Book Review: Burgo on Defences

Burgo, J (2012) Why Do I Do That: Psychological Defense Mechanisms and the Hidden Ways They Shape Our Lives. Chapel Hill, NC: New Rise Press.

Joseph Burgo, psychotherapist and expert blogger, has written a readable, informative, and above all, useful account of our psychological defences - the lies we tell ourselves to avoid emotional pain. He has a gift - you can see it in his blog - to engage with the reader and tranform complex psychological phenomena into understandable and recognisable everyday human processes. This is a good trait in a psychotherapist. In a writer it means the insights of psychoanalysis are available to the reader and he or she can use the book's contents and exercises to begin some self-analysis. The book has helped me to understand the unhelpful ways I protect myself from emotional pain and the costs involved. It offers the possibility of choice - more enriching ways of relating and being in the world, ways that are more in touch with reality.

The defence mechanisms are unconscious and repeating patterns that keep our experience of self and others predictable and safe. Burgo writes about denial, splitting, idealisation and projection as means by which pain is avoided and distressing reality kept at bay through dissociation or by locating it elsewhere, particularly in others.

The book begins with a quiz inviting the reader to explore their own psychological make up and the defences that might accompany the different ways of being. After each chapter there are exercises to help the reader identify how each defence might be being deployed in his or her life. I have found it useful to keep a journal whilst reading the book, for my observations and as a place to do the exercises. As a result I have discovered interesting things about my own defences and learnt to be even more curious about the defences employed by my clients. Like Burgo I believe defences are a part of everyday life, to be expected, even appreciated, after all their intention is a positive one: learnt at times of great stress to keep us functioning; but at a cost and ultimately defences get in the way of seeing and engaging with the world as it really is.

So I can happily recommend Joe Burgo's book, without, I hope, idealising either the book or Joe!

A New NLP Book is Published

Looks like there's a new NLP book out. Stan Rockwell has reviewed the recently published, NLP: The Essential Guide to Neuro Linguistic Programming at the @PsychCentral blog. You can read the review here. I trotted along to Amazon.co.uk and found the book on sale for £7.58, which is pretty good value for a 464 page book. Conveniently I only remembered my self-imposed moratorium on book purchases after the thing was bought and leaving the Amazon depot.

Rockwell gives a pretty positive review; he does comment on the amount of jargon filling the pages and that can't be denied; but he he goes on to say that he's been using the techniques described in the book and doing the exercises and they've been working for him. My criticism here is that yet again we have a book re-packaging NLP as an easy guide. 

What we actually need is someone developing new models, researching the effectiveness of what we already have or applying NLP in new and interesting contexts - as my friend and colleague Chris Mitchell does in her excellent Behaviour Management Toolkit reviewed by me here. I seem to remember John Grinder, one of the co-founders of NLP, talking in a YouTube clip of the need to 'replenish the well'. It's a good metaphor, as you would expect from Grinder, because of course if everyone draws water and the well is not replenished then eventually the well runs dry.

I've been having a fun time with NLP at the moment. I'm teaching the principles of NLP and drawing on my experience of using NLP as a therapist to groups of psychology students at the college where I work. Teaching this stuff has really helped me reach an even better understanding of NLP. In particular I'm really appreciating the 'explanatory power' of the approach when, for example, the class and I explore the psychology of negative emotional states - often called 'disorders' - though 'differently ordered' might be a better term; and I'm appreciating the creativity of NLP and the strengths based approach to therapeutic work: helping clients to access resources and creating choice about how they'd like to feel.

Chris Parry-Mitchell and The Behaviour Management Toolkit

I have been good friends with Chris Mitchell for a while now and this week had the pleasure of her company over coffee and a cup of tea in Blackburn's nicest cafe, The Coffee Exchange. It was great to see her again, happy and healthy. It was a great chance to catch up, and for me to talk at length about David Allen's book, Getting Things Done, and my personal quest to improve workflow and productivity. Not only did Chris stay awake during this (and she was drinking tea, not coffee) but she listened and gave good advice and inspired me to make changes; but what else would one expect from the author of The Behaviour Management Toolkit? 

I have to declare an interest at this stage, because not only is Chris a friend of mine, but we also share a common perspective on working with people and have similar training, often with the same Neuro Linguisitc Programming (NLP) practitioners and trainers. Indeed there are many similarities between Chris's work on avoiding exclusion from school and the Proactive Carer Programme I developed and delivered with my friend, Adam Gibson of Lancashire Counselling Services. Both draw on NLP and Transactional Analysis and both share a common ethos, the fundamental principle that if you help people develop resources they will have more choices and their behaviour and circumstances will change in positive ways. There are other shared principles: the power of groups and group work and the need for passionate and committed leadership that encourages and equips individuals with the knowledge and skills to make small but significant changes. I often use a metaphor that someone gifted to me, that if you sail from Portsmouth to New York and you're one degree out at the beginning of your voyage, you'll be in a different country by the time you've crossed the Atlantic. Fine if you don't mind landing in Canada, but you get the idea: small changes over time yield significant results.

So what's in The Behaviour Management Toolkit and how useful might it be to teachers and trainers working with young people at the point of being excluded from mainstream education? It's a ten session programme, with all the handouts and worksheets on a CD-ROM taped to the back page. It aims to equip young people with the insight and skills needed to make different decisions, change their behaviour and get better outcomes. Almost 300 children have been through the programme run by Chris in Preston, Lancashire, and  more than 80% of those have remained in education. Now this could be the programme, it could be the expertise of Chris and her two colleagues, John and 'Swifty' (Andrew 'Swifty' Swift is an old student of mine, but I take no credit for the excellent practitioner he has become). More likely it's a combination of these factors as well as the potential all young people have to seize an opportunity to change when they are given the chance by adults who appreciate their struggles and care about their futures!

The Behaviour Management Toolkit applies some classic NLP patterns: the Mercedes Model, submodality shifts and an extremely effective perceptual positions exercise to educate group members about their own thoughts and feelings, the impact of their behaviour on others and why that matters. It uses ideas from TA (warm fuzzies, cold pricklies, the Drama Triangle and game playing) to help young people understand and take responsibility for how they communicate. Each session begins with participants identifying and sharing their achievements that week, creating positive feelings, generating positive feedback and helping to change internal filters so a young person starts to notice what's going well in their lives and not just what's going badly. The whole programme is well put together, so each session builds on the previous  one and models learnt early in the programme are reapplied later on. Chris says she responded to feedback  from her young participants, making changes and increasing the programme's relevance and effectiveness. I think it's a superb piece of work, but the ultimate test is, does it work? Well, the statistics and the participants' feedback says it does; and whenever I've visited the project I've noticed an atmosphere that's warm and safe and purposeful, and the young people I've met there are full of praise for Chris and her team.

