Book reviews

the invisible smile: living without facial expression; the therapeutic relationship in the cognitive behavioural psychotherapies; and more, including web-only reviews

The Invisible Smile: Living Without Facial Expression Jonathan Cole & Henrietta Spalding
Oxford University Press; 2009; Hb £24.95 

This fascinating book offers an insightful and moving account of the experience of living with Möbius syndrome, a rare condition characterised by a paralysis of cranial nerves. The result is that people born with Möbius lack facial movement and expression and, in addition to having an appearance that is different to what we would consider ‘the norm’, they typically have difficulty with speaking and lateral eye movement and may also have problems with their teeth, hands and feet. Balance and hearing can be affected and some people with the condition may also have cognitive and sleep difficulties.

Many everyday activities that most of us take for granted, such as smiling, frowning, talking, eating, reading and communicating with others, are therefore particularly difficult and challenging for people with Möbius.

The book’s authors have in-depth, expert knowledge of Möbius syndrome – Jonathan Cole draws on his clinical experience as a neurophysiologist working with people with a range of neurological conditions, whilst Henrietta Spalding was born with Möbius. This powerful combination of expertise has resulted in an engaging and captivating volume offering a detailed insight into the experiences of people with the condition, their families and others around them.

Whilst Cole and Spalding give an authoritative account
of the aetiology and physical aspects of Möbius, supported by reviews of medical and psychosocial research, the strength of this book is that the personal narratives of people affected by Möbius are given prominence. As is usually the case, these varied, personal accounts add a depth and insight far beyond what could ever be possible from a third person’s perspective. These vivid descriptions of the reality of life with Möbius illustrate the ongoing physical, emotional and social challenges faced through childhood, adolescence and adulthood. The reports of realising that they are in some way different from others and of their sense of isolation in not knowing others with the same condition are particularly moving, as are their experiences of dealing with other people’s reactions to the way they look. The authors reflect on how the appearance of people with Möbius can lead others to assume they have learning difficulties or cognitive problems; they go on to challenge these assumptions, calling for abilities and need for support to be considered on an individual basis. The book also details the frustrations, difficulties and frequent delays in obtaining a diagnosis, and the difficulty of decision making about treatment, including options for invasive ‘smile’ surgery.

Interestingly, the book explores the complex relationship between how we internalise feelings of emotion and express these feelings externally, through facial expression. Contributors describe having to learn to express both positive and negative emotion through language, the tone of their voice, laughter and gestures when facial appearance alone cannot show it.
Importantly, whilst Cole and Spalding don’t shy from highlighting the difficulties facing people with Möbius, they also highlight the resilience, positive outcomes and achievements reported by many of those who live with the condition.

Overall, this is an absorbing book. It will appeal to a broad audience including psychology researchers, practitioners and students of all levels, as well as a range of health professionals.

It will be especially relevant to those with an interest in psychosocial aspects of visible differences, identity, experiences of health conditions, personal narratives, developmental psychology, and speech and language development.

Reviewed by Diana Harcourt
who is Reader in Health Psychology and Co-Director of the Centre for Appearance Research at the University of the West of England, Bristol


The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies
Paul Gilbert & Robert L. Leahy (Eds.)
Routledge; 2009; Pb £19.99

The concept of the significance of the therapeutic relationship originates in psychoanalytic literature. Recent research highlights its relationship to positive outcome across therapies. It has been discussed increasingly within cognitive behaviour therapy literature. This book draws together much of this recent research, filling a gap in books providing an evidence base for CBT.

The editors have gathered rich material from a diversity of CBT approaches, which draw on experimental evidence and theory from a range of different psychological research areas. Various conceptualisations are presented, taking account of the complexities that may present clinically. These provide useful frameworks to aid therapists to reflect on their work. Throughout the book, therapist self-reflection is promoted. While there is some helpful practical guidance, further case material could have been beneficial.

This is a useful resource for cognitive behavioural psychotherapists and, due to the breadth of the psychological material presented, may also be of interest to a wider audience of psychologists working with people to change behaviour.

Reviewed by Ruth Lukeman
who is a Chartered Clinical Psychologist, working with older people in Barnet, Enfield and Haringey Mental Health Trust


Spirituality and the Therapeutic Process
Jamie D. Aten & Mark M. Leach
American Psychological Association; 2009; Hb £56.50

This book is meant to help therapists ‘toward the ethical application of spiritual concepts’. However, although it assures the reader that spirituality is not the same thing as religion, and that the reader does not have to be religious or spiritual to use the book, the many vignettes they use to demonstrate the ethical application of spiritual concepts in therapy are pro-religious. It is obvious in reading the book that the authors are devout, as their book is biased with little consideration, that for some, religion may be detrimental to mental well-being. Also they often mention that religion has a beneficial effect, but no explanation of why this is (placebo effect, etc.), presumably because they believe it is due to a deity.

If you ‘believe’, you may enjoy this book; however if not, even if you regard yourself as spiritual, as I do, it may feel that you’ve spent a couple of hours being preached to. There is no doubt that a client’s spirituality needs to be considered and respected, but this book should have given a far more neutral and balanced view of the process.

Association; 2009; Hb £56.50
Reviewed by Dawn-Marie Walker who is at the University of Nottingham

Alphabet Kids: From ADD to Zellweger Syndrome. A Guide to Developmental, Neurobiological and Psychological Disorders for Parents and Professionals
Robbie Woliver
Jessica Kingsley; 2009; Hb £22.50

Woliver believes that parents of children with special needs should have the chance to play a role in the search for appropriate diagnoses of their children’s often complex and interrelated disorders. To this and other commendable ends, the book sets out 75 disorders commonly first diagnosed in childhood and describes the symptoms, treatment and prognosis of each one in clear and accessible terms. Case studies for each disorder are provided, helping to bring lists of complex symptoms to life.

