The Fifteen Minute Hour: Therapeutic Talk in Primary Care

Marian R. Stuart and Joseph A. Lieberman
Radcliffe Publishing, Oxon (2008)
196 pp., paperback
ISBN-13: 978 184619 288 3

The authors of this book demonstrate extensive knowledge in primary care, providing practical techniques for professionals to utilise in practice. While stating it is ‘not a psychiatry text’, nor a ‘text on providing in-depth psychotherapy or long-term counselling’ the book is underpinned by detailed scientific literature and background evidence to support their perspectives and suggested psychotherapeutic techniques.

While a very informative text, at times it overstates its claims. For example the authors write ‘… a substantial body of literature documents…’ but provide only one reference, and that to a paper published in 1991 (p. 2). Whilst this is possibly because the book has arrived at the fourth edition, it requires amendment in future publications/versions.

At times the order of the subject matter is not entirely logical. For example, the topic of ‘Differences in approach between primary care practitioners and mental health specialists’ (p. 14) is the essence of the book, and defines the major differences in both process and outcome between therapeutic interventions that are provided by primary care practitioners and mental health professionals. However, it appears after rather than before material regarding ‘How to be therapeutic’ (p. 8) and ‘The issue of power’ (p. 9).

In chapters three and four the authors provide and discuss numerous strategies and therapeutic techniques (such as cognitive behavioural therapy and other practical therapeutic interventions), and the BATHE technique (a technique designed to help practitioners determine the psychosocial background underlying the biomedical problems presented by patients, to establish rapport with patients and to serve as a rough screening test for anxiety, depression and situational stress disorders, p. 73). Chapter six details ‘The role of advice’ stating ‘…giving specific advice is always less effective than focusing patients back on their own resources…’ (p. 114); however, the paragraphs following specifically detail the principles underpinning advice to parents, in particular, the ‘Behavioural management of children’ (p. 115). This appears contradictory and takes the text from general therapeutic talk to a more specific application. Despite these comments, the text is informative, generally underpinned in detail throughout with appropriate literature. Most health professionals would be able to adopt the described strategies and therapeutic approaches and put them into practice. However, the book chapters are long and at times hard to navigate, making it difficult to locate subject matter when returning to it later. While the chapter summaries are useful, the contents page is limited to the chapter titles with no subheadings. In order to increase the ease of use for readers a separate concise manual solely containing the techniques and therapeutic approaches could be designed to complement the scientific and evidence based literature. This way the text would truly promote a ‘cookbook’ approach (p. 94). Many of these psychotherapeutic approaches and techniques, such as ‘Eliciting patients’ reactions’ (p. 82), need to be learnt and practised, though in this form it is difficult to do so amongst a great deal of theory.

To increase the scope of health practitioners this book seeks to engage, in addition to examples from medical practice, other illustrations could be supplied. For many individuals, midwives, nursing staff, physiotherapists, speech therapists and other allied health staff are often the primary contact. In general, the same principles could also be used to prevent psychological and behavioural problems in settings such as rehabilitation.

Although this text uses various American healthcare examples and figures (p. 23), it endeavours to incorporate ‘whole of system’ which can be adapted and applied to a variety of other countries’ settings. The authors provide the knowledge needed for consumers to play an informed role about the mind–body mechanism, in addition teaching practitioners the process that focuses on providing information that promotes learning and in the long term builds provider–patient confidence.

Health care systems throughout the world all have their own challenges based on individual burden of disease. Primary healthcare also experiences common areas of concern such as long waiting lists to see a general practitioner. Perhaps such matters of concern could be a factual motive for ‘the fifteen minute hour’ rather than the ‘few financial incentives for keeping people well and preventing or limiting serious illness’ (p. 175).

Overall, the authors have atftempted to create a comprehensive text using many theorists, evidence-based scientific literature and demonstrated the theoretical applications in the form of valid examples to provide a good overview of the topic. It endeavours to encompass a variety of primary care health professionals from graduates to those well established and wishing to enhance their skills. A fifth edition could usefully amend the few disparities as discussed, especially since therapeutic talk is often a learnt skill and time is a precious commodity.

Melissa Buultjens
School of Public Health
La Trobe University