I hope practitioners working with hurt young people and their sometimes challenging behaviour make use of the Toolkit. In a previous career I delivered offender programmes for the National Probation Service. These were based on the principles of Cognitive Behaviour Therapy, an approach I much admire, but which, in that context, lacked the optimism and the humanistic underpinning found in The Behaviour Management Toolkit. I use it when teaching NLP based interventions to students on the BA (Hons) degree Working with Children and Young People at The University Centre at Blackburn College, a course that 'Swifty' graduated from several years ago! Congratulations to Chris Mitchell and her team, changing lives and living your mission!

Book Review: Psychoanalysis: The Impossible Profession by Janet Malcolm

I recently spotted a tweet from my Twitter pal @RuthNinaWelsh saying she'd just bought Janet Malcolm's book, Psychoanalysis: The Impossible Profession. Before I knew it the very same book was in my Amazon basket, along with another by Malcolm, In the Freud Archives, my next big read. I've a weakness for pretty dust jackets and books about psychotherapy and with the help of Amazon I've been able to fill two rooms at my house and office. The Marsden Therapy library! It will certainly fill a large skip when I'm dead and gone.

Janet Malcolm's book fooled me a little. This latest edition was published in 2012, but the book was first published in 1981. Very dated then. It started as an article in The New Yorker, where Malcolm has been a contributor since 1963, and it's been expanded to 168 pages with detours into Freudian theory and practice. 

At the heart of the book is an extended interview with psychoanalyst "Aaron Green", a 'forty-six-year-old psychoanalyst who practices in Manhattan in the East Nineties' (3). The book is fascinating when it describes the views and experiences of Green, this 'slight man, with a vivid, impatient, unsmiling face' (3). 

To increase the word count (I suspect) the opinions of Green become departure points for fairly esoteric discussions of Freudian theory and technique (transference, analyzability) and the competing revisions of post-Freudians. In the face of all these revisions Green remains completely loyal to Freud's original conception of psychoanalysis, articulated for Green by his contemporary, Charles Brenner. 

The first chapter of the book is something of a potted history of Freud's discoveries, but after that the book becomes much more interesting. The interview with Green casts light on the politics of the New York Psychoanalytic Institute, the eccentricities of the New York Psychoanalytic Society, the manoeuvres and bids for power and status of America's leading analysts in the '70s and '80s. There are insights too - on therapy, on Freud and on human nature - so I'm looking forward to reading my other Malcolm purchase, In the Freud Archive, about Jeffrey Masson, who did us all a great service as the editor of the Freud-Fliess letters and then did a hatchet job on Freudian studies and the field of psychotherapy with his two books, The Assault on Truth and  Against Therapy

Janet Malcolm, Psychoanalysis: The Impossible Profession, London, Granta. Available from Amazon

Taming the Black Dog

A friend and counselling colleague gave me a copy of Taming the Black Dog. I'm often on the look out for self-help books I can recommend to my clients. Something to replace the classic by Susan Jeffers: Feel the Fear and Do it Anyway. Published in 2004 and written by Patrick Ellverton, Taming the Black Dog is a guide to beating depression, the Black Dog of the title.

Ellverton's book does contain a lot of good advice about healthier eating, exercise and the benefits of keeping a daily log. Ellverton recommends finding a mentor and writes admiringly  about his own source of  inspiration, Winston Churchill. There's advice on creating a daily regime of walking and prayer (or meditation) to 'restore the balance' and keep the black dog at bay. There's also advice on alcohol misuse whilst another section contains a twenty minute exercise routine. The guidance I personally found most useful was the recommendation to spend time in the evening planning the next day's tasks.

Ellverton's advice is rooted in a lifetime of coping with depression. Ellverton was an army officer and this too is reflected in his book. You can see from the description I've given that the book has a 'pull yourself up by the bootstraps' quality. He eschews counselling as tending to do more harm than good, though he offers a counselling service on his website.

I suspect Ellverton sees counselling as backward looking - a fruitless examination of unhappy past experiences likely to make depression worse. It's certainly true that rumination is a big part of depression and in my work as a counsellor I don't encourage clients to constantly dwell on their misery. I seek to acknowledge distressing memories and current unhappiness but recognise too the client's heroic side and the possibility of change.

Ellverton sees medication as a way of managing the symptoms of depression in the short-term whilst the depressed person makes changes to his or her thinking, behaviour and lifestyle. I have sympathy with that view and the need for lifestyle changes.

So Ellverton advocates a set of new habits: walking, exercise, playing a musical instrument, prayer, healthy eating and sobriety 'to keep the black dog in its kennel'. Anyone who likes this approach and can follow his prescription will find Ellverton's book helpful - replacing the behaviours that maintain depression with new behaviours that promote good mental health. The only problem is that depression tends to take away the motivation and will power needed to  make these changes. If that's the case for you then maybe some kind of therapy might be helpful.

Taming the Black Dog is available on Amazon here 

Thank You Lenny!

Every now and again I need a break, even from the things about which I'm passionate. So last week I stopped reading about psychotherapy and mental health and took 'time out' to read Humphrey Burton's biography of the American composer, concert pianist and conductor, Leonard Bernstein. What a great man! What a great life! Wikipedia provides a summary of Bernstein's achievements here and you can see and hear him conducting some of the symphonies of Mahler at my Scoop.it page here. 

Burton's biography is a fairly satisfying read that catalogues Bernstein's conducting and composing; his  friendships and sexual relationships, with men and women; his political activities, fund raising, teaching and broadcasting. Bernstein was so talented that he risked dissipating his powers on numerous different  projects. His mentors, including the composer Aaron Copland and the conductor Dimitri Mitropoulos, pushed him towards conducting and indeed he was a fabulous conductor, one of the greats. His interpretations of Mahler are wonderful, possibly because he identified so closely with the man, another conductor/composer. But at the end of his life Bernstein wished he had spent more time composing. Bernstein's works include several Broadway hits, including West Side Story; a couple of operas, three symphonies and, a favourite of mine, the delightful operetta, Candide.

