Before I talk about your book choices, first: what attracted you to work in the field of clinical psychology?
When I started studying as an undergraduate, I was already interested in knowing why people did what they did, thought what they did, and felt what they did. therefore, psychology was what I expected to answer that type of question. but what I found most interesting was what happened when everything went wrong: when people were unhappy or behaved contrary to their wishes or intentions, which is called “clinical psychology”. clinical psychologist.
You are reading: Best clinical psychology books
I guess the topics that attracted me to psychology when I was 16 or 17 are the same ones that keep me fascinated now that I’m in my 60s, which are: how do people feel and change, what does is happening and how can I help make it better for people?
You have chosen an interesting selection of books. some are classic and others very new. Do you consider clinical psychology to be a field where books are still relevant, so that you can continue to learn from them even as time goes on?
I think the key ideas and theories continue to bear fruit. it didn’t take long to choose these books; they are the ones that have influenced me and many of them are second or later editions.
The good thing about good theories, the saying goes, is that they are very practical, because when you don’t know what the hell to do, you use a theory to tell you what to do next. when you’re working with someone who’s distressed in some way and you’re trying to understand what’s going on with them, you need a good theory to anchor you. in reality, all of these books have supporting theories, or review evidence supporting interventions based on a variety of theories.
Although I have spent most of my professional life as an academic, helping, learning, teaching and trying to understand what goes on in people’s minds, I am also very practical. That’s why I’m a clinical psychologist. I always want to know: ‘so what? what does this tell us? What do we do differently with things?’
so yeah, they’re all based on theory. all the books I have chosen relate to theories that tell you what to do. practical theories, which is what all good theories should be.
in clinical psychology: a very brief introduction, raised the key question of whether clinical psychology should “compete or collaborate with psychiatry”. I wonder, could you give a brief description of how closely these fields are interrelated?
Well, in many ways, the area that we’re both trying to analyze and help resolve is the same, which is a person’s behavior and emotions that make them or other people unhappy. so the content is very similar. the key difference is that the underlying model used by classical psychiatry is medical, primarily trying to intervene at the level of the body. So: using medication, using drugs, using physical treatments. while psychologists intervene at the level of the mind. so: using the discussion, using the actions.
“How do people feel and change, and how can I help make things better for people?”
Of course, the distinction is blurred because psychiatrists (modern psychiatrists in particular, but really since people like Freud) use verbal therapy, they use the mind. so actually the distinction is not as clear cut as it could be. I think psychiatrists are particularly good at understanding the importance of the body. that is a weakness of clinical psychologists: we tend to forget that we are embodied, while psychiatrists tend to forget that we have a mind. there are weaknesses on both sides. Interestingly, when I looked at these books, many of them were written or co-written by a psychiatrist. so there are a lot of good psychiatrists out there.
absolutely. Let’s talk about your first choice of clinical psychology book: Irvin D Yalom’s Theory and Practice of Group Psychotherapy, now in its fifth edition. why is this book so timeless?
I found it when I started working with patients in the national health service. we had much more demand than we could meet. so it was of practical interest: could we use group therapy? I soon realized that this cannot be the main reason for using a therapy, that you can treat many people at the same time. but, in reality, it was a very effective form of treatment. In many cases, group therapy is more effective than individual therapy.
yalom’s book was really helpful. throughout the process my question is “what the heck is going on and how can i make sure it’s most effective” which yalom said, drawing from his clinical experience but later backed up by researchers including some of my own studies, was that there are 11 healing factors that can describe what’s going on.
“in many cases, group therapy is more effective than individual therapy”
So, I found the book very helpful because it focuses on what the healing factors are. this is back to my central question: how do people change? The two key factors, according to Yalom and subsequent studies, are group cohesion (which is people’s need to belong to a group) and interpersonal learning (which is what you learn from other people). then, it is not the centrality of the therapist that really matters; it is social, it is the group: it is the other patients who are working on the change.
Most people come to therapy because they have difficulties with other people, either in their present or in their past. it’s helping people learn more about those things by learning together, which is a really key factor.
My instinct would be that group therapy must be extremely challenging for the therapist, because there are so many factors at play. each member of the group should have their own story and their own way of processing things. but you’re suggesting that the other personalities in the room are actually a therapeutic source as well.
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It’s interesting. It is a very stimulating experience, being in group therapy. because, yes, there is a lot going on, but you are not alone, you are there with many people who want to understand themselves. It’s like being in a lab. people may find out, “Am I really the horrible person I think I am?”, which is what people who come to therapy may be thinking, or “Am I as different from others as I think I am?”
then, people have the experience of learning together. it is a wonderful experience to be there with a group that is functioning well and helping the group members to understand themselves. It’s very exciting. almost more than individual therapy because there is so much going on.
