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Cognitive behaviour therapy for psychiatric problems—A practical guide
B&x. Res. Fher. Vol. 28. No. 2. pp. 175-180. 1990 Printed in Great Bntain
0005-7967 90 53.00 + 0.00 Pergamon Press plc
BOOK REVIEWS
HAWTON, P. M. SALKOVSKIS.J. KIRK and D. M. CLARK (Eds): Cognike Behariour Therapy for Psychiatric Problems-A Practical Guide. Oxford University Press, Oxford (1989). xiv + 456 pp. f40.00 hardback; f 15.00 paperback.
K.
Edited books on cognitive-behaviour therapy are a fashionable, and presumably profitable, industry these days. Practitioners and-more particularly-those engaged in training others in clinical practice have the task of looking at new publications of this genre at regular intervals. There have been several reviews of such books in this journal in the past few years. Against this background, yet another new volume needs to be very good indeed if it is to be taken much notice of. let alone make an impact. Hawton and his editorial colleagues have no reason to fear that their product will fail to be noticed, or to make an impact. Its sheer quality will ensure both. An ambitious undertaking, it is clearly the product of clear thinking and planning, careful writing of chapters by authors who are established experts in their respective fields, and judicious editorial handling. As a practical guide to the popular and growing field of cognitivebehaviour therapy. this compares very favourably with its predecessors, and is likely to be taken as a text of choice for some time. The book begins with a chapter on the basic psychological principles relevant to cognitive-behavioural therapy, which also provides an outline of the development and basics of this field. Though brief. this is a most informative chapter. This is followed by a chapter on cognitive-behavioural assessment, again an excellent piece. The next nine chapters deal with psychiatric problems commonly presented in adult mental health settings. These are: anxiety states, phobic disorders; obsessional disorders; depression. somatic problems; eating disorders; chronic psychiatric handicaps; marital problems; and sexual dysfunctions. These all give detailed, practically-oriented accounts of how to assess and treat these problems. The treatment follows logically from the psychological model/s used for conceptualizing the disorder, and from the cognitive-behavioural assessment. Useful clinical illustrations are given where relevant, and difficulties that may arise are highlighted and commented on. Finally, a few references, not too many, are given as recommended reading. Several chapters also have useful appendices. The final chapter of the book, written by two of the editors, is called ‘Problem-solving’. This innovative general chapter is intended to give ‘practical guidance on a general approach to helping people manage personal issues’. This is an immensely sensible chapter, giving useful advice on almost every general aspect of helping a patient to deal with difficulties, including common problems of life such as loss and study difficulties, as well as coping with physical or mental illness. A brief review such as this is not the place to comment in detail on the individual chapters on the disorders discussed. What can be said, however, is that each is excellently written, concise and authoritative. Not every statement or every item of practical advice is watertight with regard to its basis in research. This is because, naturally, therapy in practice needs to go beyond the established research data; the important thing is to take these steps on the basis of sound and plausible models, which have some empirical and/or theoretical foundation, and to approach therapy in an evaluation-oriented way. This message is clearly contained in these chapters. As for the content, there are a few points which the reviewer disagrees with in some of the chapters, but these are not major ones. It is a pity, too, that the book does not include chapters on alcohol and drug addiction, sexual deviation, and forensic problems. Perhaps to do so would have made the volume unwieldy, but there are important areas which clinicians are regularly called upon to deal with. Who will benefit from this book? Trainees in the helping professions who are learning to deal with psychiatric problems are among the obvious beneficiaries. But this is not a book just for trainees. Experienced practitioners will also find these chapters most useful; indeed, I would recommend that they read those chapters relevant to their areas. The group that will be most grateful to the editors, I suspect, will be those whose task it is to train others to learn and master cognitive-behavioural therapy skills. With a book like this readily available, their task will become considerably easier, and more enjoyable. P.
DE SILVA
F. N. WATTS (Ed.): New Derelopmenrs in Clinical Psychology, Vol. 2. British Psychological Society, Leicester, and Wiley, Chichester (1988). 284 pp. f29.50. In my review of the first volume of “New Developments” I suggested that the book served as a sampler and that it provided a useful demonstration of the wide range of applicability of clinical psychologists’ skills. Much the same could be said about Volume II. Nineteen authors contribute a total of 16 chapters on the following topics: Gestalt methods, attribution therapy, problem solving therapy, agoraphobia, the role of spouses and families in treatment of adult problems, social support, emotional disorders in the elderly, work with ethnic minorities, sexual abuse of children, primary prevention in work with children, nutrition and disturbed behaviour, rehabilitation after severe head injury, eye witness testimony, evaluating community based services, assessing cost effectiveness, and consultancy in non-N.H.S. settings. The book offers a wide spectrum of approaches in clinical psychology and this is both its strength and its weakness. Its strength (and one which will not necessarily appeal to readers of this journal) lies in its eclecticism. Fraser Watts is happy to include articles on empirically verifiable treatment methods alongside articles on conceptual models and articles on styles or even schools of treatment. His breadth of scope and freedom from narrowly restrictive pre-conceptions should, I think, be applauded. The book’s weakness, like its strength, must be attributed to editorial choice. The editor sets out to portray “a broadening of the range of problems and client groups with whom clinical psychologists work beyond the traditional fortress of adult mental health”. The immediate question which this raises, given clinical psychology staffing levels in this country, is who is minding the fortress while everyone is away doing their own thing? The continued diversification of clinical psychology 175
0005-7967 90 53.00 + 0.00 Pergamon Press plc
BOOK REVIEWS
HAWTON, P. M. SALKOVSKIS.J. KIRK and D. M. CLARK (Eds): Cognike Behariour Therapy for Psychiatric Problems-A Practical Guide. Oxford University Press, Oxford (1989). xiv + 456 pp. f40.00 hardback; f 15.00 paperback.
