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Transcript of Childhood Disorders (Clinical Psychology: a Modular Course)
Journal of Psychiatric and Mental Health Nursing, 2001, 8, 373–378
© 2001 Blackwell Science Ltd 373
with constructing a model for understanding
dementia based on psychological ideas. Part three
shows how such a person-focused approach could
be applied to services for people with dementia.
Part four establishes an agenda for change and the
future for dementia care.
Part one employs a historical approach to bring
to life contentious concerns, such as the creation
and recreation of Alzheimer’s disease as a psychi-
atric disorder and the research funding this
attracted determining the caring attitude. The
historical understanding of dementia is brought to
life via a case study by Dr Alois Alzheimer of
Frau Auguste D. The essential thrust of this section
argues that the organic disease model has been
accepted, wrongly, as the principle paradigm for
explanation, leaving no room for other perspec-
tives. For Cheston and Bender, such an over reliance
on the diseased brain explanation has set the ther-
apeutic boundaries of work with this client group
too narrowly. For example, to achieve a diagnosis
of dementia, all physical explanations are excluded
and what cannot be accounted for or explained is
termed dementia.
To add credence to such a perspective, sweeping
generalizations are made to imply that services
are generally poor for dementia sufferers across
the United Kingdom. This to the reviewers is not
factual. There are an increasing number of excel-
lent services where the fundamental work of
Kitwood has been utilized, built upon, and cus-
tomized to meet local needs. Dementia care has
moved forward. There are areas where person-
centred care forms a foundation for practice, where
quality is measured in terms of well–ill being and
where services are delivered by a professional
multidisciplinary team who are both person and
disease focused.
Parts two and three of the book provide the
reader with a variety of alternative explanations
and psychological models for understanding
dementia, from a person-focused approach. This is
Understanding Dementia
R. Cheston & M. Bender Jessica Kingsley Publishers, London1999, 240 pages, £16.95ISBN: 185302 479
First impressions
As a clinician and an educationalist with deep inter-
est in dementia care, it is heartening to see how far
we have come in the last 12 years in understanding
the lived experience of those with dementia. Let
us remember that it was as recently as 1988 that
people with Alzheimer’s were referred to as ‘the
living dead’ (Miller 1988).
Cheston and Bender in this work continue the
important task of developing ways of knowing of
the personal experience of dementia. Taking us
further back from the brink when we actually con-
templated denying the psychological existence of
those with dementia with the ever-present potential
to deny them physically.
The whole tenor of the book emphasizes the sub-
jective experience and personhood of the dementia
sufferer rather than just preoccupation with the
needs of caregivers, both familial and professional.
More meaningful emphasis on the person with
dementia is discussed, rather than focusing on those
around them. After reading the chapter on thera-
peutic interventions we were excited to see that
seminal work of Kitwood (1997) has been devel-
oped further to make use of other psychological
theories. For example, Bowlby’s (1988) attachment
theories.
Structure of the book
The book is divided into four parts, which help the
reader to first understand how the organic model
has become the current dominant explanation for
the progression of dementia. Part two is concerned
Book reviewsEditor:Professor Philip Burnard
Submissions address:School of Nursing and Midwifery Studies, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK
not to say that Cheston and Bender shun the
organic perspective, they merely attempt to help us
acknowledge the wider picture. The move is one
from no cure, therefore no point, to actively seeking
to understand and offer help and most of all hope
to those with dementia. Within part three, attach-
ment theory (Bowlby 1988), generally associated
with childhood behaviour, is illustrated and applied
to dementia sufferers. The reader is helped to
understand that the fearfully strange and confusing
consequences of dementia can activate deep fears
and trigger unconscious defence mechanisms,
resulting in the portrayal of attachment behaviour,
often clinically displayed as parent fixation. We
expect that readers will identify with the clear
scenarios presented regarding respite care, and its
sometimes dire, consequences. The reviewers con-
sider these inclusions, among many others, as prac-
tically helpful considerations that enable a deeper
understanding of the subjective experience of the
person with dementia.
Service implications in relation to increasing
emotional security and maintaining self-worth and
a sense of identity are examined and examples are
given of the types of therapeutic interventions and
evaluations that could be effective. These include
developing dementia care mapping, listening skills,
knowledge of attachment needs, and viewing the
impact of care from the person with dementia’s
viewpoint.
