- Email: [email protected]
Behavior therapy casebook
Behac. Res. Thar. Vol. 24, No. 4, pp. 491496, 1986 Pergamon Journals Ltd. Printed in ~real Britain
BOOK REVIEWS V.
CURRAN and S. GOLOMBOK: Boftling If Up.
Faber & Faber, London (1985). 160 Pages. f3.25.
The first question which arose in my mind when I read this book was: Is it a doppelganger of Joy Melville’s The Trunquillizer Trap md How ro Ger Out of It? The answer I feel is, yes and no. The answer is yes. if one compares the information given in them: both volumes aim to offer an alternative to tranquillizers and how to withdraw from them. However. the present volume is specifically aimed at the woman tranquillizer user and has a much more detailed withdrawal package, and is more directive. The book is divided into three main parts. The first part addresses itself to factors which have resulted in women being prescribed tranquillizers far more than men. It refers to the recent and relevant research done in the area and communicates it in a manner understandable to the lay-reader. The second part describes terms like anxiety, phobia and depression, and again it is done in a very sensible way. This is followed by a description of tranquillizers and antidepressants. Development of dependence is usefully presented with examples of patients’ experiences. The only criticism I have here is the use of the terms ‘addict’ and ‘addiction’ with their attendant negative connotations. The term ‘addict’ may produce guilt and shame in long-term users of these drugs and I do not think that the use of this term will be therapeutic. These can be replaced with the terms ‘dependent’ and ‘dependence’. The final part offers a very detailed self-withdrawal package which includes practical details about reduction of the dosage and the use of other strategies like relaxation and anxiety management. This package implies that withdrawal can be achieved by oneself with minimal help from others. Clinical experience would suggest otherwise. The help one can draw from self-help groups is not emphasized. The authors suggest that it may be a good thing to inform one’s doctor about the intended withdrawal. I feel that the authors should have advised their readers more strongly to inform their doctors. The authors should also have made it clear that the withdrawal package refers only to tranquillizers and not to antidepressants. To make the best use of this book, I would recommend any tranquillizer user who wishes to withdraw from them and any other person who will help this person, be it a therapist, counsellor or any other concerned person, to read this book together. E.
K. RODRWJ
M. GRANT (Ed.): Alcohol Policies; WHO Regional Publications, European Series No. 18. WHO, Copenhagen (1985). 153 Pages. SW. Fr. 19. The global increase in alcohol consumption and consequent rise in the prevalance of alcohol-related problems are a major concern of the WHO. This multi-author book is based on papers presented at a meeting of the WHO Regional O&e for Europe in 1983. The aim of the meeting was to formulate national policies on alcohol as part of the WHO’s ‘health for all by the year 2000 target. Contributors assess the growth and changing patterns of alcohol consumption since the Second World War. The effects of advertising and health promotion are presented and there is a useful comparison with smoking and other public health campaigns. The drinking habits of four European countries are discussed in detail together with their different policies on alcohol. The necessity for international cooperation to reduce alcohol consumption is stressed. The book confines itself to the economic and public health aspects without presenting epidemiological data on the extent and types of alcohol-related problems or on the groups of people most at risk for developing these problems. As a consequence. individual psychological factors or the types and effects of possible treatment are not considered. The result is a book primarily of interest to those involved in national or international planning of public health policies rather than to the clinician attempting to treat the individual with an alcohol-related problem. R.
M. HERSENand C. G. LAST(Eds): Behavior Therapy Casebook.
DONMALL
Springer, New York (1985). Pages xviii + 366. 532.95.
