Reviewed by Nikos Marketos, Psychiatrist, Systemic Psychotherapist
The book by Vlassis Tomaras, "Families in Crisis," refers to systemic psychotherapeutic interventions when there is an acute psychiatric incident (and not only). As the author says in the preface, "crisis intervention provides great therapeutic benefits, both in terms of secondary (early identification of intervention and treatment) and tertiary (avoidance of recurrences of chronicity and psychosocial disability) prevention." And the intervention includes both the intra- and extra-familial environment of the person with symptoms, as it has been documented, that it is involved in the onset and course of the disorder."
From the outset, the author points out that he uses the term person or individual with a mental disorder, rather than the traditional term mentally ill or patient, because the latter gives the subject a permanent identity, whereas the disorder may be a temporary status. What the author shows is that, through the language he uses, the systems approach introduces another scientific paradigm instead of the Cartesian linear one.
This manual is the result of the writer’s lengthy experience as a psychiatrist and as a systems therapist. It contains recollections of clinical work and, at the same time, offers a compendium of the Systemic approach.
Eight cases are presented. Eight stories of people who reached their limits. This is the title of the book, "Families in Crisis."
The chapters follow the following order: At the beginning, the clinical vignette and the history of each case are presented. The course of family psychotherapy is then presented, followed by commentary and theoretical documentation.
In psychotherapeutic sessions, interventions and techniques are mentioned, which could become the issue of dialogue and discussion between family therapists, such as the reframing technique, the use of paradox, tasks, frequency of sessions, etc.
The eighth case is of a couple in therapy in crisis. It has a remarkable intervention by the author that catalyzes the impasse.
In the last chapter of the book, we find the author's reflections on the crisis in the country's super system.
In the cases of "major psychiatric disorder," the author, consistent with systems epistemology, considers that mental aberration is not born out of nothing, but is always produced within a social and family context. He studies how family dynamics intertwine with clinical symptomatology in a cyclical causality. We see, for example, in the case of the member with bipolar disorder, how the whole family dances to the rhythm of the bipolar disorder. In the case of Iphigenia, I find a correspondence between the mother, who was an adopted child, and who herself hands over her daughter to the father.
The book gives us a stimulus to rethink the value of a systemic view when dealing with major psychiatric disorders. To see how it can be effective and what kinds of interventions are effective in situations of psychiatric crisis.
The book presents difficult clinical cases. Cases are reported where systemic intervention is used when medication fails to produce results.
At the same time, it makes us reflect on the practices of classical clinical management. For example, the unfolding of a case of hospitalization makes us question whether hospitalization serves family dynamics. Family dynamics push the member into mental aberration, but does hospitalization (psychiatry's response to the problem) reinforce those dynamics? Are we unwittingly reinforcing the problem we are trying to fix?
The book is written in accessible language and in a vivid style that makes it enjoyable and useful. The narration and plot of the incidents have literary qualities and thus keeps the reader's interest peaked.
This book is addressed to mental health professionals and shows the multi-dimensional context in which mental illness manifests itself. It may be short in length, but the meanings are condensed, so it takes some time to study and assimilate these meanings. It highlights that the systemic view is essential knowledge for any professional dealing with major disorders.
The content of the book, as well as the cases, could be used as a curriculum for the training of therapist candidates.
We hope that the book will help raise awareness so that clinics and units of the public mental health system, which are on the front lines of intervention, can "inculcate" family intervention services. As the book shows, family interventions are not luxury interventions but useful and proven effective interventions that reinforce traditional forms of coping with difficult situations.
I wish Vlassis Tomaras' book "Families in Crisis. Eight Cases of Family Psychotherapy" receives the recognition it deserves.