Paul Blenkiron’s Stories and Analogies
in Cognitive Behaviour Therapy is an excellent, stimulating book
and a delightful one to read.
Anyone expecting another dry, medicalised tome will be pleasantly
surprised. Blenkiron approaches his subject with clarity, humanity
and even, at times, humour. Although Blenkiron’s target audience
are clinicians, I feel that, with a bit of interpretation on the
behalf of the reader, this book could also serve quite well as a
self-help manual. Refreshingly jargon free, this book is readily
accessible to a wide readership. Throughout, Blenkiron’s tone is
straightforward never patronising or pompous. He doesn’t “talk
down” to his readers, but instead engages them in a lively
discourse on the benefits of using stories etc within CBT. They can
even be used to ascertain if a person would benefit from CBT and
are an essential part of tracking change and progress within the
therapy.
The term “story” is often used in mental health as, to my mind, an
inappropriate and dismissive way of referring to someone’s life
experiences and medical history. However, Blenkiron places the term
story in its true context as a tale to be told for the purposes of
entertaining, explaining a situation, elucidating meaning, to
enable understanding and an attempt to clarify. Stories, analogies
and metaphors are interwoven into the very fabric of our lives from
childhood onwards. Here the author explains how figurative
language, and the telling of meaningful stories, can be used in the
therapeutic environment to enable clients to understand and,
hopefully, alter their perspective; thus allowing them to change
unhelpful beliefs about themselves, the way that they behave and
think. Blenkiron explains the therapeutic use of stories in the CBT
setting; the need for them to be understood by both parties; the
fact that some of the stories/analogies may arise from the client
themselves and the way that a good CBT therapist can use these. He
explores the risks, and benefits, of using figurative language and
the need for a therapist to be flexible in their approach and be
“in tune” with their client. As he explains, “CBT is about
focussing on what matters to the clients as much as what is the
matter with them.” Ideally, a good therapeutic story should
be one which aims to improve the quality of a person’s life. He
argues that stories/analogies cannot be applied “like a
prescription” – there is no one size fits all. Just as some
antibiotics may suit a patient, others may find the same medication
unhelpful or even harmful. The CBT therapist must remain mindful of
this when using stories and analogies.
A plethora of useful stories and analogies are included. All of
them clearly linked with the types of mental distress for which
they will be appropriate. Blenkiron gives a compelling argument for
the use of stories/analogies in a wide range of mental, and
physical, problems including: depression, anxiety, post traumatic
stress disorder, personality disorders, psychosis, anorexia and
cancer. He is realistic in his acknowledgment about the
complementary use of medication and diagnostic labels within the
CBT pool. This is not a book which dismisses the use of
medication, but instead embraces it as a means of stabilising a
person so that they are able to engage with CBT.
The book is extremely well researched. This is evidenced by the
quantity, and quality, of Blenkiron’s range of stories, analogies,
metaphors and similes. In addition, he employs a lavish sprinkling
of quotations and proverbs from sources as diverse as Roman
philosophers, political figures, writers and even Groucho Marx!
They are a helpful, enlightening and often humorous condiment to
his text.
It’s an excellently structured piece of work. Each chapter gives a
brief overview of the topic to be discussed which is then
elaborated in more detail. The text is interspersed with tables,
pictures, diagrams, graphs, quotations and case histories. While he
debunks myths about what CBT isn’t, he explains what it is and how
it can be effectively used in a therapeutic relationship. He gives
clear guidance on the “dos” and “don’ts” of using CBT including the
possible pitfalls for therapists. This includes boxes of “How not
to do CBT” which should enable the therapist to identify problem
zones. He also gives advice for trainees and supervisors. Useful
stories are offered for each “diagnosis” in addition to case
histories and practical help for the client. Each chapter concludes
with a summary and a table of key points. In his appendix,
Blenkiron lists the stories/analogies which appear for each
chapter/condition enabling the reader to access them quickly. Even
within every chapter, Blenkiron refers the reader to where a story
has been used before or may be useful. This quick reference guide
dispenses with the need to flick forwards and backwards among pages
in the attempt to locate a specific, helpful therapeutic
story.
I was surprised to see a chapter on physical health as I had not
realised that CBT could be beneficial outside the realms of mental
ill-health. Although it is a welcome addition, I would question
Blenkiron’s inclusion of eating disorders within this section.
While undoubtedly anorexia and bulimia lead to physical health
problems their roots, I would argue, lie in mental distress. This
chapter raises other issues for me. While the debate around how to
address people with mental health issues (service user, patient,
client or even customer) continues, Blenkiron doesn’t tackle it,
but instead adds another controversial dimension. Throughout the
book, the author has emphatically used the term client as “one who
uses the services of another” in preference to patient
which he explains as meaning “one who receives treatment”.
However, when discussing physical health, Blenkiron adopts the term
patient instead. He explains this shift because the word patient
derives from the Latin patiens meaning “to endure or
suffer”. This would seem to infer that those who have psychological
problems do not endure and suffer in the same way as people with
physical ill- health. Similarly, Blenkiron notes that a common
theme with depression is self-pity (“poor me”). While I acknowledge
Blenkiron’s professional experience in this area, I have yet to
meet anyone with clinical depression who exhibits this alleged
trait. Moreover, is Blenkiron suggesting that this attribute
doesn’t arise in people with other mental health diagnoses or
cancer etc?
In addition, there seems to be another anomaly in Blenkiron’s use
of “inspirational stories”. He argues these can be used to enable a
client/patient to deal with their condition. However, this would
appear at times to be naїve and ill-founded. While he acknowledges
that “inspirational stories” could be problematical for someone
with a physical, or terminal, illness as it may make them feel
“only more pressure to cope”, he fails to make the same concessions
for people with mental health problems. In particular, I would
question their helpfulness in terms of childhood trauma.
Blenkiron’s “Overcoming Adversity: true stories” focus mainly on
physical disability and poverty. They do not address the variety of
extenuating circumstances which may leave a person from an abusive
background “frozen in time”. Being told about people who have been
able to succeed in spite of adversity could only exacerbate the
sense of shame, guilt and failure which they already experience.
Finally, I feel that including Charlie Chaplin, with his
predilection for young girls, on the same page as childhood sexual
abuse to be an unfortunate example.
Notwithstanding the above comments, this is a clear and
comprehensive study. The author’s competence and expertise is
demonstrated throughout the book. Paul Blenkiron suggests that the
reader may wish to view it “like a box of chocolates” from which
they may want to only select their favourites. However, I would
recommend reading it, as I did, from cover to cover savouring every
word. Only then can you decide which parts of the text are likely
to be helpful in therapeutic practice. I believe that this book
offers all therapists an invaluable toolkit, and adjunct, for their
profession and one which I feel will prove useful for many years to
come.
Sally Dean
January 2011