The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy [Paperback]

Barry L. Duncan (Author), Scott D. Miller (Author), Jacqueline A. Sparks (Author)

Book Description

ISBN-10: 0787972401 | ISBN-13: 978-0787972400 | Publication Date: February 27, 2004 | Edition: 1

In this controversial book, psychologists Barry Duncan and Scott Miller, cofounders of the Institute for the Study of Therapeutic Change, challenge the traditional focus on diagnosis, "silver bullet" techniques, and magic pills, exposing them as empirically bankrupt practices that only diminish the role of clients and hasten therapy's extinction. Instead, they advocate for the long-ignored but most crucial factor in therapeutic success-the innate resources of the client. Based on extensive clinical research and case studies, The Heroic Client not only shows how to harness the client's powers of regeneration to make therapy effective, but also how to enlist the client as a partner to make therapy accountable. The Heroic Client inspires therapists to boldly rewrite the drama of therapy, recast clients in their rightful role as heroes and heroines of the therapeutic stage, and legitimize their services to third-party payers without the compromises of the medical model.

Editorial Reviews

Review

“… Great. Great. Great. Buy. Buy. Buy…one of the few works on therapy which I would attempt to salvage if shipwrecked on a desert island….” (Ipnosis, No.16, Winter 2004)

From the Inside Flap

Psychotherapy has for too long relegated the client to a minor role in the drama of therapeutic healing. Moreover, in today's system of managed care, the client is marginalized further as the field is increasingly medicalized and supervised by those interested only in the bottom line. The result: clients are depersonalized by diagnostic labels that have predetermined limits to care, leaving them with few options for meaningful individual treatment. And this system often forces therapists of all disciplines to forgo new or alternative treatments, leaving them enslaved to follow practices in which they no longer believe. It's time for a radical change.In The Heroic Client, Barry Duncan and Scott Miller-cofounders of the Institute for the Study of Therapeutic Change-outline the steps to revitalize psychotherapy by harnessing the client's own powers of regeneration and enlisting the client's own perceptions, and thereby making treatment more effective and accountable. This innovative approach advocates for the client's voice in all aspects of therapy and shows how to tailor both relational stances and treatment approaches to each client's personal goals. The authors present a simple, valid, and reliable way of legitimizing therapy to third-party payers using client feedback about the process and outcome of therapy.Based on extensive clinical research and field-tested experience, The Heroic Client will challenge therapists to rethink the process of therapy, recast clients in their rightful roles as heroes and heroines in their own therapy, and help therapists establish an approach beyond the limits of the medical model. Timely, highly readable, and thought-provoking, The Heroic Client will change the way therapists do therapy.[head]The book that will lead psychotherapy out of the Stone Age and into the age of The Heroic ClientIn this controversial book, psychologists Barry Duncan and Scott Miller, cofounders of the Institute for the St --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 288 pages
• Publisher: Jossey-Bass; 1 edition (February 27, 2004)
• Language: English
• ISBN-10: 0787972401
• ISBN-13: 978-0787972400
• Product Dimensions: 9.1 x 6.4 x 0.8 inches
• Shipping Weight: 12 ounces (View shipping rates and policies)
• Average Customer Review: 4.8 out of 5 stars  See all reviews (13 customer reviews)
• Amazon Best Sellers Rank: #68,197 in Books (See Top 100 in Books)

Customer Reviews

Most Helpful Customer Reviews

78 of 80 people found the following review helpful:

5.0 out of 5 stars To a different approach to helping people, November 21, 2001

By 

Coert Visser "solutionfocusedchange.com" (Driebergen Netherlands) - See all my reviews
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Amazon Verified Purchase

This review is from: The Heroic Client (Hardcover)

Barry Duncan and Scott Miller are with Marc Hubble directors of The Institute for the Study of Therapeutic Change (...). These people play an important role in improving and renewing therapy. In this book, the authors explain how therapy has for too long been been neglecting, ignoring, and depersonalizing clients, by its over-emphasis on methods and techniques, by following the medical model, by its emphasis on pathology, by hegemony of biological approaches, and so on.

The authors first debunk the myths of:

1) PSYCHIATRIC DIAGNOSIS:
a) it lacks reliability,
b) it lacks validity,
c) it puts the blame on the client, and
d) it is often motivated by self-interest, fueled by greed, and blows with the winds of fashion,

2)DRUG TREATMENT OF MENTAL PROBLEMS:
a) they work no better than therapy in the short term
b) changes brought about by medication are less likely to persist over time
c) there often are severe adverse effects,
d) drug studies often look better than they are because they rate improvement by looking to clinicians' perceptions, not clients'
e) the relationship between drug companies and psychiatry is an unholy alliance, making most of the drug-effectiveness research very suspect

3) THE MAGIC APPROACH:
a) there is no special magic silver bullet approach which is much better than another approach
b) the role of the competence and experience of the therapist is rather unimportant

According to the authors, four decades of outcome research have shown that there are four main factors of change, being:

1. Client factors (percentage contribution to positive outcome: 40%).
2. Relationship factors (percentage contribution: 30%).
3. Hope and expectancy (percentage contribution: 15%).
4. Model and technique (percentage contribution: 15%).

Some conclusions:
1. Thoughts, ideas, actions, initiatives, traits of clients are the most important predictor of therapy success!
2. Next to what the client brings to therapy, the client's perception of the therapeutic relationship is responsible for most of the gains resulting from the therapy.
3. Models and techniques are much less important than generally thought.

