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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
The ways in which most clients use therapy has long been at odds with the most popular theories of therapeutic change. As anyone who has been in therapeutic practice knows, clients tend to come to therapy in much distress and leave therapy after just a few sessions. Many theoretical paradigms have suggested that such clients cannot possibly be getting substantial benefit from their therapeutic encounters, arguing that change comes about through processes which require more time and effort than such brief encounters can provide. Recent research, however, has confirmed that therapy is remarkably effective and that treatment modality contributes very little to the positive change which clients experience.(Wampold, 2001) This same research clearly demonstrates that the most important components of therapy, primary among them, the expectation for change, can be reasonably mobilized in very few session, indeed, validating the sense that the many patients who enter therapy for very brief periods are truly benefiting from their therapeutic investments.
Rubin Battino has written a lucid introduction to the craft of very brief therapy which makes a virtue of the necessity of working with clients in very brief therapeutic encounters. The book is arranged as both an introduction to the research which validates the approaches behind brief therapy, and as a primer to the many techniques different clinicians have developed for working with patient expectation for improvement. As he makes clear in his introduction, Battino recognizes that what the field calls "brief therapy" has changed over the years, first denoting fifty sessions of treatment, then fewer, until it now tends to be in general currency as a description of treatments lasting 8-12 sessions. Battino, in contrast, refers throughout his book to "very brief therapy," by which he means treatment encounters lasting 1-2 sessions, in which patient expectations of rapid change are used to facilitate immediate therapeutic work.
The most useful part of Battino's book is the first four chapters. In them he marshals the research that forms the basis of his argument, and discusses the general shape of a brief therapy encounter. Appropriately he does this by first examining Bruce Wampold's crucial book, The Great Psychotherapy Debate, in which Wampold uses meta-analysis to prove not only that psychotherapy is remarkably effective, but that that effectiveness comes from general rather than specific factors. Battino does a good job of extracting the most salient points from Wampold's argument, highlighting the freedom from a medically dogmatic approach to treatment which results from Wampold's data. Battino also takes from Wampold validation for his project, as Wampold's data clearly shows that client expectation, or hope, for improvement is a determining factor in subsequent change.
Battino also uses the first chapter to introduce the work that Duncan, Miller, et al. have done on the role of client expectations and resources for change. One of Battino's central theses is that clients enter therapy with not only the expectation for change, but the wherewithal to pursue that change themselves once the clinician has helped to facilitate such self-healing. Battino refers to the work that Duncan, Miller and their colleagues have done to bolster this contention, and the argument is persuasive.
Battino goes on to further discuss the importance of expectation in the role of change. He properly links the notion of expectation to medical discussions of the placebo effect, and shows how integral to the client experience of therapy the hope for change is. This segues into a discussion of basic strategies for working with clients that mobilize expectation as their core approach. Among these, using "as-if" thinking and reframing are outlined at some length. Both contribute to a larger introduction to the centrality of focusing client thought and attention on the positive aspects of their lives and the positive change that they want to see occur. Whether used in solution-focused therapy, or narrative therapy (both discussed later in the book), or in some other modality, attention to the positive aspects of a client's experience is central to helping to bolster hope and foster an expectation of change.
Chapters three and four focus on the ways in which clinicians foster rapport with their patients. Chapter three examines some of the linguistic and physical cues that indicate to patients that we are in alliance with them, while in the fourth chapter Battino talks about some of the language and language strategies that he has found most helpful in working with clients during very brief therapy encounters. Battino here demonstrates his allegiance to Eriksonian hypnotic techniques, which forms the backdrop for much of this book. While his understanding of the technique seems thorough and laudable, that very understanding introduces the major weakness of this book, which is that it's introductory, and in many places cursory, nature does not leave room for adequate explanation. His chapter on the language of brief therapy describes over 30 different techniques for using language in under 15 pages, providing the merest gloss on many of them. The reader unfamiliar with these techniques is unlikely to gain any real understanding from their treatment here, although the extensive citation makes it clear that the issue is that Battino is too familiar with these techniques to realize that he may not be imparting enough information. (An example of this: Introducing his discussion of these techniques, Battino writes "Much is owed to NLP for this organization," (p.38) as if it were transparently evident that NLP refers to Neurolinguistic Programming. Granted, there is a chapter devoted to NLP later in the book, but this first introduction of the material is not properly fleshed out.)
The rest of Battino's book is fascinating and frustrating in equal measure. In about 15 brief chapters he covers twice as many sets of therapeutic techniques, ranging widely through the work of Bill O'Hanlon, Jay Haley, Milton Erickson, and Ernest Rossi. He also covers metaphor therapies, NLP, some aspects of hypnosis, as well as several other approaches. While these chapters provide some interesting introductions, they are written more as refreshers on the techniques he finds so helpful, and as such, suffer from not explaining in adequate detail the methods that they recommend. Overall, however, these chapters form a valuable and remarkable compendium of some of the techniques best suited to helping clients make significant shifts in the way they are conceptualizing the problems which have brought them into treatment. Coupled with Battino's extensive bibliography, they serve as an invitation to further study.
Battino does not discuss the ethics of solution focused brief therapy techniques, which is a shame. A strong argument can be made for the clinical ethical imperative for facilitating change for our clients as quickly as possible. Therapeutic techniques which place a premium on time spent versus change engendered may be not only doing a disservice to client expectations, but may be actively getting in the way of our clients living the lives which they desire and are entitled to live. While the research presented by Wampold suggests that all therapeutic techniques are about equal for helping clients to improve during therapy, that same research should force us to question whether or not all techniques are appropriate for all clients. Rubin Battino's book, despite its brevity and some of the flaws which that engenders, is a welcome reminder that there are as many ways to work quickly for client change as there are clients.
© 2007 Andrew Pollock
Andrew Pollock, Baltimore, MD