Sounds like a very moving experience. Are we talking about the second book, which introduces Cognitive Analytic Therapy: Principles and Practice? this is from anthony ryle and ian kerr.
well, I got into this really because of the key question: “how the hell do people change?” when I was learning as an apprentice, I was taught in a particular therapy school how change could happen. then I went to another institution that taught me a very different model of therapy. and in both cases, each of the two schools spent a lot of time criticizing the other school, saying: ‘no, no, this is not so, this is so’. in each case, they said there was no way it would change. occur if you used the other model. but my experience was that the change actually happened in both models.
I thought, what the hell is going on here? It led me to my own research, which is really trying to identify the common factors that cause change. but what anthony ryle did was much the same. started from the same position, which is: ‘hey, there are a lot of schools of therapy that can be helpful. can’t we distill the really important parts of all of them?” tried to bring together insights from cognitive therapy, about our thoughts and how we think, along with dynamic therapy, which is based on psychoanalysis but has changed over the years. to be more about the models we have in our heads of relationships.
“cat tries to help you understand why you behave in a way that actually defeats yourself”
so he is bringing together how we form relationships with others, and in particular how the models in our head, often derived from childhood, influence how we relate to each other in the present, along with how in what we think, the cognitive part. —in a formulation of the problem. Central to cognitive analytic therapy is a formulation that he develops in collaboration with his patient about what is happening. a systematic analysis of the behavior patterns people engage in.
here is an example. I’m tired. every time I get home from work, I have my kids screaming for food in the car. At that point, I feel like I’m a bad mother and a bad selfish person because they’re crying and instead of being home I’ve been out at work all day. let’s say then I start making a really good homemade quiche or something, which they make fun of. then I yell at them because they have turned their nose towards it, and they get very angry. what they want is a beef burger. and then I decide that shows how horrible of a parent I am, which makes me try even harder to do even better next time, which is to make an even better meal for them, which exhausts me even more.
Actually, it’s completely dysfunctional, because what I’m trying to do is solve a problem (my belief that I’m a bad mother and a bad person) using old patterns and ways of thinking, and not really paying attention to it. what’s going on. happening in my own life. so, in that sense, I am perpetuating, despite the best of intentions, dysfunctional ways of behaving. so what does cognitive analytic therapy (cat) do to try to help you understand why you feel like your own worst enemy and behave in a way that really defeats yourself?
sorry if this is a stupid question, but is cognitive analytic therapy, cat, related to cognitive behavioral therapy, cbt?
yes and no. again, behaviorism is an important school within psychology. When I first trained in clinical psychology in the 1970s, we only had two or three main sets of theories to draw from. one was psychoanalysis, which I won’t go into now, and the other was behaviorism, which really says that what we have to do is look at what people do and change the consequences of what they do or the rewards they get. change their behavior.
in some situations, that works very well. but in the 1970s, people started to think that we actually needed to add in the way that people think. and so cognitive behavioral therapy (cbt) was a combination of the behavioral ideas with the cognitive ideas. Increasingly, cognitive therapy is more popular than cognitive behavioral therapy.
but back to the cat, that’s combining the cognitive part and the psychoanalysis part, and there’s actually some behavioral therapy in there as well, and there’s some systems of thought as well. therefore, cognitive analytic therapy consists of at least four different theories, buried together and centralized in trying to formulate them for the individual patient.
thank you. His third book, Gillian Butler, Nick Gray, and Tony Hope Managing Your Mind: The Mental Fitness Guide, is not intended for a professional clinical psychologist but for an ordinary person, the patient himself.
yes. I started with the systemic one, which is the yalom, then I went on to the more integrative one, the ryle book, and now this book is more cognitively focused.
also does something that I found interesting: decentralizes the importance of the therapist. says, actually, you can do this yourself. The central idea is that you must value yourself and recognize that you can change, and here are some ideas on how you could change.
so the authors deprofessionalize and decenter the importance of the therapist. they say: ‘you have resources within you. here are some ideas on how you could get in shape. explains how you can better deal with uncertainty; Instead of sitting down and worrying about things, you can make changes. explains how to deal with depression more effectively. I really like that it is not only the therapist who does this, but the patient himself. It is a good book. They are good authors.
lovely, thanks. Let’s move on to What Works for Whom: A Critical Review of Psychotherapy Research by Anthony Roth and Peter Fonagy.
As you may have noticed, there are many competing ideas or theories in the field of clinical psychology. And what you tend to find is that if you’re in a particular school, you tend to think that your ideas are the best and nobody else’s ideas are correct. What Fonagy and Roth are doing is reviewing the effectiveness of all the different therapies as fairly as possible. this was an area I also worked on, although not as effectively as them!
the question they try to answer is: what is the most useful for people? many therapists do not use evidence; they use their own biases, which are often what they taught you first.