Bernstein's father reluctantly paid for Lenny's piano lessons and reluctantly paid also for Lenny to study music at Harvard. When quizzed about this later in life he would say, "How did I know my son was going to become Leonard Bernstein?" Leonard Bernstein was a handsome young man and had numerous relationships with men and women before eventually marrying the Chilean actress Felicia Cohn Montealegre. In 1976 and feeling he could no longer suppress his sexuality Bernstein left his wife and committed himself to a gay relationship. He was returning to his marriage when Felicia was diagnosed with cancer, she died in 1978. When she died Bernstein was heartbroken and never recovered from his loss. He was, however, able to live more openly as a gay man. He enjoyed the company of young men, surrounding himself with young students and musicians in thrall to the maestro.

Burton suggests that Bernstein became more rebellious, maybe even coarse after his wife's death. It did his reputation no harm and may have added to the Bernstein mythology. Bernstein was a compulsive smoker - at rehearsals he would on occasion conduct the orchestra with a cigarette! It killed him in the end, in 1990, aged 72. I was saddened then overwhelmed by emotion as I turned the page and saw the picture there of Bernstein on a New York street waving at the camera, a smile on his handsome face. A complex man who left behind so much wonderful music. Thank you Lenny!

The Courage to Create

In a break from marking essays I have just finished reading The Courage to Create, a short and delightful book by the existential psychotherapist Rollo May. I was motivated to read more of Rollo May by the video I watched and reviewed here. This deeply humane and thoughtful book was a nice antidote to the last book I finished, by the much more combative Thomas Szasz.

Rollo May's book is about the creative process. A painter himself, he draws many of his illustrations from the visual arts as well as science and psychotherapy. The title comes from May's belief that creativity is a courageous act: the discovery of 'new forms, new symbols, new patterns' challenges conformity within society, and the creative genius is often punished for it.

May writes a lovely chapter on creativity and the unconscious, exploring the experience we have all had in which we apply ourselves to a problem for days only to have the answer come out of our unconscious when we finally put our pen down, have a rest or go for a walk. My old teacher used to say 'leave it to the night shift' and he meant just this, let your unconscious mind work on the problem and it will come up with the answer. May argues that the mind needs the 'relaxation of inner controls for the unaccustomed idea to emerge' (63).

My favourite chapter though is May's meditation on 'creativity and the encounter' in Chapter Four. He argues that great art comes out of the encounter between subject and object, between, for example, the painter and the landscape. He argues that the intensity of that encounter, the passion or commitment involved, determines how great that art will be. It also brings with it anxiety (92).I love this idea of the encounter and I immediately applied it to my work as a psychotherapist. Out of the encounter between therapist and client - or out of the client's encounter with self - out of the intensity of that - come new perceptions, realisations, insights and profound change. And yes, it certainly requires courage!

Book Review: Psychiatry The Science of Lies

Reading this short book by Thomas Szasz is a real challenge. Each chapter contains half-a-dozen spring-loaded boxing gloves, which punch you on the nose as you read. That's what it felt like to have my assumptions and settled ideas about psychiatry and mental health challenged by Szasz. I had expected the attack on psychiatry, but was unprepared for his attack on patients as malingerers or the neo-liberalism that drives his approach to social reform.

The Szasz argument goes something like this: psychiatry is fake and has nothing to do with medicine. Mental illness does not exist, it is conjured into existence when a psychiatrist makes a diagnosis. So in psychiatry disease is the same thing as diagnosis. He suggests there is an unholy alliance between the state and psychiatry. The state has delegated to psychiatry the power to incarcerate individuals guilty of no crime. 

Here is Szasz in his introductory chapter, a passage that sums up his argument:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the "mental patient's' inability to prove his 'psychiatric innocence' makes psychiatry one of the dangers to liberty and responsibility in the modern world (3).

Later Szasz makes clear why psychiatric diagnoses are so damaging: 'Attributing a medical diagnosis to a healthy person does not transform him into a bodily-medically ill person, whereas attributing a psychiatric diagnosis to him does indeed transform him into a mentally-psychiatrically ill person' (15). 

If mental illness does not exist then Szasz must find a reason why so many individuals claim to be mentally ill. Szasz argues that individuals who claim to be mentally ill are in fact malingering. Szasz winds the clock back and shows us the Victorian consulting room. He says the patient arrives believing he or she is ill. The doctor must conclude that the patient is malingering or that he, the doctor, can find no disease. In the face of this unpalatable dilemma a third option emerges: the patient is mentally ill or, in the language of the time, suffering from hysteria: 'Thus arose the modern idea of mental illness, the product of the conflation of having a disease and occupying the sick role (voluntary or involuntary)' (23).

Szasz doesn't explore the 'role' of the patient much more than this. His book tends to get lost in the history of psychiatry and the wickedness of Sigmund Freud. It wages war on a number of unlikely subjects: Kay Redfield Jamison's bi-polar disorder is described as 'an alleged illness'; whilst the author, Lauren Slater, belongs on a 'list of "mad persons" using their madness to build successful careers as celebrity experts on madness' (100). Particular ire is reserved for the psychologist David Rosenhan who tricked the psychiatry establishment into admitting him and his colleagues into a dozen psychiatric hospitals despite having no symptoms of psychosis apart from a pretend 'auditory hallucination' - they told doctors that they repeatedly heard the word 'thud'. Szasz condemns Rosenhan's use of the word pseudo-patient arguing that Rosenhan was actually a real patient with a pseudo mental illness. Szazs thinks that Rosenhan had unwittingly supported the coercive system of mental health care rather than exposing it as prone to error..

If mental illness is a myth then I'm left wondering how Szasz understands the real fear and distress that people experience. There's no indication in this particular book. I see the feelings of distress that individuals experience as an understandable and legitimate reaction to stressful events.I don't see people experiencing psychosis as malingering, but as coping best they can with the circumstances of their lives. I imagine Szasz would say, 'fine' but let's not call it mental illness, and if an individual requires help let it be a be a private arrangement between the client and their chosen mental health professional, which has nothing to do with the state and it's coercive power.

This New American article, Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses, deploys the Szasz arguments against modern psychiatry and its revision of DSM-V. So Szasz is current and worth reading for his radical and alternative viewpoint, but I'm going to turn to his classic works rather than rely on this collection of essays.

