Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans [Paperback]

Barry L. Duncan (Author), Mark A. Hubble (Author), Scott D. Miller (Author)

Book Description

ISBN-10: 0393702464 | ISBN-13: 978-0393702460 | Publication Date: February 17, 1997 | Edition: 1

This book, a companion to the authors' Escape from Babel, describes therapy with a number of patients who had defeated numerous clinicians and become "veterans" of the system. Using a flexible approach that emphasizes relationship, hope, and a plan for the future, the authors turn these cases around, setting the clients on a path of independence and health.

Editorial Reviews

About the Author

Scott D. Miller, Ph.D., practices solution-oriented therapy in Chicago.

Product Details

• Paperback: 240 pages
• Publisher: W. W. Norton & Company; 1 edition (February 17, 1997)
• Language: English
• ISBN-10: 0393702464
• ISBN-13: 978-0393702460
• Product Dimensions: 9.2 x 6.1 x 0.5 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.3 out of 5 stars  See all reviews (6 customer reviews)
• Amazon Best Sellers Rank: #341,046 in Books (See Top 100 in Books)

Customer Reviews

Most Helpful Customer Reviews

10 of 10 people found the following review helpful:

5.0 out of 5 stars Stop Shifting Responsibility For The Failure of The Theory!, March 10, 2004

By 

Tony Plant (London, England UK) - See all my reviews

This review is from: Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans (Paperback)

An inspirational follow-up to Escape from Babel: this book gives both a robust challenge to the phenomenon of resistance and the labelling of some therapy veterans as `impossible' cases. Over the five-year study period, the authors encouraged other therapists and agencies to refer `impossible' cases - known in the UK as `heartsink' clients - to them. Anne Wilson Schaef argues that there would be fewer `impossible' or `untreatable' clients if those responsible for their care had to re-frame this impossibility as a personal deficit; e.g., "I do not know how to treat this client effectively", rather than the more typical, "This client is impossible/untreatable". In documenting case after case, the authors demonstrate that they have taken up Wilson Schaef's famous challenge to the therapy profession to stop locating the responsibility for intractability in the client, and that for success in the therapist.

The book identifies the therapeutic conventions that trap therapists and clients in the wasteland of impossibility, from where there is no escape, and where no further growth can be anticipated. When both clients and professionals believe in impossibility, they tend to:
· anticipate trouble;
· elevate theory over the client's practical experience of living the therapy in the multi-contextual world outside the therapeutic hour;
· refuse to question the appropriateness of the models and techniques despite absence of improvement;
· neglect client motivation.
The authors report that successful outcomes can occur with even the most heartsink cases when therapy accommodates the client's worldview and informal 'theory of change'. They argue that practitioners have much to learn from placing their confidence in therapy veterans' own resources and capabilities. Rather than regret the loss of control and status that this might imply, the authors celebrate this new emphasis, "It is the unpredictability of client methods and accomplishments that makes this work fun". With due humility the authors quote the opinion of a 10 year old `impossible' client: "So, what I'm saying to all psychiatrists is we have the answers, we just need someone to help us bring them to the front of our head. It's like they're [the solutions] locked in an attic or something".
The authors discuss many cases and describe how to:
· optimise the client's participation in therapy;
· collaborate with the client and establish a co-therapy alliance;
· leverage the power of the client's resources and theory of change;
· honour the client's motivation.
The authors successfully argue that the practice of (frankly disrepectful) labelling de-humanises clients, and can insidiously legitimate a lack of optimism that the clients can expect alleviation of the conditions that distress them. As with their other work, their strongest argument is that clients are co-therapists, not cases to be managed with a pre-formulated care plan that resembles a manual of Standard Operating Procedures.

This book has many lessons for the field of performance coaching, both for teams and individuals. Recently I met an engineer who had been referred to me because his manager and colleagues claimed that he need coaching in both time-management and effective listening: I was warned that he had been sent for similar training on previous occasions, but had 'failed to learn anything'. Within 20 minutes of meeting him, it was apparent that although the engineer had unquestioningly accepted the labelling/assessment of his colleagues, the labels were wrong. He was overloaded with responsibilities, rather than incompetent, or incapable of learning.

Influenced by the arguments of this book, we outlined a programme that more closely reflected the engineer's own needs and motivation, and both broadened and built on the strengths that had so far been invisible to his manager and colleagues. The engineer acquired several new skills that vigorously contested the previous prediction that he would 'fail to learn'.

This book merits a wide audience and should be read for its application to several fields such as education, management practices, and personal development.

9 of 9 people found the following review helpful:

5.0 out of 5 stars "Impossible to Put Down! ", May 10, 2000

By 

Peter Cote, LSCSW,LMFT (Wichita, KS.) - See all my reviews

This review is from: Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans (Paperback)

A sophisticated yet readable romp through a forest of traditional and current psychotherapies that leads to "clearing in the woods", an empirically based, outcome focused approach to change. The authors serve up one case example after another skillfully applying "the four common factors" for positive client outcome. The authors deconstruct the deconstructionists as they take us a quantum leap forward where the "client is the expert" and the therapist listens for and utilzes, the client's "theory of change". My graduate students loved this text! I highly recommend this wise,wry,and practical text to fellow clinicians brave enough to walk out into this "clearing in the woods". Our clients' and students' are there... waiting for us.

3 of 3 people found the following review helpful:

5.0 out of 5 stars Hard Cases Can Make the Best Teachers if We're Teachable, December 24, 2003

By 

Dr. Z. "Joyfully Retired" (San Rafael, CA USA) - See all my reviews

This review is from: Psychotherapy with "Impossible" Cases: The Efficient Treatment of Therapy Veterans (Paperback)

Duncan, Miller and Hubble keep writing books that explain why therapists would be wise to spend more time listening to their clients theories about how therapy can help and how the therapist can be most helpful than by listening to the theories in their own heads that tell them what to do to "fix" or change their clients. This book is one of several written by these folks and like the others they can guide you to becoming more effective in your professional work. Their concept of the "Client's Theory of Change" is brilliant and that alone is worth the price of the book. Phillip Ziegler, co-author of Recreating Partnership: A Solution-Oriented Approach to Couples Therapy