Book Review: The Sage Handbook of Counselling and Psychotherapy

This text, according to the authors, aims to bring together the Fundamentals of counselling and psychotherapy for both trainees and experienced practitioners seeking expansion of their knowledge base. The original brief for fulfilling this objective is to address what practitioners 'need to know, do, think, feel, use, reflect upon, change and abandon to be of most use to clients'. Regardless of their definition of 'need', when the authors acknowledge their comprehensive intention, I cannot but agree. Given the ambitious nature of their project you will not be surprised to know that this "handbook" weighs in at 1.166kg and 622 pages.

I need immediately to declare my position as a book-reviewer. I believe strongly in the value and potential benefits of ethical and humane therapy which an existential phenomenological way of working offers when meetings take place in the spirit of collaboration and in the quest for ordinary and truthful dialogue. I am sensitive to the many and often revered principles made in the world of psychotherapy that can variously mystify, ignore, disparage, glorify, generalise, fragment and fix human experience; attitudes which constrain and close possibilities of encounter between the two people who meet as therapist and client, and which can devalue, if not invalidate, the client's way of being.

My scepticism of this book's claim to activate a small thrust towards [...] theoretical collaboration can be illustrated in this vignette which reveals a fundamental incompatibility between one common modality and the phenomenological stance.

A therapist, well-primed in working with the transferential relationship, was being supervised by a phenomenological supervisor. The verbatim of an early session revealed that the encounter had begun with the client asking the therapist how he was. The therapist responded with a minimal polite acknowledgement, followed by a silence which the client seemed to find uncomfortable. There can be little disagreement that this is a common type of occurrence in the preliminaries of a session.

When asked to say more, the therapist revealed how he had interpreted this exchange which was that the client had asked "How are you?" speaking out of a fear of being abandoned were the therapist, transferencially the parental figure, to have fallen into bad health. The therapist had deliberately responded through the counter-transference, in parental care, to reassure the client that being in good health, abandonment was not on the cards.

Further conversations ensued between the supervisor and the therapist in which the supervisor tried to open up possibilities. "Just supposing", the supervisor put carefully, "that even if it does transpose that your client does relates to you with that stance and that he does reveal in the course of the sessions that he harbours a fear of you abandoning him, - even bearing these possibilities in mind, do you think it is possible that this man, naif to the theory that informed you, was just being polite, following ordinary social norms in the same way he might have done in any other encounter?" These possibilities had never been dwelt on by the therapist, who replied that he always interpreted. This simple enquiry in supervision began the uncovering of many embedded assumptions and biases, which had obscured and closed down the obvious and evident in the first place.

The book itself is organised into seven main sections

1. Counselling and Psychotherapy in Context.
2. Socio-Cultural Perspectives
3. Therapeutic Skills and Clinical Practice
4. Professional Issues
5. Theory and Approaches split into Psychodynamic, CBT, Humanistic Existential, and Eclectic–Integrative
6. Client Presenting Problems
7. Specialisms and Modalities

So Messrs Feltham and Horton, whilst you express a wish to encourage critical thinking in the contributors, I am suspicious. In the Notes on Contributors and Editor, many do not declare their theoretical allegiances and some do not make it clear whether or not they currently work or have ever worked with clients. And the Preface while earnest, is very tentative (apologetic almost?), realising the book is likely to fall far short of its aspirations, which it does for this reviewer immediately in section 1. Counselling and Psychotherapy in Context.

In this first section, there is no mention of phenomenology, the backbone of and probably the inspiration for mainstream humanistic trends of psychotherapy as promulgated by Rogers, Perls, May and others in the US and by R.D. Laing and, latterly, van Deurzen, in the UK. I scoured a tabulated timeline of Key historical markers in Psychotherapy and Counselling which shows Birth/Growth of Institutions, Significant Events, Appearance of schools and I found no hint of the existential phenomenological tradition that is slowly yet certainly developing an influence in the therapeutic and research world. This is all the more surprising because Emmy van Deurzen has contributed an evocative and reliable chapter about Existential Psychotherapy later in the book.

Within the whole body of the book there are some good chapters which, as independent entities, are informed, concise, well-organised and consider a breadth of perspectives. However, in my initial draft of this review, I attempted to appraise this book section by section, but finally gave up, realising that most sections do not deliver what they appear to offer and within most and across them is much inconsistency and repetition. The sections addressing Client presenting problems and Specialisms and modalities, for example, did not seem to have clear identities – and various chapters in Socio-cultural perspectives really felt they belonged elsewhere. It also occurred to me that most contributors were oblivious of what was other chapters were being produced and what their content might be. There was no sense of a dialogical and cohesive feel to the book.

The section on Theory and Approaches showed most editorial structure, which encouraged a stricter consistency of content, yet I found this section to be pedestrian. While some writers wrote well and vividly, others' communication was literal and sparse and did nothing to bring alive the very approaches they were appointed to show. Other handbooks of theory and approaches have been compiled and edited so masterfully and insightfully (e.g. Corey 1991, Dryden 2007) and what I and also counselling and therapy students value in these books is that they incorporate graphic case examples, concise and helpful comparative reflections and also criticisms and limitations of the counselling approaches. Why settle for less in this book?