Book Review: First Steps in Clinical Supervision

Cassedy, P. (2010) First Steps in Clinical Supervision: a Guide for Healthcare Professionals, Open University Press.

Cassedy has written a useful introduction to clinical supervision for those new to the profession; and I say profession because I'm a strong believer in the notion, put forward, I think, by Hawkins and Shohet, that supervision is a discrete set of skills which properly applied can benefit anybody working in the helping professions. Hence I work with counsellors, but I've also worked with teachers, group facilitators and domestic violence workers.

I'm sure Cassedy would agree with the view that supervision has the ability to build the capacity of skilled helpers in all their many forms. His book is specifically aimed at health care professionals who have been given responsibility for clinical supervision or for health care professionals embarking on supervision training.

The book begins with an introductory chapter, which, like all its friends, begins with a list of learning outcomes, describing what the reader will be able do after reading the chapter. The introductory chapter gives an overview of clinical supervision as a discipline and provides a place to address diverse topics such as the benefits of supervision and the reasons for becoming a supervisor.

Chapter two addresses the first supervision session and chapter three describes the qualities of a healthy supervision relationship. These chapters, like others in the book - on the three functions of supervision and active listening skills - are basic fayre and pretty descriptive, appropriate for practitioners completely new to supervision.

The book has a couple of interesting chapters, even for experienced supervisors. Chapter six applies Heron's Six-Category Intervention Analysis to supervision work. This provides a model for examining the interventions used by a supervisor and a framework for identifying 'degenerative' interventions. Heron's model works so well when applied to supervision that Cassedy's chapter had me returning to Heron's original work.

Cassedy also has a chapter demonstrating how Gerard Egan's Skilled Helper model can be used in supervision. Again, this fits well with the aims of supervision, but turns supervision into a problem solving and cognitive process at the expense, perhaps, of emotional and unconscious material. We can see here differences between clinical supervision and counselling and psychotherapy supervision. From conversations with NHS therapists, clinical supervision in the health service seems to have a strong normative function. The final three chapters of the book are about reflective practice, evaluating supervision and avoiding stress and burnout. So the book covers a lot of ground, breadth rather than depth, and for someone new to supervision it is a good enough starting point.

Circles of Support and Accountability

Hanvey, S., Philpot, T. and Wilson, C. (2011) A Community Based Approach to the Reduction of Sexual Reoffending: Circles of Support and Accountability, London, Jessica Kingsley

This book introduces readers to a new and innovative approach to the management of sexual offenders in the community - Circles of Support and Accountability. It will appeal chiefly to those who have a professional interest in the supervision of sexual offenders; but it also provides a fascinating read for anyone interested in safeguarding children and adults at risk of sexual aggression.

The first Circle was set up in Canada in 1994 to manage a sexual offender released from prison without statutory supervision. In response to community concerns a group of volunteers gathered round the offender to support his rehabilitation, monitor his behaviour and help him to maintain an offence free lifestyle. The experiment was successful and the model was imported into the UK where it has been tested and developed.

The book begins with a history of the Circles approach, rooted in ideas of restorative justice. This is followed by chapters on sexual offending and the criminal justice framework built to manage sexual offenders in the UK. It’s clear that Circles can complement the resettlement work done by statutory agencies, offering emotional support and practical help at a time when offenders are at increased risk of reoffending. The role of the circle’s volunteers is not simply to support the offender; trained and risk aware, they monitor the offender for signs of increasing risk, report any concerns to statutory services and hold accountable the offender’s promise of “No more victims”.

At the heart of the book are two fascinating chapters containing interviews with sexual offenders and volunteers. Both groups describe their life experiences and the benefits that each derives from being part of a circle. The striking difference between the two groups is the amount of trauma experienced in early life by the offenders. The book goes on to evaluate the effectiveness of Circles, with preliminary results suggesting a very positive effect on reoffending rates.

The final chapter criticises the press for demonising sex offenders and strengthening the public’s mistaken perception that sex offenders are ‘monsters’ and ‘strangers’ that our children must simply avoid to stay safe. In fact most sexual offences are committed by trusted family members, friends and neighbours. The book’s positive message is that whilst sexual offending takes place within the community and causes much harm, the community can respond and sexual offenders can be successfully managed by the communities in which they live. The book is a highly readable, informative and welcome addition to the literature on sex offending, safeguarding and public policy.

This book review appeared in Therapy Today (December, 2011)

Book Review: The Heroic Client by Duncan, Miller and Sparks

The Heroic Client is wonderfully polemical – a fearless examination of contemporary medical approaches to mental illness and its treatment. The book targets the pharmaceutical industry and the psychoactive drugs it produces. It attacks the medical model and its tendency to define mental illness reductively in terms of ‘biochemical imbalance”. The authors are sceptical of approaches that stigmatise individuals and reify the causes of mental illness by applying biological models and questionable diagnoses - an approach that turns clients into passive recipients of behavioural treatments and tablets. The authors ask for clients to be cast in a different light - competent, resourceful, and resilient – with the agency and self-efficacy to find solutions and make positive changes.

The book begins with a chapter entitled, “Therapy at the Crossroads”, in which the authors warn of a situation developing in which counsellors and psychotherapists exclusively work for medical practitioners. In these circumstances the medical model becomes the only way of explaining mental illness, with the therapist as an adjunct to medication, a fixer of broken people. In chapter two the authors challenge the supremacy of the medical model, calling into question the evidence base on which it rests and suggesting other constructions of mental health and mental illness that include the social context and the personal history of the client.

At the heart of the book are three chapters that provide an alternative to the established diagnostic approach. In examining the client’s story for signs of pathology the medical model misses an alternative interpretation of the client’s experience, one in which the client endures or overcomes trauma and loss through the discovery and use of social networks and inner resources. The ‘heroic client’ has a different tale to tell once he or she is freed from the template imposed on them by pathologising and medicating mental health professionals.

To support the heroic client practitioners ensure their therapy is client directed (chapter three) and outcome informed (chapter four). In my favourite chapter, rich with case material, the book highlights the importance of identifying and exploring the client’s theory of change (chapter four). The authors refer to research carried out on the innovative hypnotherapist Milton Erickson in the 1980s. Nobody could quite understand how he worked out which intervention his clients needed for recovery to take place. Eventually the researchers realised that Erickson didn’t know either, but that his clients did. Erickson listened to his clients and from them he discovered what they needed in order for therapeutic change to take place.

