374 BOOK RJZVIEWS

It really is essential to understand and accept the authors’ theoretical framework if the more pracitical aspects of the book are to be utilised. This may pose some problems as the theoretical part of the book is very heavy going and could be virtually incomprehensible to individuals unfamiliar with the area.

JANICE LEGGETT

R. W. BRSLIN (Ed.): Applied Cross-Cultural Psychology. Sage, Newbury Park (1990). 367 pp. E13.00.

This book is the fourteenth of a series by Sage on Cross-Cultural Research and Methodology, which was created to present comparative studies on cross-cultural topics and inter-disciplinary research from anthropology, political science, psychology and sociology. The present title is aimed firstly at undergraduates just beginning courses dealing with cultural factors in human behaviour and secondly at practitioners (clinical, occupational, industrial and educational) who might be seeking an up-to-date review of the topic.

The result is an extraordinarily coherent and well-edited volume of chapters that spans a very wide range of theoretical and applied models of psychology. There is, for example, a chapter on Indigenous Psychology which is aimed at identifying knowledge as understood and experienced within a culture. There is a chapter on cross-cultural psychology and the formal classroom; another on cross-cultural testing and assessment; on culture and health; on mental health; on orientation programmes; on international students; on family and home-based interventions; on acculturation; on the environment, culture and behaviour; and more besides.

If these topics whet your appetite, then this is the volume for you. The authors are themselves from every corner of the globe (Hong Kong, India, China, Nepal, Canada, Finland, but not, alas, the U.K.) and have all studied, lived and taught at leading cross-cultural centres in the U.S.A. This latter fact creates some cultural unity and single style to the book, which would otherwise be too much of a patchwork of different world views.

Brislin’s opening and excellent chapter argues that there is an identifiable cross-cultural model, and identifies common themes to all the chapters-u&., ethnocentrism; cultural-general and cultural-specific concepts; cultural awareness during interventions; and differences and deficits.

Therapists will find the mental helath chapter relevant but brief, and the book will be of value only to those who are already persuaded that a cross-cultural approach is indispensable to good clinical practice. This country may proclaim itself to be multi-racial and multi-cultural. Sadly psychology theory, teaching and application do not yet reflect this.

PATRICIA D’ARDENNE

M. CROWE and J. RIDLEY: Therapy with Couples-A ~eha~~uura~-Systems Approach to Raritan and Sexual Problems. Blackwell, Oxford (1990). xiv + 417 pp. Ef7.95.

This book not only confirms its authors’ dedication to helping couples in distress but, more importantly, it reflects their extensive experience in the field of marital and sexual therapy. Having said this, my first impression was that the authors may have been slightly ambitious in their task, as the book, whilst aiming to be a practical guide when treating marital and sexual problems, also encompasses treatment methods derived from most other types of couple therapy (except non-directive) within its own (reconstituted) behavioural-systems approach. It was soon evident, however, that the authors’ ambition was well justified because the result is an exceptionally practical, clearly presented and undoubtably useful volume for anyone involved in the treatment of marital and sexual problems.

The behavioural-systems approach discussed in the book borrows most of its basic techniques from other well established types of couple therapy, e.g. ~havioural marital therapy, structural therapy and systemic therapy, but at the same time it incorporates a number of innovations and advantages which afford it its own identity and, in some cases, superiority. One innovative example is the authors’ use of ‘deeentering’. This means that, although well established techniques such as reciprocity negotiation and communication training are used, the authors make a point of re-creating a realistic communication process for the couple, by gradually withdrawing from the discussion and encouraging the partners to address each other. They do not (initially) attempt to act as mediators or ‘referees’. The authors’ clinical experience has demonstrated a longer lasting beneficial effect in couples’ communication competence when applying this decentering approach. Possibily the most important innovation in the book is the central position accorded to the use of timetables. This is a technique also used by followers of the systems approach to marital problems. However, Crowe and Ridley demonstrate the flexibility of their repertoire by applying the technique to a wide variety of problems, notably that of ‘sexual reluctance’ in one partner. Indeed, in attempting to summa~se the advantages of the ~havioural systems approach, the most striking of these must be its adaptability not only to a large number of client characteristics but also to a diversity of presenting problems (e.g. behavioural, interactional, sexual), at varying degrees of severity. Overall, I consider that the strength of the book lies in the authors’ basic assumption that most couple problems can be reframed in such a manner as to make the relationship aspect the central focus of therapy. Consequently, there is no obvious dichotomy made between, for example, marital and sexual problems.

With respect to the structure of the book, this comprises thirteen chapters led by a forward from Robin Skynner. The last chapter is, possibly, the best place to start consulting the book, as it summarises the main ideas and can act as a gude when using the rest of the material. In this sense, this chapter may have been better placed at the start of the book. Chapter thirteen also contains useful points relating to research evidence in the field of couple therapy and discusses the position of ~havioural-systems therapy in relation to psychiatric problems, addictions, family work, divorce and marriage. Chapter three is particularly useful as it describes the overall strategy of this therapy using the hierarchy of Alternative Levels of Intervention (ALI). Briefly, this strategy attempts to match specific interventions to any given presenting problems, and practitioners can move up and down the hierarchy according to the nature and intensity of the problem.

