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Digesting psychotherapy

Last updated:

12 November 2012

Scotland

bibliography and reviews

These pages contain a bibliography and a selection of reviews of notable books and other works about psychotherapy and counselling. Most of the reviews have been published previously in professional journals.

Works are rated Rating 4 outstanding, Rating 3 very good, Rating 2 good, Rating 1 adequate, or Rating -1 poor.

Unless otherwise indicated, reviews are written by Douglas McFadzean.

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list by author (with publisher)

Click on the author link of a work to read a review or check its availability.

  1. Bergin, A E, & Garfield, S L (1994). Handbook of Psychotherapy and Behavior Change Rating 4 (4th ed). New York: Wiley.
  2. Bohart, A C, & Tallman, K (1999). How Clients Make Therapy Work: The Process of Active Self-healing Rating 4. Washington DC: American Psychological Association.
  3. Dawes, R M (1994). House of Cards: Psychology and Psychotherapy Built on Myth Rating 3.5. New York: The Free Press.
  4. Duncan, B L, Hubble, M A, & Miller, S D (1997). Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans Rating 4. New York: W W Norton.
  5. Duncan, B L, Miller, S D, & Sparks, J A (2004) (Revised edition). The Heroic Client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy Rating 4. San Francisco: Jossey Bass Wiley.
  6. Erickson, M H (various, compiled 2002). Milton H Erickson, MD: Complete Works - CD-ROM, Version 1.0 Rating 3.5. Phoenix: Milton H Erickson Foundation Press.
  7. Feltham, C (Ed) (1999). Controversies in Psychotherapy and Counselling Rating 2. London: Sage.
  8. Frank, J D, & Frank, J B (1991). Persuasion and Healing: A comparative study of psychotherapy Rating 4 (3rd ed). Baltimore: Johns Hopkins University Press.
  9. Goleman, D (1996). Emotional Intelligence: Why It Can Matter More Than IQ Rating 4. London: Bloomsbury.
  10. Griffin, J (1997). The Origin of Dreams Rating 3.5. Worthing: The Therapist Ltd.
  11. Griffin, J, & Tyrrell, I (2003). Human Givens: A new approach to emotional health and clear thinking Rating 3. Chalvington: Human Givens Publishing.
  12. House, R (2003). Therapy Beyond Modernity: Deconstructing and Transcending Profession-Centred Therapy Rating 2.5. London: Karnac.
  13. House, R, & Totton, N (Eds) (1997). Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling Rating 3. Ross-on-Wye: PCCS Books.
  14. Hubble, M A, Duncan, B L, & Miller, S D (Eds) (1999). The Heart and Soul of Change: What works in therapy Rating 4. Washington DC: American Psychological Association.
  15. Miller, S D, Duncan, B L, & Hubble, M A (1997). Escape from Babel: Toward a Unifying Language for Psychotherapy Practice Rating 4. New York: W W Norton.
  16. Mowbray, R (1995). The Case Against Psychotherapy Registration: A Conservation Issue for the Human Potential Movement Rating 4. London: Trans Marginal Press.
  17. O'Hanlon, W H, & Hudson, P O (1996). Stop Blaming, Start Loving!: A solution-oriented approach to improving your relationship Rating 3.5. New York: W W Norton.
  18. Prochaska, J O, Norcross, J C, & DiClemente, C C (1994). Changing for Good Rating 3.5. New York: Quill.
  19. Sands, A (2000). Falling for Therapy: Psychotherapy from a Client's Point of View Rating 2. Basingstoke: Macmillan.
  20. Van Ooijen, E (2003). Clinical Supervision Made Easy: The 3-step method Rating 2.5. London: Churchill Livingstone.
  21. Wampold, B E (2001). The Great Psychotherapy Debate: Models, Methods, and Findings Rating 4. New Jersey: Lawrence Erlbaum Associates.

list by title

Click on the title link of a work to read a review or check its availability.