K.
Edited books on cognitive-behaviour therapy are a fashionable, and presumably profitable, industry these days. Practitioners and-more particularly-those engaged in training others in clinical practice have the task of looking at new publications of this genre at regular intervals. There have been several reviews of such books in this journal in the past few years. Against this background, yet another new volume needs to be very good indeed if it is to be taken much notice of. let alone make an impact. Hawton and his editorial colleagues have no reason to fear that their product will fail to be noticed, or to make an impact. Its sheer quality will ensure both. An ambitious undertaking, it is clearly the product of clear thinking and planning, careful writing of chapters by authors who are established experts in their respective fields, and judicious editorial handling. As a practical guide to the popular and growing field of cognitivebehaviour therapy. this compares very favourably with its predecessors, and is likely to be taken as a text of choice for some time. The book begins with a chapter on the basic psychological principles relevant to cognitive-behavioural therapy, which also provides an outline of the development and basics of this field. Though brief. this is a most informative chapter. This is followed by a chapter on cognitive-behavioural assessment, again an excellent piece. The next nine chapters deal with psychiatric problems commonly presented in adult mental health settings. These are: anxiety states, phobic disorders; obsessional disorders; depression. somatic problems; eating disorders; chronic psychiatric handicaps; marital problems; and sexual dysfunctions. These all give detailed, practically-oriented accounts of how to assess and treat these problems. The treatment follows logically from the psychological model/s used for conceptualizing the disorder, and from the cognitive-behavioural assessment. Useful clinical illustrations are given where relevant, and difficulties that may arise are highlighted and commented on. Finally, a few references, not too many, are given as recommended reading. Several chapters also have useful appendices. The final chapter of the book, written by two of the editors, is called ‘Problem-solving’. This innovative general chapter is intended to give ‘practical guidance on a general approach to helping people manage personal issues’. This is an immensely sensible chapter, giving useful advice on almost every general aspect of helping a patient to deal with difficulties, including common problems of life such as loss and study difficulties, as well as coping with physical or mental illness. A brief review such as this is not the place to comment in detail on the individual chapters on the disorders discussed. What can be said, however, is that each is excellently written, concise and authoritative. Not every statement or every item of practical advice is watertight with regard to its basis in research. This is because, naturally, therapy in practice needs to go beyond the established research data; the important thing is to take these steps on the basis of sound and plausible models, which have some empirical and/or theoretical foundation, and to approach therapy in an evaluation-oriented way. This message is clearly contained in these chapters. As for the content, there are a few points which the reviewer disagrees with in some of the chapters, but these are not major ones. It is a pity, too, that the book does not include chapters on alcohol and drug addiction, sexual deviation, and forensic problems. Perhaps to do so would have made the volume unwieldy, but there are important areas which clinicians are regularly called upon to deal with. Who will benefit from this book? Trainees in the helping professions who are learning to deal with psychiatric problems are among the obvious beneficiaries. But this is not a book just for trainees. Experienced practitioners will also find these chapters most useful; indeed, I would recommend that they read those chapters relevant to their areas. The group that will be most grateful to the editors, I suspect, will be those whose task it is to train others to learn and master cognitive-behavioural therapy skills. With a book like this readily available, their task will become considerably easier, and more enjoyable. P.
DE SILVA
F. N. WATTS (Ed.): New Derelopmenrs in Clinical Psychology, Vol. 2. British Psychological Society, Leicester, and Wiley, Chichester (1988). 284 pp. f29.50. In my review of the first volume of “New Developments” I suggested that the book served as a sampler and that it provided a useful demonstration of the wide range of applicability of clinical psychologists’ skills. Much the same could be said about Volume II. Nineteen authors contribute a total of 16 chapters on the following topics: Gestalt methods, attribution therapy, problem solving therapy, agoraphobia, the role of spouses and families in treatment of adult problems, social support, emotional disorders in the elderly, work with ethnic minorities, sexual abuse of children, primary prevention in work with children, nutrition and disturbed behaviour, rehabilitation after severe head injury, eye witness testimony, evaluating community based services, assessing cost effectiveness, and consultancy in non-N.H.S. settings. The book offers a wide spectrum of approaches in clinical psychology and this is both its strength and its weakness. Its strength (and one which will not necessarily appeal to readers of this journal) lies in its eclecticism. Fraser Watts is happy to include articles on empirically verifiable treatment methods alongside articles on conceptual models and articles on styles or even schools of treatment. His breadth of scope and freedom from narrowly restrictive pre-conceptions should, I think, be applauded. The book’s weakness, like its strength, must be attributed to editorial choice. The editor sets out to portray “a broadening of the range of problems and client groups with whom clinical psychologists work beyond the traditional fortress of adult mental health”. The immediate question which this raises, given clinical psychology staffing levels in this country, is who is minding the fortress while everyone is away doing their own thing? The continued diversification of clinical psychology 175