Book Review: Psychotherapy & Its Discontents

Psychotherapy & Its Discontents edited by Windy Dryden and Colin Feltham, Open University Press, Buckingham (1992).

Freud's words "What a lot of accusations all at once! Nevertheless I am ready with rebuttals for them all" set the scene for this book, the latest of over fifty with which the prolific Windy Dryden has been associated as either author or editor. Here he and fellow editor Colin Feltham attempt to present an overview of current discontent with psychotherapy as voiced by eight representative critics, each of whom then engages in a brief debate with a differently-minded theorist. Among the criticisms presented are those of Kline, who disputes the adequacy of outcome research so far undertaken; Evsenck, who suggests psychotherapy may have no beneficial outcome to detect; and Masson who, once again, argues that it is actually harmful. All eight writers are asked to employ the analogy of psychotherapy as client in need of treatment: Masson declares the client terminally ill and fit only as a subject for euthanasia.

In the main, though, the element of dialogue in this book serves to extend and clarify the nature of the critic's discontent. Dryden and Feltham are careful to state at the outset that this is not a homogeneous collection of discontentment. What does unite the writers - both critics and defenders of psychotherapy -is the depth of their passion, a passion which fuels a fascinating, if occasionally acrimonious debate (Holmes' response to Masson, and Masson's rebuttal, tend to be heated rather than helpful) and suggests that something is coming into existence though its birth may be painful. All occupations develop a culture, terminology and set of rules of craft, and the attention directed at these becomes acute when an occupation is in the throes of professionalisation. If one views a profession in terms of its monopoly over certain resources (knowledge) which are deemed appropriate to certain social needs it follows that the niche which it establishes as the basis of its exploitation of these resources and the activities which derive from them will vary in the extent to which they allow a development of the area. A tension will, consequently, develop between a process of mystification (neologisms, research, creation of knowledge etc.) and demythologization. Viewed in this context the passion of the debate presented in Psychotherapy and its Discontents may be understood as indicative of the difficulty psychotherapists experience in defining their field and exploiting their monopoly. As Samuels states in his challenging foreword "This profession, which is not one, cannot even be named", (p.xi). If there is a field here at all then, he implies, it can only be defined negatively by the naming of its ills - and it may be that the latest historical trend which Dryden and Feltham identify as "Psychotherapy versus counselling' might rather be termed "Psychotherapy versus itself. If so we may expect the debate which this valuable book seeks to delineate to continue for some time.

Simon Du Plock.