psychiatric syndromes. The rest of the book is devoted to neurological syndromes such as epilepsy, dementia, stroke and head injury. Each chapter is concise, and frequent tables list and summarize relevant points. The text is clear, readable and nonrepetitive. No references are given in the text, but there is a useful reading list at the end of each chapter.

Despite the authors’ restrictive definition, I was surprised by the total absence of any reference to somatoform disorders or to the psychosocial aspects of neurology. Somatoform disorders form at least 14% of a neurologist’s practice (Mai 1995). One would have thought that any clinical textbook that included the word “behavior” in its title would also cover the field of illness behavior. However, one looks in vain in this book for any recognition of the existence of illness behavior, conversion or somatization. Even the brief description of pseudoseizures fails to mention that they may have a conversion basis. The authors do not explain the reasons for this omission, but it is likely the result of their chosen focus on neurological disease.

This approach reminds me of the old story about the drunk who returns home late at night to find he has lost the key to his front door. He then confines his search to the area around the street light, because “that’s where the light is”. The authors of this volume have similarly chosen to ignore the darker areas of neurology which, inspite of themselves, affect the clinical practice of this discipline.

In other respects, the book provides a useful and concise description of the field within die confines set by the authors. It could be of value to residents, psychiatrists and neurologists with an interest in this field. It is expensive for a soft-cover book.

SC Yudofsky and RE Hales, editors

Washington DC: American Psychiatric Press; 1994. 641 p

This paperback is a synopsis of the American Psychiatric Press Textbook of Neuropsychiatry, which was first published in 1987 (a second edition has subsequently been published). The Synopsis of Neuropsychiatry is designed to condense most chapters from the second edition, and its content is aimed at medical students and residents in psychiatry and neurology.

The book is divided into 5 sections: the basic principles of neuroscience, neuropsychiatric assessment, neuropsychiatric symptomatologies, neuropsychiatric disorders, and neuropsychiatric treatments.

The section on basic principles of neuroscience includes chapters on cellular and molecular biology of the neuron, and on human electrophysiology. The chapter by Daniel Tranel on functional neuroanatomy from a neuropsychological perspective is particularly well done. These chapters are all well organized and plentiful diagrams add interest and clarity.

The neuropsychiatric assessment section includes chapters on bedside neuropsychiatry, neuropsychological evaluation, electrodiagnostic techniques, brain imaging, and epidemiology and genetics. The chapter on bedside neuropsychiatry by Fred Ovsiew is an excellent summary of the major symptoms and signs of neuropsychiatric disorders. The chapters on electrodiagnostic techniques and brain imaging are also good overviews. I found the chapter on epidemiology and genetics too technical when describing linkage analysis and molecular approaches to the investigation of various neuropsychiatric diseases such as Huntington’s Disease and schizophrenia.

The third section on neuropsychiatric symptomatologies includes chapters on differential diagnosis in neuropsychiatry, neuropsychiatric aspects of pain management, and delirium. Chapters on neuropsychiatric aspects of aphasia and related language impairments, and neuropsychiatric aspects of memory and amnesia are also part of this section. The chapter on differential diagnosis by Richard Strub and Michael Wise has an excellent algorithm on the approach to the patient with memory loss, as well as an informative and concise table on common focal behavioral syndromes and their localization. The chapter on pain management by William Brouse and David Spiegel focusses on neurological mechanisms of pain and neuropharmacology but could be more clinically oriented. Delirium is well covered by Michael Wise and George Brandt. Frank Benson provides a superb chapter on aphasia, which presents a complicated topic clearly and succinctly. The chapter on neuropsychiatric aspects of memory and amnesia by Arthur Shimamura and Felicia Gershberg describes the neural and biochemical mechanisms of memory very well, and outlines some clinical syndromes. However, it would benefit by a section on the differential diagnosis and investigation of the patient with memory disturbance.

The next section has 12 chapters on specific neuropsychiatric disorders: traumatic brain injury, epilepsy, sleep, cerebral vascular disorders, brain tumors, human immunodeficiency virus, endocrine disorders, poisonous and toxic disorders, alcohol-induced organic mental disorders, degenerative dementias associated with motor dysfunction, Alzheimer’s Disease and other dementias, and the neuropsychiatry of schizophrenia. There are particularly comprehensive and clinically focussed chapters on sleep (by Thomas Neylan, Charles Reynolds and David Kupfer), cerebral vascular disorders (by Sergio Starkstein and Robert Robinson), Alzheimer’s Disease (by Jeffrey Cummings), and the neuropsychiatry of schizophrenia by Henry Nasrallah. There is little, in any chapter, written on the neuropsychiatric aspects of multiple sclerosis despite its prevalence. Other missing topics include autistic disorders and mental retardation, neuropsychiatric aspects of street drug abuse, and chronic fatigue syndrome.

