BOOK REVIEWS …

BOOK REVIEWS                                                                           W. Clay Jackson, M.D., Dip.Th., Editor


         Integrative Treatment for Borderline                                  To accomplish the task at hand, the author has divided
         Personality Disorder                                              the text into 4 sections. The first ensures that an accurate
         by John D. Preston, Psy.D., A.B.P.P. New Harbinger                diagnosis is made. In doing so, Dr. Preston argues that bor-
         Publications, Inc., Oakland, Calif., 2006, 177 pages,             derline personality disorder more accurately represents a
         $24.95.                                                           spectrum of presentations. The concept of identifying and
                                                                           working with the client's ego strengths rather than the
             Severe personality disorders are at the top of the list for   DSM-IV criteria is what he feels is tantamount. The second
         many clinicians when asked which group of patients are the        provides etiologic evidence for the diagnosis by summariz-
         most challenging to treat. These challenges often result in       ing the key points under both neurobiological and environ-
         clinicians' questioning their skills or feeling resentful to-     mental development theories. The third section outlines
         ward the patients. Although personality disorders as a            some of the core characteristics of the disorder with an eye
         group are fairly prevalent in the general population, little      to how this will affect treatment. Additionally, the funda-
         attention is paid to them and how they affect the delivery of     mental and common components of the varied treatment
         medical care. In a somewhat cynical view, this is because         approaches are identified. Against this backdrop, the fourth
         there are no novel therapeutic agents approved for the treat-     section of the text details specific treatment strategies,
         ment of personality disorders, which would then provide           often invoking the language of cognitive-behavioral tech-
         the army of pharmaceutical company representatives and            niques with an eye toward the briefer therapy often man-
         hosted lectures. These heterogeneous groups of patients are       dated by insurance. Specific sections on self-injurious be-
         high utilizers of services, have longstanding illness, are en-    havior and emotional dysregulation make it easy to absorb
         trenched in the mental health care system, and at first blush     the recommendations.
         offer little hope for a "cure." Of the list of personality dis-       One of Dr. Preston's greatest accomplishments is get-
         orders, borderline personality disorder meets many of these       ting all of the above done in a text under 200 pages. For the
         criteria, and insurance companies have often seized on this       novice therapist, it distinguishes the forest from the trees
         in an attempt to limit expenditures. Although this portends       with respect to the treatment of borderline personality dis-
         a challenging therapeutic encounter, it also offers a poten-      order. For the more seasoned clinician, the text provides a
         tial for therapist growth and mastery.                            thorough summary of the disorder with updated informa-
             The motivation behind Integrative Treatment for               tion and a more integrated approach than typically given by
         Borderline Personality Disorder is to provide the therapist       authors who have sworn an allegiance to a particular psy-
         with the necessary toolbox to survive and even thrive when        chotherapy school. Perhaps even more important is the
         treating patients with borderline personality disorder. Al-       anti-burnout reminder scattered throughout the text; the
         though this volume is primarily aimed at therapists treating      treatment goal for these individuals may not be "cure" but
         patients with borderline personality disorder, in the course      rather relieving some of their psychic pain. This makes the
         of the book the author identifies diagnostic concepts and         tempest we experience in the office an opportunity for suc-
         treatment strategies that make the text a valuable read for       cessful interventions that can accomplish this goal, leaving
         all therapists. Acknowledging up front some of the difficul-      both participants better off for the encounter.
         ties encountered in treating this population, the text seeks
         to develop in the reader an awareness of where the common                      Christopher C. White, M.D., J.D., F.C.L.M.
         pitfalls are and how to successfully navigate them in a typi-                                     University of Cincinnati
         cal treatment course. The target audience is mental health                          Family Medicine & Psychiatry Program
         care workers at all levels of experience and does not require                                            Cincinnati, Ohio
         significant prior experience with psychodynamic or cogni-
         tive-behavioral therapy (CBT). However, those clinicians
         who have struggled in treating this population will un-
         doubtedly see some of their interactions in the clinical          Solving Psychiatric Puzzles
         scenarios detailed. In focusing on borderline personality         by V. Sagar Sethi, M.D., Ph.D., with George W. Jacobs.
         clients, the author meets 2 difficult challenges: first. clar-    AuthorHouse, Bloomington, Ind., 2004, 371 pages,
         ifying diagnostic issues for this population and providing        $34.50 (hardcover), $22.95 (paperback).
         etiological evidence; and second, integrating diverse treat-
         ment modalities, ranging from traditional psychodynamic               Psychiatric treatment is a private experience cloaked
         theories to the more modern CBT/dialectical behavioral            in confidentiality and, often for the outsider, mystery.
         therapy, with a sprinkling of psychopharmacology on top.          Too rarely, the insiders--psychiatrist or patient--reveal the
             Dr. Preston is a practicing psychologist and has served       essentials of how the psychiatric treatment process works.
         on the faculty of the University of California, Davis, medi-      Solving Psychiatric Puzzles by V. Sagar Sethi reveals
         cal school. Moreover, he has earned his writing chops by          through the stories of his patients over the last 15 years of
         authoring over 17 books on the subject of mental illness.         practice the process by which he has assessed and treated
         His personal experience treating patients with borderline         them. It's a self-portrait of his psychiatric practice.
         personality disorder shows in his clinically focused text.            Beginning with an introduction that examines Dr.
         His prior authorship has given him a clear and concise            Sethi's personal history, the way physicians listen, psy-
         writing style, which is easily digested and relatively jargon     chiatric decision-making, and a "Very Brief History of
         free for the novice reader. This book at times reads like a       Psychiatry," the book is organized into 3 sections: "Voices
         therapy manual and at other times seems more like a casual        of Patients," "Assorted Stories," and "Appendices." The
         conversation with a learned colleague. However, it is full of     first section presents 10 cases, first through the voice of
         clinical vignettes, which bring the material to life by detail-   the patient, describing the symptoms and why psychiatric
         ing therapist-client dialogues that demonstrate key points        care was sought, then through Dr. Sethi's summary of
         and serve to clarify theoretical observations.                    the history, the treatment plan, and follow-up visits--often


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BOOK REVIEWS


including his thoughts on the difficulties involved in dosing       ous about the practice of psychiatry. He writes of his frustra-
medications, prescribing to children, hearing threats of suicide,   tions with managed care and the changes in medicine that have
involuntary commitment to hospitals, and other challenging ar-      occurred while he has practiced. Numerous editing errors are
eas of psychiatry.                                                  distracting, but minor specks on this revealing window into
   The second section presents 17 vignettes illustrating the        Dr. Sethi's practice.
range of problems faced by a general psychiatrist. The "Appen-
dices" include information for the lay reader on psychiatric dis-
orders, schools of psychotherapy, medication names, and the                                            Joseph M. Cerimele, B.A.
private practice of psychiatry.                                                                         Lawson R. Wulsin, M.D.
   Dr. Sethi has written a book that will interest the general                       University of Cincinnati College of Medicine
reader as well as physicians, medical students, and anyone curi-                                                 Cincinnati, Ohio




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