BOOK REVIEWS

Contents 

(Click on the title to be taken to the review, or reviewer's name for biodata, or simply scroll down the page)

Differences and Discrimination in Psychotherapy and Counselling  by Sue Marshall  - Reviewer Joe Sinclair 

Rational Emotive Behavioural Counselling in Action  by Windy Dryden and Michael Neenan   -  Reviewer Mark Edwards

The Rational Emotive Behavioural Approach to Therapeutic Change by Windy Dryden and Michael Neenan   -  Reviewer Mark Edwards

Revolutionary connections: Psychotherapy and neuroscience.  Editors: Jenny Corrigall & Heward Wilkinson.  Reviewer John Rowan  

Positive Energy by Judith Orloff, M.D. - Reviewer Joe Sinclair

Pills, Potions and Poisons, How Drugs Work by Trevor Stone and Gail Darlington - Reviewer John Ewing

The Curious Incident of the Dog in the Night-Time  by Mark Haddon - Reviewer Tom Maguire

The Curious Incident of the Dog in the Night-Time  by Mark Haddon - Reviewer Kevin Phillips

Family Therapy, A Constructive Framework by Roger Lowe - Reviewer Stephen Bray

Difference and Discrimination in Psychotherapy and Counselling  by Sue Marshall.  Sage Publications June  2004.   224 pages.  ISBN 1-4129-0118-9.  Paperback  £18.99.   (Also available in cloth edition £60.00)

In his review of Sugarman's Counselling and the Life Course in the previous issue of Nurturing Potential, Mark Edwards wrote: "It is important  to recognise that we bring all kinds of cultural influences to the counselling process and issues of gender, class and ethnicity have an important bearing on this process".  That might easily be an introduction to my review of Sue Marshall's book.  In her own introduction to her book, Marshall writes: "The majority of the trainees, students, supervisees and colleagues I have encountered over the years have, like myself, come from backgrounds which would not necessarily expose them to the kinds of attitudes, prejudices and adverse discrimination which, unfortunately, still pervade our society."

A difficulty that faces all practitioners (therapists, counsellors, trainers, etc.) in their professional relationships is that while they may be aware of the need to be on their guard against prejudice in their personal views of sexuality, gender, culture, age, race and disability (amongst others), they may not recognise the influence of those views in themselves. 

Identifying the practitioner's personal exposure to prejudice and discrimination is, in my estimation, the greatest single contribution this book can make to a modern therapeutic prescription of "physician heal thyself".  Healing must be preceded by awareness.

Marshall has divided the book into four main categories: Race and Culture; Gender; Sexuality; Mental Illness.  With regard to the last of these, she has very carefully defined what she means by "mental illness" within the context of this book, recognising that the very term lends itself to the accusation of prejudice.  More politically correct, indeed, would be "mental disorder", or the "neutral mental health", but what is of greatest importance is not the name that is given to the various forms of psychological distress, but "the recognition of the wider social factors on the mental health problems" of those treated by the mental health services.

Each of the four categories follows the same format, historical overview, associated theories, and influence in counselling and psychotherapy.  In addition the final category (mental illness) has a further section relating the incidence of  mental illness to the other three categories of race, sexuality and gender.

I concur utterly with Marshall's comments on the uniqueness of all individuals, but it is also important to acknowledge the effect on those individuals of their identification with their cultural identity, be it race, sexual orientation, gender, or mental disability.  If it is dangerous to make assumptions within our own cultures; how much more dangerous it is when dealing with cultures different from our own.  When therapeutic concerns revolve around cultural factors, or when the focus of treatment is the client's interpersonal relationships, differences between the cultural, racial, or sexual identities of client and psychotherapist may have a considerable influence on the psychotherapy experience.

Prejudice is, for good or ill, a part of our nature.  It is instilled in us from birth onwards.   All we can hope to do is to combat it, and the first tool in our armoury must be that of awareness.  Without this, it is very difficult, perhaps impossible, for the psychotherapist or counsellor to explore how it might be influencing the psychotherapy relationship.

