Book Review: Clinical Psychology in the Mental Health Inpatient Setting: International Perspectives

Book Review: Clinical Psychology in the Mental Health Inpatient Setting: International Perspectives

Turel, M., Siglag, M. & Grinshpoon, A. (Eds.) (2020). New York, NY: Routledge.

by, Anthony F. Tasso, PhD Fairleigh Dickinson University

Inpatient psychiatric hospitals have experienced some of the more pronounced booms and busts within the mental health field. From the early and oft-inhumane days of Bedlam, to the more clinically rich and compassionate ethos of Harry Stack Sullivan and his devotees, the nature of inpatient clinics in this country and abroad have been anything but static. Indepth psychotherapeutic work, the hallmark of clinical psychology and psychiatry, has not always been the status quo within the walls of psychiatric hospitals. All too often, the nature of residential psychiatric hospitals, where the most severely disturbed are located, has consisted of medicating, managing, and, at times, ‘warehousing’ such patients – much of which consists of (at best) minimal personalized psychotherapeutic endeavors. Although recent decades have witnessed greater attempts to individualize inpatient care, the prevailing contemporary image is that comprehensive psychotherapy in inpatient units is rather antediluvian. Insurance limitations, insufficient mental health funding, and the shuttering of far too many psychiatric hospitals all share culpability. However, it would be wrong to place the blame exclusively on external factors. Clinical psychology’s training zeitgeist shies away from concerted attention to intensive training with the seriously mentally ill. Clinical programs, explicitly or not, intimate that the role of practicing psychologists is to work with higher functioning patient populations, whereas the treatment of more severely psychopathological patients is left to our psychiatry counterparts. This ‘in house’ variable is just as responsible for perpetrating the notion that psychotherapy has no place in mental health hospitals as budget constraints or other external factors. Despite this public and professional perception, Clinical Psychology in the Mental Health Inpatient Setting: International Perspectives (Routledge) demonstrates that ‘real’ psychotherapy is currently happening in psychiatric hospitals, and is happening at a high level. Editors Meidan Turel, Michael Siglag, and Alexander Grinshpoon bring together a group of 29 clinicians from the United States and abroad to explore the various ways that inpatient clinical psychotherapeutic services are currently being designed and delivered. The book opens with a discussion about the varied roles of the inpatient psychotherapist (e.g., individual therapist, group facilitator, clinical researcher), underscoring the multitude of ways a psychologist contributes to the sustainability of a mental health hospital. This section describes a psychoanalytically informed psychiatric center in which four-times-a-week psychotherapy is the standard, adhering to the psychoanalytic ethos that making meaning of symptoms, even with the severe mentally ill, is a vehicle to facilitating a more authentic way of living. Two authors describe the landscape of inpatient work in Australia, with its multidisciplinary team approach (similar to many US hospitals where teams consist of psychologists, psychiatrists, and case workers) along with the inherent challenges that accompany limited financial resources. Clinical Psychology in the Mental Health Inpatient Setting also covers the treatment and administrative ethical dilemmas confronting those working within a psychiatric hospital. The effectiveness of behavioral interventions is reviewed in a stand-alone chapter, followed by a discussion about the various ways in which psychologists in a psychiatric center attend to patient as well as the organizational and cultural needs of the hospital. This section touches on inpatient substance abuse work (with the aim of instilling hope, healing, empowerment, and connections with others) while another chapter addresses the importance of professional self-care. This section of Clinical Psychology in the Mental Health Inpatient Setting concludes with one of the editors reflecting on his lengthy career as a clinical psychologist in an inpatient psychiatric unit – from his days as a clinical trainee to his position as training director of an APA-accredited internship at the same psychiatric hospital, charged with the essential task of training the next generations of inpatient clinicians. Part II moves to a discussion about the different types of inpatient interventions with separate chapters devoted to CBT, psychoanalytic, and mentalization-based treatment perspectives. The book then parses supportive treatment techniques (which aim to shore-up patient strengths) from intensive treatment techniques (which aim to foster