  1. Changing for Good Rating 3.5. Prochaska, J O, Norcross, J C, & DiClemente, C C (1994).
  2. Clinical Supervision Made Easy: The 3-step method Rating 2.5. Van Ooijen, E (2003).
  3. Controversies in Psychotherapy and Counselling Rating 2. Feltham, C (Ed) (1999).
  4. Emotional Intelligence: Why It Can Matter More Than IQ Rating 4. Goleman, D (1996).
  5. Escape from Babel: Toward a Unifying Language for Psychotherapy Practice Rating 4. Miller, S D, Duncan, B L, & Hubble, M A (1997).
  6. Falling for Therapy: Psychotherapy from a Client's Point of View Rating 2. Sands, A (2000).
  7. Handbook of Psychotherapy and Behavior Change Rating 4 (4th ed). Bergin, A E, & Garfield, S L (1994).
  8. House of Cards: Psychology and Psychotherapy Built on Myth Rating 3.5. Dawes, R M (1994).
  9. How Clients Make Therapy Work: The Process of Active Self-healing Rating 4. Bohart, A C, & Tallman, K (1999).
  10. Human Givens: A new approach to emotional health and clear thinking Rating 3. Griffin, J, & Tyrrell, I (2003).
  11. Implausible Professions: Arguments for Pluralism and Autonomy in Psychotherapy and Counselling Rating 3. House, R, & Totton, N (Eds) (1997).
  12. Milton H Erickson, MD: Complete Works - CD-ROM, Version 1.0 Rating 3.5. Erickson, M H (various, compiled 2002).
  13. Persuasion and Healing: A comparative study of psychotherapy Rating 4 (3rd ed). Frank, J D, & Frank, J B (1991).
  14. Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans Rating 4. Duncan, B L, Hubble, M A, & Miller, S D (1997).
  15. Stop Blaming, Start Loving!: A solution-oriented approach to improving your relationship Rating 3.5. O'Hanlon, W H, & Hudson, P O (1996).
  16. The Case Against Psychotherapy Registration: A Conservation Issue for the Human Potential Movement Rating 4. Mowbray, R (1995).
  17. The Great Psychotherapy Debate: Models, Methods, and Findings Rating 4. Wampold, B E (2001).
  18. The Heart and Soul of Change: What works in therapy Rating 4. Hubble, M A, Duncan, B L, & Miller, S D (Eds) (1999).
  19. The Heroic Client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy Rating 4. Duncan, B L, Miller, S D, & Sparks, J A (2004) (Revised edition).
  20. The Origin of Dreams Rating 3.5. Griffin, J (1997).
  21. Therapy Beyond Modernity: Deconstructing and Transcending Profession-Centred Therapy Rating 2.5. House, R (2003).

list by subject

Some titles appear in more than one subject category. Their secondary listings are enclosed in square brackets. Click on the title link of a work to read a review or check its availability.

Client views and self-help

Evidence-based practice and research findings

Practice issues

Professional controversy and regulation

Therapists

browse reviews, authors A-G

Book coverHandbook of Psychotherapy and Behavior Change (Fourth Edition)
Allen E Bergin & Sol L Garfield (Editors)
Rating 4
Wiley, New York, 1994; ISBN 0471545139
Reviews published in www.amazon.co.uk and www.amazon.com
Check availability of Fourth Edition at Amazon.co.uk
Check availability of Fifth Edition at Amazon.co.uk


"This book ... is comprehensive, wide-ranging and rooted in evidence-based practice." - Reader from Dublin, Ireland

"This book is a classic and definitive reference book for every clinical psychologist and psychotherapists in other professions. It would also be informative to the educated non-practitioner who wants to learn more about the field of psychotherapy." - Robert N Sollod

Book coverHow Clients Make Therapy Work: The Process of Active Self-healing
Arthur C Bohart & Karen Tallman
Rating 4
American Psychological Association, Washington DC, 1999; ISBN 1557985715
Reviews published in www.amazon.com
Check availability at Amazon.co.uk


"A great book, carefully researched, well-written and full of ideas worth thinking about." - Phillip Ziegler

"Researchers Art Bohart and Karen Tallman have compiled a compelling, readable, and practical summary of the research on the client's contribution to change in treatment." - Scott Miller

Book coverHouse of Cards: Psychology and Psychotherapy Built on Myth
Robyn M Dawes
Rating 3.5
The Free Press, New York, 1994; ISBN 0684830914
Review published in The Therapist Vol 5 No 4, Autumn 1998
Check availability at Amazon.co.uk


I first stumbled upon Robyn Dawes's House of Cards by chance in a university library but its importance to therapists soon became apparent. Perhaps because of its disconcerting message, this exceptionally well-written and trenchant book has remained relatively unknown since its original publication in 1994. My hope is that this review will result in greater exposure and encourage conscientious psychologists and psychotherapists to dare to question their professions' most cherished assumptions and methods.

Although the focus of the book is American psychological practice, it has far wider geographical and professional implications, particularly for public health policy and the fields of psychiatry and social work. Robyn Dawes is a respected academic psychologist and researcher with intimate knowledge of psychological practice and professional politics. His decision to write the book was, he says, motivated by "anger, and a sense of social obligation". He argues primarily that professional psychological practice has grown and attained unwarranted status, riding roughshod over research and scientific principles. The conclusion is that: "In attempting to alleviate psychological suffering, we should rely much more than we do on scientifically sound, community-based programs and on "paraprofessionals", who can have extensive contact with those suffering at no greater expense than is currently incurred by paying those claiming to be experts. We might also be better off relying more on ourselves in addressing our own problems."

