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Racial Identity, White Counsellors and Therapists: Tuckwell, G

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![][1] This book, written by a school teacher turned counsellor, aims to address anxieties facing white counsellors and psychotherapists, working with clients from other racial groups. It explores issues and processes associated with race and racial identity and also offers a
reviews
Think Good
-
Feel Good.
A Cognitive Behaviour
Therapy Workbook
for Children and Young
People
Stallard, P.
Chichester: John Wiley & Sons,
2002, »24.95 pb, 186 pp.,
ISBN: 0-470 -84290-3
This comprehensive text covers the
different aspects of cognitive
-
behavioural
approaches for children and young
people. The ext ent of knowledge required
to claim a grasp of the art of cognitive
-
behavioural therapy (CBT) is apparent
within this book and information is
presented at the requisite depth for its
target group. The book addresses theore -
tical aspects of CBT in a methodical
format, and so acts as an aide memoire
for those with some formal instruction in
the science. The introductor y section on
CBT with children and young people
usefully visits the evidence base for its
strengths and weaknesses in this age
group. It appropriately considers develop-
mental perspective issues that impact on
the success of this technique.
Whereas
Think Good
-
Feel Good
was
not intended to be delivered systemati-
cally as a package in a standardized 10-
session course, I have used it very much in
that fashion with satisfaction and success,
finding that the structure appealed to this
age group.
It is superbly complemented by age-
appropriate graphics that serve to
enhance its audience appeal and make it
less like another academic struggle. In
addition, I particularly liked the overall
dimensions, font size and page design
making the book format easy to use as a
template for sessions. Another strength
of this book lies in the free availability of
text and workbook resources through the
website, which has been well received by
its users. I have enjoyed using the book
and experienced success with it having
enriched my own clinical skill battery.
David McNamara Consultant Child and
Adolescent Psychiatrist, Oxleas NHS Trust,
2 Newman Road, Bromley BR11RJ
WorkingwithInterpreters
in Mental Health
Tribe, R. & Raval, H.
London: Brunner-Routledge, 2002,
»16.99 pb, 270 pp.,
ISBN: 0-415-18878-2
Occasionally, all psychiatrists need the
help of an interpreter. For many, working
with interpreters is a regular, and increas-
ingly frequent, aspect of routine work. An
ability to work competently with inter-
preters is now a requirement of the
MRCPsych basic specialist curriculum.
When reading this book, I conducted a
small, unrepresentative and biased survey
of mental health staff and medical
students. The re sults suggested that
although communication skills are now
widely taught, specific training on how to
work with interpreters is still a rarity. This
is an extraordinary omission. Communi-
cating effectively is the essence of what
we all do, and is never more vital than
when trying to help people from different
cultures.
This book provides the basics on how
to work effectively with an interpreter,
but also much more. Chapters written by
interpreters themselves help to highlight
the fragility of their profession, the diffi-
culties they face in day-to-day work and
their strong feelings of being undervalued.
Other chapters focus on therapeutic work
with interpreters, and theoretical models
that underpin much of the work. There are
chapters devoted to the specific problems
of refugees. Throughout the book, there
are case vignettes and descriptions of
individual services, which helps to keep
the text lively and interesting.
Sadly, some of what is advocated is
difficult, if not impossible, to put into
practice within the current time restraints
in the NHS. Ideally, out-patient appoint-
ments with an interpreter should be twice
as long as usual, and time should be given
before and after the interview to talk to
the interpreter, but where will the time
come from?
There are two important omissions
from the book. First, the editors were
unable to find anyone to write about
working with deaf patients, and signing
interpreters. Although much of the book
would apply to signing interpreters, it is
an area that would have benefited from
its own chapter. Second, the use of
psychometric tests across languages and
the interpretation of assessment
instruments are not included.
Do you really need to read a 250-page
book to learn how to work with inter-
preters? Probably not, but there is much
of interest in this book and hopefully it
will draw attention to this important area
of practice, encourage more skills-based
teaching and prompt someone to include
it in the MRCPsych examinations.
Michael Phelan Consultant Psychiatrist , Charing
Cross Hospit al, London
Clinical Effectiveness in
Psychotherapy and Mental
Health: Strategies and
Resources for the Effective
Clinical Governance
McPherson, S., Richardson, P. &
Leroux, P. (eds)
London: Karnac, 2003, »16.99 pb,
15 4 p p. , I SB N: 1 - 85 57 5 - 9 02 - 0
On reviewing this book, I had t wo things
in mind. First, what’s new in the material
presented? And second, is the material
presented likely to be effective in helping
change my clinical practice?
