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