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
With her Maximizing Effectiveness in Dynamic Psychotherapy (MEDP), Patricia Coughlin presents an ambitious attempt both to illustrate and justify the practice of short-term dynamic therapy. Integrating research and technique, the volume instructs the reader in a number of clinical skills and presents the empirical evidence that supports their efficacy. As such, MEDP is a comprehensive guide to short-term dynamic therapy, teaching its readers both how and why it works. That said, the book addresses few of the theoretical questions it raises.
Throughout MEDP, Coughlin references Intensive Short-Term Dynamic Therapy, as developed by Davanloo (1990, 2000). However, the current volume is intended not just for practitioners of this particular treatment modality: as the book's blurb announces, therapists "of every stripe [can] integrate the clinical skills presented". Borrowing from the book's title, I shall therefore speak of Dynamic Psychotherapy to mean the therapeutic method described in MEDP.
The book consists of eight chapters. The first two introduce pertinent research findings and explain how psychic conflict is conceptualised and assessed in Dynamic Psychotherapy. The remaining six chapters then illustrate the various techniques and interventions that this modality employs. Instead of summarising each chapter separately, I'll outline Dynamic Psychotherapy directly and will then comment on Coughlin's presentation thereof.
As the book's title suggests, Coughlin's main concern is with the effectiveness of psychotherapy. In turn, a therapy model effective if it "consistently produces deep and lasting change" (p.5), if it is "both rapid and pervasive" (p.227). However, "restricting the therapist's focus to the patient's conscious thoughts has proven ineffective" (p.7) when it comes to achieving this type of therapeutic change. Instead, it is necessary to "identify and resolve the underlying emotional problems causing symptomatic suffering" (p.8), by putting patients in touch with their "affective unconscious" (ibid.).
To apply this to clinical practice, Coughlin presents the central dynamic sequence (p.19). Here, the patient is "pressured" (ibid.) from the start to experience the feelings involved in the concerns that bring her to therapy -- cf. cap.2. In response to this pressure, the patient's anxiety levels are likely to rise and must be monitored. E.g., dizziness and headaches are signs that the patient's anxiety must be down-regulated before treatment can continue -- cf. cap.3. Further, defences such as projection, displacement, and intellectualisation will be triggered and must be blocked. This is done by pointing out to the patient the psychological cost of maintaining the defences -- cf. cap.4. Next, as the patient slowly abandons her defences, emotions will begin to surface. When this happens, the patient must be encouraged to experience these fully. That is, she must (a) cognitively recognise each emotion and label it, e.g. as sadness or anger; (b) feel the emotion in her body, e.g. as heaviness or heat; and (c) express a motoric impulse, e.g. to scream or punch somebody -- cf. caps.5&6. Following this breakthrough of emotions, patients often report dreams and previously repressed memories, or spontaneously make associations to their emotional experience. The penultimate step in the sequence is to make sense of this material -- cf. cap.7. Finally, as the therapy comes to an end, insights must be consolidated. In this last step, the therapist helps the client link present to past, and also reinforces the connection between defences and symptoms -- cf. cap.8.
Turning from summary to critique, Coughlin names research, technique, and theory as the three components of therapeutic competence, and states that the "master clinician is knowledgeable and skilled in all three areas" (p.5). Let me comment, therefore, on how MEDP fares in each area.
Starting with research, Coughlin is careful to provide ample evidential support for the methods she describes. While this evidence cannot be presented here, Coughlin's close attention to it achieves at least three goals. Most immediately, it provides the reader with a concrete measure of the reliability and, indeed, effectiveness of Dynamic Psychotherapy. Secondly, it offers an extensive bibliography of contemporary research papers and books in the area for further study. Thirdly, it shows that contrary to a popular myth, treatment modalities in the psychodynamic tradition can be tested empirically -- and don't do at all badly in those tests.
