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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
When the clock strikes midnight on December 31, 2012, psychiatrists across America must use the same CPT codes as their medical colleagues have used all along. Many might prefer to turn into pumpkins, for these new demands are daunting. Like MDs everywhere, psychiatrists must collect and record data about vital signs, motor movements, integument (otherwise known as "skin"), and many other bodily functions, in addition to the mental states that are the typical purview of psychiatrists. If psychiatrists perform psychotherapy, they must record those notes separately.
"Psychotherapy" must be distinguished from mere "counseling," which is deemed to be a medical service rather than a specifically psychiatric technique, according to the powers-that-be. It's all very confusing, at least at this stage of the game.
So what exactly is therapy? Questions about the "true nature" of therapy will reverberate more than ever before and will be called into question more and more. As health care reforms come into being, cash-strapped Medicare and penny-pinching managed care will demand proof of both "efficacy" and "medical necessity." Before long, believing in the value of therapy in general, without being able to prove how a specific type of therapy helps a particular clinical condition, will be become outdated. In many circles, that point of view is already outdated.
In the past, many members of the public (and a surprisingly high percentage of professionals) conflated "psychotherapy" with "psychoanalysis." Then CBT arrived in high style and stole center stage, and became the Johnny-come-lately cure-all of the early 21st century. (Forget about the fact that CBT had been delineated decades ago.) In recent years, CBT was tested in controlled settings, touted as an advance, and recommended as an adjunct to--or even as an alternative for-- psychopharmacology. Behavioral conditioning, a one-time favorite of experimental psychologists, was subsumed by CBT, as the "Cognitive" aspect of "Behavioral Conditioning" gained sway.
So little was said about supportive therapy. Supportive therapy, the stepchild of therapies, was swept to the side, Cinderella-style, as it was forced to do most of the work, without gaining respect or recognition. I add this fairy tale analogy not simply to sound poetic, but because it is an apt analogy. Supportive therapy is the most commonly used therapy of the fives therapies that psychiatric residents must master before completing their training. Like the corps de ballet that dances indefatigably in the background as the audience applauds the prima ballerinas, supportive therapy never gained much recognition because it is not as dramatic as those therapies that take center stage.
Winston, Rosenthal and Pinsker's book on Learning Supportive Therapy can rectify that situation. This slim volume, published by American Psychiatric Association's official press, APPI, is an eloquently written, easy-to-follow text that speaks directly to fledging psychiatrists (and other therapists) who are acquiring a new skill and are being educated about the value of that skill at the same time. This book could just as easily be called Re-Learning Supportive Therapy, since it includes information that will appeal to seasoned practitioners, many of whom are wondering how therapy became so splintered over time. Luckily, this book succinctly explains how therapeutic standards shifted over the decades, and so it will appeal to seasoned practitioners as well.
Learning Supportive Therapy starts with Freud, but without overemphasizing analytic jargon. It demarcates "expressive" (psychodynamic) therapy from "supportive," both in its text, and in many user-friendly graphs and charts, and via live interviews recorded on CD. It acknowledges the role of fifties' films in sculpting our expectations about therapy and "the couch cure." It swiftly moves into the real world, where time and money constraints interact with clinical concerns, and where social changes have made Freudian preoccupations with the sexual etiology of neuroses nearly obsolete.
One of the most valuable aspects of this book is its ability to accept today's therapeutic reality as it is, without engaging in polemic or political diatribe, and without romanticizing the way things were or pontificating about the way things should be. Instead, this book weaves together valuable data from clinical studies, which show that even high-functioning patients derive as much benefit from supportive therapy as from more "expressive" or dynamic therapy. The text also reminds us that therapeutic approaches are rarely as orthodox as they are presented, and that syncretic approaches that blend elements of different therapies at different times are more the norm than the exception.
The short clinical vignettes are also excellent teaching tools. They are short enough to hold the attention of the video game generation, but long enough to convey essential information. Some of the examples about transference and counter-transference are downright funny, even if they are true. One "LOL"-rated scenario about questions that a patient poses to his therapist, regarding the therapist's marital status and more, is guaranteed to make this serious book accessible to all ages. In addition, it also offers quick and simple solutions for thorny clinical problems that can arise, if not in the office, then at least in the imagination of the novice therapist. Its light-hearted anecdotes and conversational style are sure to dispel anxiety that accompanies one's first forays into the therapeutic labyrinth.
In summary, this book is essential for those learning supportive therapy, and it is equally recommended for anyone wanting a refresher course. It offers easy-to-understand explanations of changes that have occurred in therapeutic approaches over the decades. The recommendations are bolstered by hard outcomes data, plus basic facts about treatment trends. This dispassionate approach is most refreshing at a time when so many books and articles about psychiatric practice turn out to be one-sided diatribes that aim to argue rather than to educate.
© 2013 Sharon Packer
Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books include Dreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at firstname.lastname@example.org .