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Psychotherapy with older adults
Beha. Res. Ther. Vol. 26. No. 6, pp. 535-541. 1988 Pergamon Press pk. Printed in Great Britain
BOOK C.
R.
PFEFFER: The Suicidal
REVIEWS
Child. The Guilford Press, New York (1986). xviii + 318 pages. f24.95.
Suicide in children is fortunately rare, occurring in less than one in 100,000 in those aged fourteen and under. Though this absolute figure is low, it still accounts for a significant proportion of deaths in that age group. There is some evidence that rates are increasing at least in the U.S.A. The impact caused by the suicide of the child is overwhelming not only on its family, but on peers, teachers and other professionals. This book is written by a clinician who is able to combine her experience of assessing and treating suicidal children with a wide range of knowledge of the scientific literature. There are four sections: Epidemiology, Risk Factors, Assessment, and Intervention. The chapters widen out to include an overview of depression in childhood and of the child’s concept of death. The author’s main therapeutic interests are psychodynamic, and emphasis is given to the central role of the focussed psychotherapy. She readily admits however that there has been very little systematic work on the efficacy of any particular form of treatment and discusses the probable usefulness of cognitive therapy and medication. The main message that comes across, however, is the need to take seriously any suicidal threat by a child or adolescent. It seems likely that responding positively to that threat is, in itself, the most potent form of intervention. This is a careful, sober book dealing with a grim and easily sensationalized topic. It is only very recently that real attempts have been made to identify depressive disorders in children. There is no doubt that they exist and that they carry a real risk of suicide. There is a very great need for further work and in particular on the indications for different treatment approaches. This is a very useful introduction to the topic and should help clinicians become aware of the importance of depression and of suicidal threats in the young. STEPHENWOLKIND
S. SLOAN
and C.
COOPER: Pilots
Under Stress.
Routledge & Kegan Paul, London (1986). x + 230 pages. f20.00.
The year in which this book was written, 1985, was “a bad year for aviation”. Nearly 2000 people died in flying accidents and the figure for 1987 was even larger. Despite these tragedies, air travel remains less dangerous than motor travel. Nevertheless, aircraft accidents are particularly distressing, in part no doubt because of the simultaneous loss of so many lives. According to Sloan and Cooper, 45% of flying accidents “may well be attributed to pilot error”, and that figure alone would justify an extremely careful study of the training and performance of airline pilots. This study of 442 pilots follows the style of their earlier work on people in other occupations, and is organizational in approach. Almost all of the information was collected by questionnaire. They obtained personal data from the pilots, assessed their attitudes towards the job. and asked about the stresses which they encounter. The major findings are reassuring and show that the great majority of pilots are well-adjusted and highly motivated. Most of them enjoy their flying, and the stresses which they experience are those which are familiar in other occupations. They consist of clashes with colleagues, dissatisfaction with career prospects, inconvenient rosters, and so forth. The selection and training of the pilots meet the highest standards, and Sloan and Cooper found little evidence of serious personal difficulties. However. in view of the potential dangers, the airlines have sensibly introduced stress management programmes, and it is to be hoped that these will be evaluated rigorously. It is possible that this reassuring report gives too rosy an account. The 442 pilots who responded to the questionnaire comprise less than half of the 1000 who were approached, and these in turn were selected from a total sample of nearly 6000 pilots. The representativeness of the study sample is not known. The heavy reliance on a questionnaire raises the usual questions about the validity of the information which they collected. In the section dealing with use and abuse of alcohol, for example, the figures are so low as to introduce doubts about its accuracy. Their review of the literature is disappointing, and no attempt is made to link what scanty information is available on civilian pilots to the extensive literature on military pilots. In their discussion of the problem of mental ill-health among the pilots, which does not probe deeply, they were able to conclude that, “the results for anxiety and overall mental ill-health were especially clear though all were statistically quite sound,” (p. 101). I suspect that this is a familiar but unspoken paradox.
BOB KNGHT: Psychotherapy
with Older Adults.
Sage, Beverley Hills (1986). 192 pages f27.50.
