~ Pergamon 0005-7967(95)00045-3 Behav. Res. Ther. Vol. 33, No. 8, pp. 995-999, 1995

Elsevier Science Ltd. Printed in Great Britain

BOOK REVIEWS

ROBERT RUSSELL (Ed.): Re-assessing Psychotherapy Research. Guilford Press, New York (1994). 224 pp.

This collection of seven chapters, written by researchers interested primarily in non-behavioural psychotherapy process research, comes in the aftermath of psychotherapy-equivalence debate. The controversy was initiated by Luborsky, Singer and Luborsky in 1975 ("everyone has won"), and was seemingly strengthened by results of the meta-analysis conducted by Smith and Glass (1977). From start to finish, their methods and claims were criticised (major flaws in the Luborsky paper, the false impression of impartiality conveyed by recta-analysis, and their seriously misleading conclusions, etc.), and hence the present book is of particular interest. How do process researchers, including numerous workers who have in the past accepted the equivalence claim, at least to some degree, now view the debate?

David Shapiro, a leading writer on psychotherapy, and his colleagues wrote last year that, "As it is usually stated, the equivalence position is a logically flawed, overly simplistic endorsement of the null hypothesis" (Elliott, Stiles & Shapiro, 1993, p. 456). And further, "We seriously doubt that any psychotherapy researcher (or clinician) ever seriously believed in universal equivalence, but it is still useful to show that claims of universal equivalence are absurd" (p. 462). They should not doubt it however, for in another chapter of the present book, edited by Robert Russell, there is an unequivocal example for them to worry about. L. Greenberg, another influential writer on psychotherapy, states that, "Through comparative treatment studies, recta-analyses, and at least 30 years of hard work, we are finally convinced that 'Everyone has won and all must have prizes'" (Greenberg, p. 115). This is not the place to comment on the core of the debate (see Giles, 1993, among others, for a recent analysis), but I suspect that the Greenberg view is still widely held.

Several of the contributors to the Russell book are searching for constructive ways to proceed, and Shapiro et al, in Chapters I and 2, are severely critical of what they describe as the "drug metaphor" (more properly, perhaps, to be seen as another example of the unwarranted extension of the dreaded "medical model", with its language and concepts--- "diagnosis, symptoms, treatment, patients, relapse", etc.). These contributors also report the results of their major re-analysis of the influential Orlinsky-Howard data on process-outcome connections, and the conclusions are extremely discouraging. The average effect size accounted for a miserable "less than 2 percent of the variance in outcome" (Shapiro et al., p. 28). Their conclusions on the poor quality of the research methods, low reliabilities and so forth, are discouraging, and point to the need for a re-evaluation of strategy. Orlinsky and Russell conclude that, given the "bankrupt" state of "empirical research relating processes to outcomes" (p. 203), there is a need for a fresh beginning. They and their co-workers need and deserve all the good fortune they can muster. It is a complex and daunting undertaking.

S. RACHMAN

R E F E R E N C E S

Giles, T. (Ed.) (1993) Handbook of Effective Psychotherapy. New York: Plenum Press. EUiott, R., Stiles, W. & Shapiro, D. (1993) "Are some therapies more equivalent than others?". In Giles, T. (Ed.), Handbook

of Effective Psychotherapy. New York: Plenum Press. Luborsky, L., Singer, B. & Luborsky, B. (1975) Comparative studies of psychotherapies: Is it true that "everyone has won

and all must have prizes?" Archives Gen. Psychiatry, 32, 995-1008. Smith, M. L. & Glass, G. V. (1977) Meta-analysis of psychotherapy outcome studies. American Psychologist, 132, 752-760.

D. A. LANE and A. MILLER (Eds): Child and Adolescent Therapy: A Handbook. Open University Press, Buckingham (1992). xii + 260 pp. £16.99

This book aims to provide an overview of recent developments in child and adolescent therapy for trainee and practising professionals in the child mental health field. It is intended to be a clinical manual and chapters are written by senior practitioners in the field. The book is divided into three sections of which the first looks at the changing agenda in child and adolescent therapy in response to the legislative changes in health, education and social service departments which are beginning to impact on service provision. The two chapters in this section provide a lucid description of the major theoretical orientations used in clinical practice in the United Kingdom and tackles the complex area of evaluation of interventions in the form of a clear and thoughtful review. Section 2 covers six areas of practice which have been chosen by the editors as they are thought to represent current challenges to therapy with children and adolescents. A developmental model for promoting communication for non-speaking children is presented and a useful chapter by Elizabeth Newson on play therapy in a variety of contexts. Chapter 5 is a whistle-stop tour of child abuse which may leave the more erudite practitioner yearning for more, but as a useful consideration of the complex issues that face therapists in the child care field it is most welcome. School phobia and bullying are the subjects of the next two chapters and are a useful guide to these areas including reference sources. The final area considered is that of management of trauma following disaster and is an important new focus for clinicians, covered in a comprehensive and thought-provoking manner.

In a departure from traditional therapy handbooks, the final section covers the important area of the setting in which therapy takes place for children and adolescents. The residential community, child guidance clinics and the innovative field

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of community psychology are adeptly presented and provide real insight into the modern day challenges facing service users and providers.

