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Introduction to Alternative and Complementary Therapies

Richard Balon, MD

Wayne State University, Detroit, MI, USA

Physicians usually consider herbal products, acupuncture, homeopathy, and similar venues as alternative or complementary medicine or therapy, if they accept them at all. This edited volume is not, however, about herbals or acupuncture. As one of the editors, Anne L. Strozier, points out in the Introduction, “this book presents therapeutic interventions that are complementary or alternative to therapists’ verbal work [mine: to psychotherapy]… These approaches rely less on verbal interventions and more on methods that utilize the client’s mind in relationship with other senses such as touch, sound, movement, and visual stimuli” (p 1).

Edited by Anne L. Strozier and Joyce E. Carpenter; The Haworth Press; New York, New York; 2008; ISBN: 978-0-7890-2206-6; $90 (paperback), pp 297.

As Strozier explains later, complementary and alternative medicine contains 5 subcategories: alternative medical systems (eg, traditional Chinese medicine), mind-body interventions (eg, meditation, prayer, or the creative arts), biologically based therapies (eg, dietary supplements or herbal products), manipulative body-based interventions (eg, massage or chiropractic interventions), and energy therapies (eg, Reiki and therapeutic touch) (p 3). This book reviews several of these “therapies” that are particularly relevant to psychotherapists (p 5). Following the Introduction, which explains the basics and provides a brief overview of the book, the volume contains 9 more chapters and the Appendix.

Chapter 2, “Mindfulness, meditation, and health” reviews the practice of mindfulness (“consciousness that is achieved by paying attention and being present in one’s life”), meditation, and mindfulness meditation, emphasizing nonjudgmental acceptance and interested awareness. The authors emphasize that although Buddhists have added significantly to the technology of meditation practices that emphasize mindfulness, the acceptance of Buddhist tradition is irrelevant to mindfulness practice because mindfulness is a universal concept (p 13). The authors also review American interest in meditation, mindfulness, and health and clinical applications of mindfulness. Interestingly, when listing the techniques of applying mindfulness to health and well-being, the authors discuss Dialectical Behavior Therapy (DBT) in addition to Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). The chapter also includes case studies, mindfulness exercises, hints for practicing mindfulness in everyday life (“expect the mind to wander, notice any tendency to be ‘hard on yourself,’ expect to feel some relaxation, expect to become more mindful with practice, and don’t try too hard when practicing mindfulness”).

Chapter 3, “Spirituality,” focuses on the role of spirituality and religion in psychotherapy practice. The author of this chapter points out that therapists need to understand how patients view their world, current problems, and possible solutions to their problems, including religion and spirituality (p 37). The chapter also discusses ethical issues involving religion, assessment of spirituality, and various life-cycle issues.

The following chapter, “Tearing the darkness down: Poetry as therapy,” focuses on the use of poetry in therapy (eg, in residential centers) and provides guidelines for the practice of poetry therapy and poetry therapy group.

Chapter 5, “Art therapy,” reviews a more well-known complementary therapeutic approach. The author cites the definition of art therapy according to the American Art Therapy Association as “a human service profession that utilizes art media, images, the creative art process, and patient/client responses to the created art production as a reflection of an individual’s development, abilities, personality, interest, concerns, and conflicts,” (p 92). Further discussion includes art therapy approaches (art as therapy, cognitive-behavioral art therapy, developmental art therapy, humanistic art therapy, psychoanalytic/psychodynamic art therapy), research on art therapy, guidelines on the use art therapy in practice, and contraindications for art therapy (eg, untrained clinicians or self-injurious patients).

Chapter 6, “Psychodrama,” discusses the “collaborative, improvisational theater with great adaptability to treatment, education, and community” developed by J.L. Moreno. The 5 basic instruments (stage, protagonist, director, auxiliaries/supporting actors, and audience), 3 phases (warm-up, action, and sharing), and main techniques of psychodrama (role reversal, the double, mirroring, soliloquy, concretizing, personification, the empty chair, future projection, and dream projection) are reviewed, as well as examples of psychodrama in different settings.

The next chapter, “Dance/movement therapy,” discusses the ancient healing role of dance and the modern era application of dance/movement therapy, including guidelines for the use of this therapy. Chapter 8, “Music therapy,” focuses on another relatively frequently used modality, “the use of music in the accomplishment of therapeutic aims: the restoration, maintenance, and improvement of mental and physical health.” The author emphasizes that music therapy techniques used in psychotherapy are individualized—the patient can listen to music, perform music, create music, discuss music, relax to music, participate in guided imagery in music, or use music recreationally (p 196). Music therapy techniques include individual or group music therapy, active listening-based techniques, songs in music therapy, music-assisted relaxation, creating music through improvisation, and the Bonny method of guided imagery and music.

Chapter 9, “Therapists and animals: Demystifying animal-assisted therapy” discusses the role of pets in many people’s lives and the physical and psychosocial benefits of animals. The chapter then reviews the basic strategies of animal-assisted therapy in psychotherapy—animals acting as a social lubricant, as a catalyst for emotion, as adjuncts to clinicians, and as an aspect of milieu therapy. Guidelines for animal-assisted therapy, as well as some clinical examples (a bit over-interpreted) are also provided.

Finally, the last chapter, “Touch therapies,” focuses on 4 areas: touch in psychotherapy, Reiki (which is developed from ancient Japanese practice), therapeutic touch, and massage therapy. It includes a discussion of their theories, historical information, research, and ethical and legal guidelines. This area probably would be a bit controversial for many.

The Appendix provides resources for further explorations (eg, professional associations, media sources) for each modality reviewed in this book.

I have always felt that psychiatrists should be informed about other disciplines involved in mental health care, even if medicine considers them to be controversial or on the fringe of standard or conventional practice. If one does not know, how can one evaluate and supervise? This volume provides a wealth information about what many social workers (and some psychologists) practice. The book is written in what I call a “defensive style.” Lot of space is devoted to the background and at times research—though the criteria for research evaluation of efficacy are not defined (as in the chapter on dance/movement therapy). A more active writing style would shorten this part and provide very detailed, comprehensive guidelines. Most of the evidence is presented in various examples.

One would want to know how frequently these modalities are practiced, whether one can bill for them or if they are out-of-pocket, and what kind of homework one asks patients for. I, as well as the authors, understand that these therapeutic, alternative, or complementary modalities are useful in inpatient practice, and not only to fill patients’ free time. However, because most mental health care outside of acute situations has moved to the outpatient setting, one would like to know how to practice these modalities in that setting (again, homework, billing, frequency, etc.). A list of “outpatient procedures” in this area would definitely help, if it could be compiled.

Thus, there are many things this book misses. Nevertheless, many therapists—especially social workers—will find it interesting. The book also provides some important and interesting information for clinically oriented psychiatrists who collaborate with these therapists and/or supervise them.