This book consists of a comprehensive account of the knowledge that a psychologist needs to work with the elderly. The author presents the material clearly and the topics include psychotherapy, psychiatry and family work. 535
536
BOOK REVIEWS
The book starts off by examining how the effect of ageing and cohort differences affect therapy with elderly patients. Against the background of slowing in ageing and in a higher incidence of physical illness. the author argues tha: interiority (i.e. more introspective outlook and increasing concern with the meaning of one’s life) is an asset in effecting change. He goes through therapies of different theoretical frameworks and cites a string of therapists to combat the ageist remark that the cognitive structure of elderly people is too rigid to permit change. The chapters. ‘Major Topics in Therapy with the Elderly’ and ‘Major Themes in Therapy with the Aged’, are particularly useful. As well as presenting useful information from literature reviews, the author describes succinctly his own experience through the case examples. The suggested reading list is particularly useful for readers who want to pursue a certain topic further. The chapter on transference and countertransference shows how sensitive the therapist has to be because of the longer life history and hence more diverse relationships the patient has had. He goes on to discuss working in the patient’s home and what sort of problems it might cause in the patient-therapist relationship. 1recommend this book to anyone interested in working with the elderly, partly because of the content and partly because the author presents the case for doing psychotherapy with the elderly with realism and enthusiasm. Unfortunately the price may deter many interested readers from acquiring the book. DOMINIC
M. 0. CAKRUBAand J. E. BLUNDELL (Eds): Pharmacology of Eating Disorders-Theoretical Raven Press, New York (1986). ix f I78 pages. 836.50.
LAY
and Clinical Developments.
The stated objective of this book is to emphasize the interrelationships between eating behaviour, body weight regulation and neurochemistry, as adjustment to any one system may produce reverberations in the others. The span of the book is wide-ranging from molecular and receptor organisation detailed in chapters by Carruba and Nicoliades. progressing onto the behavioural pharmacology of animals in chapters by Liebowitz. Blundell and Morley, finally discussine atypical eating in man in chapters on obesity (Stunkard), “carbohydrate snackers” (Wurtman), afTective disorders (Silverstone) and anorexia and bulimia nervosa (Russell). One of the intriguing things about this book is the numerous biank spaces within the text of some chapters. The work of the censor? Or perhaps a form of self-evaluation-are you concentrating properly? Unfortunately, the most likely reason is poor production resulting from the rapid assemblage of these papers following the conference upon which this book was based. Despite this caveat. this book fulfills its promise and bridges the hierarchical systems which control eating. It should prove of use to all who are involved in the management of patients with eating disorders as the therapeutic purists are being supplanted by those who are more willing to mix their technique to match the patient. JASET TREASURE
THOMAS J. D'Z~RILLA: Prubfem-Sof~~ng Therapy-A York (1986). x + 246 pages. S26.95.
Social Cornpetenre Approach to Ci~nfcal intemention. Springer, New
Problem-solving therapy is one of the treatments which has developed since the late 1960s with the aim of increasing clients’ social competence. The aim is to help them eliminate dysfunctional symptoms by providing them with the wherewithal to cope with the everyday problems their failure to cope with which produces the symptoms, rather than by simply trying to get them to unlearn the symptoms. D’Zurilla’s account of the origins of this treatment approach and the state of the art will thus be of interest to many practitioners, whether they work in clinical or educational settings. Clients with problems are extremely abundant. The book has two main parts. The first covers the historical development of the problem-solving approach to treatment, an extended definition and annotation of social problems and the five major components involved in their solution, the author’s prescriptive model of social problem-solving. an illuminating discussion of the role of emotions in social problem-solving, and a consideration of the reIationship between ability to cope and social adjustment. Part Two describes assessment of clients for problem-solving therapy, clinical applications on both an individual and a group basis, and gives case studies and an extensive review of outcome studies. Appendices include a Problem-Solving Inventory for assessing clients and a self-monitoring form. The provision of these materials, the book’s great clarity, sensibleness and practical orientation, and the potentially wide applicability of the approach seem likely to facilitate the dissemination of problem-solving therapy to other client groups and settings. It is to be hoped that secondary school teachers will be amongst the readers, because teaching problem-solving on a formal basis in schools on a preventative basis might be the most powerful way of applying the method. An ounce of prevention could be worth several tons of cure. VlCKY RIPPERE
BOOK C.
