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Video in Mental Health Practice and Activities Handbook.
BOOK REVIEWS
blind studies, to the relative exclusion of the author's own wisdom and personal experience. The editors are explicitly critical of DSM-III. Dr. Gibbs describes DSM-III as "the failure of the medical model." Some of the chapters refer to DSM-III or to the classification devised by the Group for the Advancement of Psychiatry, without mentioning DSMIII at all. At least one chapter, "Psychophysiological Disorders in Childhood," misquotes DSM-III. Perhaps the author of that chapter was relying on a prepublication draft of the diagnostic manual. Although this criticism and avoidance of DSM-III may be informative and interesting, it limits the value of the book for most child psychiatrists and trainees, who learn to live with DSM-III for much of their work. The nonmedical perspective in this book is quite usefully expressed in the chapter on "Environmental Correlates of Mental Retardation," by Robert Bradley, Ph.D., and Lisa Tedesco, Ph.D. These authors chose not to consider at all the medical, neurological, or genetic aspects of mental retardation, but have focused successfully on the effects of the home environment on the development of intelligence. Although the authors have adequately defined the role of environmental processes in mental retardation, they fall short of achieving "an integrated view of current knowledge of child psychopathology." A major problem with Psychopathology in Childhood is the proofreading. There is some kind of grammatical or typographical error on virtually every page. One of the tables in the chapter on family therapy is almost incomprehensible because the rows of type are not aligned. The Subject Index is not very useful since it is only 2lf2 pages long. I had high hopes for the Author Index since it lists some 1800 names. However, I discovered that most of the page references in the Author Index are erroneous! Apparently the index is based on some earlier version of the book, with a different pagination. Psychopathology in Childhood does have several excellent chapters. However, the book has many weaknesses which limits its usefulness for child psychiatrists.
Video in Mental Health Practice and Activities Handbook. By Ira Heilveil, Ph.D. New York: Springer Publishing, 1983, 222 pp., price $17.95. Reviewed by Anthony D. Meyer, M.D. * This is a practical guide for therapists and supervisors who use video techniques as another dimension in their work with patients and students. The range of techniques and suggestions covers individual, group • Dr. Meyer is Director, Division of Child and Adolescent Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin.
243
and family therapy with adults, children, and adolescents. There is also a section on special populations, such as suicidal patients and anorectics. The author also gives an overview of special applications of television technology for special effects and emphasis. Overall, the author has focused on strategies and confrontations within the continuum of therapy with an emphasis on data gathering and confrontation. The use of serial-taped sessions can also provide a vehicle for the patient's and therapist's view of treatment progress, or lack of it. There is also a warning of the danger of focusing too much on the techniques and the promotion of resistance. Though emotion is somewhat flattened by the video image and the recorder may appear "gimmicky," the therapist needs to always keep in mind that it is nothing more than a tool, which can be skillfully used to aid in the treatment process. Though the technique may "enable the client to cut through the layers of denial," the patient is free to "deny the intent of the behavior." Hence, though it is helpful, it is not seen as the magic instrument for bulldozing all denial. Among the reasons for its apparent effectiveness is the ability of the patient to "recognize unconscious identifications with parents, spouses, or siblings during video confrontation." The author does leave out a valuable reason for the effectiveness of video, namely, the therapist's expectations. To enhance individual psychotherapy, the videotaped confrontation allows both patient and therapist to view their nonverbal cues. Not only can this enhance self-awareness, but resistances to self-awareness can be explored. Training techniques, such as job interview scenarios, may prove helpful for some patients. Scenarios may also be devised for vicarious desensitization, that is, constructing scenes that are presented in order from the least to the most anxietyprovoking. In the section devoted to individual child psychotherapy, various techniques are presented. Unless the derived material goes beyond observed behavior to deal with the meaning of the behavior, however, it may be limited only to confrontation and behavior entrainment without the necessary step of interpretation and subsequent adaptation and internalization. Nonetheless, it is useful. One of Heilveil's own patients, a schizophrenic, nonverbal girl, was able to begin to feel in control and verbalize vis-a-vis the television equipment. Video may also enhance the mutual story-telling technique developed by Gardner, which the author carries one step further by attempting to engage the child in affect-laden stories, such as "you're a detective and you're trying to solve the world's biggest mystery." There is brief mention of the use of video games as an extension of therapeutic game play, with a warning
