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The American Journal of Psychiatry, VOL. 156, No. 2

Book Forum: PSYCHODYNAMICS AND PSYCHOTHERAPY | February 01, 1999

How to Practice Brief Psychodynamic Psychotherapy: The Core Conflictual Relationship Theme Method

PAUL ROAZEN, PH.D.

Am J Psychiatry 1999;156:330-330.

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by Howard E. Book, M.D., D.Psych. WashingtonD.C., American Psychological Association, 1998, 173 pp., $39.95.

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This book is an interesting manual for how to conduct brief psychodynamic psychotherapy along the lines proposed by Lester Luborsky, who has written the book’s foreword. The idea of the method is that it is possible in the course of an initial evaluation and socialization phase to isolate a core conflict that will be the focus of therapy. According to this technique, it is efficacious to identify the core difficulty, as it interferes with the patient’s well-being, and then illustrate, over the course of 16 therapeutic sessions, how the core conflict constitutes an interpersonal hindrance.

Howard Book sets out by means of a clear conceptual roadmap the different phases of this sort of treatment. He also illustrates his argument with brief clinical vignettes. Book is aware of the history of brief psychodynamic psychotherapy as well as the need to establish clear criteria for the kinds of patients that stand to benefit from this approach. Throughout, he is sensitive to the value of traditional psychoanalytic concepts; he cites how countertransference on the therapist’s part can prove harmful to the patient and interfere with the success of the whole focus-orientation.

More than half of the book is taken up with the case of one particular patient, and readers will find this discussion perhaps the most enlightening aspect of the volume. Book willingly admits his mistakes, even in the course of this successful treatment; for example, he says he was not sensitive enough to a secondary core conflict that existed besides the one he chose to concentrate on initially. Book does not believe that the method he is advocating is a panacea for all possible difficulties. He is open to the advantages and use of long-term psychotherapy and psychoanalysis as well as medication. This is a conscientiously detailed account of a special method especially suitable for a limited number of psychologically minded and highly motivated patients. In a time when decreasing therapeutic resources coincide with increasing demand for treatment, the core conflictual relationship theme method is designed to improve access to psychotherapy.

It is impressive to me how Book has been able to rely on the whole tradition of psychoanalysis in order to illustrate a technique that is substantially at odds with Freud’s own technical recommendations and practices. One hopes that in the spirit of scientific tolerance, the approach that Book illustrates in this manual will seem welcome to practitioners of a variety of different schools of thought.

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PAUL ROAZEN; How to Practice Brief Psychodynamic Psychotherapy: The Core Conflictual Relationship Theme Method. American Journal of Psychiatry. 1999 Feb;156(2):330-330.

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