Far from being a unitary concept, child and adolescent therapy spans a wide theoretical and clinical spectrum which the editors bravely set out to condense into one volume. This they do with varying success and this book is surely a must for trainee mental health practitioners, with some useful and provocative pointers for more experienced professionals. The editors express the hope that this text "reflects the excitement and confusions that currently impact on therapy services" and is a timely reminder that we cannot bury our professional heads in the sand, that clients and purchasers now have a more proactive role to play in the uptake of services offered, and that the systems involved in such services must be shown to be effective in meeting the needs of their clients in a multitude of settings.

MICHELLE NEW

JON KABAT-ZINN: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hyperion, New York (1994). xxi + 277 pp. $19.95

Kabat-Zinn's writings are the fruits of his clinical experience gathered in his practice at the University of Massachussetts Medical Center. The scientific work of the author has been published in authoritative journals (e.g. Kabat-Zinn, Massion and KristeUer, 1992). The present book is more of a day to day guide, a successor of the earlier bestseller "Full Catastrophe Living". It is divided in three parts and 70 small chapters. Each one of them can be read at random, while most chapters contain a suggestion for an action oriented assignment, a poem or a nice citation to contemplate upon.

The author 's endeavours require admiration in several respects. He not only conducts excellent research, he also challenges academic conformism by going beyond its traditional confines. Kabat-Zinn has the guts just to pioneer in the mental health field without bothering to become marginalized in the psychological/psychiatric community. The reason may be that his basic discipline is that o f a molecular biologist, a natural scientist who is ardently involved in meditation since his early twenties. The day to day manual is performance based, but does not necessarily breathe a coguitive-behavioural orientation, which seems to be largely unknown to the author, perhaps because of his background.

However, this Buddhist inspired book imbibes a cognitive-behavioural atmosphere, without explicitly referring to the latter. Indeed, many of the Buddhist teachings have a striking resemblance with a cognitive-behavioural position, and I even dare to state that many of the prescientific Buddhist and cognitive-behavioural views are compatible. For instance the notion that one chooses one's own emotional destinies (see de Silva, 1990). The beautiful title o f the book indicates the essence of any meditation, id est to be in the 'herenow' instead of unproductive dwelling in the past (causing depression) or in the future (causing fear). But why bother about awareness of the present moment, if not in agony?

The ultimate rationale for training meditation is to prepare for the utmost moment in life and the only absolute certainty a human being posesses: death. To die peacefully is a legitimate wish for most of us. And if one lives in the unfortunate condition of being ill or stressed, as many of Kabat-Zinn's clients, the experience of physical decay is not exceptional. Except of learning therapy, which is obliged for some psychotherapists in training, a therapist can choose to care for his/her own mental health by meditating. Mindfulness meditation is a practice to celebrate life (memento vivere) as well as to celebrate death (memento mori). To live meditatively is to prepare oneself for the last breath.

To close, the term mindfulness strikes me as a misnomer, if we consider meditation as a process of watching or witnessing. In my opinion 'mindemptiness' would be a more suitable term, because it is the mind--where the machinery of thinking resides--that the meditator wants to eliminate. Kabat-Zinn seems to sense this as he also applies terms like 'heartfulness' and 'wakefulness'. But 'what 's in the name' after all? The message is to be there wherever you go, and this book is a fine medium for clients and therapists, non-doing doers who like to take the effortless effort to practice.

MAURITS KWEE

R E F E R E N C E S

de Silva, P. (1990). Buddhist psychology: A review oftbeory and practice. Current Psychology: Research Reviews, 9, 236-254. Kabat-Zinn, J., Massion, A. O. and Kristeller, J. (1992). Effectiveness of a meditation-based stress reduction program in

the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936-943.

JEAN KH A L FA (Ed.): What Is Intelligence? Cambridge University Press, Cambridge (1994). 207 pp. £19.95

What is intelligence? The obvious answer is of course that it is a scientific concept, defined empirically, and having considerable practical usefulness. This, however, is not what this book is about. Indeed, it is not clear what the book is all about--certainly none of its authors is identified with the classical body of knowledge that constitutes the essence of our textbooks. Each views what he considers 'intelligence' from a very odd and unusual point of view; it is this that makes the book both interesting and infuriating. It is as if you bought a book on "What is gravitation?", only to find chapters by an upholsterer concerned with the way cushions react to different-shaped bottoms, or a balloon manufacturer who was concerned with the art of releasing thousands of balloons simultaneously at a concert. There is hardly any reference to established facts. Penrose can write a lengthy chapter on 'mathematical intelligence' without ever referring to the Lubinski & Benbow studies of mathematical talent, or Weiss's work on the genetic determinants of mathematical ability. For anyone interested in mathematics, this is a fascinating chapter, but without any real relevance to the alleged topic! Like much else in the book, it is philosophical and introspective, not empirical or psychological.

There is a curious arrogance about the various chapters; they seem to say: "Psychological experiments and arguments are so unimportant. What I think, regardless of the facts, is much more interesting!" Some of it is downright absurd. Gregory precedes a gratuitous attack on IQ tesiing with: "As Sir Peter Medawar and others have pointed out, the IQ notions of intelligence as a single dimension along which to judge children and adults, is among the most personally and socially