For a student of psychology or a practitioner, this would be an excellent reference tool. However, the main problem with this text is that it is not as accessible as it could be for parents. For a parent concerned about the accuracy of her child’s diagnosis, the text would be more useful if it were organised around symptoms rather than disorders. In the current format, parents would have to read through the entire book searching for other disorders that may be characteristic of their child; I’m not sure this process would be the best way to provide illumination or comfort.

Reviewed by Charlotte Cox who is undertaking the Postgraduate Diploma in Psychology at Cardiff University


Political Psychology: Situations, Individuals, and Cases
Routledge; 2009; Pb £29.99
David Patrick Houghton

This textbook provides a concise, logically organised overview of the pertinent topic of political psychology, written in an accessible yet sophisticated way with undergraduates in mind. Houghton goes as far as to directly challenge students to consider themselves being in certain situations that involve intense moral and political dilemmas, such as being a young member of Hitler Youth in the 1930s and adjusting your mindset towards justifying the group objectives and committing heinous crimes.

A particular focus is the situationist–dispositionist debate; whether individual beliefs, values and attitudes (‘bad apples’) or situations individuals find themselves in (‘bad barrels’) affect political behaviour more. For example, terrorists are routinely found to be psychologically normal individuals caught up in a bad barrel situation. Yet our legal and political systems largely assume individual culpability, as seen in the trials of the Abu Ghraib soldiers. Houghton considers this debate through relevant political topics including voting behaviour, genocide, racism, terrorism
and international relations, referencing explanatory mechanisms such as behaviourism, obedience, personality, groupthink, cognition, affect, emotion and neuroscience.

It is important to note that this text is written with largely American examples. Political psychology is an area in which international perspectives and diversity between them are valuable and informing, so some exploration of the field and examples from the author’s undergraduate base (the UK) would have been welcome also. Nonetheless, there is a scarcity of up-to-date general textbooks in the area of political psychology. This book fills the void in providing an introductory overview that is both highly accessible and interesting.

Reviewed by Fidelma Butler who is an occupational psychologist in training  

Web-only reviews

The Child’s Voice in Family Therapy: A Systemic Perspective
Carole Gammer

This is a compact and succinct book that comes across as well written, informed, encouraging and thoughtful. It offers a lot of practical ideas, obviously drawn from a wealth of knowledge and experience. The book is split into three parts.

The first section provides an overview of techniques that can be used with families (e.g. dramatisation, externalisation) and also looks at setting limits and play. The second section provides a ‘roadmap’ going from the first interview to continuing with change.  It looks at challenges of each stage of therapy with a family and about ways of engaging families through this. The third section focuses on hyperactive behaviour and sibling relationships. This section could have been longer focusing on a wider range of difficulties.
The author provides an enjoyable read. Gammer has a warm and positive attitude towards including children and provides interesting and supportive vignettes, highlighting their crucial contributions to family therapy. The author suggests further reading and offers insight into where her own ideas are drawn from – it would have been interesting to have these lists expanded further.

Publisher:  W.W. Norton; 2009; Hb £19.99
Reviewed by Hannah Gough, who is an assistant psychologist with CAMHS – Disability and Paediatric Psychological Services, Stoke-on-Trent

Play in Childhood

Margaret Lowenfeld

In this authoritative text, Margaret Lowenfeld guides the reader through an interesting, insightful and hands-on tour of the importance of play in childhood. The author outlines play as being influential in social, emotional and cognitive development and serving as an essential therapeutic tool.

Lowenfield takes us through a history of the theories of play, with detailed attention given to the different varieties of play, how these can influence behavioural and emotional processes in adult life, and consideration of the effects upon children unable to play.

Refreshingly, the author has managed to provide an influential text without becoming overbearing in scientific terminologies and theories, whilst also providing several informative and sometimes humorous case studies involving her seemingly fearless “workers” from the Institute of Child Psychology. This is a real strength of the text and leads the reader to reflect on their own experiences.

The book is written in a very warm and accessible way, achieving academic reference value whilst being engagingly absorbing and informative to the non-specialist. Indeed I found the book difficult to put down.

Sussex Academic Press; 2009; Pb £17.95
Reviewed by Hannah Butler, who is an assistant clinical psychologist with Blackpool, Fylde and Wyre Psychology Service for Children, Young People and Their Families

Appreciating Asperger Syndrome: Looking at the Upside – with 300 Positive Points
Brenda Boyd

Written from the perspective of a parent of a son with Asperger syndrome and her own diagnosis, the primary aim of this book is to help individuals with the condition to understand their uniqueness and strengths, and to reach a deeper understanding (appreciation) of Asperger syndrome.

The text is organised into 11 chapters presented in an easy-to-read style. The first half contains a review of the basic characteristics of Asperger syndrome. The second-half of the text provides the reader with a list of 300 Positives (A–Z) with suggestions on how ‘Aspies’ can be more positive in the way they think and respond to the challenges of their diagnosis.
Individuals with a fundamental knowledge of Asperger syndrome will discover little original information in this book. Although inspirational, the inference that Asperger syndrome is in and of itself a special gift or talent and the frequent comparison to exceptional people such as Albert Einstein, Michelangelo and Mozart may challenge the reader’s comfort level. Nevertheless, Appreciating Asperger Syndrome offers an uplifting perspective on the condition and describes how a diagnosis can lead to greater self-understanding, self-advocacy and (ultimately) self-acceptance.

Jessica Kingsley Publishers, 2009, £12.99
Reviewed by Lee A. Wilkinson, who is a chartered psychologist and faculty member in the Center for Psychological Studies, Nova Southeastern University, Florida

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