244
BOOK REVIEWS
about the use of the video game as a form of resistance for both patient and therapist. In group therapy, video provides a way to repeatedly confront patients to "identify patterns of manipulative, self-defeating, hOb\;ile or withdrawing behavior." There are practical suggestions devised to help the clinician structure the use of television for more effective confrontation. All forms of group therapy are discussed. The author includes a wide variety of uses of television in conducting family therapy, with the emphasis on process of family interactions. The section on training and supervision provides a sound rationale and useful suggestions spanning inservice training for large groups to "micro-counseling." The latter focuses on highly specific psychotherapy skills. Simulation tapes are also described so that techniques are developed which give the supervisor or teacher an opportunity to develop a curriculum. The book concludes with a view of special populations, including the suicidal patient, seizure disorders, alcoholics, anorexia nervosa patients, Tourette's syndrome, assertion training, parent training, and sex therapy and helpful suggestions are provided for using specific television techniques. Finally, the appendix provides a wide variety of resources for script, educational television, specific videotapes in the mental health field, and material for providing information to parents in guiding their children's television viewing. In all, Heilveil has produced a useful overview and reference book on video for the practitioner and teacher.
The Child and Television Drama: The Psychosocial Impact of Cumulative Viewing, Formulated by the Committee on Social Issues, Group for the Advancement of Psychiatry. New York, Mental Health Material Center, 1982, 124 pp., price: $13.75. Reviewed by Anthony D. Meyer, M.D. While there has been much speculation about the harmful effects of television, this report presents a concise, thorough review of the implications of cumulative viewing for children and adolescents based on current, available studies. There is knowledgeable speculation about the interface of child/adolescent ego development and the impact of television. The book poses emergent, research questions and raises related issues. Though television is a potentially positive medium for bringing the outside world to people, for cultural enrichment, and as an opportunity to share events and knowledge, the authors' view oftelevision's impact on children is essentially negative. Highlights from the study include a description of
the profit-motive 10 programming, which is in fact paramount. Children with family troubles and unstable peer relationships will often become heavy viewers. They tend to turn away from more active and developmentally appropriate solutions to their problems. Television is then seen as a substitute for the intimacy and engagement of a nurturing parent/child relationship. The process of identification is consequently affected. The authors emphasize the different influences at various developmental levels. For example, the toddler may use television as a transitional object. Cartoons have a special appeal to preschoolers. Prolonged television viewing for the adolescent engenders isolation and may be used to avoid appropriate separation from the family and building intimacy with others. A very key issue is the merger of fantasy and reality which television portrays. The flat, quick-fix solutions to problems foster disillusionment in children when they discover that real life is not what television has made it appear to be. There has been concern about television's promotion of passivity. However, some of the studies suggest that passivity in a child leads to heavy viewing rather than the opposite. It is clear that the immediate, passive gratification provided by television may create problems for some children. Conflict is central to drama, but conflict does not always equal violence. Conflict is unfortunately oversimplified by television, reduced to good or bad or right or wrong. There is no promotion of the mature aspects of uncertainty and doubt. The resolution of conflict is heavily action-oriented; there is a dearth of thinking, feeling, and talking things out. This leads into the obvious effects of violence. A great number of studies note that children manifest greater aggressiveness after viewing televised violence. Television portrayals of violence tend to desensitize people to its effects and break down inhibitions against such behavior. The study points out television stereotypes in people that reflect simplistically and badly on men, women, minorities, feelings, and character traits. The ultimate consequence of such stereotyping is a kind of dehumanization that underscores a tendency to project blame and fault. Though emphasizing the negative effects, the book leaves one with an optimistic note, giving parents and professionals guidelines and recommendations. The guidelines provide a solid rationale. Clearly, it is up to mental health leadership to stimulate continued interest and guidance to parents and educators on issues of television viewing. This book is a valuable resource and guide book for anyone concerned about children and television. It leaves one wondering whether tele-