This is a very welcome publication. While text books on behaviour therapy-and indeed on other psychological therapies-abound, volumes providing detailed case descriptions illustrating the therapy used are few and far between. Students and practitioners alike find such books very useful, for they can fulfil several functions that conventional texts normally do not. These include the illustration of how standard techniques need to be applied imaginatively to the real clinical problems that one has to deal with, the development of innovative variants of standard methods, and the need to 491
BOOK REVIEWS
492
use multiple approaches to deal with multiple and/or multifaceted problems that individual clients not infrequently present with. In this book, the editors have brought together 25 cases studies provided by invited authors. most of them well-established figures in the field. Sixteen of these deal with adult cases and nine with childhood and adolescent problems. A variety of operant, classical conditioning. and cognitive approaches are represented. There is. in addition. an introduction by the editors that highlight some of the main issues that are relevant to the practice of behaviour therapy today; this includes an excellent if brief section on therapeutic flexibility. The case studies themselves are rich and varied. They range from simple phobia and compulsive rituals to rape trauma and fear and avoidance of dental treatment in adults. and common problems such as school phobia. anorexia and learning disability in the child and adolescent populations. The case histories follow a uniform format: (1) description of the disorder: (2) case identification; (3) presenting complaints; (4) history; (5) assessment; (6) selection of treatment: (7) course of treatment; (8) termination; (9) follow-up; and (IO) evaluation. This ensures full and detailed discussion of most aspects of the cases and enhances the instructional value& the studies considerably. Most of the case descriptions are excellent: it would be misleading to pick on examples, but special mention must be made of the case of an agoraphobic housewife described by Steketee and Foa. and of a woman with sleep problems described by Bootzin. All chapters, by the way, also provide a not-too-long list of relevant references. There is one curious omission in this otherwise excellent book. The editors. in discussing the need for such a book as this, refer to two similar previous publications-Ullmann and Krasner’s Cuse Siudies in Behavior Mod$carion and Wolpe’s Theme and Variufions. No mention is made, either in the Preface or in the editors’ introductory chapter, of what 1 would consider to be the most important previous publication: Eysenck’s (1976) Case Studies in Behariour Therapy (Routledge & Kegan Paul, London). Eysenck produced this edited volume to demonstrate that the uses of behaviour therapy are not. and should not be, confined to simple cases and simplistic applications. He illustrated how complex and difficult cases could be handled, by the imaginative use of behavioural principles by skilled clinicians. This is precisely one of the main aims of the present volume. It would have been nice if the editors had acknowledged the fact that someone else had responded to this challenge nearly a decade before them. P. DE SILVA
M. E.
BERNARD and M. R. JOYCE
Strategies.
Prevention
(Eds): Rational-Emorive Therapy wirh Children and Adolescents: Merhods. Wiley, New York (1984). Pages xxii + 489. E39.50.
Theor?,. Trearmenl
Perhaps the most striking thing about rational-emotive therapy (RET) with children is how similar it seems to other cognitive behavioural methods. Much of this book is about using cognitive behavioural interventions informed by rational-emotive theory. This is not really surprising, since it is clear that the philosophical stance of much of Ellis’s work needs to be modified if it is to be used with children. The broader spectrum of cognitive behaviour therapy takes account of developmental factors. In this book attention is paid to the way in which irrational beliefs can be modified in age appropriate ways, and in ways which can catch the imagination of the child. Using cartoon characters and playing ‘Challenge-a game to demonstrate rationality’ are just two ways in which this is done. In addition to much interesting information on how to work with children, parents and teachers using this approach, the book covers the theoretical and research literature on cognitive methods with children. It is written in a style which is refreshingly free from the New York accent most RET writers seem to get into their books. Its practical advice makes this book worth browsing through, but it is probably too specialized and too expensive for most clinicians with only a passing interest in this field. A better introduction, though with less clinical material, is the recently published Cognitive Behavior Therapy with Children edited by Meyers and Craighead. S. M~~REY
IAN
R. H. FALLOON, JEFFREY L. BOYD and CHRISTINE W. MCGILL: Family Cure of Schkophrenia: Approach to the Trearmenr of Menral Illness. Guilford Press, London (1984). Pages xii + 451.
a Problem-solving
The title of this book does not indicate the very wide range of its contents. It is divided into three sections. The first section covers various aspects of the relationship between families and schizophrenia. The lack of evidence for the claim that certain types of families cause schizophrenia is discussed. On the other hand, life events and ‘expressed emotion’ have been shown to play a significant role and these are dealt with along with the enormous burden of family care and how some families cope better than others. Traditional community rehabilitation methods and various forms of non-behavioural family-based treatment are also included. The second section outlines the model of treatment the authors describe as behavioural or problem-solving therapy. Detailed illustrations of all aspects of the treatment programme are provided in the form of a manual and it it made clear that functional analysis of family behaviour is the essential ingredient. The therapist thus aims to build upon the strengths of the family to help them overcome the weaknesses in their problem-solving activities. Major deficits in the accurate
BOOK REVIEWS V.
