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Book Review: Generalist practice with organizations and communities

those with considerable familiarity with the model. Some cautionary notes can be sounded. One reservation might be that the organization of the volume, while generally clear and reasonably linear, occasionally seems to double back on itself, leaving the reader temporarily disoriented. An example of this is seen on page 123 of Chapter 10 (which concerns the MI phase of focusing), under a subheading ‘‘Four Broad Ethical Values.’’ Arising seemingly from nowhere, this passage provides a synopsis of abstract principles commonly used for guidance with ethical reasoning in medical and human services professional settings. Subsequent sections of the chapter go on to offer suggestions for handling ethical dilemmas that may occur during MI sessions, and these suggestions do relate back to the preceding discussion on ethical thought, and are potentially helpful. However, upon first encountering this passage on ethical thought, readers may wonder how it relates to the ‘‘through line’’ of the chapter as a whole, which is at a considerably more applied level, and the abrupt shift to a much higher level of abstraction is somewhat disconcerting. In many places throughout the volume, a brief sentence or phrase of transition, cuing the reader that what may seem at the moment like a digression or an ‘‘aside’’ is soon going to prove relevant, would be very helpful. Another questionable feature of this updated text is a certain tone that can creep here and there into the prose style, which occasionally goes beyond enthusiasm, and begins to sound practically fervent or quasi-religious. For example, a text box on page 24 is labeled ‘‘Personal Reflection: An MI Prayer.’’ This tone tends at times to cast readers unwittingly into the role of acolytes, or followers of a movement, rather than simply interested clinicians and readers, and can be a distraction for readers who may not count themselves as members of such a camp. In a way, this tendency is understandable, since the authors of the text have by now achieved international acclaim, and have no doubt been the recipients of numerous testimonials from helping professionals worldwide, attesting that skills gained with MI have been life-changing, both for themselves and for their clients. However, passages written in a tone as if speaking privately to an inner circle of devotees of MI are scattered throughout the volume, and in the opinion of this reviewer, would be more appropriately reserved for some other forum or medium of communication. One final reservation centers on a relative want of suggestions for melding MI with other helping modalities. For instance, a case study is presented in segments in the text, describing MI as applied in the case of a client called Julia. Vignettes taking from this case appear sequentially throughout the volume, each intended to illustrate a particular phase or aspect of MI. As the case unfolds, Julia makes significant progress toward resolution of her issues, and as a whole, the case study is a moving testimonial to the interpersonal power of the helping process. However, some of the client’s major gains are made through the development of insight achieved via seemingly serendipitous introspection. At this point, one gathers that Julia has long since resolved any ambivalence toward change she may have had at the outset, and readers may wonder whether her insights might have been developed just as surely, and perhaps more quickly, had her treatment provider felt more free to draw elements from other modalities that are more specifically geared toward achieving similar gains, thus reducing her overall suffering. MI is a powerful and uniquely effective way of reducing helper/client dissonance (the interpersonal phenomenon formerly known as ‘‘resistance’’), but it is not designed to replace or substitute for all other therapeutic forms. Some readers of the text might wish for additional coverage of possibilities for an eclectic melding of MI with other forms and methods in the helping process overall. Ultimately, setting all reservations aside, only one conclusion seems possible: This is a major work, and the significance of its contributions is great. All who are engaged in a helping process and who routinely encounter clients that seem difficult to engage due to ‘‘resistance’’ (in other words, anyone) would do well to read this text, and also go beyond it, and to begin the slow and gradual process of skill development with MI. For social workers in particular, the excellence of fit between the underlying philosophy of MI and the values and ethics of the profession is compelling and should not be overlooked.