BOOK REVIEWS 435

L. BALDWIN: Ourselves-Multiple Personalities, 1811-1981. McFarland & Co., Jefferson, North Carolina and Bailey Brothers and Swinfen, Folkestone (1985). Pages xii + 163. E20.35.

This interesting little book contains 28 case histories of what has been described as ‘multiple personality’. Symptoms, behaviour, causes, problems in diagnosis, and treatment are highlighted. The cases range from Mary Reynolds (1811) to William Milligen (1981). There is a very good bibliography, including some key early references which are of historical interest. The foreword is lucid but brief. The book would have benefitted from a more ambitious introduction and/or commentaries on the cases. But, even as it is, it is a very readable book, and certainly is useful reading for anyone interested in, or curious about, the phenomenon of ‘multiple personality’.

P. DE SILVA

P. G. NEY and D. L. MIJLVIH~LL: Child Psychiatric Treatment-A Practical Guide. Croom Helm, London and Sydney (1985). Pages xvi + 367. f 12.95 paperback; f25.00 hardback.

What happens to children admitted to psychiatric wards when they are not seeing their doctor or psychologist and they are not in the ward school? Milieu Therapy. What this comprises, varies from unit to unit and within units over time. It is not always therapeutic.

The greater part of this book contains a considerable number of suggestions for techniques and outcome measures for staff to use with children or their parents for particular therapeutic ends. This part of the book is unreferenced. It probably contains something for everybody, although the rationale for some of the procedures is idiosyncratic. The opening chapters make greater demands upon the reader, and I suspect they will discourage many. The procedures, at their various levels, are fitted into a framework for all referrals. No referral is refused and all children are admitted for 5 weeks. Intervention in the family home continues for a further 5 weeks and then the child and family are discharged to ‘sink or swim’.

If children who would not be admitted by other units are admitted (and not apparently for reasons of distance in New Zealand), what of severely disturbed children who would be admitted elsewhere? Ten examples of programmes for specific conditions are given. The programme for depression mentions linoleic acid, but not suicidal precautions. This, I am afraid, is where the authors lost my sympathy.

MEHAEL PFtENDEaGAST

D. T. MAYS and C. M. FIUNK~ (Eds): Negative Outcome in Psychotherapy and What to Do about It. Springer, New York (1985). Pages xiv + 365. $34.95.

The contributors to this curious book frequently highlight the problems associated with evaluating negative outcome (patients getting worse as a result of treatment) but never really come to grips with solutions. The emphasis of the book is somewhat towards psychodynamic approaches, and a number of authors cannot resist veiled swipes at behaviour therapy with thinly veiled versions of the now very stale symptom substitution argument. The evaluation of negative outcome is treated as a similar problem to that of the evaluation of outcome in general. Different criteria are required here, and this has not been properly dealt with in this volume, despite a number of attempts. Nowhere is this as obvious as in the chapter on negative outcome in behaviour therapy, which misses the obvious conclusion. Carefully implemented single case experimental designs could overcome most of the obstacles identified in this chapter and do so routinely ‘in the field’, which the author rightly pinpoints as the crucial locus. Is single case experimentation still so difficult for those involved in psychological therapies?

Interestingly, the chapter focussing on obsessions is focussed on behavioural treatment. This is clearly highly appropriate, and this chapter is a well written, comprehensive review of treatment failures in behaviour therapy for obsessional- compulsive disorder. However, the editors take -this excellent summary as a clear indication of the low risk of negative outcome for obsessionals in general. This has been implicitly and invalidly general&d in the last chapter to non-behavioural treatments. If the number of long-stay leucotomised in-patients could be regarded as an index of negative outcome, then this generalisation may not be warranted. Behaviour therapists used to being the last port of call for these patients will be familiar with the severe anxiety experienced by patients whose obsessions have been subjected to crude interpretative treatment, and who believe that the obsessions are thoughts which keep ‘much worse thoughts’ at bay!

The chapters on obsessions and depression are worthy of attention, but I cannot otherwise recommend this book. The recent emphasis on treatment failures in behaviour therapy provides a more promising and inclusive approach.

PAUL SALKOVSK~~

A. HOLZMAN and D. TURK (Eds): Pain Management-A Handbook of Psychological Treatment Approaches. Pergamon Press, New York (1986). 287 pages.

The convincing and assertive writings of Melxack and Wall, and the establishment of the first pain clinic by Bonica, have helped to promote the welcome rush of interest in psychological aspects of pain, including its management. Pain clinics are flourishing and now number in their hundreds. Research into the psychological aspects of pain, the transfer of existing