Counselling for Problem Gambling: Person-Centred Dialogues

By Richard Bryant-Jefferies. (2005).Oxford, UK: Radcliffe Publishing, xiii, 177 pp., ISBN 1-85775-740-8 (paperback only). Price: $38.00 USD.

Reviewed by Timothy W. Fong, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA. E-mail: tfong@mednet.ucla.edu

Currently, there are several different types of psychotherapeutic approaches that can be used with problem gamblers. Those most commonly used are cognitive-behavioral therapy (CBT), psychodynamic therapy, motivational interviewing, and supportive psychotherapy. Research into the effectiveness of each of these therapies is just now beginning. Demand for treatment services, however, is rising quickly in every developed country. Coupled with the fact that only a limited body of evidence supports pharmacotherapy for problem gambling is a pressing need for ongoing training and supervision in the therapy of problem gamblers. For instance, in the state of California, there are relatively few gambling-certified specialists and there is no formalized network of clinical supervisors.

To address this gap in training and need for supervision, Richard Bryant-Jefferies has written Counselling for Problem Gambling: Person-Centred Dialogues. (The author has written a series of "Person-centred Dialgues" books.) This text is designed to demonstrate the person-centered approach to counseling problem gamblers. It takes the reader through a series of dialogues, from the first therapy session. The book is geared toward those who treat problem gamblers, primarily therapists and counselors.

The book describes the details of the therapy as it is applied to two patients with problematic gambling behaviors. Max, a slot machine and Internet gambler, initiates treatment, while Rob, a horsetrack bettor, is compelled to come to treatment at the request of his wife. Their counselors, Clive and Pat, utilize the same approach but have different counseling styles.

Each counseling session is presented in dialogue format, giving the reader the sense of being present in the room. Most interesting are the highlighted boxes within session texts that summarize what is happening therapeutically with patient and therapist. Each chapter closes with a set of discussion questions that engage the reader to reflect further on that session. In addition to the patient dialogues, the book also has sections on supervision and sections that focus on the counselor's therapeutic techniques. The latter is a feature unique to this book, as it demonstrates that therapy for problem gamblers is not always unidirectional and that therapists also bring their own conceptions, distortions, and expectations about gambling to the therapy sessions.

Bryant-Jefferies presents the person-centered approach, otherwise known as client-centered therapy. This was developed by Carl Rogers in the 1940s and 1950s as a way for therapists to have a more personal relationship with patients and to help patients realize that they can help themselves. Change in behaviors is facilitated by recognizing the core themes of congruence, having positive regard for the client, and utilizing empathy as a way to move the patient toward personal growth.

The strength of this book comes from the personal and explicit dialogues presented between patient and therapists. The book reads as if the reader were watching a video, and because the techniques are highlighted well, the reader is left with a clear understanding of how to provide this type of therapy for problem gamblers. Common mistakes made by therapists are highlighted and discussed, and the types of patients described within the book are reflective of the types who present to treatment. Furthermore, the book is timely, including updates on dealing with Internet gambling and current treatment resources. Therapists who are just beginning to treat problem gamblers or who are looking to try a different therapeutic approach will benefit most from this book. Even those who have been treating problem gamblers for a long time will appreciate this book because of the details of the sessions that are presented.

One criticism of this book is that it lacks empirical evidence for the effectiveness of this approach to treating problem gambling. A recent meta-analysis of psychological treatments for problem gambling showed a large effect size of favorable outcomes (Pallesen, Mitsem, Kvale, Johnsen, & Molde, 2005). The majority of these treatments, however, were CBT or eclectic and not specifically the person-centered approach. Despite this, the clinical experience of the author and of this approach cannot be denied. The techniques that are presented within are practical, commonly used, and easily mastered. Additional books in this format that describe other forms of psychotherapy, such as cognitive-behavioral and psychodynamic, would be quite helpful, particularly in highlighting the differences and similarities between therapeutic approaches. I would also like to see more closure with the cases, including how many sessions are needed, and also an examination of whether these changes are lasting once the therapy stops. Finally, the two cases are both male; the book would be strengthened by having a section on other gambling populations, including women, the elderly, and adolescents.

In sum, this is a highly recommended book for therapists with any level of experience with problem gamblers. Because of the dialogue format, this is a quick read and is likely to stimulate more discussion about treatment approaches and what may or may not work.  

Reference

Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B.H., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: A review and meta-analysis. Addiction, 100, 1412–1422.

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This article was not peer-reviewed. Submitted: January 29, 2007. All URLs were available at the time of submission.

For correspondence: Timothy W. Fong, MD, assistant clinical professor of psychiatry, codirector of the UCLA Gambling Studies Program, Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Ave., Room C8-887, Los Angeles, CA 90024 USA. Phone: 310-825-4845, fax: 310-825-0301, e-mail: tfong@mednet.ucla.edu, URL: http://www.uclagamblingprogram.org/

Competing interests: The reviewing author has received research support from the National Institute on Drug Abuse and from the State of California 's Office of Problem Gambling.