In the first half of the book, through a careful examination of research evidence, Dawes systematically exposes the myths surrounding professional expertise, personal experience, clinical prediction and state licensing. Particular attention is paid to society's responsibility to ensure that the individual (and especially the child) is not abused as a result of shoddy psychological testing and the unreliable court testimony of expert witnesses. The evidence for the efficacy of psychotherapy is reviewed in detail and it is interesting to note that the author himself became involved in the meta-analysis of outcome studies. Indeed, his own initial scepticism was overturned. An investigation of the factors which make a therapist effective finds that professional training, credentials and experience are largely irrelevant. Advocates of practitioner registration or state licensing can take little comfort from Dawes's work; the myths surrounding these issues are also laid bare and better alternatives proposed.

The second half of the book concentrates on exploring why western culture has allowed both the profession and mythology of psychology to become more powerful than the science of psychology. This exploration may take a more personal view, but it is still cogently argued and well-informed with numerous references. Dawes says: "As well as leading to a misplaced trust in professionals, undisciplined theorizing of leaders in the mental health professions has led to unjustifiable and pernicious obsessions; obsessions with self-esteem, with the quick attainment of desirable goals, and with an unrealistic sense of superiority to other people. These obsessions do not have desirable consequences for our society."

It would be quite wrong to give the impression that Robyn Dawes simply wishes to knock professional psychological practice. House of Cards does much more than that: it skilfully blends the author's personal mission with extensive research evidence and many constructive suggestions. The result is a potent work which deserves a place on every therapist's bookshelf.

Book coverPsychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans
Barry L Duncan, Mark A Hubble & Scott D Miller
Rating 4
W W Norton, New York, 1997; ISBN 0393702464
Check availability at Amazon.co.uk


The authors' follow-up to Escape from Babel is a fascinating read. Over a five year period, they positively encouraged other therapists and agencies to refer "impossible" cases - therapy veterans - to them. Their study of how therapeutic intractability comes about and how its rules can be changed shines a bright new light on effective psychotherapy practice.

The book starts by identifying the pathways to impossibility: expecting trouble, elevating theory over therapy, doing more of the same, neglecting client motivation and threatening dignity. With numerous clinical examples explored over a solid research background, Psychotherapy with "Impossible" Cases finds that successful outcomes can occur with even the most difficult cases when therapy accommodates the client's worldview and informal 'theory of change'. It is humbling to read just how much Duncan, Hubble and Miller learned from placing their trust in therapy veterans' own resources and capabilities. The words of a 10 year old (!) "impossible" client summarizes so much: "So, what I'm saying to all psychiatrists is we have the answers, we just need someone to help us bring them to the front of our head. It's like they're [the solutions] locked in an attic or something." Wisdom indeed from one so young.

The authors fully describe how the client's participation in therapy can be optimized, how to collaborate with the client and learn their 'theory of change', how to put this theory into practice, and how to replace the invalidation that accompanies therapy veterans. No thoughtful therapist can fail to learn from this work and the extensive case vignettes and transcripts which illuminate the approach.

Book coverThe Heroic Client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy (Revised edition)
Barry L Duncan, Scott D Miller & Jacqueline A Sparks
Rating 4
Jossey Bass Wiley, San Francisco, 2004; ISBN 0787972401
Review of revised edition published in Ipnosis No 16, Winter 2004
Check availability at Amazon.co.uk


Executive summary: Great. Great. Great. Buy. Buy. Buy!

Seriously though, this is a very good book indeed - one of the few works on therapy which I would attempt to salvage if shipwrecked on a desert island. It really would motivate me to return to civilization and work with those troublesome clients again. Now with a third author credited and some fresh contributors, this book is a revised paperback edition of the original work published in 2000. This revision has had much more than a lick of paint applied: it has evolved substantially from the original to become more user-friendly, easier to apply in practice, better illustrated with case studies, better informed by research evidence, and last, but not least, even more persuasively argued. Owners of the first edition can rest assured that an investment in purchasing this revision will be well rewarded. It appears that the authors have genuinely taken on board some minor criticisms of the original edition and responded appropriately. For example, the addition of a name index is most helpful, and the introduction of some Norwegian research broadens the geographical context.

The authors' style of writing is very accessible and engaging, successfully carrying the reader over a wide range of territories - research, practice, politics, ethics, common sense, and not forgetting humour. (I particularly savoured their description of Borderline Personality Disorder as "the mental health equivalent of the "thing" in horror movies" and how "Challenging [a particularly difficult client] would have only meant joining the conga line of failure".) While the writing firmly asserts voices often ignored, forgotten or disrespected in therapy (usually the clients'), it is accompanied by maturity, inclusiveness and a healthy degree of humility: opposing viewpoints are respected; difficulties and inconveniences are not shirked.