blind studies, to the relative exclusion of the author's own wisdom and personal experience. The editors are explicitly critical of DSM-III. Dr. Gibbs describes DSM-III as "the failure of the medical model." Some of the chapters refer to DSM-III or to the classification devised by the Group for the Advancement of Psychiatry, without mentioning DSMIII at all. At least one chapter, "Psychophysiological Disorders in Childhood," misquotes DSM-III. Perhaps the author of that chapter was relying on a prepublication draft of the diagnostic manual. Although this criticism and avoidance of DSM-III may be informative and interesting, it limits the value of the book for most child psychiatrists and trainees, who learn to live with DSM-III for much of their work. The nonmedical perspective in this book is quite usefully expressed in the chapter on "Environmental Correlates of Mental Retardation," by Robert Bradley, Ph.D., and Lisa Tedesco, Ph.D. These authors chose not to consider at all the medical, neurological, or genetic aspects of mental retardation, but have focused successfully on the effects of the home environment on the development of intelligence. Although the authors have adequately defined the role of environmental processes in mental retardation, they fall short of achieving "an integrated view of current knowledge of child psychopathology." A major problem with Psychopathology in Childhood is the proofreading. There is some kind of grammatical or typographical error on virtually every page. One of the tables in the chapter on family therapy is almost incomprehensible because the rows of type are not aligned. The Subject Index is not very useful since it is only 2lf2 pages long. I had high hopes for the Author Index since it lists some 1800 names. However, I discovered that most of the page references in the Author Index are erroneous! Apparently the index is based on some earlier version of the book, with a different pagination. Psychopathology in Childhood does have several excellent chapters. However, the book has many weaknesses which limits its usefulness for child psychiatrists.
Video in Mental Health Practice and Activities Handbook. By Ira Heilveil, Ph.D. New York: Springer Publishing, 1983, 222 pp., price $17.95. Reviewed by Anthony D. Meyer, M.D. * This is a practical guide for therapists and supervisors who use video techniques as another dimension in their work with patients and students. The range of techniques and suggestions covers individual, group • Dr. Meyer is Director, Division of Child and Adolescent Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin.
243
and family therapy with adults, children, and adolescents. There is also a section on special populations, such as suicidal patients and anorectics. The author also gives an overview of special applications of television technology for special effects and emphasis. Overall, the author has focused on strategies and confrontations within the continuum of therapy with an emphasis on data gathering and confrontation. The use of serial-taped sessions can also provide a vehicle for the patient's and therapist's view of treatment progress, or lack of it. There is also a warning of the danger of focusing too much on the techniques and the promotion of resistance. Though emotion is somewhat flattened by the video image and the recorder may appear "gimmicky," the therapist needs to always keep in mind that it is nothing more than a tool, which can be skillfully used to aid in the treatment process. Though the technique may "enable the client to cut through the layers of denial," the patient is free to "deny the intent of the behavior." Hence, though it is helpful, it is not seen as the magic instrument for bulldozing all denial. Among the reasons for its apparent effectiveness is the ability of the patient to "recognize unconscious identifications with parents, spouses, or siblings during video confrontation." The author does leave out a valuable reason for the effectiveness of video, namely, the therapist's expectations. To enhance individual psychotherapy, the videotaped confrontation allows both patient and therapist to view their nonverbal cues. Not only can this enhance self-awareness, but resistances to self-awareness can be explored. Training techniques, such as job interview scenarios, may prove helpful for some patients. Scenarios may also be devised for vicarious desensitization, that is, constructing scenes that are presented in order from the least to the most anxietyprovoking. In the section devoted to individual child psychotherapy, various techniques are presented. Unless the derived material goes beyond observed behavior to deal with the meaning of the behavior, however, it may be limited only to confrontation and behavior entrainment without the necessary step of interpretation and subsequent adaptation and internalization. Nonetheless, it is useful. One of Heilveil's own patients, a schizophrenic, nonverbal girl, was able to begin to feel in control and verbalize vis-a-vis the television equipment. Video may also enhance the mutual story-telling technique developed by Gardner, which the author carries one step further by attempting to engage the child in affect-laden stories, such as "you're a detective and you're trying to solve the world's biggest mystery." There is brief mention of the use of video games as an extension of therapeutic game play, with a warning