In concluding the book, part four presents a
gloomy picture and a ‘restless farewell’. Readers
are forced to come to terms with the fact that
unless they, or people the authors refer to as the
‘young–old’, convince those in positions of power
that services are not adequate, then all is lost. The
suggestion is made that inadequacies in service pro-
vision have to be shouted about loud and clear or
the homes and facilities we visit as professionals
today may be the ones we spend our retirement
living in tomorrow. The authors suggest that change
from within organizations is well meaning but not
nearly enough. It is not therapy or magic that is
needed, but money and resources. For this to occur
the needs of the elderly require a boost up the pri-
orities on the political agenda if truly individualized
person-centred care is to be realized and delivered.
Conclusion
After reviewing the book, despite our reservations,
we are still of the opinion that this is an important
text which will be practically useful to all those
engaged in dementia care from students to qualified
nursing staff. We strongly recommend it as a source
book for dementia care teams.
References
Bowlby J. (1988) A Secure Base: Clinical Applications ofAttachment Theory. Routledge, London.
Kitwood T. (1997) Dementia Reconsidered: The PersonComes First. Open University Press, Buckingham.
Miller J. (1988) Life File, BBC Television (Midlands),
Audio Transcript.
GRACE SANSOM1 & MIC RAFFERTY2
1Senior Nurse for Quality & Development forSwansea NHS Trust
2Programme Manager for Clinical DevelopmentsSchool of Health Science
University of WalesSwansea
UK
Treating Complex Cases: the CognitiveBehavioural Therapy Approach
N. Tarrier, A. Wells & G. Haddock (eds)John Wiley & Sons, London1999 ISBN: 0-471-97839-6 (Pbk)
This book is edited by three clinical psychologists,
two of whom (Tarrier and Haddock) have been
associated with the Thorn Programme at the
University of Manchester. The editors have
managed to bring together some of the leading
experts in cognitive behaviour therapy from around
the world and the 17 chapters cover the spectrum
from social phobia and agoraphobia to issues in
treating rape and sexual assault and the manage-
ment of parasuicide.
As the editors point out, the practice and
application of cognitive therapy has expanded
enormously over the past decade or so and the core
categories of phobia and obsession, once targeted
by nurse therapists, have grown to include not only
depression and general anxiety, but a wide range
of other clinical problems and the phenomena of
aggression and violence and sexual assault. The
editors have specifically targeted the management
of complex cases which, in their own words, do not
Book reviews
374 © 2001 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 8, 373–378
fit comfortably into simple case conceptualizations
or diagnostic categories. They have attempted, with
varying success in the chapters, to examine the
management of comorbidity, unremitting chronic-
ity and the admixture of social problems and
psychosis which bedevil simple mental health
interventions.
From the point of view of the clinician, the
chapters provide a great deal of very practical
information which will certainly assist with the
management of complex cases. All of the chapters
without exception, are well written and authorita-
tive, but I found several which stood out. Kevin
Howells provides the chapter on anger, aggression
and violence and highlights that this is a neglected
area within therapy research. His overview of
topics which should be assessed, is invaluable. Gary
Sidley wrote the chapter on parasuicide and pro-
vided both an authoritative overview of the litera-
ture and two very useful case studies. As might
be expected, Haddock and Tarrier contributed an
excellent chapter on the assessment and formula-
tion processes in the treatment of psychosis. I shall
certainly ensure that the students on our psycho-
social interventions programmes read and digest
this most valuable contribution. Finally, I must pay
tribute to Paul Gilbert, whose chapter on shame
and humiliation provided me with a new perspec-
tive on these issues which underpin many types of
psychological difficulties. Gilbert writes, not only
as a very respected academic figure in cognitive
therapy, but also as a clinician with enormous
insight into some of the underlying processes one
sees in therapist/patient relationships.
I really have two areas of concern about this text.
The first concerns the contribution of behavioural
techniques. In my view, the book underplays the
significance of behavioural procedures. I am
of the firm opinion that some of the chapters
go beyond the evidence base, to be in my view,
overly optimistic about the efficacy of the cognitive
approaches. In some ways, I believe cognitive
therapy has become one of the new religions with
cult followers who have ceased to be objective. One
needs to remind one’s self that although the evi-
dence base for cognitive behaviour therapy in psy-
chosis is promising, the Cochrane review published
in 1998, contained only four randomized trials.