Some chapters were particularly
impressive. The chapter on political mile-
stones gave a very good overview of the
evolution of a quality agenda in mental
health. Other chapters in the early part of
the book seemed full of ‘management
speak’ and did not sustain my interest. T he
chapter entitled ‘In defence of NHS
Psychotherapy’ by Phil Richardson and
Columns Reviews
columns
184
Peter Hobson was published previously in
Psychoanalytic Psychotherapy
. It presents
a good case for the services provided at
the Tavistock. Ther e is litt le ev idence of
Tavistock NHS psychotherapy wishing to
learn from current research so that clinical
practice may be improved, and the plan-
ning, organisation and delivery of psycho-
logical therapy ser vices made more
effective. Chapter seven emphasises that
‘it is no longer a disorder that is being
treated but a person’. Phil Richardson here
presents a good overview of evidence-
based practice and the psychodynamic
psychotherapies. However, this chapter
seems rather discouraging and dispiriting
for an individual attempting to base prac-
tice on evidence. Such an individual might
well wish for guidance on a range of
solutions, rather than just reading about
the complexities and problems inherent in
much evidence-based practice.
In their useful overview of the audit
cycle, McPherson and Richardson recog-
nise that the most difficult part of the
audit cycle is in implementing change. I
believe the attempts to distinguish
between audit and research in chapters
nine and ten create confusion and are not
helpful. In the later chapters, complexities
and problems are raised in the choice of
outcome measures. The writers do not
write as if the measures have been incor-
porated into the ever yday evaluation of
Tavistock Clinical Services. The examples
given come from ser vices outside the
Tavistock Clinic, such as the Brandon
Centre. I was disappointed that health
service users seemed to be mentioned as
a two-page afterthought in chapter
fifteen. Clinical effectiveness in
psychotherapy and mental health ser vices
might be greatly increased by the
thoughtful involvement of health ser vice
users in the planning, organisation, devel-
opment and delivery of psychological
therapy serv ices at t he Tavistock and
elsewhere.
I hope the next book on clinical effec-
tiveness will be more forward-looking and
will present a clearer vision of how things
can move on in evaluating the psycho-
logical therapies, and with the Tavist ock
Clinic at the forefront of developments.
Kevin Heal y Consultant Psychiatrist in
Psychotherapy, Clinical Director, Cassel Hospital
Cognitive BehaviourTherapy
for People with Cancer
Moorey, S. & Greer, S.
Oxford: Oxford University Press,
2002, »24.95 pb, 208 pp.,
ISBN: 0-19-850866-2
Psycho-oncology is a rapidly growing sub-
speciality, and this book should be an
extremely useful aid to those involved in,
or connected to, the subject. It is
described in the foreword as a new
edition of a previous book,
Psychological
Therapy for Patients with Cancer: A New
Approach
(Moorey & Greer, 1989), but it
has been substantially rewritten and
updated.
Within the covers of a commendably
short book the authors provide: a concise
account of cognitive theor y; an overview
of the current evidence base of psycho-
oncology; a description of the adaptation
of CBT (cognitive
-
behavioural therapy),
termed APT (adjuvant psychological
therapy), for people with cancer, and
practical descriptions of the application of
APT in a variet y of situations. The infor-
mation is presented clearly, and is a
pleasure to read.
Much of the material in the book will be
familiar to experienced CBT therapists,
who may feel that detail is either lacking
or superficial. On the other hand, oncolo-
gists and other professionals working in
oncology may well feel that it is too
specialised to be of use to them. My main
concern is therefore: does the book fall
between two stools? Hopefully not: this
is a handy text that should prove useful to
a variety of professionals. Oncology nurse
specialists, liaison nurses, liaison psychia-
trists, health psychologists, and CBT
therapists who only occasionally work
with people with cancer are just some of
the groups who may benefit from this
book. Anyone negotiating with service
commissioners may also find it a handy
reference.
The techniques described in the book
are mostly equally applicable to people
with other serious, chronic or terminal
physical illnesses, but this is not a point
made in the book. Inadvertently, there-
fore, the book could be seen as giving the
message that psychological responses to
cancer, and subsequent therapeutic inter-
ventions, are somehow peculiar to cancer.
It would be unfortunate if this book rein-
forced such a misapprehension, already
prevalent among some colleagues in
medicine.
Paul Gill Consultant in Liaison Psychiatry, Sheffield
Family Work
for Schizophrenia:
APracticalGuide,
second edition
Kuipers, E., Leff, J. & Lam, D.