The book contains a critical examination of psychoactive medication. The fact that so many children are being prescribed stimulants and anti-depressants ought to concern us all. The authors explain just how flimsy the evidence is supporting anti-depressants, with many proving hardly more effective than placebos. So, this book is a cri de coeur – urging therapists to stand against the drug companies and the medical model and to listen instead to clients and their heroic stories. A very good read!

Book Review: An Anatomy of Addiction by Howard Markel

My favourite book this year turns out to be An Anatomy of Addiction: Sigmund Freud, William Halsted and the Miracle Drug Cocaine by Howard Markel. Such an enjoyable read: a good story, well written with humour and insight from a doctor and professor of the history of medicine.

Markel provides some entertaining chapters on the discovery and early use of cocaine. It was used as a pick-me-up added to soft drinks and wine, as a cure-all for the depressed and liverish and as a local anaesthetic that revolutionised surgery. By the time cocaine's addictive and destructive properties were recognised thousands were addicted to the drug.

Markel's account of Freud's cocaine use is fascinating, fair and balanced, an antidote to E.M. Thornton's tendentious Freud and Cocaine - also reviewed on my blog here. He describes Freud's early research into the drug's medicinal properties, including the disastrous treatment for morphine addiction of his friend, Ernst von Fleischl-Marxow. Despite his friend's double addiction to morphine and cocaine and resulting death, Freud became an advocate of cocaine and used the drug himself for around ten years. It is fascinating to consider how much cocaine influenced Freud's ideas in the 1890s, including his Analysis of Dreams.

William Halsted was a contemporary of Freuds. He has been called the father of modern surgery. He advocated the antiseptic approach of Lister, and at a time when surgeons operated in dress coats, insisted his staff wear surgical garb, scrubbed their hands and don rubber gloves. He developed new operations and new treatments and yet throughout his career he was addicted to morphine and cocaine. Halsted's cocaine addiction began when he started testing the drug's anaesthetic qualities, injecting himself under the skin and cutting himself to see how deep he could cut without pain. Soon he was addicted. His friends and colleagues attempted to rehabilitate Halsted whilst preserving his reputation. Thus they sent him on a sea voyage to wean him off the drug and when this failed he was sent to a mental hospital where he was prescribed morphine in order to manage the symptoms of cocaine withdrawal. Halsted was addicted to drugs for the remainder of his life but managed to control his drug use (but with frequent relapses) thanks to a huge effort of will. After some years working in the pathology lab at the new Johns Hopkins University Medical School he was appointed to a professorship and continued to advance the profession of surgery until his death in 1922.

Markel's book provides an entertaining account of the lives of these two great Victorians, advancing the cause of medicine whilst battling their own demons and the problems of drug misuse and dependency. An excellent read!

Book Review: What is Madness by Darian Leader

I’ve just finished reading Darian Leader’s latest book, What is Madness? It’s an absorbing read – sometimes difficult – but ultimately, fascinating and humane. Leader explains the roots of psychosis using the psychoanalytic theories of Jacques Lacan and at times the explanations seem rather more complex that the phenomena being explained. The discussion of Lacan’s client, “Aimee”, for example, is labyrinthine in its use of competing psychoanalytic explanations for her psychosis and behaviour. That's why I appreciated Leader's comment that, "A psychoanalytic theory of psychosis does not imply a psychoanalysis of psychotic subjects" (294). Indeed Leader points out that individuals experiencing psychosis are suffering from too much meaning and do not benefit from the interpretations of therapists.

The book opens with a chapter entitled, “Quiet Madness” in which Leader draws our attention to a mistake commonly made in conversations about psychosis. According to Leader it is wrongly assumed that madness and the visible symptoms of madness are the same thing. For Leader the symptoms of madness - hallucinations, paranoia, delusions - are the individual’s attempt to make sense of the horror that has befallen him or her: ‘responses to madness, attempts at self-cure’ (17). This is a fascinating insight and extends my own belief that emotional disorders such as depression or anxiety are perfectly functional when seen in the context of the individual's history and current experience. This realisation ought to guide the therapists approach. Attempts to remove the symptoms of psychosis without helping the patient to explore their condition may well interfere in the process of self-healing. As Leader says, medication is useful because it tempers the intensity of psychotic symptoms but should also serve as a 'platform for dialogue'.

Leader emphasises the importance of symbolism and language when explaining madness. He sees madness as a breakdown in these structures, resulting in a terrifying loss of meaning and a disconnection from reality. In response to this the individual cobbles together what he can to make sense of his experience. This may show itself as paranoia or other delusions. The individual may believe he or she has been abducted by aliens if this restores meaning and makes sense of a catastrophic event. Psychotic individuals (and psychoanalysts?) cling to the most unlikely ideas in their attempt to make sense of the world.

In what Leader calls, “Quiet Madness”, the individual may appear balanced, keeping his delusional world under wraps and thereby achieving the semblance of normality. In an interesting chapter, Leader suggests that the serial killer, Harold Shipman, is an example of “Quiet Madness”. To his patients and colleagues he appeared to be a professional, kind and diligent doctor; but it was this role that enabled Shipman to stabilise his madness, part of which involved the murder of hundreds of patients.

Leader argues that quiet madness can erupt into full blown psychosis through various trigger events, often associated with rites of passage. Marriage, divorce or having a book published, all have the potential to trigger psychosis: moving the individual from ‘being mad’ to ‘going mad’. Events have this potential because they require from the individual a new set of symbols, and if the individual cannot symbolise this transformation they are at risk of becoming psychotic. Leader spends several chapters exploring this process so my summary here is incredibly superficial.

The final chapter of this complex book suggests ways of working with psychosis. Following his hero, Jacques Lacan, the author uses the metaphor of the secretary - to quote Lacan, the therapist ought to be, “the secretary of the alienated subject” (305). Leader likes this description, likening the therapist to a secretary who faithfully records, asks for clarifications and doesn’t intrude too much (305). The therapist as secretary helps the client to build a personal history, helps the individual to explore their own frame of reference and thereby helps in the work of self-healing. Leader is honest about the amount of time, hard work and commitment required to work with clients experiencing psychosis. He is hostile to therapies that seek to return clients to “normal” and measure success by how far their clients have adapted to social and community norms. Instead Leader suggests that an “investment in dialogue and a curiosity about the logic of that person’s world can open up new therapeutic directions and offer the possibility of change. Therapy can do no more and no less here than to help the psychotic subject do what they have been trying to do all their lives: create a safe space in which to live” (330).