Sue Marshall has, in this book, performed a valuable task in that direction, and has done in it very cogently in a most difficult area.  I applaud her.

Joe Sinclair

Rational Emotive Behavioural Counselling in Action  by Windy Dryden and Michael Neenan.  May 2004.  Sage Publications.  128 pages.  Paperback £18.99 (ISBN 1-4129-0213-4).  Cloth £60.00 (ISBN 1-4129-0212-5)

The Rational Emotive Behavioural Approach to Therapeutic Change by Windy Dryden and Michael Neenan.  February 2004.  Sage Publications.  160 pages.  Paperback £18.99 (ISBN 1-7619-4896-1).  Cloth £60.00 (ISBN 1-7619-4895-3)   

These books each serve as an introduction to Rational Emotive Behavioural Therapy (REBT) as developed by psychologist Albert Ellis over the latter half of the twentieth century.  It is an approach to counselling which has clear links with Cognitive Behaviour Therapy and the books give a very thorough explanation of how it works. A fundamental tenet of REBT might be expressed by Shakespeare’s  ‘there is nothing good or bad but thinking makes it so.’

The key to change is in identifying the faulty thinking that creates the emotional disturbance. This is usually an irrational belief and much of the work lies in pinpointing exactly what it is. To do this therapists use the A-B-C model : A is the event, B is a belief about the event and C is the consequence of the belief about the event. The client will often make an irrational inference about an event which leads to emotional upset; the task of the therapist is to replace this with a rational response, which will lead to a healthy expression of emotion, rather than an unhealthy experience.

REBT in Action comprises three sections:  these are the basic principles; the REBT sequence and the REBT process. The book  is highly readable and makes extensive use of an actual case study in order to illustrate the approach.

It does the job it sets out to do, which is to provide a comprehensive overview of this particular approach to counselling and therapy. In this respect the book is difficult to fault  – and the authors are even at pains to point out that REBT is not for everyone, based as it is on the premise that emotional problems are built on faulty thinking.  I was amused to observe, once again, a phenomenon that seems to occur with monotonous regularity – that of the authors criticising Neuro-Linguistic Programming (NLP) while outlining many techniques that are themselves fundamental to NLP! This is particularly evident in the sections on belief change, and I am increasingly curious as to why NLP is so much more susceptible to criticism than are approaches such as REBT.

However this is not the place to debate such wider issues – the book is a solid introduction to REBT and could be read with benefit by all aspiring counsellor/therapists.

The REBT Approach to Therapeutic Change is again an excellent introduction for trainee and practising counsellors, or anyone interested in the subject. The outline of the approach is very clear and is helped by examples in chart form. The authors clarify some of the differences between REBT and other forms of counselling : mainly that the ‘core conditions’ stated by Carl Rogers (the founder of person-centred counselling) of empathy, congruence and unconditional positive regard may, although desirable, sometimes hinder the process of change for the client. Change is painful, as the book rightly asserts, and an overly warm relationship between client and therapist may protect the client from the pain of confronting difficult areas.

The relationship between client and therapist dominates much of this book with chapters on the role of the client and therapist respectively. I found the emphasis on obstacles to change very useful and the book tackles these with honesty and realism; for example ‘putting words in your client's mouth’ which is something that all therapists and counsellors will be aware of.

Both books are highly readable and give a thorough grounding in REBT.  Even if you suspect this approach is not for you, the books are well worth a read and will provide therapists with useful additional resources.

Mark Edwards

Revolutionary connections: Psychotherapy and neuroscience.  Editors: Jenny Corrigall & Heward Wilkinson.  Publisher: Karnac  2003.   Price: £19.99   pp.223.  ISBN 1–85575–941–1

This is one of the most disappointing books I have had to review.  It is based on the Professional Conference of the UKCP held in 2001, designed to open up the field of neuroscience for psychotherapists.  Unfortunately, the level at which it was pitched failed to make clear the distinction between two very different approaches to neuroscience, one coming from what Wilber calls the Mental Ego level, and one coming from what he calls the Centaur level.

