Publication Title: Clinical Handbook of Couple Therapy (4th edition)
Publication Author: Alan S Gurman (Editor)
Publisher, year of publication: Guilford Press, 2008.
This edited volume presents the core theoretical and applied concepts of Couple Therapy in modern clinical practice. The 736 pages cannot be reviewed in any kind of depth, so here is a brief overview of its structure and content.
The book is divided into two parts: Models of Couple Therapy, and Applications of Couple Therapy (which includes special populations, problems and issues). All of the best-known authors are here, such as Baucom and Epstein, the Gottmans, Johnson, Christensen, Hoyt, Snyder, Gurman, Lebow, and Bray among the fifty included. In Chapter I, Gurman presents a framework for comparing Couple Therapies, with potted histories of the major movements in this domain. This is a well-structured overview of Couple Therapy from an historical and structural perspective. In Part I, the models are categorised as Behavioral, Humanistic-Existential, Psychodynamic and Transgenerational, Social Constructionist, Systemic or Integrative. Part II covers these topics: (1) Rupture and repair of relational bonds: Affairs, divorce, violence and remarriage; (2) Couple Therapy and the treatment of psychiatric and medical disorders; and (3) Couple Therapy in broader context (addressing issues of gender, sexual orientation, ethnicity, and legal and ethical issues).
Gurman discusses four major shifts on Couples Therapy over time that have shaped it to be what it is today. First, the individual has been re-included, acknowledging the psychological contribution that each individual makes to the relationship. For many years, the individual was excluded – considered to be unimportant in the relational frame. Second, there has been an acknowledgement of the independent contribution of psychiatric/psychological disorders to relationship functioning, rather than insisting that all relationship problems are reducible to systemic levels of analysis. Third, the forces that have shaped Couple Therapy in the past twenty years have come from all domains of psychology (for example, cognition, behavioral, neuroscience, and emotion) rather than only from the family therapy tradition. Finally, it is the culmination of many years of diversification and integration that have allowed the development of “one of the most vibrant forces in the entire domain of psychotherapy-in-general” (Gurman & Fraenkel, 2002, p. 248).
Each therapeutic model is presented to include these components: The structure of the therapy process (to describe the treatment setting, frequency and duration of treatment); The role of the therapist (to describe the stance the therapist takes with the couple); Assessment and treatment planning (to describe the methods used to understand a couple’s clinically relevant patterns of interaction, symptomatology and adaptive resources); Goal setting (to describe the nature of therapeutic goals and the process by which they are established); Process and technical aspects of the therapy (to describe techniques and strategies always or frequently used in the approach, and their tactical purposes); Curative factors/mechanisms of change (to describe the factors, that is, mechanisms of change, that lead to change in couples and to assess their relative importance); and Treatment applicability and empirical support (to describe those couples for whom the approach is particularly relevant, and to summarise existing research on the efficacy and/or effectiveness of the approach). This means that the reader is able to understand the approach in terms of its mechanisms of change, and to learn techniques that might help to bring about positive change in the couple’s functioning.
I liked the way that the various models are presented by their originators. So, Emotionally Focussed Couple Therapy is presented by Sue Johnson, Gottman Method Couple Therapy by John and Julie Gottman, Integrative Behavioral Couple Therapy by Andrew Christensen and colleagues, and Integrative Couple Therapy by Alan Gurman. There is enough detail in each model to be able to pick out techniques and use them in practice. Most chapters address techniques and mechanisms of change (or curative factors), the role or stance of the therapist, empirical support for the treatment and case studies. There are suggestions for further reading and comprehensive references for each chapter.
There are therapy options to suit all personal predelictions, preferences, and situational demands from brief, problem-focused approaches that could work in Family Court settings (restricted to 6 sessions and often focused on conflict about custody and access) to longer-term approaches to therapy that addresses relationship functioning more generally. There are very specific populations (e.g. people facing various physical or mental health problems, demonstrating how inextricably linked the soma and the psyche really are) and very specific problem areas (e.g. sexual dysfunction, domestic violence, and stepfamilies).
This book is a must-have resource for any clinician working in the field of Couples Therapy who wants to expand their understanding of the tremendous complexity of the field and their treatment repertoire. The fact that this is the 4th edition in nearly 25 years is testament to its importance in the field. The book is readily available from Footprint Books (www.footprint.com.au) or from local specialist bookshops.
Reviewer: Fran Vertue
Review date: 2009