R.
PFEFFER: The Suicidal
REVIEWS
Child. The Guilford Press, New York (1986). xviii + 318 pages. f24.95.
Suicide in children is fortunately rare, occurring in less than one in 100,000 in those aged fourteen and under. Though this absolute figure is low, it still accounts for a significant proportion of deaths in that age group. There is some evidence that rates are increasing at least in the U.S.A. The impact caused by the suicide of the child is overwhelming not only on its family, but on peers, teachers and other professionals. This book is written by a clinician who is able to combine her experience of assessing and treating suicidal children with a wide range of knowledge of the scientific literature. There are four sections: Epidemiology, Risk Factors, Assessment, and Intervention. The chapters widen out to include an overview of depression in childhood and of the child’s concept of death. The author’s main therapeutic interests are psychodynamic, and emphasis is given to the central role of the focussed psychotherapy. She readily admits however that there has been very little systematic work on the efficacy of any particular form of treatment and discusses the probable usefulness of cognitive therapy and medication. The main message that comes across, however, is the need to take seriously any suicidal threat by a child or adolescent. It seems likely that responding positively to that threat is, in itself, the most potent form of intervention. This is a careful, sober book dealing with a grim and easily sensationalized topic. It is only very recently that real attempts have been made to identify depressive disorders in children. There is no doubt that they exist and that they carry a real risk of suicide. There is a very great need for further work and in particular on the indications for different treatment approaches. This is a very useful introduction to the topic and should help clinicians become aware of the importance of depression and of suicidal threats in the young. STEPHENWOLKIND
S. SLOAN
and C.
COOPER: Pilots
Under Stress.
Routledge & Kegan Paul, London (1986). x + 230 pages. f20.00.
The year in which this book was written, 1985, was “a bad year for aviation”. Nearly 2000 people died in flying accidents and the figure for 1987 was even larger. Despite these tragedies, air travel remains less dangerous than motor travel. Nevertheless, aircraft accidents are particularly distressing, in part no doubt because of the simultaneous loss of so many lives. According to Sloan and Cooper, 45% of flying accidents “may well be attributed to pilot error”, and that figure alone would justify an extremely careful study of the training and performance of airline pilots. This study of 442 pilots follows the style of their earlier work on people in other occupations, and is organizational in approach. Almost all of the information was collected by questionnaire. They obtained personal data from the pilots, assessed their attitudes towards the job. and asked about the stresses which they encounter. The major findings are reassuring and show that the great majority of pilots are well-adjusted and highly motivated. Most of them enjoy their flying, and the stresses which they experience are those which are familiar in other occupations. They consist of clashes with colleagues, dissatisfaction with career prospects, inconvenient rosters, and so forth. The selection and training of the pilots meet the highest standards, and Sloan and Cooper found little evidence of serious personal difficulties. However. in view of the potential dangers, the airlines have sensibly introduced stress management programmes, and it is to be hoped that these will be evaluated rigorously. It is possible that this reassuring report gives too rosy an account. The 442 pilots who responded to the questionnaire comprise less than half of the 1000 who were approached, and these in turn were selected from a total sample of nearly 6000 pilots. The representativeness of the study sample is not known. The heavy reliance on a questionnaire raises the usual questions about the validity of the information which they collected. In the section dealing with use and abuse of alcohol, for example, the figures are so low as to introduce doubts about its accuracy. Their review of the literature is disappointing, and no attempt is made to link what scanty information is available on civilian pilots to the extensive literature on military pilots. In their discussion of the problem of mental ill-health among the pilots, which does not probe deeply, they were able to conclude that, “the results for anxiety and overall mental ill-health were especially clear though all were statistically quite sound,” (p. 101). I suspect that this is a familiar but unspoken paradox.
BOB KNGHT: Psychotherapy
with Older Adults.
Sage, Beverley Hills (1986). 192 pages f27.50.