Using research, MEDP tries to achieve a fourth goal: to challenge -- and perhaps even discredit -- alternative treatment modalities. To cite just one example, Coughlin writes about CBT that the "notion that a patient's emotional disturbances are the result of faulty thinking has little scientific evidence or support" (p.7). However, whether or not such evidence exists, Coughlin's stance seems unnecessarily aggressive. How effective Dynamic Psychotherapy is, does not depend on the (in)effectiveness of other therapy types: the reader learns little about Dynamic Psychotherapy from the hostility Coughlin displays in some places.
As a second point of criticism, Coughlin presents substantially less research in MEDP's later chapters. This is particularly unfortunate as these chapters concern more 'speculative' notions like "inner being" (p.175), "authentic connection with others" (p.177), and "emotional truths" (p.200). An attempt to link these concepts to ones that are empirically more traceable, would have further supported the claim that Dynamic Psychotherapy is founded on solid research.
Moving on to technique, Coughlin uses detailed case vignettes, each several pages long, to illustrate the methods and interventions employed in Dynamic Psychotherapy. These vignettes not only serve to illustrate the individual steps of the central dynamic sequence. They also allow the reader to trace the effects these interventions have on the patient. In almost all cases, a change in attitude and affect is immediately noticeable, making the technique's effectiveness concretely tangible for the reader. The claim that Dynamic Psychotherapy is "both rapid and pervasive" (p.227) is demonstrated well.
In total, MEDP contains around thirty vignettes from about twenty different patients. This makes it somewhat difficult for the reader to appreciate each individual case and patient. Often, one vignette 'blends into' in the next. Perhaps it would have been better, therefore, to discuss only four or five patients, and to present their treatment from start to finish. This likely would have offered the reader a deeper insight into each case, and an opportunity to empathize more with each patient. It also would have helped clarify which phase of the treatment a particular vignette stems from -- beginning, middle phase, or ending.
Turning finally to theory, this is the area where MEDP has the least to offer. One way to see this is by asking: what exactly makes Dynamic Psychotherapy a psychodynamic form of therapy? While Coughlin talks a lot about defenses and the unconscious, other distinctly psychodynamic concepts are missing entirely. E.g. while the transference is discussed, there is no mention of the counter-transference. Is this therapeutic tool not employed in Dynamic Psychotherapy? If not, is it not needed, is it ineffective, is it not "rapid and pervasive" (p.227) enough?
To mention just one more concept, at the intersection between theory and practice, Coughlin says nothing about the so-called therapeutic or analytic frame. (Cf. e.g. Jacobs 2010, cap 4; Howard 2010, cap.4; Lemma 2016, cap.4). Apparently, intake session can last several hours (cf. p.19); "a three-day block therapy" is mentioned (p.211) as an alternative to weekly sessions. However, the reader does not learn how therapists are meant to choose between these options. Is this merely a matter of convenience, or does Dynamic Psychotherapy espouse that there is a deeper significance to time-keeping and boundary issues? As these examples show, MEDP leaves unclear which theoretical commitments a practitioner of Dynamic Psychotherapy is required (not) to make.
In sum, MEDP is "a resource for novice and experienced therapist alike" (p.13), insofar as these therapists are looking to expand their therapeutic repertoire with interventions that have evidential support. However, since the volume does not describe the conceptual framework in which the practice Dynamic Psychotherapy takes place, at least some readers will likely be hesitant to use this resource.
Davanloo, H. (1990). Unlocking the Unconscious, Wiley.
-- -- -- (2000). Intensive Short Term Dynamic Psychotherapy, Wiley.
Lemma, A. (2016). Introduction to the Practice of Psychoanalytic Psychotherapy, 2nd ed., Wiley.
Jacobs, M. (2010). Psychodynamic Counselling in Action, 4th ed., Sage.
Howard, S. (2010). Skills in Psychodynamic Counselling and Psychotherapy, Sage.
© 2017 Sebastian Petzolt
Sebastian Petzolt, DPhil