Advances in Psychotherapy—Evidence-Based Practice: Vol. 5. The Schizophrenia Spectrum by W. D. Spaulding, S. M. Silverstein & A. A. Menditto (review)

The stated intent of this book is to provide "an overview of current conceptualizations of, and treatments for, schizophrenia spectrum disorders" (p. v). While clearly not an exhaustive coverage of the topic, the book achieves its intent to provide an overview of the description, models, assessment, and treatment dimensions of schizophrenia as well as a range of current treatment approaches.

Updating the 2006 release, this edition was intended to address major recent developments in diagnosis (e.g. the DSM-5; APA, 2013); approaches to treatment as evidenced in the increasing adoption of the idea of recovery in treatment and rehabilitation; advances in psychopathology that characterize mental illnesses as a noncategorical, multidimensional process; a proliferation of modalities for treatment and rehabilitation; and ongoing challenges with implementation and regulation of treatment and rehabilitation methods in mental health services.

The authors identify their intended audience as ranging from students for whom this text may be an introduction to schizophrenia, to advanced clinicians and researchers "looking for a compact review of current conceptualizations and clinical tools" (p. v). The text is clearly designed as an introduction for the novice practitioner or student. For example, in the discussion of acute treatment and related services, the authors note that "the practitioner must be prepared to deal with hospitalization, or more explicit forms of incarceration, not as treatment but as an environmental event for which people with schizophrenia spectrum disorders are at high risk" (p. 63). Most experienced clinicians would be well aware of this reality.

In their description of the origin and evolution of schizophrenia as a concept, the authors provide a concise foundation for understanding the schizophrenia spectrum both as a mental health policy construct and a psychiatric diagnosis. Coverage of theories and models of the schizophrenia spectrum provides an introduction to current etiologic understanding, beginning with genetic factors and extending to environmental factors. Last, the authors provide a review of 16 different treatments or treatment approaches. This review is balanced, identifying supporting evidence along with fundamental limitations, and noting areas remaining for subsequent development. For example, in the area of supported employment (SE) they noted that while demonstrating some success, SE may have an insurmountable limitation in that "many people with schizophrenia spectrum disorders choose to live on disability pensions" (p. 62) instead of choosing to work.

The text covers both established treatments such as social skills training, family therapy and clubhouse models, and emerging treatments such as high-risk first-episode therapies (e.g., Kane et al., 2016). The text also provides a useful critique of the "one size fits all" approach to mental health services planning, noting that "for the schizophrenia spectrum, the practice of clinical psychology usually must include advocacy for service diversification and personalization, as well as for evidence-based practice" (p. 67).

The work also provides realistic challenges to implementation of any treatments, noting limitations in a number of conditions necessary for the dissemination of evidence-based treatments. The authors highlight constraints in research review and meta-analysis, social policy, funding streams and regulation, training of practitioners, and realities of provider economics.

The final section of the book provides two useful hypothetical case vignettes that offer contrasting cases typifying people with schizophrenia spectrum disorders; however, they have uniformly positive courses, which may not be entirely representative of the course of the disorder for many clients. The vignettes also do not provide any examples of the challenges of comorbidities and side effects of psychopharmacology with which many people with schizophrenia spectrum disorders must contend.

While this text is well organized and covers a broad spectrum of descriptive, theoretical, and practical information, it is strongly based on North American research and techniques. Although it is true that a large majority of research and literature has been produced in North America, the book provides no explicit considerations of cross-cultural aspects of schizophrenia...