insight). The chapter concludes by underscoring how most treatments consists of an integration of the two. The bridge between the inpatient unit and community care is examined, with procedural information on how a psychiatric hospital treatment team facilitates outpatient mental health connections. A chapter also delves into inpatient psychotherapeutic interventions that directly target violence and those convicted of crimes. This discussion provides nuanced material on the role of forensic work within a mental health hospital. Assessment and diagnosis are the focus of Part III, which profiles the Austen Riggs and Menninger hospitals, two premiere American psychoanalytic treatment centers. The authors emphasize how these psychiatric hospitals incorporate comprehensive psychological testing (i.e., objective, projective, and cognitive assessments) as a means of illuminating symptomatologies and character structure. This section of Clinical Psychology in the Mental Health Inpatient Setting also discusses the ways in which mentalizating abilities – a person’s capacity to attend to the thoughts, feelings, and behaviors of self and others – are identified and supported by certain psychiatric hospitals. Key to this section is how some inpatient assessment measures go beyond mere symptoms or observable behaviors by aspiring to attend to the entire person. Put otherwise, there are indeed inpatient centers that still aim to treat the person rather than their symptoms alone. The next section focuses on inpatient clinical training. The book accentuates the inevitable excitement and anxieties idiomatic of trainees working in a psychiatric hospital. This section further delves into the doctoral internship experience of working as part of a multidisciplinary clinical team (e.g., psychologists, psychiatrists, nurses). The author underscores how such intensive training in the inpatient psychiatric unit provides a solid professional identity fostering a sense of autonomy and independence as well as building the neophyte’s confidence in assessing and treating the breadth and depth of psychiatric disorders and behavioral control struggles. Clinical Psychology in the Mental Health Inpatient Setting also examines patient suicide. Difficult at any professional stage, the book taps into the oft-severe impact a patient’s suicide can have on an early career professional. The summation of this erudite section nicely highlights the personal and professional growth associated with such meaningful inpatient training. The last section of Clinical Psychology in the Mental Health Inpatient Setting contains the editors’ final reflections, consisting of musings on topics ranging from the omnipresent tensions between biomedical versus biopsychosocial perspectives to the challenges of cultivating empathy with patients so disconnected from reality to the difficulties of working with those with severely compromised psychological structure. The book provides grounding information for those currently, or considering, patient work in such settings. The editors conclude by asserting that, despite the tremendous challenges for the practicing psychologist working in an inpatient psychiatric hospital, the professional and personal rewards are enduring. Clinical Psychology in the Mental Health Inpatient Setting is a welcomed text for practicing clinicians, regardless of their professional setting or experience with inpatient populations. In other words, one doesn’t need to be an inpatient psychologist to benefit from the insights provided by inpatient psychologists, which allow the practicing therapist to peer in to the meaningful clinical work occurring in the inpatient units. This, I argue, allows an outpatient therapist to have greater confidence in referring patients to a higher to a highly level of care based on a deeper understanding of the procedural aspects of hospitalized treatment. The illustrative clinical vignettes bring these processes to life for those who may have never stepped foot on a psychiatric hospital floor. Of course, those psychologists working, or planning to work, in a psychiatric hospital stand to benefit the most from reading this book. The clinical psychology trainee will gain powerful insights into such work from the wealth of information provided by these authors, who are working professionally both stateside and abroad. The mid-career and seasoned clinician will further develop their skills by tapping into the collective wisdom of inpatient therapists from around the globe, who bring their varied experiences to address a range of patient populations through different theoretical modalities. This book will surely enhance the reader’s clinical acumen as well as interventional and supervisory skillsets. An ancillary benefit of this book is the overall ‘support’ provided across the pages, with many of the authors admirably opening up about the exasperation and stress that comes from working in such an environment. Turel, Siglag, and Grinshpoon bring together a group of exemplary clinical scholars, each of whom makes a meaningful contribution to the text, just as they have to the lives of the most severely ill amongst us. As such, Clinical Psychology in the Inpatient Mental Health Setting is a worthwhile read.

Anthony F. Tasso, PhD, ABPP is Professor of Psychology and Deputy Director of the School of Psychology & Counseling, Fairleigh Dickinson University. He also maintains a private practice in Whippany (Hanover Township), Morris County, NJ.