Indeed, I think it is worth adding that a recent 5-
year follow-up of a randomized trial of cognitive
therapy in acute psychosis (Drury et al. 2000)
demonstrated that there was no overall long-term
benefit for cognitive therapy in a cohort of patients
with schizophrenia followed-up for 5 years. The
authors did report that a subgroup analysis found
some benefit in patients who had no relapse or only
one relapse over the follow-up period. However,
this was a post hoc analysis and I certainly had the
feeling when I read this paper that the authors were
desperately trying to retrieve something positive.
With regard to the neglected area of behavioural
interventions per se, I think that the book overall
failed to convey that it is quite difficult to separate
out the effects of behavioural interventions from the
cognitive therapy additions. In two areas at least,
i.e. obsessive compulsive disorder and severe ago-
raphobic avoidance, I believe there is, as yet, no real
evidence to suggest that cognitive therapy adds to
the efficacy of comprehensive behavioural manage-
ment. Some of the cognitive approaches described
in the book clearly have promise, but no real data
to attest to efficacy. My second and perhaps most
important point concerns an area that I have
covered in other reviews and articles, i.e. the capac-
ity of trained cognitive behaviour therapists to
deliver treatment. At the present time, there are
a few hundred, or at most a thousand or so in-
dividuals who have received higher level cognitive
behaviour therapy training. At the same time,
there are literally millions of people in the United
Kingdom who have disorders known to be respon-
sive to such approaches. With the best will in the
world, we can only target small numbers of patients
and we need to consider where we place our finite
resources. Jan Scott’s excellent chapter on cognitive
therapy for people with chronic depressive dis-
orders, I think spells out the difficulty. She describes
a case example ‘Edith’ and her 28 treatment ses-
sions with continuing follow-up, which included
four booster sessions per year over a 3-year period.
How many patients with depression will be able
to access such treatment? Furthermore, should we
be giving precious cognitive behaviour therapy
resources to populations which have very high rates
of spontaneous remission, such as anxiety and
depression or should we be confining our activities
to populations where spontaneous remission is rare
and where evidence for efficacy is very strong.
In conclusion, this book is a worthwhile read and
all experienced cognitive behavioural practitioners
will benefit from some, if not all, of the chapters.
Nevertheless, as my comments above suggest, the
purchaser of this book should also obtain the
proverbial pinch of salt!
© 2001 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 8, 373–378 375
Book reviews
Reference
Drury V., Birchwood M. & Cochrane R. (2000) Cogni-
tive therapy and recovery from acute psychosis: a con-
trolled trial 3. Five year follow-up. British Journal ofPsychiatry 177, 8–14.
KEVIN GOURNAYInstitute of Psychiatry
De Crespigny ParkDenmark Hill
London SE5 8AF
UK
Forensic Nursing and MultidisciplinaryCare of the Mentally DisorderedOffender
David Robinson and Alyson KettlesJessica Kingsley Publishers, London, Philadelphia2000ISBN: 1–85302–754–5
Given the nature of the limited availability in liter-
ature review with regard to forensic nursing, this
book is unique in attempting to examine the role
of the professional forensic nurse and explore
the multi-professional boundaries within mental
health. Its contents provide an insight into the
cross-cultural thinking and the complexities and
conflict of the forensic nurse. It attempts to define
this complex role within mainstream psychiatric
nursing and puts forward strong arguments that
forensic nurses require different and advanced
nursing skills. There is a national and international
flavour to the book and it would therefore be of
value to nurses, psychologists, psychiatrists and
health care practitioners, and also prison nurses,
the police, and probationists.
Chapter 1 examines the definition of forensic
nursing, and questions whether forensic nursing is
nursing at all. It also examined the relationship
between health professionals and the criminal
justice system. Chapter 2 is of particular impor-
tance to nurses working within the field of forensic
nursing. The authors query the role of the for-
ensic nurse and ask whether such a person as a
forensic nurse exists. The current thinking by con-
temporary nurses is that forensic nursing is still
viewed as an elitist subspecialism of mental health
nursing. Mike Collins, from the Rampton Hospital
Authority, provides an insight into the detailed
practice and policies in caring for the mentally dis-
ordered offenders. He highlights the lack of pre-reg-
istration education in preparing nurses to work in
the field of forensic nursing. He strongly advises the
inclusion of clinical competencies within mental
health nursing curriculum.