What Duncan, Miller and Sparks have achieved so successfully is the translation of our current best evidence from research into pragmatic steps to enhance the benefit of any therapeutic approach. Their cogent examination of the research lays bare the severe limitations of the medical model, together with its handmaiden psychotropic medication, and debunks the myth of the "silver bullet": that a client's problem is best treated with a prescribed psychological intervention. The data clearly shows that psychotherapy works primarily through factors related to the client, the therapist, and commonalities among psychotherapies rather than theoretical models and specific techniques. "Third-party payers and those in control of the various professional groups ... not unlike the pigs in Orwell's Animal Farm, continue to assert that some therapies are more equal than others. Guild and market pressures, not science, motivate this assertion."

The authors display considerable skill and courage in the way they take on the medical and pharmaceutical giants, while graciously acknowledging their importance to western culture and client preference. You can respect the medical Borg but still reject assimilation by them! Of course, beyond psychiatry and the medical profession generally, there are many other "school" psychotherapists and psychologists with huge vested interests in "mental health business as usual". The Heroic Client will undoubtedly ruffle their complacent feathers too.

The authors' 'client-directed and outcome-informed' philosophy does exactly what it says on the tin. "We argue that attending to clients' centrality to change by monitoring the client's view of progress and fit dramatically improves effectiveness and makes psychotherapy accountable to both consumers and payers." Ways of letting the client guide the therapy and using outcome feedback to improve effectiveness are explained in practical detail. Examples of outcome and session measures are helpfully provided and are free for individual practitioner use (see www.talkingcure.com).

The ramifications of Duncan, Miller and Sparks' work go far beyond the therapy room itself. The definition of practitioner competence shifts from proficiency in applying specific therapeutic methods (propounded by a therapy model) to the achievement of good outcomes for individual clients. Training and professional ethics should reflect this change in focus. Service providers and funders can dispense with many of the pseudo-medical trappings, such as assessments, diagnoses and so-called "evidence-based treatments", which contribute hardly anything to successful client outcomes. The authors summarize: "The key figure, the client, has been left out, and the search for the magical processes that produce change distracts us from the critical variable of outcome. Therapists do not need to know what approach to use for a given diagnosis as much as whether the current relationship is producing results and, if not, how to adjust therapy to maximize the chances of success."

The Heroic Client will appeal to a wide range of readers - clients, practitioners, agencies, trainers, funders, policy makers - who can all benefit from its wisdom. Duncan, Miller and Sparks have done a grand job of privileging the client's immense contribution to successful therapy. They look into the future of psychotherapy and earnestly ask whether la même chose is a viable way forward. If we continue on our present course, I'd rather jump the psychotherapy ship before it wrecks itself on the looming rocks. I'm no hero myself, but life on that desert island might not be so bad with a book like The Heroic Client for company. A delight.

Review of first edition
Published in The New Therapist Vol 7, No 3, Autumn 2000

This is an inspiring and timely book. In an era when psychotherapy practice is riven by turf wars and struggling to resist medical domination, Barry Duncan and Scott Miller remind us why we became therapists in the first place. By carefully reviewing the current best evidence from research, the authors show how therapy can be made more effective and accountable by harnessing the client's own resources and perceptions.

The Heroic Client builds on the solid foundation laid by the authors' previous works (such as Escape from Babel and The Heart and Soul of Change) about the common factors of therapeutic change, and also expands on material from their informative website www.talkingcure.com. This is certainly their most openly political work, aimed at influencing not only practitioners, but also clients and third-party payers: "We critically examine and slaughter the sacred cows of the mental health profession. We empirically attack the medical model as it applies to the human dilemmas clients and therapists routinely face. We sound the alarm bells and put a call out to therapists and consumers to question mental health authority."

These are not empty promises; you will not be disappointed by either the quality of the arguments or the evidence offered. Duncan and Miller do not simply carp about what's wrong with psychotherapy practice and the profession today. They demonstrate a real compassion for the client and constructively suggest many empirically valid ways to liberate both clients and therapists from "Jurassic practice". "Our vision of this alternative embraces change that is client directed, not theory driven, subscribes to a relational rather than a medical model, and is committed to successful outcome instead of competent service delivery."

The first two chapters review the current state of affairs in psychotherapy and successfully debunk the three most potent and pervasive myths in mental health today: the superiority of drug treatments over psychotherapy; the utility of psychiatric diagnosis in either selecting treatment or predicting outcome; and the superiority of any therapeutic approach over any other. Although the political context for the discussion is specifically North American, there are many aspects which are, or may be in the future, pertinent to Europe. For example, the massive financial clout of pharmaceutical companies and the special privileges of the psychiatric profession are already encountered world-wide. Also, there are clearly many lessons which can be learned in Europe from the American experience of managed care: "a monster made in the field's own image - a hodge-podge of empirically dead practices pieced together and now running amuck and terrorizing the citizenry."