Leader, D. (2011) What is Madness? London, Hamish Hamilton

Book Review: Integration in Counselling and Psychotherapy by Lapworth and Sills

I teach on a counselling course that requires students to make sense of a number of different approaches to therapy; so I've been giving a lot of thought to integration and how it can be successfully achieved. After reviewing Cooper and McLeod on my blog here I have turned my attention to Lapworth and Sills and the second edition of their Integration in Counselling and Psychotherapy. The two books are similar because both are concerned with giving the reader an over-arching framework to help make integration possible; but whilst Cooper and McLeod provide one approach to integration - pluralistic counselling and psychotherapy - Lapworth and Sills provide an overview of what is needed if integration is to be achieved, their own model of integration - the Multi-dimensional Integrative Framework - and brief chapters on four other approaches, including a chapter on the therapeutic relationship and an outline of Multi-modal Therapy.

I am trying to work out why I disliked the first part of Lapworth and Sills. I found it too theoretical. I was left wondering how I had managed the task myself of integrating different counselling approaches. I was reminded of the cartoon strip in which Garfield the cat is stuck on the stairs after wondering how on earth he was able to co-ordinate the movement of his four legs. I could be at fault because I'm more of an activist when it comes to learning, which may also explain why my favourite chapter in the book is a case study of the Multi-dimensional Integrative Framework in action. But I don't think it's the theoretical nature of the material in these early chapters that's the problem, rather it's the lack of time taken to explain and illustrate what is being said. I was left with the sense of skating across the subject because of the authors' preference for summaries, outlines and bullet points. This tendency can also be seen at the end of the book when the authors give a brief outline of four competing theories of integration. It can also be seen in the first chapter where the authors give a potted history of integration in counselling whilst apologising because they don't have room to explore the topic further.

So for me the life saver, the thing that enabled me to go on reading, is the diagram on p89 and the case history that forms chapter six. Here the authors apply their Multi-dimensional Integrative Framework and the reader gets to see how useful it is as a model for explaining the problems experienced by the client, how these might be addressed (a formulation) and how therapy is progressing over time.

The authors argue in this book that in order for integration to happen successfully the therapist must have an over-arching framework that gives the therapist an understanding of human beings and of therapy and informs the choices the therapist makes about the strategies and techniques to borrow from different schools of therapy. It is the over-arching framework that gives those choices coherence and therapeutic power. I am reminded yet again of Yalom's point about creating a therapy for each client and I'm happy that ultimately Lapworth and Sills provide a way of doing that - and summaries of alternative frameworks that the reader can investigate further.

Lapworth, P. and Sills, C. (2010) Integration in Counselling and Psychotherapy, 2nd Edition, London, Sage.

Book Review: Resilience by Boris Cyrulnik

Boris Cyrulnik is a French psychiatrist and psychoanalyst who has worked with deeply traumatised children in Rwanda and Columbia, children who have survived genocide or served as soldiers. I mention this because Cyrulnik himself points out that an individual's traumatic history is often revealed in his or her choice of career, and Cyrulnik's history is certainly traumatic: a child during the Second World War, he evaded the Nazis by working on a farm, whilst his parents, like thousands of other French Jews, were arrested by the French police and deported to Auschwitz where they were murdered by the Nazis. Cyrulnik says that after the war nobody wanted to hear his story, it didn't fit with France's need for de Gaulle's narrative of resistance and liberation. So, like numerous victims, before and since, Cyrulnik adapted to his environment and developed a secret history, 'splitting' his personality into acceptable and unacceptable parts until the day when he would have enough strength to tell the whole story. There is a subtext here, and an insight into the French 'collective unconscious', still coming to terms with the events of the Second World War. Cyrulnik points out that cultures often need a narrative that negates the true horror of things. Thus the French war in Algeria, which resulted in the death of 28,000 French soldiers, was termed a 'policing operation' and the conflict in Northern Ireland, with over 3,500 deaths was known as the "Troubles".

Narratives are important for Cyrulnik, they have the ability to defend an individual, as well as a culture, from the horror of things. Cyrulnik's style is aphoristic and discursive so there is no bulleted list of protective factors contributing to a child's resilience, instead Cyrulnik argues that, 'Biological and developmental forces are articulated with a social context to create a self-representation that allows the subject to see his or her life in historical terms' (51). It is the historical perspective that offers redemption: 'The things I've been through. I've come one hell of a long way. It wasn't always an easy journey' (51). The trauma of the victim is reframed as the triumph of the survivor, victor in the face of death! So, Cyrulnik's message is an optimistic one because he believes our histories do not determine our fate, that many individuals experience traumatic events in childhood and go on to live happy and meaningful lives. Like another psychotherapy optimist, Bill O'Hanlon, Cyrulnik argues that the wounds we suffer have the potential to give our lives substance and meaning, they are, or can be, to use Cyrulnik's metaphor, the grit in the oyster that transforms into a pearl.

Cyrulnik, B. (2009) Resilience: How Your Inner Strength Can Set You Free From the Past, London, Penguin

Book Review: Pluralistic Counselling and Psychotherapy by Cooper and McLeod

If the counselling and psychotherapy profession had a cricket team then Cooper and McLeod might make a fine opening pair. Historically Freud and Jung are the greatest openers we've ever had, though they ended their careers on opposing teams. Sorry, I'm being silly! Cooper and McLeod have written an excellent book on the need for a pluralistic approach to counselling and psychotherapy. They argue, convincingly I think, that no one school of therapy has all the answers when it comes to helping clients make changes; instead the authors recommend an approach based on goal setting and collaboration: an exploration with the client of the changes they would like to make, the tasks that need to be completed to get there and the methods most appropriate to achieving those tasks. Interestingly Cooper and McLeod extend their pluralism to counselling research, training and supervision. So the book advocates a sea change in how we approach therapy, one that is inclusive, drawing on many traditions to makes sure 'each client gets the therapy that is most suited to them' (vi). This seems to be the trend in therapy. I'm reminded, for instance, that Yalom talks of the psychotherapist creating a therapy for each individual client, though I would call it co-creating. It's an approach I follow and I'm grateful to the authors for producing what amounts to a manifesto for the pluralist approach. It's going to be essential reading for students attending my courses on brief therapies, giving coherence to the plethora of different but equally valid approaches they'll study.

