Although this 720-page textbook does not make for light reading, it does come in handy as a reference on mental disorders. In Essential Psychopathology and Its Treatment, Mark D. Kilgus, Jerrold S. Maxmen, and Nicholas G. Ward step back from a strictly theoretical approach and toward scientific evidence with clearer standards for data-driven treatment.
The book offers new evidence without throwing away what is already known — the authors kept what works and added new discoveries. They place clinical information in historical context so that newer clinicians can understand how the field has evolved, and create a kind of reference manual, perhaps especially helpful for psychology students who don’t yet know all the terms.
A large portion of the book deals with disorders themselves. But the authors also review other important aspects of being a clinician. They break down the components of a diagnosis and explains the purpose of it, highlighting the difference between descriptive approaches (objectivity) and psychological (subjectivity). While covered briefly, these distinctions are important.
Case descriptions throughout the book help the reader understand abstract concepts when it comes to treatment. Those who are just beginning in the field will appreciate the clinical cases and how decisions are made in treatment. And the authors cover a lot of detail about the eight suggested steps for an assessment. They remind clinicians how to ask challenging questions, such as those around prescription drugs. For example, one might ask “Have you ever used more than the amount prescribed?” rather than “Are you a drug abuser?” Clearly, the first is much less startling!
There are tables throughout the book that highlight the questions to ask in each phase of the historical data collection, such as areas around family of origin and across the different life stages. New clinicians who are ready to gain experience in a clinical setting may want to go directly to the section on mental status examination so they know what to look for in a crisis situation as well as in an outpatient clinic. It’s a good reminder that what the patient says with their words is often different than what they say with their appearance, attitude, or tone.
The diagnostic process is by no means a simple one. The book discusses differential diagnosis and how to look at the primary distinctive features, how this is displayed, and what it may mean. Looking for a disorder’s a single cause, they write, is misguided: “what initiates a disorder usually differs from what perpetuates it.”
Indeed, causes can build on each other such that the presenting problem, when you are face-to-face with a client, is not a hundred percent clear. (Students may at this point realize why they studied all those psychosocial theories and disorders they had not planned to treat.)
The chapter on treatment briefly describes what’s included in a treatment plan, which may be helpful for newcomers as well as seasoned clinicians who need a refresher of the basics. (We clinicians know that it can be easy to let clients drive the sessions and move away from the overall plan.)
As a clinician myself, I know that during the initial assessment and throughout treatment there may be biological causes to rule out. In addition, clients will come in with different world views. When I see a client with a strong Christian faith, for instance, versus one who has no interest in religion, the way we work toward treatment will look different. There is no one-size-fits-all mode of therapy.
In terms of what Kilgus, Maxmen, and Ward cover, I would have liked to see a longer section on group treatment. In my experience, clients who see me individually for therapy and who feel they are all alone tend to progress much more quickly when they also attend group. This is a powerful modality that I happen to be biased toward.
The book’s psychopharmacology section is not extensive, but provides enough information to help therapists understand medications used to alter brain chemistry. It will help clinicians work in partnership with psychiatrists for their patients care.
And then, of course, much of the book is dedicated to mental disorders themselves. The tables throughout include diagnostic criteria based on the ICD-10 and DSM-5, how each disorder presents to clinicians, and factors to consider in differential diagnosis.
Although Essential Psychopathology and Its Treatment certainly did not meet its described goal of being concise, it does provide solid material for clinicians across levels of experience. It is also a good general reference on the different disorders and modalities of treatment, and those looking for updated information on the ICD-10 and DSM-5 will find it a valuable resource.
Essential Psychopathology & Its Treatment, 4th Edition
W. W. Norton & Company, October 2015
Hardcover, 720 pages