With copious references to research evidence, subsequent chapters show how the client's contribution to successful therapy (on average 70 percent) can be empowered. In particular, the authors advocate making the client's goals and informal 'theory of change' central to therapy. They argue that effectiveness is best maximized by strengthening the therapeutic alliance and modifying the treatment approach according to the client's feedback about process and outcome. Practical methods of putting client-directed and outcome-informed therapy (tagged "co-therapy" by the authors) into action are discussed in detail. Several highly illuminating and challenging case studies accompany the text. How would you deal with a client who started off by declaring himself a paedophile who is looking into chemical castration?

A chapter on involving the client in therapy research and therapist supervision really whets the appetite for more. The ideas discussed make much more sense than the paternalistic attitudes and unsubstantiated diktats currently emanating from many professional bodies in the field. An intriguing selection of appendices is provided, ranging from the serious, political, and informative to the downright humorous (the "Loony Bird Awards"). There are only a few minor quibbles and omissions worth mentioning. To make this work more self-contained, a discussion on how therapy can best be geared to the client's stage of change may have been worthwhile. A consideration of the possible counter-therapeutic effects of measuring process and outcome would also have been useful, particularly in view of cultural differences between the United States and Europe. To help keep better track of research findings, the provision of a more comprehensive name index would have been helpful too. But these are small criticisms when compared with the overall value of this book.

Duncan and Miller (and their 12 additional contributors) write with wisdom, wit and style. They simplify, but are certainly not simplistic, and they remain firmly rooted in the client's everyday language and practicalities of life. By abandoning a reliance on the "Five D's" of diagnosis, disorder, dysfunction, disease and deficit, Duncan and Miller have convincingly recast the client in the leading role of psychotherapy. Though the client may be the hero, the authors deserve at least an honourable mention in dispatches for bravery under fire. They have dared to raise their heads above the professional parapet to see what we, and our clients, are really fighting for.

Book coverMilton H Erickson, MD: Complete Works - CD-ROM, Version 1.0
Designed by Dan Short
Rating 3.5
Milton H Erickson Foundation Press, Phoenix, 2002; ISBN 0971619034
Review published in Ipnosis No 11, Autumn 2003


Psychotherapy and counselling have spawned many gurus over the years, some legitimized by their record of achieving outstanding outcomes with real clients, and some who have mostly talked a good game instead. Milton Erickson (1901-1980) falls into the former category, fortunately, and this CD-ROM collection of his entire written work proves how much he had to crack the psychiatric mould to really help his patients. As a leading authority on medical hypnosis and a pioneer of modern hypnotherapy, Erickson's approaches to healing and skills development have found their way into many modern therapies. Erickson also had to apply his skills to help himself. After suffering paralysis from polio at 17 years old, he used hypnosis each morning throughout the rest of his life to shed the yoke of chronic pain. On the CD, Jay Haley comments that: "Erickson's youth was marked with times of isolation and solitude as well as intervals of physical hardship. His life philosophy was shaped by the resulting appreciation of the values of observation, patience, perseverance, and hard work."

I will describe the information content of the CD, billed as "the most comprehensive collection of Erickson's work currently available", before moving on to comment on its organization and presentation. The database on the CD comprises more than 2600 pages of articles dating from 1924 to 1977, mostly published but some unpublished. Two indexes, one listing the articles by date and the other listing the articles alphabetically, make it easy to browse the article titles. A comprehensive search facility is provided to find selected keywords or phrases anywhere in the collection. In addition, the CD contains a 16 minute audio clip of Erickson speaking, a biographical sketch of Erickson as a young man, a professional chronology, and a listing of other Ericksonian literature and recordings.

The articles present an amazing range of discussions on hypnosis, therapy and life. They take various forms: formal scientific papers, reviews, surveys, collected and individual case studies, anecdotes, observations and musings. Undoubtedly, Erickson was a master storyteller and his "teaching tales" were an integral part of his therapeutic approach. Anyone unfamiliar with Erickson's work will be surprised at the extent of the human problems - mental, physical and relational - which he studied and helped, mostly through hypnosis.

Browsing through the titles found some curiosities, such as 'Breast Development Possibly Influenced by Hypnosis' (1968) and 'On the Possible Occurrence of a Dream in an Eight-Month-Old Infant' (1941), and significant social comment illustrated by 'Study of the Relationship Between Intelligence and Crime' (1929), 'Marriage and Propagation Among Criminals' (1929) and 'Critical Evaluation: The Inhumanity of Ordinary People' (1968) - the latter in support of Stanley Milgram's classic experiments.