Gaskell, 2002, »15 pb, 152 pp.,
ISBN: 1-901242-77-3
There is ample evidence going back more
than a decade that working with the
families of people with schizophrenia
reduces the rate of relapse significantly,
yet in prac tice this rarely happens. This
book, written by the most prominent
researchers in this field, could help change
that. It offers strategies, as well as
describing issues and concerns that need
to be kept in mind while working with
these families.
Columns Reviews
columns
185
It is primarily a practical guide; after a
brief theoretical description, it moves on
to describe strategies in family work. The
book offers advice on setting up and
running family groups; and disc usses
engagement, co-therapy, psycho-educa-
tion, communication training, and dealing
with the emotional responses of the rela-
tives. Some of the commonly occurring
problems in high expressed emotion
families like anger, conflict, rejection,
overinvolvement and grief and loss are
also discussed and advice is offered on
how to deal with them. At the end it talks
about running a relatives group in parallel
with the family work, and emphasises the
importance of cultural difference.
Although it is meant to be a manual for
family work, it will be of interest for
professionals who come into regular
contact with the families of people
suffering from schizophrenia, since it can
help colleagues in dealing with conflicts
within family settings and their own
conflicts with the family members. There
are many transcripts from real life to
explain the issues under discussion.
Although there is an excellent chapter on
improving communication among family
members, it could be expanded, as this is
the most vital part of family work.
Being a manual, the book does not
describe and discuss in detail the theore-
tical background or the evidence base for
family therapy for schizophrenia. But it
does describe the family therapy techni-
ques in an easy to understand way. Useful
practical details and advice on commonly
arising situations, e.g. what to do when
the therapist is offered tea, coffee, or a
cake during a family therapy session in a
patient’s home! But the most outstanding
feature of this book is its brevity and
conciseness
-
the kind of book you can
read while waiting for your train.
Farooq Nae em Department of P sychiatry, Royal
South Hants Hospital, Southampton S014 0YG.
E-mail: Fn4@soton.ac.uk
Racial Identity,White
Counsellors and Therapists
Tu c k we l l, G.
Buckingham: Open University
Press, 2002, »16.99 hb, 188 pp.,
ISBN 0335-21021-X
This book, written by a school teacher
turned counsellor, aims to address anxi-
eties facing white counsellors and
psychotherapists, working with clients
from other racial groups. It explores issues
and processes associated with race and
racial identity and also offers a framework
for extending the understanding of race
on the sense of self. As such, it is one of
the few books available to do so as most
of the existing literature concentrates
more on understanding the different
cultural groups, the impact that their race
has on them, their experience of society
and the impact of racism on them. Fewer
people from Black and other minority
ethnic groups are known to be referred
for talking therapies. Even less is known
about how they respond to these treat-
ments
-
whether it is from white thera-
pists or from the small (but growing)
band of black therapists. T he publishing of
this book is therefore timely.
This book discusses frankly the euro-
centric model of white supremacy and
domination, which influences important
attitudes relating to superiority and infer-
iority. It proposes a broader and deeper
understanding, which should take account
of intra-psychic, interpersonal and socio-
political factor s. The author argues that
practitioners need to recognise their own
racial attitudes and counter-transference
reactions in relation to clients, as collec-
tive beliefs about white supremacy can be
damaging. The case for the role of super-
vision and training to help develop racially
aware practice, is well-made and well
accepted by all practitioners.
It is a shame that the style of the book
could deter novices to this field as it
coherently brings together world-wide
expert views and current thinking in this
complex field. A shame too, because it is
a refreshingly honest attempt to grapple
with much that is never openly spoken
about, but that nevertheless exists. I
particularly found the summing up section
at the end of each chapter useful as this
promotes reflective prac tices. This book
will probably be avidly sought by experts
in the field of counselling and
psychotherapy rather than the majority of
the readers of this journal because of its
specialist stance.
Deenesh Khoosal Consultant Psychiatrist
and Clinical Teacher in Psychiatry, Brandon Mental
Health Unit, Leicester General Hospital,
Leicester LE5 4PW
Terrorism and Disaster.
Individual and Community
Mental Health Interventions.
Ursano, R. J., Fullerton,
C. S. & Norwood A. E. (eds)
Cambridge: Cambridge University
Press, 2003, »4 0 pb, 364 pp.,
ISBN 0-521-53345-7
The e vents of 11 September 20 01c hanged
our world for ever. The w orld has become
a more dangerous and uncertain place,
and no-one is safe or immune from the
threat of terror. In an instant the lives of
victims and their families are irreparably
transformed; leaving for some an
enduring scar blighting lives with disability
as great as any physical injury.
