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Book Reviews

BEECH, H. R. Changing Man's Behaviour. Harmondsworth, Middlesex, England: Penguin Books, 1969. 282 Pp. 8 shillings. (U. S. A. Penguin Books, Baltimore, Md. $1.95.)

This is a book written for the general reader, and it must therefore be evaluated as such. Presumably, it should have two main functions--to present a reasonable amount of "hard" information in a form that can be easily assimilated, and to convey a feeling of the current status of this subarea in the wider fields of psychiatry and psychology. It seems to me that Beech succeeds fairly well on the first count (and I am very much involved myself in trying to present this kind of material to the layman), but I have. rather serious doubts about his approach to the second. Since the standpoint is mainly that of Eysenck and his associates, perhaps my doubts follow from this.

These doubts begin with the opening paragraph of the first chapter, where a fictional agoraphobic patient undergoing behavior therapy sets off from the hospital gates--"After a few final words of encouragement from the therapist . . ."! One can almost hear the ghostly chuckle of Sigmund Freud himself behind his beard. Granted that encouragement alone rarely cures agoraphobia, surely no sophisticated behavior therapist is going to maintain that it is entirely irrelevant. If he does, the intelligent general reader will not be likely to take him seriously. On the very next page, Beech refers in a brief footnote to the work of Truax and Carkhuff; this shows--in a way which should satisfy most scientists--that, whether or not dynamic psychotherapy is a useful method of treatment, given the appropriate conditions, people have effects on people. The same difficulty appears a little further on, where we are told that a patient receiving behavior therapy will quickly appreciate " . . . that the thera- pist is generally much more active, encouraging and persuasive (than a dynamic therapist) and that relatively little importance is attached to personal relationships." Now I may have gotten this all wrong, but the sentence strikes me as totally self-contradictory. Later in the book, Beech rightly criticizes Wolpe for using "homespun philosophy" as an allegedly specific element in a behavioral program, but here he seems to have fallen into the same trap himself.

Marks and Gelder (whose work is not given sufficient attention in this book) have found that some patients respond best to psychotherapy whereas behavioral techniques are best for others. Furthermore, certain patients may need both, perhaps at different stages of their illnesses. In my opinion, there is no need to present the situation in terms of a confrontation as Beech does. Insistence on doctrinal purity was one of the worst drawbacks of the Freudian school, and there is much evidence--perhaps inadequately mentioned by Beech-- to the effect that, in many respects, Freudian and behavior theory are describing the same phenomena in different languages. Dogmatic rigidity is wrong for behaviorists and psycho- analysts alike, and I wished throughout my reading of this book that there could have been more emphasis on the value of a more broad and synthetic approach. Since every psychiatric treatment method--from counseling to psychosurgery--is still in its infancy, this really seems to be the only reasonable view at this time.

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266 BOOK REVIEWS

Though at times under-critical, e.g., of Wolpe's "90% cure" series, Beech is able to state frankly that "little or nothing is to be gained from using formal psychological tests" in selec- tion of patients or of treatment methods. It is all the more a pity, therefore, to see space devoted to the naive notion that altering "conditionability" by drugs can affect the course of behavior therapy. In the first place, the evidence for such a general factor is at best equivo- cal; in the second place, there is no evidence that, if there were such a factor, the success of behavior therapy would be related to it. In fact, this whole tissue of improbabilities has remained virtually without evidence for over l0 years, but this is not the impression to be derived from Beech's account. One really cannot go on, well into a second decade, insisting that "more research" will fit everything into place any day.

The best chapter is that on "Thinking Processes and Behaviour Therapy." Here, the author deals competently with fundamental issues, e.g., whether changing overt behavior modifies cognitions. He points out that, if neurotic illness were simply a matter of unadap- rive anxiety (without unadaptive cognitions), there would be no need to argue that changes in behavior produce changes in cognitions. Wolpe's position is effectively shown to be a wholly illogical one, and Beech rightly comments that " . . . it is one thing to abandon 'men- tation' as a barren field for experiment attack, and quite another to assume that cognitive processes are irrelevant to the exploration of human behavior." The chapter ends with unanswered questions, the posing of which may be of vastly more value in the long run than the spurious "certainties" put out by the P. R. men of behavior therapy.

HUGH FREEMAN Salford Royal Hospital

Lancashire, England

GRAY, BURL B., & ENGLAND, GENE, Eds. Stuttering and the Conditioning Therapies. Monterey, Cal.: The Monterey Institute for Speech and Hearing, 1969. x + 222 Pp. Gratis.

This book is largely the product of the International Seminar in Stuttering and Behavior Therapy held at Carmel, California, in November, 1966. Forty-seven psychologists, psychi- atrists, and speech pathologists from Australia, England, South Africa, and the United States met for 4 days to discuss the application of principles of learning to the understanding and treatment of stuttering. There was a 3-year delay in publishing these proceedings, but it is apparent that most authors updated their manuscripts, and references are made to articles published in the interim:

Rather than comment on each of the 19 chapters, this reviewer will simply indicate the scope of the book, what he considers to be the outstanding contributions, and his overall im- pression of the behavioral approach to stuttering as revealed by this book.

Appropriately enough, the first substantive chapter is by Joseph Wolpe of Temple U niver- sity and concerns the deconditioning of the emotional factor in stuttering. Wolpe presents a clear exposition of the rationale for this approach and illustrates it with a case treated by sys- tematic desensitization and another by assertive training. These procedures constitute the core of many of the treatment programs described later in the volume. In contrast to this classical conditioning emphasis is the approach which treats stuttering as behavior to be