Maria Gilbert and Vanja Orlans
Hove: Routledge 2011
Reviewer Sally Forster
The publishers claim that this book provides ”a concise and accessible guide that allows professionals and students to look beyond specific approaches in order to draw upon ideas and techniques that will best help the client”, which, along with the title, conjures precisely the kind of whistle-stop tour to eclecticism that the authors themselves do not support. I would suggest that what the book actually has at its heart is a meander through the rich and varied more-recent developments in the field that are largely independent of modality and which any ethical therapist needs to find a way to embrace regardless of their training modality. As such, it makes a full and well-annotated reading list for any student of counselling or psychotherapy. The book touches upon the common factors across modalities that support good outcomes, the factors that facilitate change for the client – learnings from neuroscience, affect regulation, attachment styles, early relational trauma, the centrality of the relationship and non-verbal communication, body awareness, the co-creation of the space between therapist and client, how to assess the needs of the person who walks through the door – to mention but a few of the 100 key points and techniques.
Each of the 100 nuggets is presented as a self-contained, well-referenced parcel of information. Each nugget focuses on a different idea or looks through a different lens or at a different layer. My personal response to the book was one of underwhelm! While on the one hand it is an impressive condensation of the material, the corollary is that there is little space for digestion, or indeed for a more deep and open-ended look at the questions that arise when you are trying to blend the work of different writers each with their own perspective and lexicon.
Raised for me were knotty questions such as:
How do we “not throw the baby out with the bathwater” (p103) when the new ‘enhanced’ DSM V would have the majority of us diagnosable with a mental disorder on one axis or another? (This would perhaps not be a problem were it not for the power differential between the group making the diagnosis and the group being diagnosed).
Can we reconcile notions of treatment with an I-Thou encounter, with its necessary absence of an agenda? That we do it is discussed on p134 but not the how of it, or whether there is an alternative.
Is it still useful to use the word transference as for example in the discussion of shame on p198, which presumes an archaic relationship being projected onto a blank screen rather than a coming together of the client’s way of being in the world and the therapist’s way of being in the world leading to a “system of reciprocal mutual influence” ? (p137).
How do we ethically pay attention to contemporary research in the field while holding the position that each client-therapist encounter is unique and co-created? This is particularly tricky with randomised control trials and “manualised treatment”; is the research really validating the treatment or the skill of the therapist’s relationship building, or indeed something even more subtle? Certainly the link between the hypothesised causative mechanism and the outcome is not necessarily proven.(Cooper,2008:135)
Can we orientate ourselves towards well-being, and perhaps put more effort into researching whether the work that a given therapist is doing with a given client is satisfying rather than research that tries to prove which form of therapy should be practiced? (Botella, 1999)
These questions may not have answers but I believe that these and questions like them need to be struggled with. While I have my ideas about their absence – to do with space and series style and possibly political correctness – without them the book feels limited and seems to deliver a mixed message. On the whole, the text honours the complexity of therapy, the co-created nature of the relationship, the need for each therapist to work through their own integration, to be self-reflective, to be their own researcher, and the enormity of the task of reconciling the thinking of psychotherapists with different formulations and languages with the relevant material from other disciplines; however, the form of the book – the series title, the concise nuggets, neat sub-headings, neat summings-up, lists of lists, no index – speaks of written recipes, simplicity, complexity glossed over or smoothed out. Rather than a guide that allows practitioners to look beyond specific approaches I would say that it is a map of the complex territory that needs to be considered by developing therapists of all approaches; as such it will hopefully provide a springboard to boundless further reading, questioning, experiencing and self-definition.
Sally Forster is an Integrative psychotherapist and supervisor working in private practice in North London. She graduated from the Minster Centre in 1998 and has since been very influenced by Formative Psychology, the work of Stanley Keleman. She studied for her Diploma in Supervision at the Gestalt Centre with Gaie Houston.
Botella, L. (1999, July) Personal Construct Psychology, Constructivism and Psychotherapy Research. Retrieved June 14, 2009 from www.massey.ac.nz/~alock/virtual/PCpres.htm
Cooper, M. (2008) Essential Research Findings in Counselling and Psychotherapy: the facts are friendly London: Sage