How best to respond to these needs is
not obvious and there is little evidence to
tell us what exactly we should be doing,
when and to whom. Conducting metho-
dologically robust trials of any intervention
in the chaos and confusion that follows a
disaster is almost impossible and the
evidence, such as t here i s, i s limited. What
is clear however, is that inappropriate or
ill-timed early interventions can do
considerable harm. Responding to trau-
matic events therefore requires a cautious
pragmatic approach building on the
experience and lessons learned from
those who have first hand experience of
dealing with disaster.
Spawned in the wake of 9/11,
Terrorism
and Disaster
, accompanied by a CD-Rom,
makes compelling reading. Recent
terrorist atrocities, their aftermath and
the response of mental health services are
described. The efficacy of early interven-
tions is reviewed, as well as the pre-
exposure screening of high risk groups
such as soldiers and emergency service
workers. Particular problems associated
with more unusual traumatic events such
as body handling, radiation exposure and
contamination are described in addition to
a review of wider public mental health
columns
Columns Reviews
186
issues and problems associated with re-
location stress.
This is an excellent book and required
reading for anyone involved in disaster
planning. Disaster is a unique experience
for most mental health professionals:
considering any of us could be called upon
to advise and assist, this is a field with
very few ‘exper ts’. It is therefore crucial
that we learn from the experiences and
lessons of colleagues who have had first-
hand experience;
Terrorism and Disaster
allows this opportunity.
The war on terror has barely begun and
there will be many more innocent victims.
Considering that conflict is taking place in
more than 100 countries and terrorism in
many more besides, the needs of victims
constitute a public health problem of
global proportions and a major challenge
for psychiatry in these troubled times.
Martin Deahl Consultant Psychiatrist, Shropshire
County PCT & Visiting Profe ssor, City University,
London
the college
Psychiatric services to
accident and emergency
departments
Council Report CR118,
February 2004, Royal
College of Psychiatrists and
British Association for
Accident and Emergency
Medicine, »10, 96 pp.
This report supersedes the previous joint
report (CR43) from the Royal College of
Psychiatrists and the British Association
for Accident and Emergency Medicine.
Since the publication of the original
report, new demands have been placed
on both mental health services and
accident and emergency (A&E) depart-
ments. The requirement that 90 % of
patients, rising to 100% by the end of this
year, must have been discharged from
A&E departments within 4 hours of arrival
(Department of Health, 2001) will have a
major impact on the interaction bet ween
mental health services and A&E
departments.
The main report examines the common
mental health scenarios that occur in the
A&E department, issues affecting patients
from ethnic minorities, specific problems
in the A&E department, personnel issues
and the organisation of services.
The principal recommendations in this
report are as follows:
Summary of
recommendations
.There is a joint re sponsibility for
commissioners, me ntal health serv ice
managers, and acute ser vice managers
to ensure that the input of mental health
serv ices to A&E departments is not
overlooke d in negotiations.
.A consultant p sychiatrist should b e
named as the s enior member of staff in
the loc al mental health ser vices
responsible for liaison w ith the A&E
department.
.A&E depar tment personnel should have
adequate know ledge of mental health
issues, and feel c onfident in making an
initial assess ment of people with ment al
health problems.
.Mental health proble ms should be
included in the triag e process.
.A&E depar tment staff training should
include the reco gnition of common
mental health problem s, and the
appropriate responses to that
recognition.
.Mental health s taff training should
include training from A&E depar tment
staff re garding what is helpful.
Conversely, A&E depart ment staff
require training from the mental he alth
staff about what is prac ticable.
.Common t raining initiativ es invol ving
both st aff groups address not onl y
trainingissues, but also can lead to
major operational bene fits.
.local policie s should be agre ed
regarding common mental health
problems t hat arise in the A&E
department.
.The A&E depar tment should include
facilities and resources for the
asses sment of patients wit h mental
health problems. This should include an
interview r oom with adequate safet y
features.
.Staff training should include s afety
issues.
.A liaison group, wit h representative s
from the A&E depart ment and from
mental health ser vices, s hould review
issues of joint working bet ween the two
serv ices, establish jo int working
protocol s, and ensure that the
recommendations c ontained within this
repor t are considered and
implemented.
.The liaison group should be authorised
by, and have agre ed report ing
structure s to, the respectiveTrust
boards.
columns
Columns The College
187
... Racial Identity, White Counsellors and Therapists (Tuckwell, 2002 ...
Article
Full-text available
The concept of ‘culture’ is gaining in significance within the discourse of counselling and psychotherapy, as a means of making sense of the ways in which shared identities and behaviours are constructed and maintained. The selection of papers included within this Theme Section explore different aspects of the use of the idea of culture within counselling and psychotherapy. In this introductory piece, we seek to place this work in a social and professional context.
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