Turning now to the computing aspects of this work, the database is fronted by HTML files viewed with any reasonably modern web browser and the articles themselves are stored as PDF files, accessed by the Adobe Acrobat Reader and its browser plug-in. Thankfully, no installation in Windows (98 or later recommended) is necessary and the files, totalling 107 MB, can be manipulated direct from the CD if you wish. Apart from some presentation issues and an occasional glitch with frames management, the HTML software worked satisfactorily with the browsers I tested, namely Opera versions 6 and 7, and Internet Explorer version 5.5. However, I was disappointed that the PDF files could not be read by Acrobat Reader version 4, which is faster and less bloated than later versions (version 5 is supplied on the CD). Also, I am baffled as to why the single sound file on the CD is provided as a PDF file weighing in at an unwieldy 66 MB, more than half the entire data! Other sound file formats could reduce this size greatly.

Although there are already many different collections of Erickson's work on paper, this CD-ROM is a very comprehensive, accessible and compact resource. The ability to search the indexes and article files by computer yields a huge advantage. With only a few reservations about the presentation and formatting of the CD-ROM, I would recommend this title to anyone interested in learning more about Erickson's remarkable work.

Book coverControversies in Psychotherapy and Counselling
Colin Feltham (Editor)
Rating 2
Sage Publications, London, 1999; ISBN 0761956417
Reviewed in October 1999
Check availability at Amazon.co.uk


Reading this book reminded me of what Charles de Gaulle once said of the French: "How can you govern a country which has 246 varieties of cheese?" Well, psychotherapy and counselling are at least as diverse and they continue to be riven by acrimonious power struggles and deep-seated contention. Colin Feltham airs a selection of controversies old and new in the sensible belief that therapy needs sufficient scientific anchorage as well as emotional faith. He says, "Although a public relations avoidance of controversy may be expedient, there is ultimately no purpose in defending theories and practices that cannot stand up to challenge. Falsification, exaggeration, convenience and lies surely have no place in therapy." Anyone concerned about the credibility and future survival of the field will undoubtedly welcome this work.

The book is divided into four parts corresponding to theoretical issues, clinical issues, professional issues and social issues. An introductory chapter written by the editor is followed by 15 pairs of more or less opposing chapters. Writers were invited to argue for or against a certain case, but were not shown each other's chapters. Some of the viewpoints are highly polarized; others are more complementary. The contributors are predominately English and around half have academic status. Although the British psychotherapy and counselling "establishment" (such as UKCP, BAC and BPS) is more than adequately represented, there is notably little input from, for example, the voluntary sector or more radical practitioner groups. The rather restricted cross-section of contributors inevitably reflects on the width and depth of the debates, and limits their applicability to a wider European context.

The list of topics is not intended to be exhaustive, but is based, according to the editor, "on certain expressed interests, current debates and willing authors". It includes perennials such as the unconscious mind, false memories, effectiveness, psychopathology and diagnosis, boundaries, training, core theoretical models, personal therapy, registration, and psychotherapy's social impact. However, it is surprising to see primal therapy discussed at length while, for example, self-healing, hypnosis, and the growth of solution-focused therapy and EMDR receive little or no attention. Also, Freud's shadow unduly obscures several important topics. For instance, the debate on the unconscious is much more about defending and attacking Freudian concepts and interpretations than about objectively assessing our scientific knowledge to date.

The arguments themselves range from the sublime to the ridiculous - from open-minded, constructive comment to blinkered, defensive posturing. Some are well-researched, carefully substantiated and bring real clarity to the issues which have to be addressed. Others are based on the strength of personal conviction alone (for example, Fay Weldon's attack on 'Therapism'). Disappointingly, a few arguments plainly exhibit crooked thinking, are "economical with the truth", or worse still, simply parrot professional party lines. To help expose poor reasoning, I think that the book would have been much strengthened by ending each chapter with a few well-chosen questions from the editor (or the opposing contributor) and the writer's responses. However, the diversity of viewpoints and writing styles is fascinating in itself, although it sadly confirms the depth of the chasms which exist between different therapeutic traditions and between research evidence and practice. The arguments over training and supervision, written by Jim McLennan and Mary Connor, and the cases for and against practitioner registration, written by Digby Tantam and Richard Mowbray respectively, illustrate just how much work needs to be done for psychotherapy to put its house in order. Brian Thorne's trenchant contribution, arguing that psychotherapy and counselling are indistinguishable, emphasizes the urgency of this task.

Overall, Controversies in Psychotherapy and Counselling is well worth reading, though you will certainly encounter exasperation and obfuscation on the way. Colin Feltham has partially achieved his stated aims for the book, but there are more than a few missed chances and some very loose ends. Most of the topics would require multiple viewpoints to do them justice; two nominally opposing views are really insufficient. Feltham states that: "Controversy can and arguably should be utilized as a teaching aid, prompting students to think critically about the subject from the outset." I do hope that this book will help encourage such constructive debate among trainees and further promote evidence-based practice. My reservation is that trainees will have to work rather hard to disentangle the truths, untruths and half-truths from much of the material presented. Faced with making this effort or simply conforming to existing professional norms, valid or not, I suspect many will take the path of least resistance. Perhaps Jeremy Homes's concluding words are most apt: "The professionalization of therapy still has a long way to go before it can legitimately claim to put the needs of patients first. Humility, balance, and constructive scepticism are needed - the very values which therapy might itself hope to instil."