Readers would find Chapter 5, on the role of the
forensic nurses in the community, of great value.
Phil Woods, from the University of Manchester,
makes a brave attempt to unlock the conflicting role
of the forensic nurses working within a community
multidisciplinary setting. Chapters 6 and 7 offer
valuable information from a psychiatrist’s perspec-
tive on the contribution of forensic nurses in caring
for the mentally disordered offenders.
Social workers working in the field of forensic
medicine would find Chapter 8 of interest. It high-
lights some of the administrative wrangle between
local authorities, and also the value that inter-
professional education could have in providing a
collaborative approach to caring for the mentally
disordered offenders.
John Swinton, from the University of Aberdeen,
provides a spiritual perspective on forensic nursing.
He provides convincing evidence towards the thera-
peutic benefits of spirituality for mental health. He
advocates the inclusion of spirituality within the
theory and practice of forensic nursing. Swinton
and Boyd provide an insight into the complexities
of ethical practices within forensic nursing
(Chapter 10).
The role of the forensic nurse in clinical supervi-
sion is discussed in Chapter 11. Mary Addo claims
there is no finer model of clinical supervision, but
states that it is possible to move between different
modes at any one time. Heron’s Six-Category
Intervention Analysis is advocated. Gournay and
Carsom, from the Institute of Psychiatry, examine
stress in the forensic environment. The Special Hos-
pital’s Nursing Staff Stress Survey, undertaken by
the two authors, provides a better understanding of
stress in forensic nurses.
Chapters 13–18 are of special interest to nurses
who wish to develop a better understanding of
cross-cultural thinking within the realm of forensic
nursing. The role of forensic nurses in countries
such as Netherlands, Australia, Canada, USA,
Norway and Germany are examined in great depth.
It highlights many dilemmas and challenges facing
Book reviews
376 © 2001 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 8, 373–378
nurses in these countries. The key question remains
– there is no clear definition of forensic nurses.
Many questions have yet to be answered regarding
what all forensic nurses should know. The debate
between forensic psychiatric nursing as a speciality
area of nursing vs. general mental health nursing
continues. There appears to be a cry for a national
policy involving a statement of principles and goals
with regard to the role of forensic nurses.
Using empirical data, the contributors within the
book have provided a strong platform in promot-
ing a better understanding of Forensic Nursing,
both nationally and internationally. The issues
of training and multi-professional collaboration
remains central to the care for the mentally disor-
dered offenders. This book is highly recommended
to all health care practitioners involved in the field
of forensic medicine.
DAVE GUKHOOLAssistant Director, Mental Health
School of Nursing and Midwifery StudiesUniversity of Wales College of Medicine
Caerleon Education CentreGrounds of St Cadoc’s Hospital
CaerleonNewport
NP18 3XRUK
Spirituality, Healing and Medicine.Return to the Silence
David AldridgeJessica Kingsley, London, Philadelphia2000, 240 pages, £14.95ISBN: 1-85302-554-2
This book is the third of three related titles, the first
of which is about music therapy in the art of
medicine, the second concerning suicide. This third
book can be described as a synthesis. It is an exis-
tential account of what it is to perform health, how
that performed health is dependent upon a variety
of negotiated meanings and how these meanings are
transcended. In this book the author challenges the
reader to engage in talking about spirituality in a
culture of health care delivery. David Aldridge
presents the first unified approach to the subject.
The literature is evaluated across the disciplines
to ascertain just how effective and influential
spiritual healing may be on the patients’ physical
and psychological well-being.
The second chapter offers a series of explanations
regarding spirituality. Seeing it as being of the indi-
vidual, ineffable and implicit. The third chapter
offers a series of definitions on religion. Seeing it as
being about the social, spoken and explicit. The
overlap between religion and spirituality is then
explored.
Chapter four takes its material from incidents in
everyday life and is entitled ‘Lifestyle, charismatic
ideology and a praxis aesthetic’. The incidents indi-
cate the difficulties that we face when we talk about
health and the practices that are used to main-
tain and promote such health. This chapter also
explores various definitions of health and the
definers of health.