The good news is that there is a lot of good evidence in favor of psychotherapy in the broadest sense, that it is better than other approaches that have been tried to reduce psychological distress, including some medical approaches. but the bad news is that there is still much we don’t know about what is most likely to be most helpful for any particular person with their own specific difficulty in their unique personal and social circumstances. so, we need more research.
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“many therapists don’t use evidence; they use their own biases, which are often what they taught you first”
This is not a book to sit down and read from cover to cover. it is more like a reference text. what it’s really saying is: if you’re going to seek help, you need to know what helps the most for your condition, under what conditions, with what type of therapist, with what type of therapy, for how long, with whom. it’s kind of complicated.
compare it to medicine. You know, if you have diabetes, arthritis, and a cold, you wouldn’t expect to be prescribed the same medication for all of those conditions. I would expect there to be very little difference in the medications prescribed for each, depending on their age and condition. but within psychological therapies, there was a tendency in schools to give the same treatment to everything. which doesn’t make any sense.
What works for who is really saying, “let’s find out, given your condition, what the evidence says will be most effective for you.” and that’s complicated. there are so many different factors involved, so it’s not surprising that we don’t always get it right. but a book like this helps therapists when faced with a patient with a particular condition. So instead of giving you what I know how to do, let’s break down what the evidence shows with what would be better. however, it’s tricky because we don’t have enough therapists, so sometimes you end up getting what you get.
yes, and as you mentioned before, there tends to be a bias towards the approach that the therapist learned first. so presumably a good clinical psychologist should put a lot of emphasis on continuing to learn and apply new methodology throughout their career.
absolutely. and that’s always hard when you’re trying to make a living; you have time set aside to go and learn a new method. i think what’s interesting is when you look back, and again, why i was interested in tony ryle’s ideas, as dispassionately as you can, actually, most therapies, if they’re conducted professionally, respectfully, and ethically , are reasonably effective for a good number of the people they treat. although they may have very different and, in a certain way, contradictory ideas; behavioral therapy is very different from cognitive therapy, which is different from psychoanalysis—done correctly, they can all be helpful.
It seems that what is necessary is for the therapist to have a coherent understanding, which is a little different from the patient’s, which allows for a fruitful discussion between the two and allows for a possibility of change to occur. So, as a therapist, you have a theory, some practice that challenges and maybe helps unstuck the patient. It almost doesn’t matter what theory you have. but you have to believe in it. which is a bit of a paradox.
yes! that’s really intriguing. Let’s move on to his latest book, which is recent: Why don’t I feel good enough?
is a lovely book by helen dent, a lovely summary of attachment theory. Attachment theory underpins much of psychology: the simple observation that as humans we need to relate to other people. in fact, you can’t survive as a human if you don’t have relationships. your baby, on its own, would literally die. she has to have a committed parent or caregiver. throughout our lives, we need other people.
I know there are one or two hermits in the middle of nowhere. but they are a small, small, small minority. most of us are social and need and interact with other people.
so attachment theory really underpins a lot of work in current psychology and child labor and development work. it is for life: our attachment patterns affect the way we relate to others. so it helps us try to understand what our particular relationship patterns are.
“attachment theory underpins much of psychology: the simple observation that, as humans, we need to relate to other people”
Most people are reasonably securely attached and have had good relationships with parents so that our relationships with others are reasonably stable and meet our needs, more or less. there are some who, based on unfortunate childhood experiences, have more difficulty in relationships. attachment theory helps us try to understand what happens with those people who later have difficulties in their relationships.
I think this book presents it very well. once again, it is written for the layman, so that he can see his own attachment and understand what he could do differently. I like the fact that it’s not just written for academics.
thank you. As a final question: what advice would you give to someone considering a career in clinical psychology?
I think I would encourage them to get as much experience as possible, including doing things that aren’t technically labeled as psychology: talking to a lot of people, having a lot of life experience, and reading a lot of novels.
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I was very tempted, when you asked me for my five books, to name five novels. those are my parallel learnings, so to speak. just talking to people, serving people and reading the distilled experience of others, in the form of stories. I said novels, but I also mean plays, theater, etc. stories often have, at their core, a human dilemma: how do we relate to people? How do we treat people who abuse power? How do we survive relationships and their problems? how do we prosper? and so on.
then: sharpen the tool of empathy.
yes, empathy. I can’t know everyone’s life experience. so reading novels about other people’s lives is very important. reading about the lives of people who have come to live in a different country, what it is like to be an immigrant, what it is like to be old or young. it is very difficult just from your observation of life, as the people you meet tend to be more like you. so getting out there and reading stories can give you more insight into other people’s experiences.
As a therapist, you don’t just rely on these five beautiful books I’ve been talking about, as important as they are. they are there to help you know what to do next, as I mentioned. they are good theories that are practical. but you also draw, of course, from your own experiences and your own relationships. your own feelings of despair or hopelessness or envy or love or friendship. you know about them through your own experience and through reading stories. So I think novels and literature are also hugely important.
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