244
BOOK REVIEWS
about the use of the video game as a form of resistance for both patient and therapist. In group therapy, video provides a way to repeatedly confront patients to "identify patterns of manipulative, self-defeating, hOb\;ile or withdrawing behavior." There are practical suggestions devised to help the clinician structure the use of television for more effective confrontation. All forms of group therapy are discussed. The author includes a wide variety of uses of television in conducting family therapy, with the emphasis on process of family interactions. The section on training and supervision provides a sound rationale and useful suggestions spanning inservice training for large groups to "micro-counseling." The latter focuses on highly specific psychotherapy skills. Simulation tapes are also described so that techniques are developed which give the supervisor or teacher an opportunity to develop a curriculum. The book concludes with a view of special populations, including the suicidal patient, seizure disorders, alcoholics, anorexia nervosa patients, Tourette's syndrome, assertion training, parent training, and sex therapy and helpful suggestions are provided for using specific television techniques. Finally, the appendix provides a wide variety of resources for script, educational television, specific videotapes in the mental health field, and material for providing information to parents in guiding their children's television viewing. In all, Heilveil has produced a useful overview and reference book on video for the practitioner and teacher.
The Child and Television Drama: The Psychosocial Impact of Cumulative Viewing, Formulated by the Committee on Social Issues, Group for the Advancement of Psychiatry. New York, Mental Health Material Center, 1982, 124 pp., price: $13.75. Reviewed by Anthony D. Meyer, M.D. While there has been much speculation about the harmful effects of television, this report presents a concise, thorough review of the implications of cumulative viewing for children and adolescents based on current, available studies. There is knowledgeable speculation about the interface of child/adolescent ego development and the impact of television. The book poses emergent, research questions and raises related issues. Though television is a potentially positive medium for bringing the outside world to people, for cultural enrichment, and as an opportunity to share events and knowledge, the authors' view oftelevision's impact on children is essentially negative. Highlights from the study include a description of
the profit-motive 10 programming, which is in fact paramount. Children with family troubles and unstable peer relationships will often become heavy viewers. They tend to turn away from more active and developmentally appropriate solutions to their problems. Television is then seen as a substitute for the intimacy and engagement of a nurturing parent/child relationship. The process of identification is consequently affected. The authors emphasize the different influences at various developmental levels. For example, the toddler may use television as a transitional object. Cartoons have a special appeal to preschoolers. Prolonged television viewing for the adolescent engenders isolation and may be used to avoid appropriate separation from the family and building intimacy with others. A very key issue is the merger of fantasy and reality which television portrays. The flat, quick-fix solutions to problems foster disillusionment in children when they discover that real life is not what television has made it appear to be. There has been concern about television's promotion of passivity. However, some of the studies suggest that passivity in a child leads to heavy viewing rather than the opposite. It is clear that the immediate, passive gratification provided by television may create problems for some children. Conflict is central to drama, but conflict does not always equal violence. Conflict is unfortunately oversimplified by television, reduced to good or bad or right or wrong. There is no promotion of the mature aspects of uncertainty and doubt. The resolution of conflict is heavily action-oriented; there is a dearth of thinking, feeling, and talking things out. This leads into the obvious effects of violence. A great number of studies note that children manifest greater aggressiveness after viewing televised violence. Television portrayals of violence tend to desensitize people to its effects and break down inhibitions against such behavior. The study points out television stereotypes in people that reflect simplistically and badly on men, women, minorities, feelings, and character traits. The ultimate consequence of such stereotyping is a kind of dehumanization that underscores a tendency to project blame and fault. Though emphasizing the negative effects, the book leaves one with an optimistic note, giving parents and professionals guidelines and recommendations. The guidelines provide a solid rationale. Clearly, it is up to mental health leadership to stimulate continued interest and guidance to parents and educators on issues of television viewing. This book is a valuable resource and guide book for anyone concerned about children and television. It leaves one wondering whether tele-