The next chapter is concerned with the body and
how the pursuit of pleasure can become an activity
that is far from pleasurable and uses the example
of alcohol-related disorders as a major health care
problem throughout the rest of the chapter.
In the chapter that follows, the author looks at
the area of prayer and healing. There is an explo-
ration of the forms of prayer and their content,
definitions of prayer, spiritual healing research in
the medical setting, prayer in medicine.
The last chapter is entitled ‘Pluralism and treat-
ment, healing initiatives and authority’. As the
words used for describing differing forms of healing
are based on varying traditions and have differing
meanings, this chapter looks at healing today and
explores the differences between health practi-
tioners, modern spiritual healers and traditional
shamans.
This book lacks a concrete conclusion and is
quite difficult to read for the lay person who merely
has an interest in the subject. A wide range of dis-
ciplines is covered, including medicine, anthropol-
ogy, psychology and sociology. I would recommend
that this book be suitable for those with a special-
ist interest whose work cuts across these disciplines.
DEBORAH EDWARDSUniversity of Wales College of Medicine
School of Nursing and Midwifery StudiesHeath Park
CardiffCF14 4XN
UK
© 2001 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 8, 373–378 377
Book reviews
Childhood Disorders (ClinicalPsychology: a Modular Course)
P. C. KendallPsychology Press, Hove2000, 229 pages, £11.95ISBN: 0-86377-609-4
This textbook forms part of a series of volumes
entitled Clinical Psychology: a Modular Course.Although it is stated in the book that it aims to
provide an accessible introduction to the field for
both students and professionals, it is not clear
precisely which professional groups are the target
audience.
The introductory chapter deals with models of
childhood mental ill health, although this is fairly
superficial. An exploration of the whole range of
mental health problems of childhood is then offered
in successive chapters. Information is offered on the
causes, presentation and treatment of the various
forms of mental health problems in childhood.
Little vignettes are used to introduce applied
aspects of theoretical ideas by presenting scenarios
of children with a range of mental health issues.
This helps to make the material feel more immedi-
ate and human. These case studies are a good way
of illustrating the global effects of mental health
problems in childhood not only for the child but
also for the wider family and community. The
potentially pervasive effects of mental health
problems on the child’s life and experience of life
are clearly shown.
Treatment modalities tend to be under-
emphasized, details on management tend to be
sketchy. However, this book does provide a useful
overview and discussion of a range of research in
this field. The style of writing is clear and fluent
and the text has a comprehensive index.
Overall, this text will probably be of interest to
the nonspecialist child or mental health care
worker. However, I would imagine that the spe-
cialist child and adolescent mental health care
worker will seek more detailed information and
discussion than is to be found in this book.
JIM RICHARDSONUniversity of Glamorgan
GlamorganUK
Researching Children’s Perspectives
A. Lewis & G. LindsayOpen University Press, Buckingham2000, 239 pages, £16.99ISBN: 0-335-20279-9
This edited volume has been written by a wide
range of contributors, although the majority are
teachers or experts in education. The Editors note
that they have attempted to produce a multidisci-
plinary approach to the investigation of children’s
perceptions and experiences. This would obviously
mirror current thinking on best practice in those
services aimed at children and their families.
The book is broadly divided into three sections:
theoretical and conceptual issues, practical applica-
tions and an overview. Within these sections a rich
diversity of topics is examined and discussed.
The emphasis throughout this book is placed on
new and innovative approaches to the complex and
challenging field of researching with children. There
is a clear acknowledgement of the specific issues
in relation to researching the lives of children of
differing ages, backgrounds, characteristics and
needs.
It is pleasing to note that a particular focus is
placed on the rights of children as a core and crucial
factor in researching children’s perspectives. An
interesting discussion of the legal and ethical
requirements of working as a researcher with
children is presented.
The text is well referenced and contains a useful
concise index. A range of appendices offers rele-
vant, interesting materials such as issues to consider
when interviewing young people with moderate
learning difficulties.
This is an absorbing and stimulating text. It
offers insights which may be useful in leading all
those who work with children and their families
to reappraise aspects of their practice. Although
intended as a multidisciplinary venture, a health
care perspective is missing. This does not neces-
sarily detract from this book, but rather indicates
an area for future development.
JIM RICHARDSONUniversity of Glamorgan
GlamorganUK
Book reviews
378 © 2001 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 8, 373–378