Cooper, M. and McLeod, J. (2011) Pluralistic Counselling and Psychotherapy, London, Sage

Book Review: Tales from the Therapy Room by Phil Lapworth

There are numerous great story tellers amongst the psychotherapy fraternity, even if I can think immediately only of Sigmund Freud and Irvin Yalom - a lack of knowledge on my part rather than a lack of style on the part of my colleagues. I can reveal another name to join my brief list of fine story tellers, because Phil Lapworth has written a lovely collection of ten short stories about therapy and what goes on in the therapeutic relationship. I read his Tales from the Therapy Room in a couple of ways: firstly, I read them for enjoyment, because each tale is full of humour and pathos; and secondly, I read them with a critical eye on the role of the therapist and the observations and interventions he makes. So each of the stories is both an entertainment and an education. On reflection there is a third way of reading this book, an invitation I have yet to take, and that is to use each story as a starting point for an exploration of practice issues, ethical dilemmas and counselling theory. The book contains what Irvin Yalom calls, "teaching tales". Lapworth helps with this process by providing an interesting final chapter, in which he recommends further reading and asks questions about each of the stories he has so beautifully written. So I will revisit each of these tales and reflect on what they have to say about me, my practice, psychotherapy and the human condition. Thanks Phil!

Lapworth, P. (2011) Tales from the Therapy Room: Shrink Wrapped, London, Sage

Book Review: Person-Centred Counselling by David Rennie

This slim volume is an account of David Rennie’s approach to person centred counselling. The book started as a set of training materials, its ideas tested in the training room, but the book is also informed by Rennie’s own practitioner-research and by the suggestions of peers such as Mearns and Thorne. We are left with a short, lucid and well written account of Rennie’s ideas for developing the person centred approach and one that will undoubtedly improve the therapeutic skills of every reader.

At the heart of Rennie’s understanding is the client as reflexive agent. In other words the client’s job in therapy is to reflect on their experience and from that reflection arrive at a deeper understanding of the issues that confront them and the choices they can make. Rennie believes that greater understanding can lead to greater agency.

The therapists job is to keep the client on track with their reflections and to use empathic and process orientated interventions to deepen the client’s exploration. Empathic communication includes paraphrasing and reflecting, the interventions one would expect from a person centred therapist. But Rennie also advocates presenting the client with visual imagery and metaphors, symbolic representations that can emerge out of the clients experience as reported to the counsellor, or from the counsellor’s unconscious, in tune with the client’s experience.

There is an excellent chapter on transparency with sound advice on when counsellor’s ought to express congruency; but Rennie’s greatest contributions to person centred therapy are in his chapters on process identification, process direction and meta-communication. Rennie argues that therapists are able to deepen the clients exploration of their experience and the felt-sense associated with it by encouraging reflexivity, and this can be promoted if the therapist appropriately comments on the client’s process issues. At its simplest this involves pointing out what the client is doing: “As you said that you raised your eyebrows”. This brings into the client’s awareness thoughts and behaviours that were out of awareness and as a result the client becomes more self-aware. Rennie’s discussion of metacommunication invites therapists to deepen their relationships with clients by commenting on the meaning behind their own or their client’s communication.

There are some things I disagree with in Rennie’s book. I do not think, as Rennie does, for example, that it’s OK for the contracting process to become a “five minute routine”. I see the contract as part of the therapy and an opportunity to explore with the client their anxieties about therapy and issues such as confidentiality. But this small book has a great deal to offer therapists looking to deepen their contact with clients and I will be urging my students to read it.

Rennie, D.L. (1998). Person-Centred Counselling: an Experiential Approach, London: Sage

Book Review: Freud and Cocaine: the Freudian Fallacy by E.M. Thornton

My beliefs about Sigmund Freud have been severely challenged by reading E. M. Thornton’s blistering attack on the founder of psychoanalysis. I’d considered Freud one of the greatest thinkers of the Twentieth Century. If anything, I imagined him to be a victim of his own success - so many of his ideas are a part of mainstream culture that Freud has become associated only with the eccentric and unacceptable leftovers.

I think Freud represents a paradigm shift in how we think about the mind and human motivation. We accept the notion that individuals are driven by unconscious wishes and the idea that the mind can cause physical illness. But for E.M. Thornton, these are just two examples of the false beliefs that underpin psychoanalysis. Her argument is that Freud’s theories are a product of his cocaine addiction. She also argues that Freud’s case studies, on which the whole edifice is built, are more likely to be suffering from temporal lobe epilepsy than hysteria. She argues that a great deal of time has been wasted by physicians who could have been working on physical medicine and neurology rather than the drug induced fantasies of Freud.  Towards the end of her book she goes so far as to describe Freud as 'a man of pathological preoccupations' (291).

The early chapters of Thornton’s book are a disappointment, focused too much on medical history and hardly at all on Freud. She writes about Freud's early encounter with cocaine following its recent discovery and importation into Europe from South America as a new cure-all. Freud took it, recommended it to friends, prescribed it to patients, supplied his fiancé and published an article on its medicinal qualities, recommending it as a cure for opiate addiction. In his affection for coca Freud was joined by a great many others, particularly in America. Thornton calls this the great cocaine epidemic and provides an interesting account of cocaine use in the late Nineteenth Century, before cocaine was eventually outlawed in the United States in 1902. Initially it was seen as a wonder-drug and widely prescribed, even introduced into soft drinks; but over time the case against cocaine and its dangers emerged. Individuals, especially doctors, became addicted and developed an insatiable need for the drug. Side effects included paranoia, violence, hallucinations, egomania and physical effects such as heart problems and impotence. Addicts described obsessions with sex and had sexually explicit hallucinations, they believed they were in possession of a great truth and simply had to share it with others. Later on of course Thornton will argue that Freud suffered from these symptoms of prolonged cocaine use and that cocaine produced not just a runny nose but the Standard Edition of the Complete Works.

Thornton is claiming that just at the time Freud developed his most contentious theories, such as the Oedipus Complex, he was misusing and suffering the symptoms of cocaine addiction. How else, she argues can we explain Freud's belief in the sexual origins of the neuroses. My understanding is that Freud had come to the seduction theory because that is what his patients had been telling him and that Freud's reading and research in the late 1880s at La Salpetriere, which pointed to high levels of sexual abuse in French society, had made more believable the disclosures made by his patients.