The final section on neuropsychiatric treatments includes chapters on psychopharmacological treatment in neuropsychiatry, psychotherapy for neuropsychiatric disorders, cognitive rehabilitation and behavior therapy, stress and coping in family caregivers, and ethical and legal issues in neuropsychiatry. The chapter on psychopharmacology by Steven Dubovsky is comprehensive and well organized. I found the chapter on psychotherapy too long and wordy, although the tables nicely summarize the lengthy discussion in the text. The chapter on cognitive rehabilitation and behavior therapy by Mark Lovell and Christopher Starratt is a well-written overview, and serves as a good introduction to this topic. Stress and coping in family caregivers is covered mostly by discussing theorical models with little attention to clinical issues. Ethical and legal issues in neuropsychiatry are well covered in the chapter by Robert Simon.

Overall, this is a strong textbook which provides a solid overview of neuropsychiatry. The authors are all recognized neuropsychiatry experts. Every chapter is well referenced, which enables the reader to investigate any topic in more depth, if necessary. A strength of almost every chapter is the liberal use of tables, diagrams and figures. Unfortunately, several chapters contain diagrams and figures that require colour to be useful, such as figures of PET and SPECT scans. The reader is referred to The American Psychiatric Press Textbook of Neuropsychiatry, second edition, for full-color figures. This is extremely irritating, and it is unlikely that many readers will have ready access to the larger textbook when reading this chapter, thus losing the benefit of illustrations. I suggest that the publisher consider adding full-color figures even if it increases the cost of the Synopsis of Neuropsychiatry.

This book will be very useful for residents in psychiatry, particularly during a rotation in consultation-liaison psychiatry, and also for neurology residents and neuropsychology interns. Medical students will benefit from this book during their rotations in psychiatry and neurology. It will also be useful to clinical psychiatrists involved in inpatient and consultation-liaison psychiatry, although other textbooks will be necessary if an indepth look into a particular area is desired.

K. Roy MacKenzie

Washington DC: American Psychiatric Press, 182 pp., 1994.

Managed care is clearly an area of current and growing concern for psychiatrists. Even in jurisdictions where managed care itself is not currently part of the practice climate, the containment of cost and measurement of efficacy of treatments are central to health care planning. In some ways it is surprising that a book like this has not appeared earlier, as the face validity of group therapy as a cost containment measure seems obvious.

This book is one of the American Psychiatric Press’ Clinical Practice Series and, hence, is a relatively succinct outline of both the potential role of group therapy in managed care systems, and some of the possible forms that such treatment systems may take. Thus, the book includes chapters on the rationale for group psychotherapy in managed care and an overview of managed care and competition. It also includes several chapters on various forms of group therapy systems that have been devised for such varying clinical populations as the seriously mentally ill, personality disordered patients, depressed patients and individuals who have experienced loss. There is, however, nothing dealing specifically with patients at either end of the age spectrum — children and adolescents, or the elderly.

The book draws on contributions from an impressive group of authors, and is, therefore, able to reflect in many ways the state of the art in group therapy systems. The editor, Dr. Roy MacKenzie, is an experienced and well-known group therapist who has worked in both Canada and the United States, giving him a useful perspective on managed care. The other authors include such highly respected names as Dr. William Piper, Dr. Howard Kibel and Dr. Walter Stone.

The strength of the book and its greatest value lies in its ability to challenge the reader to think creatively about service delivery in psychiatry and psychotherapy. Anyone who is looking at the issue of providing effective and efficient psychotherapeutic interventions for a patient population would be well-advised to consult this book, both for its usefulness in presenting what has been done and, hence, stimulating one to think creatively about service delivery, and for the ways that several of the authors have attempted to measure the effectiveness of their work. If one is thinking of setting up a new treatment system or trying to assess the effectiveness of an ongoing psychotherapy service, the chapters in this book provide useful models.

Despite its claim on the cover to “provide a solid understanding of how group programs work,” this book is not a textbook of group therapy. It will not help someone learn how to provide effective group therapy. It will instead help an experienced therapist expand his or her horizons. It is not an extensive examination of the technique, but rather an excellent overview of the possibilities of group therapy.

