Childhood maltreatment. Advances in psychotherapy

OVERALL RATING Excellent

STRENGTHS Relevant case vignettes; important points highlighted in margins

WEAKNESSES None

AUDIENCE All family physicians, particularly those who conduct psychotherapy

Childhood Maltreatment is a brief, evidence-based review of the epidemiology, assessment, and treatment of individuals who have been mistreated in childhood. The focus is on psychotherapy, and the authors succeed in providing an excellent, easy-to-read review of the topic. The use of case vignettes throughout the text, including a detailed account of the process of psychotherapy in an abused individual, bring the concepts to life and leave the reader with a true understanding of psychotherapeutic modalities.

The book begins by describing the framework of how abuse results in psychopathology, showing how common developmental goals are disrupted by early abuse. The association between abuse and a multitude of psychological disturbances is outlined. This information serves to increase awareness among family physicians and should prompt screening for abuse in patients who present with the correlated disorders described. The idea of preventing psychopathology through early identification and treatment is introduced.

The topic of maltreatment is vast and the book is all-encompassing, including not only sexual abuse, but also neglect and physical and emotional abuse. The authors use bolded highlights in the margins for easy reference and to emphasize key concepts. All family physicians will benefit from the tips given for reporting maltreatment, including the importance of not involving perpetrators in the process owing to risk of coercion and increased abuse. The information is relevant and up-to-date, and includes a review of the literature demonstrating cognitive behavioural therapy as perhaps the most effective therapy available for victims.

A few shortcomings to point out: Childhood abuse is a complex life experience, but the text considers primarily the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnoses. Another omission of particular importance to family physicians is the increasing evidence of the roles that childhood education and home visitation play in the prevention of abuse.

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