 Neuroscience at the Mental Ego level looks for causal connections and empirically validated laws.  It also tends to move along the lines of trying to prove that Freud was right all along, and makes what I cannot help feeling are crass connections such as: "The left side (of the brain) is involved with conscious response and the right with the unconscious mind."  (p.10)  When we find the expert neuroscientist saying things like: "The interactive regulation of right brain attachment biology is thus the substrate of empathy" (p.23), we can only be in the presence of the Mental Ego.  The excessive dependence upon attachment theory is often found here, because it offers a seemingly objective and empirical set of measurements.

Neuroscience at the Centaur level is very different.  Instead of talking about the way in which the brain processes information, it starts to be interested in the way in which the brain is involved in making or generating information.  And it is very interested in the self, as something distinct from the brain.  "We do know that all the places and levels of the brain are fantastically interconnected and integrated.  And, of course, the brain and the body are inseparably linked at every stage .  That wholeness of the functioning being is what I understand by the self."  (p.75)  It is at the Centaur level that we get a more dialectical way of talking about the brain, and insights emerge such as: "Ours is an intersubjective recursive field, within which we are always at risk of unconsciously making linear unsystematic idealizations of what science can 'objectively' offer us."  (p.177)  We may also draw up comparisons between the Mental Ego approach to science, or 'classical science', and the kind of 'new science' that emphasises things like emergent properties, non–linear thinking, and the value of chaos.  (p.194)  And happy formulations follow, such as: "Therapy in general seems to offer a particular opportunity for intensifying the ordinary self–organizing process of life."  (p.200)  This in turn can lead to insightful statements such as: "Change is not linear but rather a continual process of organization, disorganization, and reorganization."  (p.208)  And this can lead to the understanding, nowhere mentioned in this book, that subunits within the brain and nervous system can form the basis for subpersonalities.

This book throws away a valuable opportunity for understanding these matters, and also avoids any discussion of transpersonal issues.  It seems that we shall have to wait a while before we get the book than genuinely links the advanced theory of people like Mindell and Hycner in the psychotherapy field with the advanced theory of people like Varela and Minsky in the neuroscience field.

I also thought it was unfortunate that the contribution of David Boadella to the conference was not included "for copyright reasons".  He might have had something to say that went a bit deeper.

John Rowan

Positive Energy by Judith Orloff, M.D.  2004.  Published by Harmony Books, New York.  354 pages.  Price US$24.00.  ISBN 0-609-61010-4

There is nothing really new in the area of psychotherapy, positive health, personal growth and self-help techniques.  Yet every so often a new book hits the bookstands, creates a stir,  becomes a major influence in one or more of those areas, and spends varying amounts of time on the best seller lists.  It also gets espoused in the most lyrical terms by many soi disant authorities and experts.

How does one account for it?

In a word: Packaging!

Joe Sinclair

Pills, Potions and Poisons, How Drugs Work by Trevor Stone and Gail Darlington.  Published by Oxford University Press.  Paperback.  476 pages.  ISBN 0-19-860942-6.  Price £9.99

Being a keen cyclist, I fairly scrambled to get my hands on this when it was first offered for review.  The use of drugs so bedevils the sport – most sports, come to that – that an authoritative explanation of exactly how they might influence performance was something I was looking forward to.  Alas, it’s not there.  Although there is a section devoted to the abuse of drugs, this deals with recreational use rather than the manipulation of athletic results.  I was not really disappointed, though, for the book is otherwise so informative that I have since spent hours dipping in here and there, looking up this and that, and I have rarely been able to come up with anything that it doesn’t cover.