Group psychotherapy is frequently treated as the poor cousin of individual psychotherapy. MacKenzie’s book goes some way to show that group therapy may, in fact, have an extremely important role to play in the future, as we are increasingly forced to examine the efficiency and effectiveness of our treatments in psychiatry.

Kenneth N. Anchor

Toronto ON: Hogrefe and Huber Publishers, pp. 402, 1991

This book claims to present “a wide range of cost-effective medical psychotherapy perspectives and methods.” The editor, Kenneth Anchor, is a proponent of interdisciplinary cooperation among mental health fields which is evident in his selection of contributors whose backgrounds include clinical psychology, medicine, law and economics. Dr. Anchor suggests that the richness and diversity of approaches presented in these papers contribute to the current fund of knowledge of medical psychotherapy. The title of the book suggests that a comprehensive overview of medical psychotherapy with particular reference to issues of cost-effectiveness is presented.

Medical psychotherapy is defined as “a professional interdisciplinary endeavour” which serves as a vehicle for the management of patients with psychiatric, behavioural and/or medical difficulties with a psychological basis. Contributions are made from an exhaustive list of disciplines ranging from anthropology to vocational rehabilitation counselling. However, it remains unclear what distinguishes a medical psychotherapist from therapists in general.

The style and focus of the papers in this volume vary considerably. Some authors write opinions, some review and organize known facts and others describe the results of recent studies. There is an excellent and comprehensive review of neurology for psychotherapists. Several papers focus on program planning and the organization of mental health care delivery systems. Several papers describe refreshing approaches to psychotherapy and some include clinical vignettes. The disorders which are covered include panic disorder, chronic pain, post traumatic stress disorder and psychosomatic disorders. There seems to be a slight bias in favour of cognitive and behavioural therapy.

Dr. Anchor’s “Introduction to Medical Psychotherapy” clearly documents the need for interdisciplinary collaboration and the need to offer proven, cost-effective, quality services. The remainder of the volume is eclectic and each paper presents novel, interesting or unusual ideas. However, the book suffers from a lack of organization as well as a lack of consistency in the style, perspective, rigour and focus of the individual papers. Cost-effectiveness is an issue that is of growing importance in mental health care. However, no case is made for the inclusion of papers on, for example, behavioural neurology or psychological autopsy in this volume which is subtitled “Cost-Effective Strategies in Mental Health”.

While any psychotherapist might refer to any one or two of the papers included in this book, it is difficult to envision any professional finding the majority of these papers applicable to his or her clinical practice.

Edited by John E. Morley, Rodney M. Coe, Randy Strong and George T. Grossberg

New York, NY: Springer Publishing Company, 1992

This new book is based on the proceedings of a recent symposium on aging and memory disorders and is presented as a series of essays on various topics. As such, it provides a glimpse into the contributors’ areas of research interest but does not give a global overview.

The book is divided into three sections. The first deals with biochemical and molecular genetic bases of memory. This includes a concise discussion of trophic factors as well as chapters on the influences of neurotransmitters, neuropeptides and hormones on memory functions. The second section deals with animal and human models, theories of neurodegenerative disease and such diverse topics as the role of the hypothalamic pituitary axis, hormones, autonomic nervous system function and the effects of nutritional factors on memory function and associated diseases. Discussions of axonal transport and vascular factors are well presented.

The third and last section deals with diagnostic and therapeutic aspects. Chapters on diagnostic markers, neuropharmacological modeling and new approaches to cholinergic deficits are offered. There are a couple of rather cursory chapters at the end on behavioral management and psychotherapy. Since the rest of the material was of a biological nature, these could have been left out or put into a new section and expanded upon. In addtion, a concluding chapter summarizing the material and placing it in perspective would have been useful.

The contributors are from many fields, including psychology, psychiatry, geriatrics, neurology, pathology and occupational therapy, giving the discussion a more wide-reaching and varied perspective. The quality of the publication was good and it was easy to read, although some poor editing was noted. For example, there were missing labels in diagrams and errors in citations and spelling.

In general, the book is a good overview of some postulated biological mechanisms of memory function and dysfunction. The topics discussed highlighted various areas in a thought-provoking manner, and while not “mainstream” research, provide some tantalizing alternative hypotheses. This book is not of general interest, but would be useful for anyone involved in the areas of neurodegenerative disease and cognitive research. It should at least be available in the libraries of institutions doing work in these areas.