November 2023

Routine Outcome Monitoring and Feedback in Psychological Therapies

K de Jong, J Delgadillo and M Barkham

(Open University Press)

This book provides information and guidance on routine outcome monitoring (ROM) and feedback, based on the latest research and theory, and experience in the Dutch and English healthcare systems. ROM involves regular progress measurement during therapy; feedback involves using the measures to continually inform treatment.

In the first chapter the authors cite evidence that they argue supports the use of ROM. They conclude from a review of 58 studies that there is an overall (albeit small) positive effect in terms of symptom improvement. Some of the findings are sobering, for example a study asking therapists to compare their performance with peers showed that 25% ranked themselves amongst the best 10%, and none rated themselves below average.

The core of the book is a practical guide to implementing ROM and feedback, covering the selection of suitable tools; barriers and enablers for implementation; common problems, and how to introduce ROM to clients. There is guidance on interpreting scores; recognising when a client is not improving; clinical trouble-shooting for such clients, and integrating ROM into supervision. The final chapter looks at consolidation and future challenges.

The book presents a comprehensive yet admirably concise guide, written in clear and accessible language. For me, it raised useful questions about our ability to assess ourselves and the impact of our work, but also questions about the validity of ROM that weren’t fully addressed. One important strength is that it does not promote or focus on any one measurement tool, but provides information to support selection. This book would be a very valuable resource for any individual or organisation considering implementing ROM, or wanting to understand more about it.

September 2023

The Mystery of Emotions: seeking a theory of what we feel

RD Hinshelwood

(Phoenix)

I was intrigued by the title of this book, and hoped to deepen my understanding of the human emotional experience which is so fundamental in our work. The first part of the book is an argument for emotions (affect) to be accorded more attention. The book ‘challenges the priority of cognition’ and presents a thought experiment to justify that challenge. For me, and perhaps many BACP members, no such persuasion is needed. The second part presents Hinshelwood’s model for a theory of affect. His starting point is to propose that common factors can be drawn from the literature on affect over the centuries. He selects three disciplines: philosophy, academic psychology and classical psychoanalysis (split into instinct theory and object relations theory), and for each discipline summarises how its ideas about human emotion have developed over time. From each summary, Hinshelwood identifies a list of features of affect and identifies commonality across the disciplines. Common features are grouped into clusters, resulting in three ‘dimensions’ which can be represented in graphical form. Unique human emotional experiences are then plotted as single points onto 3D graphs. 

Hinshelwood presents a highly original model. His approach is methodical and analytical, and he warns that it will not appeal to everyone, concluding that ‘it might have been better to remain spontaneously authentic than to invade the personal with rigid mathematised graphs and dimensions.’ He acknowledges the irony that in challenging the priority of cognition he uses a method that is highly cognitive.

For me, this analysis provides an intriguing perspective which is of intellectual value, but which ultimately feels unsatisfying and somehow misses the point about the mystery of emotions.   

September 2023

Therapy in Colour: intersectional, anti-racist and intercultural approaches by therapists of colour

Isha McKenzie-Mavinga, Kris Black, Karen Carberry and Eugene Ellis (eds)

(Jessica Kingsley Publishers)

This collection, emerging from the Black, African and Asian Therapy Network (BAATN), is ambitious in its aims and broad in its intended audience. It is a resource designed to inspire, educate and inform potential students, trainees, practitioners and lay people. Contributors discuss the trauma of racism and discrimination, the dominance of the eurocentric perspective in therapy, the lack of attention to these issues in training institutions and the ways in which the contributors have experienced and addressed these challenges.

The book comprises 21 chapters from a broad range of experts and is organised into five sections: Anti-racist Reflection, Training, CPD, Therapeutic needs and Psychological Wellbeing and Intersectionality. The editors have skilfully avoided the traps that can afflict collected works; the book has a coherence and flow that make it a compelling read. The styles, approaches and messages of the contributors naturally vary, but this lends freshness and interest to the whole and locates the book in a space which manages to be scholarly, experiential, challenging and accessible. The book contains wisdom, powerful and impactful personal testimony and important concepts and models relevant to training and practice.

Ellis writes that this is the book the members of the BAATN leadership team ‘would have liked to have available to us when we were students’ and Black expresses the hope that it becomes a core text. Reflecting on my own training, I can only endorse that hope. This book would, I believe, have made a difference for all of us in my cohort and our future clients. I am grateful for the opportunity to learn from it now.    

July 2023

A Straight Talking Introduction to The Causes of Mental Health Problems (2^nd edition)

John Read and Pete Sanders

(PCCS Books)

This book is part of the ‘Straight Talking Introductions’ series which aims to provide accessible information on mental health topics to a wide readership. The authors emphasise the role of beliefs in the debate about causes of mental illnesses, and disclose their position, that they are 'the result of complex events…. and our reactions to them.’ I found this emphasis refreshing in a debate which can be dominated by the medical model without acknowledging its underlying beliefs.

The book provides a brief history about causes of distress, and presents evidence to support the idea that most people think mental illness is caused by ‘bad things happening to people’. The core chapter is a research-based description of causes, including poverty, gender and trauma in all its forms, stressing that there is often a combination of factors. I felt that this chapter would be even more useful to its wider readership if it included case studies illustrating the link between causal factors and people’s mental health experiences.

There is a summary of the main psychological theories and a chapter encouraging readers to work through their own case formulation, although it does warn that some might need professional support to do this safely. The final chapter looks at recent developments and includes a call to action to address the societal factors in mental distress.

The perspective and findings in this book are likely to chime with many BACP members. It includes valuable information and insights and is written in everyday language. It would be a useful resource both for professionals and for recommendation to clients, friends and family.  

June 2023

Beyond the Binary: essays on gender

Shari Thurer (ed)

(Phoenix Publishing House)

I was interested to read this slim volume, published under the auspices of the Boston Psychoanalytic Society and Institute (BPSI), as a step in educating myself about gender identity. Two of the nine chapters are autobiographical accounts by nonbinary people assigned female at birth. These accounts are powerful, and, for me, by far the most illuminating contributions in the book. Haas writes that ‘every day felt like torture’, with an intense sense of wrongness and unacceptability, following their first traumatic experience of having to choose a gender line to stand in at kindergarten. Their therapy experiences, while somewhat helpful, largely left unidentified and unexplored Haas's experience of gender confusion  – a salutary lesson to us all. 

Ely-Spence’s experience of being nonbinary has been a ‘DIY project’ partly rooted in rejection of cultural expectations of women and of the ‘tyranny of the male gaze’. The chapter by their parents provides insight into being alongside an adult child during a process of gender exploration.

The remainder of the book I found less compelling and lacking coherence. The absence of a contribution from a nonbinary person assigned male at birth feels remiss. The book wears its BPSI pedigree rather heavily and reads like a mea culpa for BPSI’s historically rigid and discriminatory perspective on gender and sexuality. While important, this history is perhaps of limited interest to UK readers. The book’s first-person accounts are worthwhile, and as a whole it has value for those curious about understandings of gender identity in the north American psychoanalytic community. This is likely to be a limited readership; other books may better meet a more general need for education on gender identity.