Book coverPersuasion and Healing: A Comparative Study of Psychotherapy (Third Edition)
Jerome D Frank & Julia B Frank
Rating 4
Johns Hopkins University Press, Baltimore, 1993; ISBN 0801846366
See published review of Wampold (2001)
Check availability at Amazon.co.uk


This remarkable and enduring book (first published in 1961 and last updated in 1991) is of more importance than ever to the field following the publication of Bruce Wampold's The Great Psychotherapy Debate in 2001. The Franks' contextual model of psychotherapy, in which outcome is dominated by general effects, has been emphatically validated by Wampold's comprehensive review of the research findings to date.

Four essential features shared by all psychotherapies are discussed at length: 1) the therapeutic relationship; 2) the therapeutic setting; 3) the therapeutic rationale; and 4) the therapeutic ritual. Healers, healing settings, belief systems and the role of demoralization are thoroughly examined in both industrial and non-industrial societies, ranging from religious and magical healing to traditional mental hospitals and contemporary psychotherapies.

This is a seminal book which can strengthen the ties among the various psychological and medical healing professions, to benefit both the individual client and society as a whole.

Book coverEmotional Intelligence: Why It Can Matter More Than IQ
Daniel Goleman
Rating 4
Bloomsbury, London, 1996; ISBN 0747528306
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Daniel Goleman has carefully digested research findings (notably Joseph LeDoux's work) to produce probably the most accessible and practical guide to the emotions you will find. He compares and contrasts our rational and emotional minds and explains how we get "emotionally hijacked", to use his own memorable phrase. The profound physical effects of emotions on the body are also described at length. The remarkable chapter entitled "Passion's Slaves" encapsulates how most human misery arises and how it can be alleviated. If just these few pages were more widely disseminated, the world would surely be a much happier and less dangerous place.

From the research evidence, the author identifies the emotional qualities - such as self-awareness, impulse control, persistence, motivation, empathy and social competence - which constitute what he terms "emotional intelligence". Often having more predictive power than the traditional IQ indicators, these qualities are shown to lead to personal well-being, flourishing relationships and success socially and at work.

Around half of the book is devoted to exploring the ways in which emotional management can be improved in society, particularly in children and young people. There are many, many applications for this important work and it is heartening to read of the progress already achieved. Although Emotional Intelligence has spawned many derivatives and imitations, this original work is still highly recommended reading.

Book coverThe Origin of Dreams
Joseph Griffin
Rating 3.5
The Therapist Ltd, Worthing, 1997; ISBN 1899398309
Review published in Counselling in Scotland, September 1997
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Dreams and nightmares have fascinated us since time immemorial and conjectures as to their meaning and function in our lives have abounded. However, the difficulty in drawing the biological and psychological aspects together with any scientific rigour has allowed all kinds of mystical and fantastic beliefs about dreaming to persist. For those dreams we can remember, we instinctively search for meaning and many counsellors and psychotherapists struggle to help their clients gain insight by disentangling imagery and obscure symbolism. Joseph Griffin' s book is billed as "the first holistic synthesis, a recognition of the interdependence of the biological and the psychological, that explains the origin, function and meaning of dreams". The evidence that supports this claim is very convincing, and therefore the book has great practical potential to enlighten clients and assist the work of all therapists.

In addition to carrying out his own research, Griffin has examined current theories and the findings from a wide range of psychological and biological research. Of course, the ideas of Freud and Jung are well known, but for example, learning of the relatively unknown work of C S Hall was particularly interesting. It is clear that any advance in psychological theory has to be consistent with the findings of increasingly sophisticated biological research into REM sleep, such as that by W Dement and M Jouvet. Griffin's synthesis is summarized in three hypotheses:

  1. Dreams are the sensory analogues of emotionally arousing introspections left unresolved at sleep onset.
  2. Dreams deactivate the pattern of arousal from the previous day (leaving the brain prepared for the following day's experiences).
  3. Dreams are expressed as sensory analogues, or metaphors, because of their intimate association with the REM sleep state which evolved to programme instinctive behaviour.

Dedicated followers of Freud and Jung will be disappointed: Griffin convincingly reinterprets their respective "Irma's injection" and "collective unconscious" dreams using his theory. Attempts have been made before to reinterpret these seminal dreams (for example, J A Hadfield's "biological" interpretation in 1954) removing their extraordinary qualities, but Griffin's reinterpretation seems by far the most credible I know of.

