Expanding the Limits of Individual and Family Therapies. A Critical Realist Approach. By DavidPocock, Psychoanalytic Psychotherapist and Systemic Family Therapist, Calne, Wiltshire, UK: Palgrave Macmillan. 2024. pp. 1–274. ISBN: 978‐3‐031‐76308‐3

This timely, ambitious and important book invites the reader to reconsider the philosophical constraints shaping much contemporary individual and family therapeutic practice. The author's central argument foregrounds critical realism, which he suggests (illustrating it with an Indian parable and poem about blind men's perceptions of an elephant) is a coherent philosophy of science which both expands the capacity of the therapist to become much more aware of the multidimensional, multi-layered and causally disparate nature of the therapeutic encounter and points to the value of a systemic understanding of human difficulties. In the author's view, individual and family therapies have become progressively narrowed by an over-reliance on positivist assumptions, and that not enough attention is paid to the ways in which our ability to think about our theoretical standpoints is curtailed both by our culture and our institutions, limiting a wider systemic appreciation of ideas and systems of understanding. The author suggests that in the absence of critical reflection on theoretical assumptions, the inclusion and exclusion of ideas by training institutions can be based as much on ideology and tribalism as on clinical value. Institutional inattention to the multiple causal powers operating systemically in the outer world and the bodies of individuals poses questions around the dangers of psychological colonisation and ethical clinical practice. Against this backdrop, the book advocates for a critical realist framework as a way of reclaiming depth, complexity and ethical seriousness in clinical thinking. For psychoanalytic psychotherapists, this is a deeply familiar concern, yet one that benefits from being articulated within a coherent philosophical structure capable of speaking to wider debates in the psychotherapy field. A strength of the book lies in its clear exposition of critical realism not as abstract philosophy, but as a way of thinking clinically. Drawing on Roy Bhaskar's distinction between the real, the actual and the empirical, the author emphasises that psychic life is not exhausted by what can be directly observed or reported. What is unconscious, latent or structurally embedded may nevertheless exert profound causal force. This orientation legitimises inference, uncertainty and interpretation as forms of knowledge rather than relegating them beneath ostensibly “objective” clinical data. For psychoanalytic readers, there is an immediate recognition of kinship. The emphasis on generative mechanisms resonates with long-standing commitments to unconscious process, developmental and relational formations, and the layered nature of meaning. Where the book contributes something distinctive is in insisting that such thinking need not collapse into relativism, nor into disdain for empirical enquiry. Instead, it encourages a stance in which truth is approached with humility, yet taken seriously; where interpretations are acknowledged as theory-laden yet grounded in disciplined clinical attentiveness. In this sense, the framework proposed sits comfortably with psychoanalytic practice, in which meaning is continually tested, revised and deepened in the transference relationship. One of the most engaging aspects of the book is its attention to multiple levels of causality. Individual and family therapies are not presented as techniques operating on isolated psyches, but as encounters situated within intersecting intrapsychic, relational and social contexts. The clinical illustrations demonstrate how a critical realist stance can support the therapist in holding these levels simultaneously and resisting premature closure. There is a valuing of uncertainty, and an encouragement to tolerate complexity, rather than defending against it. The critique of outcome-driven cultures in psychotherapy will feel particularly resonant within contemporary NHS and higher education contexts. While the author does not dismiss evaluation, there is a thoughtful recognition that prevailing research paradigms often fail to capture the nonlinear, slow and at times contradictory processes involved in meaningful psychic change. These arguments feel clinically grounded rather than rhetorical, and they serve as a helpful reminder of what may be lost when therapeutic work becomes subordinated to narrowly defined measures. At the same time, it is important to recognise that the book does not shy away from ethical and political complexity. Pocock's discussion of sameness and otherness, and his insistence on what he calls a second-order reflexivity, invites therapists to do more than simply acknowledge positionality. He encourages a deeper interrogation of how therapeutic frameworks themselves may unconsciously preserve privilege, maintain institutional comfort or collude with subtle forms of exclusion. His reflections on injustice, racism and marginalisation are not incidental to the clinical project, but woven into an argument that ethical practice requires sustained attention to the ways that power, ideology and “who is allowed to belong” are enacted in therapeutic culture. This is a significant and thoughtful contribution, opening space for clinicians to consider the social, institutional and unconscious dimensions of othering, as well as the discomfort involved when sameness is no longer silently assumed. A critical realist commitment to uncovering generative mechanisms seems intrinsically compatible with serious engagement with systemic injustice. Psychoanalytic readers may occasionally wish for a more sustained dialogue with psychoanalytic theory itself. Classical and contemporary analytic contributions are referenced less than one might expect, and at times clinical discussion could have been deepened through closer engagement with established psychoanalytic concepts. Yet this restraint may also reflect a deliberate positioning. Rather than centring psychoanalysis as the privileged depth discipline, the author situates it alongside other relational and process-oriented approaches, unified by a shared suspicion of reductionism rather than by theoretical allegiance. Overall, Expanding the Limits of Individual and Family Therapies offers a thoughtful and compelling contribution to current debates about what constitutes knowledge in psychotherapy. It does not simply defend traditional forms of practice but provides a philosophical grounding for why interpretive, relational and theoretically informed work remains essential in an era increasingly shaped by technocratic pressures. Its tone is measured; its thinking is careful; and its invitation to clinicians is both challenging and affirming. For psychoanalytic psychotherapists in particular, it offers a language through which long-held intuitions may be articulated beyond the analytic community, while also inviting reflection on areas—particularly around social inequality and institutional power—where our own thinking may need to expand further. This is a book that asks us to think more deeply about what therapy is for, what kinds of truths we are prepared to recognise, and what may be lost when complexity is sacrificed in the search for certainty. In doing so, it contributes meaningfully to the preservation of depth, nuance and ethical seriousness within contemporary therapeutic practice. The data that support the findings of this study are openly available in Palgrave Texts in Counselling and Psychotherapy at https://doi.org/10.1007/978-3-031-76309-0.