Steven A. Frankel

This book addresses the principle that successful treatment incorporates a remarkably broad range of clinical variables. Clinicians must identify the extent to which each factor contributes to the success of the treatment process, and how to utilize this information strategically so that their combination enhances outcome. Complex clinical situations involve numerous macroscopic and microscopic components and their interactions. This book describes clinical practices and variables, that should be weighted according to their relevance for achieving treatment precision and improved results. The book is divided into sections, each containing topically organized chapters. Sections build from identifying discrete components of the clinical field to combined variables as they impact treatment progression. The clinical narratives that make up the latter part of the book elaborate on the course of care and the challenges involved in managing complex clinical situations. Cases range from primary care patients with systemic medical and psychiatric co-morbidity to more complex cases requiring the involvement of medical specialists, allied health professionals, and multiple health care systems. Scholarly, practical, and comprehensive, Complexity in Health Care enables clinicians to incorporate previously underappreciated health-related factors into their thinking and practice.

'Complex patients' are a sizeable population who generally require disproportionate attention for their management and respond poorly to treatment. Their systemic medical, psychiatric and personal needs have a tendency to drain or exceed the capabilities of those who treat them whilst overutilizing health care resources. As this patient population grows, we move ever closer to a crisis in health care delivery. This volume presents an innovative team-based approach for assessing and managing diagnostically complex and management intensive patients. The physician-led 'Medical-Psychiatric Coordinating Physician (MPCP)' model not only improves patient treatment, but also provides for the containment of costs by reducing redundancy and curbing excess in the use of services. Other benefits include improved diagnostic accuracy and decision making, as well as better communication among physicians and allied health professionals. This book is essential reading for psychiatrists, primary care physicians, and physicians, directors and administrators working in multidisciplinary specialty clinics.

This book squarely addresses the question: does interpersonal treatment, including psychotherapy, work? It proposes an innovative model of psychiatric and psychological assessment and treatment. Having read this book, the practitioner will have a set of invaluable, new techniques for conducting a results-oriented treatment. The book and the methods it advocates can be used as a practice guide for any office-based psychiatrist or mental health clinician. Emphasized is the practitioner’s responsibility to deliver a treatment that is effective and has built in provision for independent monitoring of treatment progress. Apart from psychometric assessment and self-report questionnaires, information about diagnosis and progress comes from collaboration between clinician and patient. The approach described has been evolved and tested by the author and his colleagues for over fifteen years. The book is clearly written and replete with clinical illustrations that capture the dilemmas typically faced by practicing psychiatrists and psychotherapists.

This book squarely addresses the question: does interpersonal treatment, including psychotherapy, work? It proposes an innovative model of psychiatric and psychological assessment and treatment. Having read this book, the practitioner will have a set of invaluable, new techniques for conducting a results-oriented treatment. The book and the methods it advocates can be used as a practice guide for any office-based psychiatrist or mental health clinician. Emphasized is the practitioner’s responsibility to deliver a treatment that is effective and has built in provision for independent monitoring of treatment progress. Apart from psychometric assessment and self-report questionnaires, information about diagnosis and progress comes from collaboration between clinician and patient. The approach described has been evolved and tested by the author and his colleagues for over fifteen years. The book is clearly written and replete with clinical illustrations that capture the dilemmas typically faced by practicing psychiatrists and psychotherapists.

In this fine book, Dr. Steven A. Frankel paints the portraits of his collaborating patients vividly, graphically and with consummate compassion. Treatment for Frankel is never a discussion and surely not one filled with the therapist's abstinence; it is a vital, interactive and changing experience for both partners. He is no less skillful in engaging and educating the reader. His review of psychoanalytic theories and research is, in itself, a prodigious and productive education. It is tempting to suggest that this important contribution to psychoanalysis and psychoanalytic therapy is one illustration of theory finally catching up to sensitive and effective practice. Frankel closes his lovely book with thanks to the reader 'for coming on this part of my journey.' Shirley Cooper, LCSW