Knowledge of the self is the mother of all knowledge. So it is incumbent on me to know myself, to know it completely, to know its minutiae, its characteristic, its subtleties and its very atoms.

—Khalil Gibran

Psychotherapy is a very important part of psychiatry’s identity and practice. In the Preface to the book Seminars in the Psychotherapies, its editors Rachel Gibbons and Jo O’Reilly note that “working in mental health puts us in touch with the complexity, depth, creativity and turmoil of the human mind” (p. xiii), which is a process where psychotherapy has a prominent role. They further write, “We are not only individuals, we function within groups, intimate relationships, family networks, and larger social and global arenas, a matrix of emotional connections which profoundly affects our mental health. This complicates and diversifies a reductionist biological perspective and makes for a much deeper, richer understanding of our human struggle” (p. xiii). They note that psychiatry has moved from an early preference for psychoanalytic understanding of the etiology of mental distress to the precedence of biological explanations over psychological or relational factors, which is partially due to previous resistance of the analytical movement to bring together different perspectives. Psychiatrists became most interested in gathering information, making diagnoses, and prescribing psychopharmacological interventions. However, as they write, “there has been a gradual rapprochement between the biological, social, and psychological, and a recovery of the understanding that mental health is a holistic discipline. The central role of unconscious processes in mental life, and the importance of life experiences, relationships, and the quality of early nurture in shaping the mind are now widely accepted” (p. xiii). Thus, the editors decided to put together a volume that would reflect this change, prioritizing the central importance of relationships in emotional life, psychological functioning, and serious mental illness. They gathered a group of British clinicians who are mainly medical psychotherapists trained in psychiatry and psychological therapy, most of whom are psychosocially and psychodynamically oriented.

The book is divided into two parts: I. Therapy Theory and Practice, and II. Applied Psychotherapeutic Thinking.

Part I has two sections, one covering psychodynamic psychotherapy (with chapters on psychodynamic theory, psychodynamic approach to psychiatry, referral for psychodynamic psychotherapy: processes and considerations, psychodynamic psychotherapy: the consultation process, psychological models for case formulation, and an introduction to psychodynamic psychotherapy practice) and the other covering other forms of psychotherapy—cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), brief psychodynamic psychotherapies, systemic family therapy, cognitive analytic therapy, group analytic psychotherapy, and mentalizing in psychiatric practice.

These chapters are informative, well written, and good in explaining basic principles. They of course do not cover everything about all the mentioned therapies, but they do not shy away from certain topics as some analytically oriented texts in the USA do. For instance, the chapter on psychodynamic theory acknowledges the contributions, among others, of Carl Gustav Jung, noting that “Jungian depth psychology provided for many a modern method of accessing the spiritual power of the deep psyche at a time when traditional religion was losing its relevance” (p. 11). The chapter on the psychodynamic approach to psychiatry presents a lot of food for thought. It emphasizes, among other items, that “Psychoanalytic theory views the psychological mechanisms of pathological states as more extreme versions of normal function” (p. 25) and “Psychoanalytic theory places the ability to mourn as being of central importance in the development of the psyche” (p. 27). Some chapters include useful tables, such as the chapter on referral for psychodynamic psychotherapy, which includes a table listing clinical/situational presentations for referrals, reasons for caution, and suggested responses to referrals (this chapter also includes an appendix with guidelines for referrers for psychodynamic psychotherapy, such as where is therapy likely to help, what are exclusion criteria, and what are criteria for treatment). The chapter on psychodynamic psychotherapy consultation is both interesting and useful, describing the appropriate time for initial consultation (usually 90 min), settings, process, follow-up, and outcome (e.g., referral to various therapy services). The chapter on models of psychological case formulations includes tables on biopsychosocial models and on the five Ps model (presenting problem and predisposing, precipitating, perpetuating, and protective factors).

The introduction to CBT and DBT describes aptly the three waves of CBT development—behavioral therapy and cognitive therapy as the two first waves and the third wave including DBT, mindfulness-based cognitive therapy, and acceptance and commitment therapy. Interestingly, the chapter on systemic family therapy traces roots of this modality to Alfred Adler’s work as he saw children with their parents. It describes various models of family therapy and emphasizes the advantage of a systemic perspective with a focus on embedded relationships and contextual factors explored in family therapy.

