Foundations of Psychological Therapy
Ian M. Evans
- Engaging and accessible to novice and experienced therapists
- Encourages therapists to think critically about the process of change
- Deconstructs commonly accepted concepts in CBT
- Promotes new developments in CBT according to current psychological theory
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Book Review
58 vol 8 no 2 November 2016
The New Zealand Psychological Society
How and why people change: Foundations of
psychological therapy
Reviewed by Peter Stanley, Counselling psychologist, Taurang
Ian Evans PhD will be familiar to many readers as he was Professor of Psychology at both the University of Waikato and at Massey University. Prior to coming to this country he taught behaviour therapy at the University of Hawaii and was Director of Clinical Training at SUNYBinghamton. Evans has also been a clinical psychologist in private practice.
How and Why People Change is the culmination of a lifetime of experience and thinking on the fundamental questions that confront therapeutic psychology and psychologists. In this book Evans argues that it is important to derive principles of change that can be applied to any problem of living and he contrasts this with the present preoccupation amongst practitioners with techniques, discrete therapies, and evidence-based programmes. The author describes the personal difficulties that bring clients to therapy as being like the “wicked” problems of mathematics, in that they are complex, multicausal, and resistant to resolution. To make sense of them it can be helpful to adopt something like a circles of influence model (similar to Bronfenbrenner’s systems theory) with the inner ring consisting of personality and cognition, the intermediate ring reflecting more immediate contextual effects, and the outer ring representing culture and society. Evans contends that we cannot regularly prioritise one of these circles of influence over another in therapy. “Daily routines are as important as emotional schemas; relationships with family, friends, and workmates are as important as the relationships between
overt behaviour, thoughts, and feelings” (p. 265). In these circumstances, the prerequisite to planful therapeutic change is understanding the chains of causal influences in a client’s life and targeting some or all of them for intervention.
How and Why People Change underlines the significance of stimuli in people’s lives for eliciting thoughts and actions, and most especially in giving all manner of objects emotional valences. Equally, altering behaviour through contingency management is described as one of “the great technical success stories of psychology” (p. 115). But, notably, humans have the advantage of personal agency and so they can select rewards and punishments for themselves as well as for other people. An individual’s personality determines his or her unique response to a common context, although as a social species we tend to be motivated by opportunities for acceptance, intimacy, and influence. Cognitions are at the core of what we do, and these include both fleeting thoughts and studied self-reflection. Typically operating through words, cognitions give us the interpretations that we place on events and settings, and they also allow us to adjust in more or less adaptive ways in relation to the routines and rituals of the
cultures to which we belong.
Evans acknowledges that evidence-based programmes frequently contain principles of change, but the packages are often applied to a clinical syndrome without a detailed understanding of the processes that are maintaining the problematic behaviours in the present instance. Something is “being done” to the client and this could represent an affront to his or her culture, and it might also deny the active role that people can choose to take in their own affairs. Evans makes clear that the meaningful measurement of therapeutic change is fraught and complex; and evidence-based programmes can give undue, and uncritical, prominence to dubious outcome measures. The author argues that the history of evidenced-based treatment packages shows that the movement is actually antithetical to good treatment principles because they “drop them as quickly as possible when a new one comes along” (p. 261). Effectively, a therapy market place has developed, with “name brand” treatments, and “a professional culture of ‘mine is better than yours’”(p. 264).
How and Why People Change is a challenging text to review because it contains an extended argument with innumerable enrichments and many insightful digressions. The central thesis regarding principles of change does not ultimately result in a tidy integration of all that is best in psychological theory and research. Quite simply, this cannot be done. Schools of psychotherapy
are, in effect, social movements with their own language systems, methods of enquiry, and standards of proof. Similarly, psychological research covers a multitude of topics and is highly fragmented. It is difficult enough to achieve some familiarity withthis vast knowledge base, and it is a more demanding matter again to derive a specific therapeutic response as this will typically
call on a number of separate streams of psychological investigation. Nonetheless, Evans has made a major contribution to therapeutic psychology by elevating our gaze above packaged programmes and the assorted pickings of eclecticism. His view of the significance of experience for behaviour is also an optimistic one, and it means that proven principles and processes of change “can be translated into multiple ingenious, humane, and socially just intervention practices” (p. 249).