The authors advocate a new and refreshing approach characterised by:
1) Client-directedness. Clients' beliefs, values, theories and goals are repected, close attention is being paid to clients' initiatives, interventions and perceptions. Much attention is given to establishing the quality of the relationship, and to monitoring the clients' perception of the quality of the relationship.
2) Outcome informedness. Progress is measured from session to session using paper and pencil questionnaires. By the way: the client's experience of meaningful change in the first few visits is emerging as one of the best predictors of eventual treatment outcome.

Two thoughts come up after having read this book. First, this book is refreshing indeed and a shock to the therapy system. Second, the ideas ventilated in this book might be relevant for work outside the therapy field as well. Consider for instance what management consultancy and managing coaching could learn from this......

26 of 27 people found the following review helpful:

5.0 out of 5 stars an 11th hour reprieve for both client and therapist, May 1, 2000

By 

john mann lcsw (temecula,ca.) - See all my reviews

This review is from: The Heroic Client (Hardcover)

For many years,both clients and therapists alike have been encouraged, rewarded,and more recently pressured into trying to squeaze themselves into what all too often becomes an ill-fitting medical model box.This box sometimes fits the needs of particular client and therapist,but most of the time one or both of the participants in this drama become disenchanted/disheartened and they remove themself from the interaction either physically ( drop out of therapy - leave the profession ) or emotionally ( burn-out/become bad therapists ).The work of Scott Miller,Barry Duncan,and others have, over the past few years, served to help breath some much needed life into the helping professions...particularly that of psychotherapy.Their most recent book,The Heroic Client, is, with the benifit of hindsight, a logical extension of their previous works/philosophy.This is a book for therapists who work in the proverbial trenches on a day to day basis.It speaks to the everyday concerns of therapists...how to be of help to others, and still like yourself in the morning...and actually want to get up in the morning to do it all over again.This book encourages therapists to surrender their hardwon professional ego/identity in the higher service of helping others discover who they are and what they want versus us trying to " encourage " our clients to learn to want what we think they should want( to be ).I for one though compassionate/sensitive etc. have done more than my fair share of theraputic manipulation over the past 23 years as a social worker.This book nurtures an impulse I've had growing inside of me for years to leave behind the illusion of security of the medical model of mental health ( does that not qualify as an oxymoron?)for the more exciting and potentially liberating process of working in a more colaborating fashion with my clients.This books medium ( no distancing professional jargon;an abundance of enlighting humor; easy to read; it's brevity;and willingness to tackle the difficult and politically incorrent issues like the limits of psychopharmacology )is very much in concert with it's message.I highly recommend The Heroic Client for both therapists and those who are considering going into therapy as a client.

20 of 20 people found the following review helpful:

5.0 out of 5 stars A Scientific Approach to Change, March 24, 2004

By 

Brian W. DeSantis (Colorado Springs, Colorado United States) - See all my reviews
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This review is from: The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy (Paperback)

In the thorougly revised edition of the "Heroic Client", Duncan, Miller, and Sparks now advocate "A Revolutionary Way to Improve Effectivness." They invite mental health professionals, of any discipline, to partner with clients in all aspects of their care and abandon the search for the best therapeutic process or evidence-based therapy, and instead, focus on client-based outcome feedback to improve effectivness by an incredible 65 percent!

As in the previous edition, the strength of the authors' arguments for practicing "Client-Directed, Outcome-Informed Therapy" lies in their comprehensive and enlightening review of the science behind "what works" in psychotherapy. The revised edition updates the reader on the latest empirical findings targeting the limitations of applying the medical model toward resolving human problems-namely the myth of psychiatric diagnosis, the myth of evidence-based practice, and the myth of the magic pill. The sections examining the science of evidence-based practice and the ethics and science of using medications (especially for children) are significantly expanded, thought provoking, and timely. Also of significance, in the revised edition is the authors' unvailing of their own empirically tested process (Session Rating Scale-SRS) and outcome (Outcome Rating Scale-ORS) measures which have adequate psychometric properties, and of equal importance, are designed to be feasible for clinical settings. Using the SRS and ORS together, the authors report that their outcome management system offers the only system currently available which tracts both outcome and the alliance in a practical manner. Finally, as in the original text, Duncan, Miller, and Sparks intersperse case examples throughout their book to demonstrate the application of their approach to helping people change.

The revised edition could stand alone, without the reader needing to read it's predesesor. The only dissappointment to this reviewer was the mention in the first edition of The Nova Southeastern University (NSU) Pilot Project- Duncan and Miller's proposed solution to address some of the problems associated with conducting outcome research in the clinical setting. In the original "Heroic Client", they stated that results were preliminary because the study was still underway at press time and that two replications were planned. Unfortunately, the revised edition does not revisit this promising study.

Nonetheless, Duncan, Miller, and Sparks offer a simple, yet compelling message which has tremendous ramifications for the training, practice, and the delivery of mental health services. They are not just whinning about "business as usual" nor do they advocate another theory or therapy method which falls short of empirical support. Instead, the authors remind therapists that we are in the business of change, and out of respect for our clients who seek our sevices and the third party payors who help reimburse it, we must translate empirical research into an approach that they so rightly state will be "effective, accountable, and just." Their alternative vision of the future of mental health is a must read for students and practitioners alike.