email page print pageAll Topic Reviews
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 HealingE-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 Clients Make Therapy WorkHow 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 ArtOvercoming 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 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
Since it was published last year, The Heroic Client has already established itself as part of the psychotherapy canon. Barry Duncan and Scott Miller's book is, quite simply, one of the most important books about psychotherapy of the last decade.
In many ways The Heroic Client is the companion volume to their earlier, edited collection of stateoftheart psychotherapy and outcome research, The Heart and Soul of Change: What Works in Therapy. Where The Heart and Soul of Change marshaled an impressive amount of science to make the case that psychotherapy works very well, but not for the reasons we usually think it does, The Heroic Client is a more user-friendly condensation of the literature. Above all else, it champions the cause of effective psychotherapy. Rather than remaining captured in the schoolist fray about what theories and techniques comprise competent psychotherapy, The Heroic Client will allow patients and therapists to focus on issues of outcome and effectiveness to evaluate the utility of their clinical work.
The Heroic Client will appeal to therapists desperate to find not only empowering survival strategies in today's managed mental health care environment, but it also offers simple yet rigorous outcome tracking systems to better make a datadriven case for the effectiveness of one's practice should that be necessary as well. The Heroic Client should also be of interest to current and potential consumers of psychotherapy services in its consideration of the common-sense factors of successful psychotherapy and its taking a somewhat jaundiced eye toward the often inflated claims of a strictly medical model view of treatment.
The Heroic Client not only demonstrates the application of common-factors in psychotherapy process and outcome, but it demonstrates how to utilize scientifically reliable and valid outcome instruments in an ongoing clinical process. The OQ45 is emerging as the gold-standard in patient-anchored outcome measurement and The Heroic Client reveals strategies for incorporating ongoing outcome assessment into the treatment process. Such "research methods" should no longer scare off the clinician; rather simple yet rigorous research methods will provide a key to success for therapist in the future. The Heroic Client helps to demystify the science behind our work while also encouraging us to attend to it.
Though there are times when the tone and arguments of Heroic Client read like the anti-psychiatry polemics of Thomas Szasz or Peter Breggin, the authors seem more interested in helping non-medical therapists and their patients reclaim their power and voice in providing effective psychotherapy than in simply toppling the scientific advances of mainstream psychiatry. In their application of science to "Mental Health Mythology," Duncan and Miller also expose the "Myth of the Magic Pill." Their withering examination of the potential financial conflicts of interest and overstated conclusions within the antidepressant medication outcome literature in particular will, if nothing else, enable patients to have a fuller conversation about the risks and benefits of the medical treatments their physicians may offer. The Heroic Client does not advocate the simple rejection of medication in the treatment of suffering patients; the authors offer a way to evaluate whether the physician's or therapist's theory of change matches with his patient's theory of change.
Additionally, what will strike many therapists and their patients as powerful about The Heroic Client is its exposure of the enormous financial stakes in perpetuating the medical model's dominance of all mental health care practice. The Heroic Client seeks to advance the science behind psychotherapy's similarly compelling effectiveness. Although much less well-funded and well-marketed than the interests of the pharmaceutical industry, psychotherapy has every reason to be proud of its comparable efficacy in many instances. With its companion, The Heart and Soul of Change, The Heroic Client reclaims a scientific legitimacy for psychotherapy and does not merely advocate a new theoretical mythology in contrast to the medical model.
Through the use of many illuminating case histories and a generally breezy tone, the authors provide a roadmap for patients and therapists about how truly collaborative, outcome-informed therapy is co-created. In attending to patients' motivation for change, goals for treatment, view of the treatment relationship, preferred views of themselves, and theory of change, therapists can reduce the chance for treatment failure and enhance cooperation better than in rigidly applying the same model or the same theory to every patient. Therapy becomes something that is truly patient-centered rather than centered on the therapist's theories about what must be wrong with his patient. Not that therapists don't need theories; they just are often not consistent with patient's theories, and sometimes an authoritative imposition of the therapist's position only alienates patients.
Finally, although The Heroic Client is an essential psychotherapy text, what is most intriguing about it are its political implications. The Heroic Client does not just advance anti-psychiatry and post-NAMI consumer/survivor positions by rote, but points to a way to integrate and amplify psychotherapists' voices in the midst of the din from the medical model and managed care.
Psychotherapy has been on the ropes because therapists have not been able to articulate the science behind the effectiveness of our work. We have been too busy squabbling amongst ourselves about how long therapy should take, how many sessions patients should be allowed, and which theory is the best for which diagnosis. Miller and Duncan's work points to a synthesis of therapy interests around issues of effectiveness rather than ongoing debates about competence. If we can collect and pay attention to the data about our work, instead of just relying on myth and tradition to guide us, we will see that therapy works quite well, often as well as medications. We should share this information and sing it from the rooftops.
But in so doing we will also see that some therapists are, quite simply, better than others. Even if we "risk-adjust," for diagnosis, demographics, severity, comorbidity, and the like, we will find that some therapists do a better, more efficient job. And success will not be due to age, gender, professional degree, years of experience, institutional affiliation, or theoretical orientation. Effectiveness will increasingly become a function of how well people have understood the lessons of The Heroic Client.
This is a finding around which patients, providers, and payers must unite if psychotherapy is not to become some elite, expensive, boutique treatment option, threatened perpetually with extinction. Big Brother will continue to watch us unless we can better watch ourselves. The Heroic Client leads us to consider how, ironically, Big Brother must become You, Watching.
Copyright © 2001 DLBuccino
Dan Buccino is Co-Director of The Baltimore-Washington Brief Therapy Institute and is on the faculties of the Johns Hopkins University School of Medicine and the Smith College and University of Maryland Schools for Social Work.