BOOK REVIEWS 375

Finally, although one reservation I have is that this book may prove a little daunting to the novice in the field of couple therapy, the other side of the coin is that its flexibility, adaptability and unlimited potential for creativity must make it a valuable tool for anyone seriously involved in helping couples. Equally, used with expert guidance, the book should be very practical to trainees on clinical training courses.

TINA BAKER

L. E. DE LISI (Ed.): Depression in Schizophrenia American Psychiatric Press, Washington, D.C. (1990). 162 pp. f15.95.

This book is based on a symposium which took place at a meeting of the American Psychiatric Association in 1986. The contributors, half British, half North-American, can also be split fairly evenly into those who believe that depression is an integral part of schizophrenia (mostly the British contingent) and those who believe that the two are entirely separate entities (the North-American contributors). One of the former, Dr Crow from Northwick Park in London, takes an extreme position, in regarding them as both part of one and the same psychotic process.

I entirely disagree with Crow’s position on this matter, and for the reason that he entirely ignores psychological (including neuropsychological) evidence to this effect. There is other-genetic-evidence against the unitary psychosis theory, which is well presented by several of the contributors here, but it is the psychological evidence which is overwhelming. It is true that the cause of each of the major psychoses (those delineated by Kraepelin in the 1890s-mania, depressive psychosis, schizophrenia/dementia praecox) is still unknown, but their nature is generally well known. By the latter I mean the complex of psychological deficiencies and phenomena. I do not see any need to re-open a debate on the psychological distinction between the three psychoses, when the issue has been examined from so many angles and found to hold up well. In fact an analysis of the phenomena and the psychological deficits in schizophrenia and depression generally shows the two conditions to exhibit completely opposite tendencies in this matter, not just different tendencies. In the sphere of memory, for example, schizophrenics have preserved short-term but impaired long-term memory whereas depressives show the reverse pattern. In the sphere of thought, concept attainment is one of the few aspects of a schizophrenic’s thought which is preserved but one of the few aspects of a depressive’s thought which is impaired. In schizophrenia their motor and speech problem is one of deviant movements and utterances, in depression it is one of quantitatively deficient output. The list can go on and on.

Only when psychiatrists learn to take heed of the psychological level in their work will they understand what they are doing.

JOHNCUTTING

A. S. BELLACK and M. HERSEN (Eds): Handbook of Comparative Treatments for Adult Disorders. Wiley, New York (1990). xviii + 556 pp. f50.00.

This multi-author book consists of 27 chapters divided into 9 sections. The first section provides an overview and introduces the general principles of the three treatment approaches covered in the book-psychodynamic psychotherapy, behavioural- cognitive psychotherapy and pharmacological treatments. The other sections cover 8 disorders: depression, panic/ agoraphobia, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, borderline personality disorder and alcohol/substance abuse. At least 2 treatment approaches are described for each disorder, usually 3. The authors are well known for their expertise in the field.

In general, the authors begin by defining the phenomena of the illness in question, followed by their conceptualiz- ation of the disorder, and then proceed to describe the implementation of their treatment strategies, ending by outlining the management of a typical case. Some authors briefly review the outcome using that approach. Each section ends with a short editorial commentary on the preceding chapters, wherein the use of a combined approach is usually advocated.

The book suffers from a frequent drawback with multi-author books-repetition, particularly as there are are often three chapters on each topic. Many overlap on phenomenological and nosological issues. Also, there is much variation in the quality of individual chapters. Even though some authors briefly review short-term outcome using their approach, there is little information on comparative outcomes, in terms of cost-effectivess, side-effects, safety and short- and long-term outcomes. Overall, the book does little to help the clinician decide on the most appropriate intervention for a specific illness. The problem with case illustrations is that they typically present the ‘ideal’ case where the application of stretegies runs smoothly, but in clinical practice problems are often not as straightforward. The book is intended to be of use to clinicians but the drawbacks mentioned above limit its value.

GERALDINEO'SULLIVAN

IVY-MARIE BLACKBURN and KATE DAVIDSON: Cognitive Therapy for Depression and Anxiety-A Practitioner’s Guide. Blackwell, Oxford (1990). viii + 230 pp. f 19.50.

This is a welcome addition for trainee practitioners in cognitive therapy. The text deals with depression, generalised anxiety and panic disorder. There are introductory sections on phenomenology, diagnosis and epidemiology which I thought were superfluous as I would expect most readers to be sufficiently well-read already. The book does not cover phobic disorders as the authors state that there is no satisfactory evidence to date of the efficacy of cognitive therapy in