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Issues and approaches in the psychological therapies
BOOK
REVIEWS
D. BANNISTER (Ed.). I.ssurs and Approaches in the Psychological 1975. 261 pp. f8.75.
Therapies. John
Wiley
and
Sons.
London.
This book presents a wide variety of approaches to psychological treatment. These include group work. family counselling. personal construct, gestalt and rational+motive psychotherapies. behaviour therapy and behaviour modification. The reader. if he were ignorant of any one of these treatments. would obtain from the relevant chapter a flavour of that treatment and a useful reading list. Only one of the chapters. by D. H. Malan, is seriously concerned with the central issues: the reproducible explication of therapeutic processes, and the relation to outcome of the behaviour of therapists and patients. (The research work of the Rogerian school is not represented in this book). Malan investigated brief psychoanalytic psychotherapy. He found no relationship between outcome on the one hand and severity and chronicity of neurosis on the other. There appeared, however, to be a positive, statistically significant. relationship between outcome and (i) the proportion of interpretations dealing with the transference-parent link. (ii) patient’s motivation, (iii) early transference and termination, and (iv) the extent to which the therapist can stick to a therapeutic plan. Some of the other chapters might be said to have claims to scientific status because they make references to the empirical literature. However, there is almost a total lack of critical and constructive evaluation of the studies quoted. They are merely listed in support of particular assertions. Other chapters. like that of Bannister on personal construct psychotherapy, make pratically no reference to controlled observations or facts. Such neglect, however, is no surprise in view of the attitudes expressed in Bannister’s introduction. He would have us think that the science of psychology is confined to investigations of the behaviour of rats and wood lice, and to the accumulation of 5 per cent significance levels for storage in the journals. He apparently sees only one alternative to a rigorous scientific approach: “personal experiment which actually changes people and nourishes psychological understanding”. Fine sounding words; but there is no escaping the scientific requirements to describe their operational implications and to validate these implications empirically. Otherwise such words amount to yet another expression of obscurantism and mysticism. The one point of agreement between all the contributors is that the outcomes of their favoured procedures have not been assessed. This state of affairs is responded to in varying ways: from mild regret to es carhedra statements about the difficulties of outcome studies. At best, we are given references to read and evaluate for ourselves. One of our main needs. at the moment, is a detailed and constructive evaluation of the many studies that have in fact been carried out. It is only on the basis of such evaluation that one might formulate lines of future research and arrive at generalizations, however tentative. An overriding question is whether the contributors have the moral right to offer the public their treatment services for general use. All they seem entitled to claim is that they are at the moment trying out their methods. The facts that they appear to enjoy doing so can have no particular merit for the community as a whole. M. B.
H. MILNE and S. J. HARDY (Eds.) Psycho-sexual Problems. Bradford Crosby Lockwood Staples. London. 1976. 210 pp. Price: f6.00.
University
Press
SHAPIRO
in association
with
This collection of papers represents the Proceedings of the First International Congress on Psycho-sexual Problems held at the University of Bradford. 1974. Notwithstanding the basic lack of original ideas or original discussion. some of the articles are almost interesting. The book starts quite reasonably with potted summaries of the physiology and psychology of sex by Paintin and Gwynne Jones respectively. Paintin in particular manages to cover a lot of ground quickly but clearly. and is one of the few authors in this collection who gives a reasonable list of references that the reader can follow up. There follows three papers on the potential role of gynaecologists and psychiatrists. two of which very briefly report lightweight data; one pertaining to the psychological effects of the hysterectomy (Ross and Tyrer) and the other to the effectiveness of a psychosexual clinic (Mime). Next. comes the low spot of the book; an article on non-consummation by Tunnadine and another on impotence by Main. Between them. on these hugely important topics, they can only scrape up one reference. Dr. Prudence Tunnadine replaces academic discussion or academic reference with several mentions of a lady called Briinhilde and a perfectly sweet little precis of the Sleeping Beauty fairy tale. Main’s article virtually begins with the brilliant insight “1 would like to emphasize.. that sexual intercourse can be looked at as a matter of two bodies.. .“. But at least he is unintentionally funny (“Interest in the penis.. leads to.. a kind of cock-eyed thinking.. .“) and conjurs up some fascinating images (“, and the private parts of the body are among the last to be handed over.“) At this point, one would be forgiven for throwing the book away, but if one struggles on it gets better. For example, although YalIe says nothing about pornography he at least says it in very few pages. Eventually. one comes to two quite interesting but rather uninformative articles by West and McGrath on homosexuality and sexual offenders. and at last to a quality piece by Bancroft who very neatly introduces readers to the behavioural approach to sexual disorders. 217
REVIEWS
D. BANNISTER (Ed.). I.ssurs and Approaches in the Psychological 1975. 261 pp. f8.75.
Therapies. John
Wiley
and
Sons.
