Book Review: Psychotherapy and Counselling in Practice: A Narrative Framework

Psychotherapy and Counselling in Practice: A Narrative Framework

Digby Tantam. (2002). Cambridge: Cambridge University Press.

A must for all trainees and therapists; this book is a valuable resource for those embarking upon or currently in clinical practice. The book is presented in a straightforward and accessible way, with plenty of examples from both clinical and theoretical perspectives. The clinical vignettes are not just taken from sessions between psychotherapists and clients, but include the medical profession, doctors, nurses and other health care professionals as well, which enhances appeal of the book.

Digby Tantam skilfully brings together the mental health profession as a whole, emphasising the importance of the therapeutic relationship rather than one particular 'treatment'.

Tantam refers to a variety of practitioners from different approaches: Existential, psychodynamic, cognitive behavioural and group therapy amongst others, as well as novelists, to illustrate the points that he is making. His examples are excellent; clear, interesting and at times amusing, and they add to the topic under discussion, and reflecting the depth of Tantam's knowledge and his wealth of experience.

The book covers aspects of the therapeutic relationship, which are not always made explicit in psychotherapy texts, such as concerns, values, flavours and meaning. Clients bring their concerns and problems, the things that matter to them, to their therapy sessions. Tantam examines this area further, highlighting the rich context contained within each concern that can be explored with the client. Tantam states that a concern has three elements to it: Emotion, appraisal and value (pg 15), and that examination of these elements within the therapeutic relationship will lead to greater insight into the client and their world.

Chapters 4 (Narrating the Treatment) and 5 (Narrating the Self) introduce the narrative framework for psychotherapy. Tantam puts forward a rationale for narrative approaches to psychotherapy in that 'they recognize that the need to tell one's story is an important impulse for people in distress, and that telling one's story to a receptive audience lifts some of the burden of the events depicted in it' (pg 81). This highlights the relational aspects of human being; that our well-being is affected by how we relate to others and how we talk about the story of our life. As Tantam remarks we narrate our life story in different ways depending on the situation and the person listening, which indicates that we are in a constant state of relating to others and the world and in that process we change and amend our life story and therefore, ourselves. Tantam states 'a person's life tells a story about the person themselves' (pg121) and that through listening to the client's life story therapists can gain an insight into the client's values, beliefs and world view.

Tantam however, also warns of some of the dangers and potential pitfalls that therapists may fall into, such as what he calls 'the struggle of narratives' (pg 85). What Tantam means by this is that the client narrates his/her life story in the session, however, there are many ways in which this session can be re-narrated by the client or therapist through their perception, understanding and what is written down in notes etc. Which is saying in effect that we cannot capture, analyse or write down our moments of relating without changing something about the essential nature of that encounter.

The book is packed with useful facts and theoretical considerations, dealing with everything from first sessions, confidentiality and listening skills, through to note taking and endings; with informative sections on crises, addiction, relaxation techniques and universal techniques for resolving predicaments to name but a few. In some ways the extent of what is covered is the book's downfall in that there is so much information and references to different theoretical approaches that the focus on the narrative framework gets a bit lost and can often feel tangential. It takes a couple of readings to fully appreciate what the book holds. The major thrust of the book seems to imply that the narrative framework is transtheoretical and can sit with any approach. In particular it shares many qualities with the existential-phenomenological approach in its emphasis on the relational aspects of human beings, and on an exploration of the client's emotions, values, meanings and world view. The client's narrative is dealt with in a phenomenological way, allowing clients to discover their own meaning.

All in all this is an excellent resource and a valuable addition to any clinician's bookcase.

Claire Arnold-Baker

Claire Arnold-Baker