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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 PsychotherapistBecoming MyselfBefore 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 CounselingExercise-Based Interventions for Mental IllnessExistential PsychotherapyExpectationExploring 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 ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMaybe You Should Talk to SomeoneMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness 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 PracticeNietzsche and PsychotherapyOn 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 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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 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Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
The authors of How Clients Make Therapy Work are unrepentant optimists. Clients have within them, say Bohart and Tallman, the seeds of their own cures: "[T]he active efforts of clients are responsible for making psychotherapy work" (p. xi).
However, in another sense, these authors are also pessimists. The healing powers of the therapist are much more limited than professionals would like to believe, they claim. "It is the client's self-healing capacities and resources that are responsible for the resolution of problems and for change . . . in any form of psychotherapy" (p. xii).
In this view, the therapist's only role in achieving a successful outcome is to support and encourage the client in the self-healing process. The therapist is a "participant consultant" (p. 16), and all theoretical models and techniques can be equally effective in the psychotherapy endeavor (the "dodo bird" verdict), as long as this self-healing tenet isn't violated.
The so-called "medical model" of psychotherapy likens the client to a patient suffering from some externally caused disease or illness, which can be cured or eliminated by the intervention of the expert practitioner. Bohart and Tallman reject this understanding of therapy. They insist that clients' problems are not illnesses, but are rather the result of ineffective interactions with their environments. "Psychological problems arise when people's coping skills and abilities are unable to handle problems and obstacles that confront them in their life space" (p. 84). Throughout the book, the authors stress repeatedly that the therapist's job is to understand and support the client, not to direct treatment or "intervene". Success in psychotherapy is not a "cure" as in the control of symptoms or elimination of a pathogen. Therapy is seen to be more like the processes of education and exploration, in which the client's abilities and world-view are expanded.
The strengths of this book are several. The authors write clearly and illustrate their positions with case examples. Alternative positions are examined and discussed. Most chapters conclude with a concise recap of the major assumptions underlying the authors' view in that chapter, which helps the reader maintain focus. For the therapist, the book serves as a reminder that psychotherapy is by its nature more of a collaborative effort than most medical procedures. And it's good to recall the humanistic principle that people are, in general, problem-solving creatures who seek to actualize their potentials. But because psychotherapy clients vary in their abilities to understand themselves and in their motivation to achieve effective outcomes, the therapist must be adaptable in order to successfully achieve and maintain the role of coach and collaborator.
Some of the questions addressed near the end of the book deserve even further consideration. For example, can therapists effectively employ this approach when working with clients who suffer from biologically-based disorders, extreme personality styles, or secondary-gain issues? One illustration used by the authors is that of the court-ordered, involuntary client (p. 301). The authors suggest that if therapy is a medical-like procedure, such clients should successfully respond in spite of their resistance. However, the authors argue that therapy is not an external intervention, and that these clients can benefit only from a therapeutic relationship in which they feel supported and valued and in which they are active participants.
(It should be noted here that the use of medical terms by psychotherapists does not mean they define these terms in the same way physicians might. For example, although therapists have borrowed and make use of the term intervention, they would not see this as something done to the client, but rather as referring to the specific activities of the therapist in working with the client. In the same way, treatment in psychotherapy does not refer to an externally applied agent, but rather to the general process of therapy.)
Finally, in arguing for a humanistic approach to therapy, the authors of this book brings to the surface another significant issue, perhaps the most crucial issue facing psychotherapists in this era of managed care - - the lack of an operational definition of successful outcomes. That is, what exactly is psychotherapy supposed to accomplish? How do we know when it has been successful? Third-party payers and community mental health systems are increasingly reluctant to cover services that have ambiguous goals or that look too much like chitchat sessions. If, as suggested above, psychotherapy is more like an educational process than a medical procedure, how can we convince payers that it should be included in a medical-model treatment system? Quantitative and actuarial data are the best evidence for this sort of purpose, and such data is difficult to extract from qualitative research and clinical studies, especially when successful outcome is left loosely defined. Keith Harris, PhD, is a clinical psychologist and supervisor of Victor Valley Behavioral Health Center in San Bernardino county, California. Hisinterests include clinical supervision, the empirical basis forpsychotherapy research (and its design), human decision-making processes,and the shaping of human nature by evolutionary forces.