London.
This book presents a wide variety of approaches to psychological treatment. These include group work. family counselling. personal construct, gestalt and rational+motive psychotherapies. behaviour therapy and behaviour modification. The reader. if he were ignorant of any one of these treatments. would obtain from the relevant chapter a flavour of that treatment and a useful reading list. Only one of the chapters. by D. H. Malan, is seriously concerned with the central issues: the reproducible explication of therapeutic processes, and the relation to outcome of the behaviour of therapists and patients. (The research work of the Rogerian school is not represented in this book). Malan investigated brief psychoanalytic psychotherapy. He found no relationship between outcome on the one hand and severity and chronicity of neurosis on the other. There appeared, however, to be a positive, statistically significant. relationship between outcome and (i) the proportion of interpretations dealing with the transference-parent link. (ii) patient’s motivation, (iii) early transference and termination, and (iv) the extent to which the therapist can stick to a therapeutic plan. Some of the other chapters might be said to have claims to scientific status because they make references to the empirical literature. However, there is almost a total lack of critical and constructive evaluation of the studies quoted. They are merely listed in support of particular assertions. Other chapters. like that of Bannister on personal construct psychotherapy, make pratically no reference to controlled observations or facts. Such neglect, however, is no surprise in view of the attitudes expressed in Bannister’s introduction. He would have us think that the science of psychology is confined to investigations of the behaviour of rats and wood lice, and to the accumulation of 5 per cent significance levels for storage in the journals. He apparently sees only one alternative to a rigorous scientific approach: “personal experiment which actually changes people and nourishes psychological understanding”. Fine sounding words; but there is no escaping the scientific requirements to describe their operational implications and to validate these implications empirically. Otherwise such words amount to yet another expression of obscurantism and mysticism. The one point of agreement between all the contributors is that the outcomes of their favoured procedures have not been assessed. This state of affairs is responded to in varying ways: from mild regret to es carhedra statements about the difficulties of outcome studies. At best, we are given references to read and evaluate for ourselves. One of our main needs. at the moment, is a detailed and constructive evaluation of the many studies that have in fact been carried out. It is only on the basis of such evaluation that one might formulate lines of future research and arrive at generalizations, however tentative. An overriding question is whether the contributors have the moral right to offer the public their treatment services for general use. All they seem entitled to claim is that they are at the moment trying out their methods. The facts that they appear to enjoy doing so can have no particular merit for the community as a whole. M. B.
H. MILNE and S. J. HARDY (Eds.) Psycho-sexual Problems. Bradford Crosby Lockwood Staples. London. 1976. 210 pp. Price: f6.00.
University
Press
SHAPIRO
in association
with
This collection of papers represents the Proceedings of the First International Congress on Psycho-sexual Problems held at the University of Bradford. 1974. Notwithstanding the basic lack of original ideas or original discussion. some of the articles are almost interesting. The book starts quite reasonably with potted summaries of the physiology and psychology of sex by Paintin and Gwynne Jones respectively. Paintin in particular manages to cover a lot of ground quickly but clearly. and is one of the few authors in this collection who gives a reasonable list of references that the reader can follow up. There follows three papers on the potential role of gynaecologists and psychiatrists. two of which very briefly report lightweight data; one pertaining to the psychological effects of the hysterectomy (Ross and Tyrer) and the other to the effectiveness of a psychosexual clinic (Mime). Next. comes the low spot of the book; an article on non-consummation by Tunnadine and another on impotence by Main. Between them. on these hugely important topics, they can only scrape up one reference. Dr. Prudence Tunnadine replaces academic discussion or academic reference with several mentions of a lady called Briinhilde and a perfectly sweet little precis of the Sleeping Beauty fairy tale. Main’s article virtually begins with the brilliant insight “1 would like to emphasize.. that sexual intercourse can be looked at as a matter of two bodies.. .“. But at least he is unintentionally funny (“Interest in the penis.. leads to.. a kind of cock-eyed thinking.. .“) and conjurs up some fascinating images (“, and the private parts of the body are among the last to be handed over.“) At this point, one would be forgiven for throwing the book away, but if one struggles on it gets better. For example, although YalIe says nothing about pornography he at least says it in very few pages. Eventually. one comes to two quite interesting but rather uninformative articles by West and McGrath on homosexuality and sexual offenders. and at last to a quality piece by Bancroft who very neatly introduces readers to the behavioural approach to sexual disorders. 217