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Brief Intervention for School Problems.
Murphy, Duncan . The Guilford Press, New York, 2007. 210, US $30.00.
Murphy and Duncan’s 2nd edition of Brief Intervention for School Problems is a fresh perspective on client-practitioner relations and intervention-based solutions for school problems experienced by children and youth. Although directed towards practitioners such as social workers and psychologists, the lessons from dealing with school problems generalize to any emotional or behavioural problem, since the majority of such problems centre around relationships and dealing with challenges. There are therefore useful and pertinent messages for child psychiatrists, regardless of their involvement with school problems per se. Perhaps the most important message for all who counsel such children is that shaping an intervention by using and enhancing client protective factors, both internal assets and external supports, is likely to be more effective than a focus on an intervention that is based on a particular diagnoses. In other words, one must work to identity and promote resilience factors for that individual child and to not reflexively fall back on a strict application of a particular intervention that may not fit that child.
The book is focused on relevant issues in intervention: the importance of client-practitioner alliance, recognition of the client’s voice, story and abilities, and continual thorough evaluation of implemented interventions. Topics covered in the book range from assessing individual maladjustment to ways to empower the client.
The authors engage the reader in an examination of students’ disruptive behaviour, poor academic performance, and internalizing problems like anxiety and depression. The authors provide an evidence-based empirical framework on which to construct interventions as well as practical guidelines. Narrative examples bring their intervention guidelines to life. Their organized chapters are well rounded with useful bulleted guidelines and thorough conclusions throughout.
Murphy and Duncan highlight the importance of the alliance between the practitioner and the client. They stress the absolute necessity of agreement on tasks and goals of the intervention and they present research that is evidence to this need: the strength of the alliance predicts dropout rates and outcome of an intervention far more than the type of intervention.
Their take on this subject gives due respect and consideration to the client and her or his capability and voice. Acknowledging the beliefs, situations, and events that lead clients to where they are allow the practitioner to better understand and therefore approach an individualized intervention. An implicit assumption of their guidelines is that the client is the vehicle of change. The practitioner who believes in the client’s own abilities to overcome and solve problems will elicit awareness in the client and help her or him use her/his abilities to achieve positive outcomes.
Collaboration is integral to the success of the client-practitioner alliance. The authors promote the initiation of this collaborative process at the first meeting and every moment of every meeting thereafter. When each moment is taken advantage of to its fullest value, both client and practitioner can feel that the productivity is high and intervention will inevitably take less time. Brevity of the intervention doesn’t come at the cost of intensity and value.
The authors emphasize a key element to successful intervention: “think small to create big change”. Recognizing the smaller, perhaps seemingly insignificant details in the client’s narrative and using those small strengths, delights, or tools of change to facilitate a larger change in the client’s life is an often overlooked, and is a critical strategy for change.
A particular strength of the book is providing a justification and means for continuous evaluation of the intervention process (especially the therapeutic alliance) and outcomes. The appendices provide feasible and reliable tools in the form of visual-analogue scales that practitioners can use to assess change. This will counter the demonstrated tendency of practitioners to overestimate their skills and client outcomes, because they have achieved a certain comfort level in applying familiar interventions.
This book, although focused on addressing school problems, takes into account all domains of the life of the affected child. Individual nuances and home life environments are considered influential on the individual’s life in the classroom, rather than the more typical consideration that the classroom is an isolated environment. Much of the book is devoted to finding solutions based on the many positive relationships and environments, and strengths elsewhere in the student’s life and sometimes incorporating those into classroom strategies.
There is one chapter, titled “Medication, Children and schools”, that attempts to address the complex topics of psychiatric diagnoses and the role of psychotropic medications. The authors cite a handful of reviews that cast serious doubt on the reliability and validity of clinician-rated psychiatric disorders, as well as reviews that downplay evidence for any biological basis. This chapter will be disappointing for readers that have a more nuanced view of the challenges of psychiatric diagnoses and the risks and benefits for psychotropic medications and recognize that these topics cannot be dealt with fairly in a few pages. Fortunately, those readers can ignore this chapter without fear of losing the key directions and focus of the book.
With the exception of the tangential chapter reviewed in the previous paragraph, “Brief intervention for School Problems” is a well-organized and succinct look at the intervention, the client and the practitioner. Murphy and Duncan examine practitioner philosophies, theories and models of intervention through the critical lens of evidence-based practice. The book is accessible to busy front-line workers and provides practical suggestions and tools.