This book consists of a comprehensive account of the knowledge that a psychologist needs to work with the elderly. The author presents the material clearly and the topics include psychotherapy, psychiatry and family work. 535
536
BOOK REVIEWS
The book starts off by examining how the effect of ageing and cohort differences affect therapy with elderly patients. Against the background of slowing in ageing and in a higher incidence of physical illness. the author argues tha: interiority (i.e. more introspective outlook and increasing concern with the meaning of one’s life) is an asset in effecting change. He goes through therapies of different theoretical frameworks and cites a string of therapists to combat the ageist remark that the cognitive structure of elderly people is too rigid to permit change. The chapters. ‘Major Topics in Therapy with the Elderly’ and ‘Major Themes in Therapy with the Aged’, are particularly useful. As well as presenting useful information from literature reviews, the author describes succinctly his own experience through the case examples. The suggested reading list is particularly useful for readers who want to pursue a certain topic further. The chapter on transference and countertransference shows how sensitive the therapist has to be because of the longer life history and hence more diverse relationships the patient has had. He goes on to discuss working in the patient’s home and what sort of problems it might cause in the patient-therapist relationship. 1recommend this book to anyone interested in working with the elderly, partly because of the content and partly because the author presents the case for doing psychotherapy with the elderly with realism and enthusiasm. Unfortunately the price may deter many interested readers from acquiring the book. DOMINIC
M. 0. CAKRUBAand J. E. BLUNDELL (Eds): Pharmacology of Eating Disorders-Theoretical Raven Press, New York (1986). ix f I78 pages. 836.50.
LAY
and Clinical Developments.
The stated objective of this book is to emphasize the interrelationships between eating behaviour, body weight regulation and neurochemistry, as adjustment to any one system may produce reverberations in the others. The span of the book is wide-ranging from molecular and receptor organisation detailed in chapters by Carruba and Nicoliades. progressing onto the behavioural pharmacology of animals in chapters by Liebowitz. Blundell and Morley, finally discussine atypical eating in man in chapters on obesity (Stunkard), “carbohydrate snackers” (Wurtman), afTective disorders (Silverstone) and anorexia and bulimia nervosa (Russell). One of the intriguing things about this book is the numerous biank spaces within the text of some chapters. The work of the censor? Or perhaps a form of self-evaluation-are you concentrating properly? Unfortunately, the most likely reason is poor production resulting from the rapid assemblage of these papers following the conference upon which this book was based. Despite this caveat. this book fulfills its promise and bridges the hierarchical systems which control eating. It should prove of use to all who are involved in the management of patients with eating disorders as the therapeutic purists are being supplanted by those who are more willing to mix their technique to match the patient. JASET TREASURE
THOMAS J. D'Z~RILLA: Prubfem-Sof~~ng Therapy-A York (1986). x + 246 pages. S26.95.
Social Cornpetenre Approach to Ci~nfcal intemention. Springer, New
Problem-solving therapy is one of the treatments which has developed since the late 1960s with the aim of increasing clients’ social competence. The aim is to help them eliminate dysfunctional symptoms by providing them with the wherewithal to cope with the everyday problems their failure to cope with which produces the symptoms, rather than by simply trying to get them to unlearn the symptoms. D’Zurilla’s account of the origins of this treatment approach and the state of the art will thus be of interest to many practitioners, whether they work in clinical or educational settings. Clients with problems are extremely abundant. The book has two main parts. The first covers the historical development of the problem-solving approach to treatment, an extended definition and annotation of social problems and the five major components involved in their solution, the author’s prescriptive model of social problem-solving. an illuminating discussion of the role of emotions in social problem-solving, and a consideration of the reIationship between ability to cope and social adjustment. Part Two describes assessment of clients for problem-solving therapy, clinical applications on both an individual and a group basis, and gives case studies and an extensive review of outcome studies. Appendices include a Problem-Solving Inventory for assessing clients and a self-monitoring form. The provision of these materials, the book’s great clarity, sensibleness and practical orientation, and the potentially wide applicability of the approach seem likely to facilitate the dissemination of problem-solving therapy to other client groups and settings. It is to be hoped that secondary school teachers will be amongst the readers, because teaching problem-solving on a formal basis in schools on a preventative basis might be the most powerful way of applying the method. An ounce of prevention could be worth several tons of cure. VlCKY RIPPERE