The final chapters discussing dreams and REM sleep in relation to creativity, hypnosis and psychotherapy are sufficiently tantalising to merit expansion. For example, is hypnosis a direct route to accessing the 'reality simulator' of the dream state? The implications raised by this book for all forms of counselling and psychotherapy are significant; it deserves to be very widely read.

Book coverHuman Givens: A new approach to emotional health and clear thinking
Joe Griffin & Ivan Tyrrell
Rating 3
Human Givens Publishing, Chalvington, 2003; ISBN 1899398260
Review published in Ipnosis No 12, Winter 2003
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This book presents the authors' developing approach to understanding human nature and alleviating distress. By 'human givens', they simply mean our innate physical and emotional needs and tools for survival. Griffin and Tyrrell argue that "It is the way those needs are met, and the way we use the resources that nature has given us, that determine the physical, mental and moral health of an individual." They also assert that psychotherapy is most effective when it is aligned with the 'human givens'. Fair enough, but can Human Givens live up to its billing in the Foreword: "as significant, perhaps, as the introduction of zero was to mathematics" and "[providing] the basis for rational treatment which could save millions of pounds"? Given that the authors are "using all available approaches in one session", one must wonder if a psychotherapeutic approach which attributes emotional health and clear thinking to the whole of human nature devolves to no particular approach at all!

Much of the material has already been published over the last four years in a series of monographs and articles in the Human Givens journal. However, consolidating it in one place is certainly helpful for reference purposes and provides a more coherent overview of the approach. Five of the seven appendices are by additional contributors, describing well how the human givens approach can help social work, disability issues, education, and the treatment of trauma and pain. Overall the writing is straightforward, well-illustrated with case studies and metaphors, and refreshingly clear of psychological jargon (with the exception of the Afterword). Extensive references and notes are provided for each chapter, though the inclusion of an author index would have been helpful in a work of this size and scope. Also, some graphics may have relieved the hefty 433 pages of pure text.

The work is divided into three main parts. Part 1 explores the metaphorical pattern matching ability of the human brain; the role of the REM (rapid eye movement) state in programming instinctive behaviour and deactivating unexpressed emotional concerns through dreaming; and related trance phenomena. Griffin's work on dreaming and the comments about psychosis are particularly useful. Part 2 looks at our emotional needs and natural tools in detail; our social context and differences between the sexes; and the links between the distressed mind and body. The last chapter in this part conjectures that autism results from a child's failure to fully develop mammalian behavioural response patterns. Part 3 introduces the APET (Activating agent - Pattern-matching - Emotion - Thought) model for effective psychotherapy, the authors arguing persuasively that this sequencing reflects current research evidence about how the emotional and rational minds actually work. The practical application of this therapy model to typical disorders is described in detail, and whole chapters are devoted very productively to the major problems of depression and trauma.

An Afterword pondering the nature of consciousness unfortunately leaves the pragmatic grounding of other chapters far behind, describing how "to keep within the laws of science, we must postulate that conscious awareness is made from some kind of matter we have called each particle of it a 'relaton'". Echoes of Rupert Sheldrake's (A New Science Of Life, 1983) controversial formative causation idea (which is uncited)? The book would probably be more cogent if the highly speculative Afterword and chapter on autism were omitted.

Although Human Givens provides a treasury of information and understanding, and undoubtedly several original insights, I am concerned that its evidence base is somewhat skewed. For example, the landmark works of Frank & Frank (1991), Prochaska et al (1994), Hubble et al (1999) and Wampold (2001) on the common factors of therapeutic change are neither cited nor accommodated. This results in the inaccurate statement that "Until the 1970s, studies seemed to find that all therapies were roughly as good or bad as each other More objective research has overturned that view." Also, Wampold's work on therapist and therapy allegiance effects would throw a different light on the appendix which apparently substantiates the efficacy of the 'rewind technique' for treating trauma.

The 'human givens' approach is currently being strongly marketed through its diploma training school, publishing house, television and radio. It would be a pity if the good stuff it contains were compromised by less than objective science and over-enthusiastic marketing hype. Lying aside these misgivings, psychotherapists and counsellors will find Human Givens well worth reading and a rich source of practical ideas to help them and their clients. Besides, who would really argue that psychotherapy should not be based on human nature?

notes

Disclaimer: This website only provides general information derived from research findings. It is not a substitute for a consultation with a mental health professional about an individual case. While every effort is made to ensure the accuracy and objectivity of information on this site, the authors accept no responsibility for the consequences of errors or omissions. Information about the practice of psychotherapy and counselling in the United Kingdom and/or Scotland may not be applicable in other countries. External websites are linked in good faith, but their contents cannot be vouched for.

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