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Book Forum: Psychotherapy   |    
Psychotherapy Indications and Outcomes
Am J Psychiatry 2000;157:141-a-142.
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New York, N.Y.

edited by David S. Janowsky, M.D. Washington, D.C., American Psychiatric Press, 1999, 398 pp., $49.95.

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"Who has won?" the crowd of panting racers asks the Dodo bird in Alice in Wonderland when he proclaims that the caucus-race is over. After a great deal of thought the Dodo said, "Everybody has won, and all must have prizes."

This compendium of papers from the 86th annual meeting of the American Psychopathological Association in 1996 is designed to review the status of various psychotherapies at the close of the 1990s. It begins with Lester Luborsky and colleagues comparing the efficacy of psychodynamic versus other psychotherapies and asking whether, indeed, all psychotherapies have won and everyone must have prizes. This useful update of Luborsky’s classic 1975 paper is followed by two chapters based on the National Institute of Mental Health Collaborative Study of Depression data examining patient and therapist factors associated with positive outcomes and an additional chapter by David Janowsky, the volume’s editor, on therapist and patient characteristics as assessed by the Myers Briggs Type Indicator.

These general opening chapters are followed by numerous chapters on various psychotherapy "brands," often written by those who developed them, including Marsha Linehan on dialectical behavioral therapy of borderline personality disorder, Myrna Weissman on interpersonal psychotherapy, David Spiegel on group psychotherapy with the medically ill, and Ira Glick on family therapy. Although each of these chapters attempts to address the question of the relative efficacy of their psychotherapeutic approach compared with others for a given set of disorders, there are often very few real data distinguishing them. In addition, the proponents of each type of psychotherapy seem, predictably enough, to be somewhat biased in favor of their own approaches. Of course, this same criticism might also be leveled at a psychopharmacological researcher who has spent much of his or her career primarily studying one medication.

The evidence for the efficacy of cognitive behavior therapy and interpersonal therapy alone and when combined with medication for the treatment of depression are reviewed before the book provides a look at important methodological considerations in psychotherapy research such as how to study the relative efficacy of medications and psychotherapies and how to create solid comparative studies. Donald Klein’s comprehensive checklists are characteristically rigorously thought-out examples of the rules of evidence that must govern any comparison of psychotherapeutic approaches. These thoughtful perspectives on methodology seem to bring the book full circle, reminding us how much we need not only studies that dissect in detail how each psychotherapeutic technique works but also rigorous demonstrations of the therapeutic features that different psychotherapies share. One thing this solid survey of the current status of psychotherapy makes clear is that psychotherapy research in the 1990s is off to the races. The book closes by asking what is perhaps the most crucial question of all: with managed care in charge, will there be enough prizes left to go around?




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