CURRAN and S. GOLOMBOK: Boftling If Up.
Faber & Faber, London (1985). 160 Pages. f3.25.
The first question which arose in my mind when I read this book was: Is it a doppelganger of Joy Melville’s The Trunquillizer Trap md How ro Ger Out of It? The answer I feel is, yes and no. The answer is yes. if one compares the information given in them: both volumes aim to offer an alternative to tranquillizers and how to withdraw from them. However. the present volume is specifically aimed at the woman tranquillizer user and has a much more detailed withdrawal package, and is more directive. The book is divided into three main parts. The first part addresses itself to factors which have resulted in women being prescribed tranquillizers far more than men. It refers to the recent and relevant research done in the area and communicates it in a manner understandable to the lay-reader. The second part describes terms like anxiety, phobia and depression, and again it is done in a very sensible way. This is followed by a description of tranquillizers and antidepressants. Development of dependence is usefully presented with examples of patients’ experiences. The only criticism I have here is the use of the terms ‘addict’ and ‘addiction’ with their attendant negative connotations. The term ‘addict’ may produce guilt and shame in long-term users of these drugs and I do not think that the use of this term will be therapeutic. These can be replaced with the terms ‘dependent’ and ‘dependence’. The final part offers a very detailed self-withdrawal package which includes practical details about reduction of the dosage and the use of other strategies like relaxation and anxiety management. This package implies that withdrawal can be achieved by oneself with minimal help from others. Clinical experience would suggest otherwise. The help one can draw from self-help groups is not emphasized. The authors suggest that it may be a good thing to inform one’s doctor about the intended withdrawal. I feel that the authors should have advised their readers more strongly to inform their doctors. The authors should also have made it clear that the withdrawal package refers only to tranquillizers and not to antidepressants. To make the best use of this book, I would recommend any tranquillizer user who wishes to withdraw from them and any other person who will help this person, be it a therapist, counsellor or any other concerned person, to read this book together. E.
K. RODRWJ
M. GRANT (Ed.): Alcohol Policies; WHO Regional Publications, European Series No. 18. WHO, Copenhagen (1985). 153 Pages. SW. Fr. 19. The global increase in alcohol consumption and consequent rise in the prevalance of alcohol-related problems are a major concern of the WHO. This multi-author book is based on papers presented at a meeting of the WHO Regional O&e for Europe in 1983. The aim of the meeting was to formulate national policies on alcohol as part of the WHO’s ‘health for all by the year 2000 target. Contributors assess the growth and changing patterns of alcohol consumption since the Second World War. The effects of advertising and health promotion are presented and there is a useful comparison with smoking and other public health campaigns. The drinking habits of four European countries are discussed in detail together with their different policies on alcohol. The necessity for international cooperation to reduce alcohol consumption is stressed. The book confines itself to the economic and public health aspects without presenting epidemiological data on the extent and types of alcohol-related problems or on the groups of people most at risk for developing these problems. As a consequence. individual psychological factors or the types and effects of possible treatment are not considered. The result is a book primarily of interest to those involved in national or international planning of public health policies rather than to the clinician attempting to treat the individual with an alcohol-related problem. R.
M. HERSENand C. G. LAST(Eds): Behavior Therapy Casebook.
DONMALL
Springer, New York (1985). Pages xviii + 366. 532.95.