The final chapter of this part delves into mentalizing in psychiatric practice that draws upon “psychoanalytic, cognitive and relational models of psychological functioning, attachment theory and neuroscience” (p. 147) and is defined as describing “a particular facet of the human imagination: an awareness of mental states in oneself and in other people, particularly in explaining their actions… It involves perceiving and interpreting the feelings, thoughts, beliefs and wishes that explain what people do” (p. 147). The text recognizes four different dimensions of mentalizing: controlled vs. automatic, mentalizing the self vs. mentalizing others, mentalizing with regard to external vs. internal features, and cognitive vs. affective mentalizing. The chapter also includes an interesting discussion of an underlying failure in mentalizing and its relationship to adversity and attachment as a model for borderline personality disorder (BPD).

Part II is divided into three sections: psychological and psychodynamic approaches to psychiatry, work in practice, and contemporary developments. The first section includes chapters addressing psychological approaches to affective disorders, psychosis, personality disorders, complex posttraumatic stress disorder, and approaches to medically unexplained symptoms; these are followed by chapters on the psychodynamics of self-harm, psychodynamic aspects of suicide and homicide, and forensic psychotherapy. These chapters are well written and present basic psychodynamic principles in approaching various disorders and areas. For instance, the chapter on approaches to psychosis starts with Freud’s statement that “We can’t cure a patient of their delusional world unless we understand the conditions in which they became necessary” (p. 175) and then outlines ideas on which the approach is built on, for example, that psychotic symptoms represent a return to psychological processes which are normal in childhood and that their content has meaning and expresses material from unconscious areas of the mind. The chapter on personality disorders includes a good table comparing evidence-based therapies for BPD, including their background, key concepts, mechanism of change, the patient-therapist relationship, and treatment goals. Chapters in this section are again well written, clinically oriented, and bringing many new ideas. The chapter on forensic psychotherapy discusses, among other topics, consultations to forensic institutions and individual and group forensic therapies.

The second section on work in practice addresses issues such as the effect on staff and organizations of working with patients with psychotic illness; introduction to organizational dynamics (that includes organizational consultancy), reflective practice, and working psychotherapeutically with children. The most useful is probably the chapter on reflective practice. It suggests that reflective practice could be provided in various settings, including supervision, case-based discussion groups, staff support groups, reflective practice groups, and case discussion groups, including Balint groups. The discussion of specific examples of reflective practice groups, for example Balint groups, with detailed description of structure, principles, and process may be especially useful when considering wellness measures in training programs.

Finally, the third section delves into issues such as the open dialogue approach, neuropsychoanalysis and neuroscience, psychedelic-assisted psychotherapy, and psychotherapy development through the life of the psychiatrist. The chapter on neuropsychoanalysis reviews some of Eric Kandel’s work and five principles of his “New Intellectual Framework for Psychiatry.” The important one, relevant for psychotherapy, is the fifth one: “If psychotherapy is effective in bringing about long-term changes in behavior, it presumably does so through learning, changing gene expression, altering the strength of synaptic connections and bringing about structural changes” (p. 349). I also liked the last chapter on the psychotherapeutic development of psychiatrists. It reminds us that psychiatrists are drawn to psychiatry “by a multitude of factors but it is the unconscious drive to care for, repair and make amends to our internal objects that underlies this motivation alongside our aspirational identification” (p. 383). The text also suggests some hope for continual growth in an Eriksonian sense, as “This is a careerlong endeavour that inevitably goes through cycles like the seasons—there may be periods of drought and mourning but the rain will come and times for renewal at all stages of a career and it’s being able to take in nourishment when it arrives that is vital for growth even at the end of a career” (p. 383).

This volume, written mostly by biopsychosocially and psychodynamically oriented medical psychotherapists (i.e., psychiatrists) from the UK, provides refreshing views of modern-day psychotherapy that are firmly rooted in principles psychoanalysis. It covers various areas not always included in psychotherapy texts. It is a good read that could be used in teaching the principles and practice of mostly dynamically oriented psychotherapy, either as an assigned reading text for trainees or using selected chapters for discussion in psychotherapy seminars. And, as noted in the last chapter, even psychiatrists beyond their training could use it for enhancing their further growth after periods of drought.