So what is in this fascinating book?  A series of chapters, each one either a type of drug – steroids, poisons, etc. – or an area of application such as heart, epilepsy, schizophrenia and, of course, abuse.  Each chapter reviews the normal physiology of the area it treats, the abnormal conditions that may arise, and the manner in which drugs are employed in response.  The book is so well-written that there isn’t much risk of this becoming dry but, just in case, ample anecdote is provided – Napoleon’s hair is there, as are many less well-known stories, such as Clermont’s extraordinary luck in not being killed by his invention of the first organophospate compound – he tasted it.  Organophosphates include not only many “harmless” modern pesticides, but also such juicy items as sarin and tabun.  Each chapter ends with a short boxed summary.

A book like this needs a plentiful index, and this one provides it.  Twenty-five pages, writ tiny, cover around two and a half thousand drug names, conditions, and related keywords.  This is sometimes a little fanciful – Turkey, for example, leads to a passage on withdrawal symptoms – but none the worse for that.  It is otherwise exhaustive and I have not yet been able to fault it. It would help if the primary entries on a topic were set in a distinctive typeface, but this is a quibble.

If you like, you can use the book as nothing but a reference, but you will lose out by doing so, for its authors have provided much more.  If you read it sequentially you will receive the bones of a pharmacological education, both on human biochemistry and on how drugs act upon it.  This is what I decided to do after skipping from compound to condition for a few days: the references to ion channels and 5HT became too much for me.  This takes a bit more effort, but so far it feels worthwhile.  Incidentally, one thing that strikes me in doing so is the incredible detail of our knowledge of human physiology: once you begin to appreciate this, you also appreciate the important role that marketing plays in the progress of alternative medicine.

The book suffers here and there from being the unrevised reissue of a hardback edition first published in 2000.  A couple of times it refers to this century, meaning the last, which is unimportant; but it would have been useful to find something on some more recent findings, such as the increased risk of suicide in people coming off antidepressants.  I‘m sure that a future edition will cover this: I hope it will cover abuse in sports as well.  A paragraph or two on a much older topic, mushroom poisons, wouldn’t go amiss either. These drawbacks, however, are tiny in comparison to what this work has accomplished.

So who will enjoy it?  Well, I‘m a computer guy with a vague interest in the mechanisms of diabetes, being a sufferer (see metformin, page 41).  If you are curious about poison gases, see sarin, page 409.   Botox isn‘t there, but botulinum toxin is on pp 423 and 424. Dieting drugs aren‘t there, but look up appetite and you‘ll find that amphetamines reduce it.  And if you write whodunits, you can TomClancy your ion-channel blockers or acetylcholinesterase inhibitors with authority by referring to any number of pages (“He was poisoned with cone snail venom, m‘lud…“).  It’ll make a change from muzzle velocities.

John Ewing 

What do Bill Gates (Microsoft), George Lucas (Star Wars), Steven Spielberg (Film Director), Steve Jobs (Apple) and Jerry Yang (Yahoo) have in common? Well, they are highly successful in their professions, stinking rich and are all said to have Asperger’s Syndrome (AS).

Those diagnosed with AS have a normal or high intelligence quotient, but they have a low emotional quotient. They find it difficult to empathise with other people, they follow compulsive routines, they have very focused interests and they tend to detail rather than to the larger picture.

The Curious Incident of the Dog in the Night-Time is a novel written from the perspective of Christopher, an adolescent with AS. Right from the start the author, who does not have the syndrome, puts us right into the boy's mind through a story about smileys. Chris cannot match the different smiley faces with the feelings that they portray. The tragedy is that he cannot do this with real people's faces either. So he cannot connect to their feelings, cannot empathise, cannot form a relationship. Can there be a neater way of showing the reader just how emotionally handicapped the boy is?