One aspect of Corey's book is that for each approach appraised, there is a heading Contributions to Multicultural Counseling. This works for me. I think a failing of separating out Socio-Cultural Perspectives in this tome, is that the editors did not seem to have formulated precisely angles to cover, nor is it evident they were committed to considering a range of perspectives and questions – it is as if they included this section in for the sake of political correctness. This section for me was problematic for a number of other reasons. The tone of many chapters was negative rather than invitational and questioning. The pessimistic tone of the chapter by Carol Mohamed on Race, Culture and Ethnicity seemed to end up as a political diatribe against white man's treatment of black people. What about the whole other host of questions that might interestingly have been discussed such as being in-between cultures, difficulties between minority cultures/ethnic groups, and how to engage with our xenophobia as therapists.

Much of the writing in this section contained psychodynamic pathological jargon issued as truths. David Pilgrim authors a very disappointing chapter on Age which I felt would have more happily have sat in the Client Presenting Problems section, although I would happily have removed this without trace. Mercilessly theory driven, he chose to focus exclusively on the three so-called 'stages': childhood, a lot devoted to childhood abuse – which is dealt with sensitively and elegantly elsewhere, young adulthood, dominated by discussions about schizophrenia – which is dealt with predictably elsewhere, and old age, a little on dementia and abuse in old age, but much more about depression – yes, dealt with elsewhere too. He says, 'When we come to treat depression we cannot afford to be a 'one-club golfer'' – which in itself depresses me as I haven't got one golf club let alone a whole set. Pilgrim's concluding discussion was not even a half-hearted attempt to broaden viewpoints, and he did not begin to ask fundamental questions about passage of time and human temporality. He also failed also to think about the impact of generational differences between therapist and client.

And why did the editors let a good chapter written by Dominic Davies be published under the title Sexual Orientation, when it was about non-heterosexuality? In fact, in the index, homophobia, homosexuality, lesbianism had 13 references, whereas heterosexuality had none (mind you, neither did transgenderism or bisexuality). Interestingly, when I leapt to Llynwen Wilson's chapter on Sexual Dysfunction, in the Client Presenting Problems section, there appeared to be a completely unquestioned heterosexual bias (although I might well have got it wrong when I assumed it was a female in stockings and high shoes that is the fetishistic object of desire of a male with sexual dysfunction).

Therapeutic Skills and Clinical Practice was a section which had no consistent feel or flavour. It did however include a noteworthy chapter by Francesca Inskipp on Generic Skills which was thorough, accessible and useful to any practitioner at any level. I was also encouraged that she included Gendlin in her list of references. In perusing this section, I wondered how the editors had failed to notice that there were numerous and various formulations of person-centred skills scattered throughout the book, described in varying degrees of detail.

In spite of having something of an identity crisis, my favourite section is Professional Issues: some good writers talking about the real issues of practising in the real world. Questions of practitioner liability were here, as were details of Data Protection, Therapy and The Law, Ethical Codes and Guidance, Private Practice, Insurance, Advertising, Responding to Complaints and other important questions that are typically not given much coverage as would probably be useful. I thought the chapter on Psychopharmacology by Linda Gask would have been relevant here rather than in Client Presenting Problems. Yet, buried in this section is the chapter Client Experiences. There is also no reference to Qualitative Research methods.

Now wouldn't it have been interesting to have devoted a section to Client experiences? The client definitely has too little voice in this book

And so I navigated my way round this book confused and lost at times, wishing the index was more comprehensive. I enjoyed some chapters and despaired at others. I think it is important to engage with ideas presented through diverse theoretical lenses, so long as these biases are made evident and that critique and alternative viewpoint is accounted for. While some chapters achieve this well, others peddle theory and offer no other critical angles. Few offer a phenomenological view. Happily some, though alas, too few, do.

I would be reluctant to recommend this publication to a student starting out, for all the reasons stated above. I would rather refer them to several trustworthy publications in which each piece of writing was crisp, comprehensive, organised, transparent and part of a cohesive whole. Nor, do I think an experienced practitioner would be in the market for such a careless, broadsweep of a book, in spite of its occasional good chapters.

For all that is good in this book, the editors have not been committed, incisive, visionary, ruthless or rigorous enough in its conception, commissioning or editing. This book needs a major overhaul and the contributions of an inspired set of practitioners and professionals committed to 'theoretical collaboration' and discourse; this would not only produce a vastly improved product, but one which would likely weigh in at two-thirds of the size.

References

Corey, G. (1991). Theory and Practice of Counselling and Psychotherapy. 4^th Edition. Brooks/Cole.

Dryden, W (Ed.). (2007). Dryden's Handbook of Individual Therapy. 5^th edition. Sage.

Simone Lee