This is a very welcome publication. While text books on behaviour therapy-and indeed on other psychological therapies-abound, volumes providing detailed case descriptions illustrating the therapy used are few and far between. Students and practitioners alike find such books very useful, for they can fulfil several functions that conventional texts normally do not. These include the illustration of how standard techniques need to be applied imaginatively to the real clinical problems that one has to deal with, the development of innovative variants of standard methods, and the need to 491
BOOK REVIEWS
492
use multiple approaches to deal with multiple and/or multifaceted problems that individual clients not infrequently present with. In this book, the editors have brought together 25 cases studies provided by invited authors. most of them well-established figures in the field. Sixteen of these deal with adult cases and nine with childhood and adolescent problems. A variety of operant, classical conditioning. and cognitive approaches are represented. There is. in addition. an introduction by the editors that highlight some of the main issues that are relevant to the practice of behaviour therapy today; this includes an excellent if brief section on therapeutic flexibility. The case studies themselves are rich and varied. They range from simple phobia and compulsive rituals to rape trauma and fear and avoidance of dental treatment in adults. and common problems such as school phobia. anorexia and learning disability in the child and adolescent populations. The case histories follow a uniform format: (1) description of the disorder: (2) case identification; (3) presenting complaints; (4) history; (5) assessment; (6) selection of treatment: (7) course of treatment; (8) termination; (9) follow-up; and (IO) evaluation. This ensures full and detailed discussion of most aspects of the cases and enhances the instructional value& the studies considerably. Most of the case descriptions are excellent: it would be misleading to pick on examples, but special mention must be made of the case of an agoraphobic housewife described by Steketee and Foa. and of a woman with sleep problems described by Bootzin. All chapters, by the way, also provide a not-too-long list of relevant references. There is one curious omission in this otherwise excellent book. The editors. in discussing the need for such a book as this, refer to two similar previous publications-Ullmann and Krasner’s Cuse Siudies in Behavior Mod$carion and Wolpe’s Theme and Variufions. No mention is made, either in the Preface or in the editors’ introductory chapter, of what 1 would consider to be the most important previous publication: Eysenck’s (1976) Case Studies in Behariour Therapy (Routledge & Kegan Paul, London). Eysenck produced this edited volume to demonstrate that the uses of behaviour therapy are not. and should not be, confined to simple cases and simplistic applications. He illustrated how complex and difficult cases could be handled, by the imaginative use of behavioural principles by skilled clinicians. This is precisely one of the main aims of the present volume. It would have been nice if the editors had acknowledged the fact that someone else had responded to this challenge nearly a decade before them. P. DE SILVA
M. E.
BERNARD and M. R. JOYCE
Strategies.
Prevention
(Eds): Rational-Emorive Therapy wirh Children and Adolescents: Merhods. Wiley, New York (1984). Pages xxii + 489. E39.50.
Theor?,. Trearmenl
Perhaps the most striking thing about rational-emotive therapy (RET) with children is how similar it seems to other cognitive behavioural methods. Much of this book is about using cognitive behavioural interventions informed by rational-emotive theory. This is not really surprising, since it is clear that the philosophical stance of much of Ellis’s work needs to be modified if it is to be used with children. The broader spectrum of cognitive behaviour therapy takes account of developmental factors. In this book attention is paid to the way in which irrational beliefs can be modified in age appropriate ways, and in ways which can catch the imagination of the child. Using cartoon characters and playing ‘Challenge-a game to demonstrate rationality’ are just two ways in which this is done. In addition to much interesting information on how to work with children, parents and teachers using this approach, the book covers the theoretical and research literature on cognitive methods with children. It is written in a style which is refreshingly free from the New York accent most RET writers seem to get into their books. Its practical advice makes this book worth browsing through, but it is probably too specialized and too expensive for most clinicians with only a passing interest in this field. A better introduction, though with less clinical material, is the recently published Cognitive Behavior Therapy with Children edited by Meyers and Craighead. S. M~~REY
IAN
R. H. FALLOON, JEFFREY L. BOYD and CHRISTINE W. MCGILL: Family Cure of Schkophrenia: Approach to the Trearmenr of Menral Illness. Guilford Press, London (1984). Pages xii + 451.
a Problem-solving
The title of this book does not indicate the very wide range of its contents. It is divided into three sections. The first section covers various aspects of the relationship between families and schizophrenia. The lack of evidence for the claim that certain types of families cause schizophrenia is discussed. On the other hand, life events and ‘expressed emotion’ have been shown to play a significant role and these are dealt with along with the enormous burden of family care and how some families cope better than others. Traditional community rehabilitation methods and various forms of non-behavioural family-based treatment are also included. The second section outlines the model of treatment the authors describe as behavioural or problem-solving therapy. Detailed illustrations of all aspects of the treatment programme are provided in the form of a manual and it it made clear that functional analysis of family behaviour is the essential ingredient. The therapist thus aims to build upon the strengths of the family to help them overcome the weaknesses in their problem-solving activities. Major deficits in the accurate