Haddon puts the reader in the driving seat of the novel by using a first person narrator. Everything is seen through the eyes of Chris. This creates humorous episodes due to the incongruence the character sees in world around him. Incapable of guile he expects others to be completely truthful. He observes, for instance, that people break rules all the time by driving drunk, speeding, going to war, and he decides that as others don’t abide by the rules than he won’t either. However, Chris needs detailed instructions in order to understand norms and can’t distinguish between the Wars of the Crusades and punching Sarah or pushing others off the swings in order to get a shot. This will get him into a lot of personal relationship problems.

The author is able to effect this adventure into the mind of an AS child through a variety of strategies. As Chris can only understand reality through quantification, Haddon simulates this by accumulating lots of sense information in one paragraph. One mind-boggling example of this is when Chris finds himself in a London train station and looks round. He can make no sense of the signs which the author presents to us as a string of juxtaposed information. We can made little sense of this data, either, and so suddenly find ourselves perceiving the world as Chris does. This frightening display of how the child sees the world has the added effect of eliciting empathy for him on the reader’s part. We are beginning to see, feel and hear the problems an AS person may experience. Haddon also uses simplified sentences, the punctuation of dialogues with the repetition of: "I said,", "She said,", "He said," as well as the use of factual description and concrete sense language that convey to us something of the AS adolescent's perceptual quandary. It is certainly a literary tour de force that the author has been able to evince in us the very empathy the character lacks while at the same time transmitting the child’s emotionally handicapped perception.

Haddon's use of graphics is another authorial sleight of hand to communicate how Chris thinks. Internal vision is a resource that the character uses to great effect in resolving his problems with reality. He understands the world though graphs, street maps, building plans, timetables and even a postmark. These of course are presented to the reader as drawings and Haddon makes good use of simple graphics to put us inside Chris's head. It is curious to reflect that while many of us are trying to bring mind maps into education to make learning easier, mapping techniques come naturally to the handicapped AS child.

Chris is presented as an idiosyncratic but also as a resourceful person, thus ensuring our respect for the character. For example when under duress he uses a convoluted but apparently effective remedy – algebra! He knows that the effort to solve a highly complex mathematical problem will keeps his brain concentrated and he will remain calm enough to get out of a fix. Groaning and closing his ears are other tricks to shut out a world which appears just as complex to him as algebra does to most other people. Another resource he uses frequently is the tips he got from his school psychologist, Siobhan, who appears as the only other human being really able to help him. Most people he meets are uncomprehending and rather intolerant of his unusual behaviour. This only raises Chris’s prestige in the reader’s eyes, because, of course, we perceive events from his point of view.

Haddon has done us all a service by allowing the reader a privileged glimpse into the personal problems, resourcefulness and intimate perception of another human being.

Tom Maguire

The Curious Incident of the Dog in the Night-Time by Mark Haddon.  Random House Books 2003, 272 pages.  ISBN 0 09 945676 1.  Paperback  £6.99

The book has a central figure with Asperger's Syndrome like myself, making it easier for me to understand the story from his perspective.

The author, Mark Haddon has written in a conversational prose. This makes one almost feel directly addressed by the central character and thus feel a part of it more. If I have any negative criticism, the story could lead to a stereotype of the socially inept mathematical genius forming in some minds.

The book does have a tendency to digress at critical points during the story instead of following on from the scenario that has been described, but I suppose a picture has to be produced of the condition of the central character, Christopher Boon, of how he thinks and how the condition affects him.

The story begins with Christopher finding his neighbour's dog Wellington murdered by a garden pitchfork. This sets off a race in his mind to find the person responsible. Even at this early stage, two aspects of his personality come into play - a need for the truth and a preference for animals over human beings. The latter is what drives him so intensely to find the culprit as, according to him, dogs are "faithful and honest". He becomes obsessed with this activity and goes to all lengths to do so. Eventually his own father (his mother was dead at the time of the murder - or so it seemed) loses his temper with the obsession and warns him against mentioning the chief murder suspect, a Mr Shears who owned the dead dog before he disappeared from the
area altogether. 