Thornton reminds us that the patients treated at La Salpetrier by Freud’s mentor, Charcot, were more likely suffering from temporal lobe epilepsy than hysteria. She certainly paints a grim picture of the Salpetrier and its mainly female patients, performing for doctors and medical students from around the world, all attending to hear Charcot’s lectures and see demonstrations of hypnosis. She goes on to argue that because of their epilepsy these patients were susceptible to hypnosis, indeed that hypnosis is actually only possible with patients suffering from this pathology because hypnosis is a form of temporal lobe seizure. She scorns Bernheim of the Nancy School of hypnotism for believing that most people are hypnotisable and claims that most of Bernheim’s patients were pretending to be hypnotised out of fear of upsetting him. As someone who has experienced and practised hypnosis and studied the work of Milton Erickson I have to disagree with Thornton's narrow definition of what constitutes hypnosis and the hypnotic state. In the end her critique of hypnosis serves one purpose, it is in furtherance of her attack on Freud, who learnt and briefly practiced hypnosis but decided he wasn't proficient enough and abandoned the technique. For Thornton all the trees in the forest must be cut down so she can swing her axe at the mighty oak.

Thornton's analysis of the Anna O case is an excellent read. She argues that Anna O was not hysterical but suffering from meningitis contracted whilst nursing her father who had died of tuberculosis. She charts the changes in Anna O's presentation and makes the case for an organic cause, principally brain lesions, where Breuer had ascribed a psychological cause. She makes use of research by Ellenberger (1972) who had discovered what happened to Anna O after her treatment ended. It turned out to be an orderly handover to other physicians rather than the story put about by Freud in which Anna O developed a hysterical pregnancy that caused Breuer and his wife to flee the country. Ellenberger discovered that Anna O had not been cured by Breuer and that the account of her treatment in Studies of Hysteria differed from the contemporaneous case notes made by Breuer and found with Anna O's medical file in the asylum at Bellevue. Thornton also suggests that another case of Freud’s, "Frau Emmy", was not suffering from hysteria but almost certainty a variant of Tourette's disease. She suggests that Freud was mistaken when he took mild tonic seizures to be evidence of the effectiveness of the cathartic method. Thornton also writes about Freud’s “pathological” treatment of 'Dora', another of his cases with epilepsy rather than hysteria. Freud analysed Dora and her dreams, and with an imaginative use of symbolism discovered a sexual cause to 'Dora's' neuroses but after three months 'Dora' discontinued her therapy.

After her chapter on Anna O, Thornton begins looking for evidence of cocaine use in Freud's letters to Fleiss. She argues that Freud’s heart condition, messianic traits, 'monotony of interpretation', headaches, nasal problems, depression, death anxiety and dysphasia all point to cocaine misuse and appeared after April 1894. The idea that Freud experimented with cocaine in the late 1880s and then stopped is disproved by the Fleiss letters. Later on she suggests that Freud’s preoccupation with 'irregular modes of sexual gratification' (241) is a result of his cocaine addiction. She also thinks that Freud's relationship with Fleiss had a 'homosexual element' and this too 'would be consistent with the other symptoms of cocaine usage' (242).

Thornton attacks Freud for criticising Charcot: "Such brash interpolations by a then little known neurologist in the work of a man of Charcot's eminence were undoubtedly the result of a cocaine effect" (209). At that point I wondered if Thornton might also be making “brash interpolations” and just as Freud everywhere saw sex as a cause of mental distress so Thornton sees cocaine use as the cause of psychoanalysis. Thornton (254) correctly states that Freud's self-analysis (1897 - 1900) was responsible for some of the most basic ideas in psychoanalysis. She criticises the subjective nature of this process and argues that it is particularly untrustworthy as a method because Freud's cocaine use was distorting his memories and creating vivid dreams. Freud's first full analysis of a dream was his 'Irma dream' on 24 July 1895. Thornton makes an interesting point when she suggests that vivid dreaming is a mark of cocaine misuse and that Freud’s patients were also having vivid cocaine sponsored dreams. So it was that dreams came to occupy a major place in the practice of psychoanalysis.

A final attack on psychoanalysis comes at the end of the book when Thornton makes the point that psychoanalysis has had a negative impact on research into brain disorders - organic brain disorders being the true cause of neurosis/psychosis for Thornton.  She argues that patients who could have had cures were instead given ‘hopeless psychoanalytical diagnoses’, including the catch all diagnosis of hysteria. Freud’s nemesis puts her pen down at the end of her book, arguing that as Freud’s later work rests on unsupported theories he developed during his cocaine years there is little point discussing them. Her assessment is damning: 'As we have seen, the foundations of this edifice were presented in a series of papers characterised by inconsistencies and circular arguments, with a total lack of evidence for the postulates they contained' (290).

  

Thornton, E.M., (1983). Freud and Cocaine: the Freudian Fallacy, London: Bond and Briggs

Book Review: Trauma by Gordon Turnbull

This book will be a very pleasant surprise for readers anticipating a dry textbook on psychological trauma. Instead Turnbull has written a wonderfully engaging account of his career as a psychiatrist in the Royal Air Force and private practice as an acknowledged expert on post-traumatic stress disorder (PTSD). The reader is alongside Turnbull as he uncovers the ways exceptionally traumatic events affect individuals and how PTSD develops as a means of coping in the midst of overwhelming terror.

For Turnbull PTSD is a natural response to events outside normal human experience and the symptoms of PTSD are often part of the recovery process. But his pioneering work is treated with suspicion by senior officers in the military who prefer to blame the individual for a ‘lack of moral fibre’ rather than accept PTSD as a natural outcome of military conflict.

Turnbull pioneered his technique of psychological debriefing with members of RAF mountain rescue teams attending the Lockerbie disaster. He worked also with released British POWs after the first Gulf War and the hostages John McCarthy and Terry Waite. He argues convincingly that service men and women need time for decompression before returning to civilian life, so soldiers returning from Afghanistan stop off in Cyprus to recuperate before returning home. Turnbull advocates a group approach to recovery and recommends cognitive therapy, but he also embraces hypnosis and EMDR as methods for transforming right-brain sensory material into left-brain narrative and meaning.

Turnbull illustrates his book with fascinating case material. He learns as much about trauma from his clients as he does from research and colleagues. Indeed the high regard Turnbull has for his clients and his view that trauma can lead to emotional growth makes his book an optimistic account of psychological trauma. Counsellors and psychotherapists of all persuasions will be entertained and educated by its insights.