The investigation leads to much more than what the schoolboy turned detective bargained for. He does eventually find the culprit, but it wasn't the "Evil" Mr Shears. He also finds that his mother is not dead. 

Thus, he has to come to terms with not only the fact that his mother is alive and well, but that she has run off to London and the truth about who killed the dog. This leads to Christopher tracking down his mother and takes him to London.

From reading this story, one gains an insight into a mind of a logical person fighting against an illogical world made up of illogical beings - a person who finds basic social interaction difficult but which most people take for granted;  complex but alternatively can solve complex mathematical equations without effort. The book however points out the social vulnerabilities that people Asperger's Syndrome have and the modifications that society has to make so they are understood a great deal more. Whether it is them getting into trouble with the police or the behaviour and interaction skills that so-called ordinary people find baffling in public places or just understanding how their minds work and the fact that they are wired different to the majority.

This story must be learned from by all.

Kevin Phillips

Family Therapy: A Constructive Framework by Roger Lowe.  Sage Publications Ltd.  2004   224 pages including index. ISBN 0 7619 4303 X.  Price £17.99

This average size primer on constructive family therapy is rather wordy, and suffers from the over statement of the author’s personal processes. For example when using a metaphor he writes: “I will begin with a travel analogy”.  Similarly when quoting another writer he sometimes uses expressions such as: “I have borrowed the umbrella term constructive from . . . “

It’s not that the book lacks information, nor insight, but rather that its style is over polite and politically correct. On page 9 the author claims that one feature that distinguishes a constructive therapy is that it has moved away from a hierarchical distinction toward a greater respect for differences and a more egalitarian offering of ideas. On page 149 however within a case vignette he proceeds to make a value judgement about a client’s response to his intervention: “Alice’s response . .  is perfectly legitimate”.

This begs the question according to whom? As written, Alice’s response is acceptable to the author, who is acting as the arbiter of the appropriateness of her behaviour for both himself, and the book’s readers. This is not egalitarian, nor does it display respect for differences at any but the most superficial level. The author, as he writes his account, is not responding as person-to-person respecting differences, but rather as a ‘trained expert’, acting within a mask of political correctness. Explicitly the book is politically right, whilst at a higher logical level it claims both academic and professional superiority over both client and reader.

The book is dangerous reading for novice therapists to encounter for the first time. It assumes a general knowledge of family therapy, and the history of brief psychotherapy without which readers may assume that such approaches began circa 1990.

To be fair, some earlier references are cited, but in ways that suggest that these approaches were unnecessarily directive, or manipulative. For about ten years there has been a growing embarrassment, certainly in family therapy, about the ‘bluntness’ of it’s founders, such as Milton Erickson, Jay Haley, or Sal Minuchin. Yet these pioneers helped people, often with greater integrity and respect for others than some of today’s practitioners. On the rare occasions that they truly used their hierarchical positions as therapists they did so openly and explicitly allowing their stance to be challenged by both clients and professional peers.

Perhaps the book’s greatest weakness is set out in the introduction.  The author states that he wishes to bring together brief collaborative and competence based therapies, with the rich knowledge of the nature of relationships. To a novice this seems a fine aim but really the author has simply created a problem and then written a book to solve it. Systemic therapists, such as family therapists, have always sought to collaborate and build competence, and indeed have always understood the nature of relationships.

It is also claimed that constructive therapists see themselves as working within a range of contexts that range from individual therapy to business organizations. This is in fact largely untrue. Most work either with individuals and couples, or couples and families, or with organizations. Few explicitly and deliberately, in my experience, work with the broad range of contexts that may be engaged using systemic approaches. Some notable family therapists have attempted to work with organizations and failed. The idea of using systemic approaches to work across the range of context suggested by the author is not however confined to so called constructive therapists. 

These criticisms aside the book provides a good overview of a number of recent approaches to working with families as well as how the author thinks about them.

Stephen Bray