Customer Reviews

Short-Term Therapy for Long-Term Change

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I found this book to be a remarkable and consise description of a complicated topic. The authors summarized the state of the field of short term dynamic therapy. They held no information back and identified the areas of controversy, particularly conflicting opinions and data on the use of confrontation in the Davanloo approach versus the approach preferred by McCullough and Alpert. Furthermore, the inclusion of EMDR as a dynamic treatment was inovative and exciting. Neborsky and Solomon's chapter on "Changing the Love Imprint" explained how EMDR and the STDP's may have a common therapeutic action, which was helpful to me as was their integration of attachment theory. Finally, David Malan's chapter on the science of outcome evaluation and what we might learn from his career was an inspiration to read. I hope this group continues to write and create more material for clinicians like this!

This is a book that is bound to improve the psychotherapeutic skills of practitioners who read it. For those unfamiliar with recent developments in the dynamic short-term therapy movement, it convincingly dispels the concept of "non-specific factors" in treatment outcome. For those more familiar with the authors it reveals the pivotal foci to which they attend while using disparate appearing techniques in their treatments. Surprisingly, the reader would be hard pressed to find another volume that similarly stresses the importance of developing therapy techniques to fit one's personality instead of one's theoretical orientation. Michael Alpert's system focuses on the therapist's affection for the patient and the patient's response. Robert J. Neborsky presents Habib Davanloo's method of accessing defended impulses and feelings. Leigh McCullough's approach is to desensitize "affect phobia" (an expression becoming standard in the lexicon of psychotherapy). Marion F. Solomon has incorporated short-term theories and techniques for use in couples therapy. Francine Shapiro, whose eye movement desensitization techniques resulted in what initially appeared to be an almost purely behavioral treatment, here acknowledges the dynamic aspects of this method, recognizing that the significance of the trauma being desensitized is directly related to trauma suffered in early life attachments. There is frequent reference to the short-term work of Freud, Alexander and French, and others, putting this state of the art presentation in a clear historical perspective. The book concludes with a delightful chapter by David Malan, a pioneer in the short-term movement. His statistical references are fascinating rather than dry, citing study after study supporting the results of the dynamic short-term models. He directs the reader on how to make immediate use of the critical factors discussed by the authors. Practitioners of many different theoretical orientations stand to benefit from Short-Term Therapy for Long-Term Change. It directs therapists' attention to critical moments in treatment and provides various techniques for making the best use of these opportunities. The final goal of all the authors is to free patients or their debilitating symptoms thus allowing them to trust and experience their true feelings and impulses. This ultimately leads to a richer, enhanced ability to relate to the other important people in their lives.

As a practicing psychologist, I am always looking for ways to improve the efficiency of psychotherapy. Not to satisfy managed care, but to alleviate the pain of my clients. All of us in clinical practice have encountered "difficult clients", those with whom what is helpful to many of our other clients just is not helpful. What does one do when traditional cognitive therapy is not helpful? In my experience, this is when a psychodynamic perspective is most useful. Such a perspective does not necessarily mean that years of psychoanalysis is required. Short-term psychodynamic psychotherapy (STPP)offers an alternative. The authors of this book provide the reader with an array of STPPs, varying from the more confrontive style originated by Davenloo, through "softer" modifications (but still focused), including one with a focus almost exclusively on conveying empathic understanding to the client (the first I had heard of what might be thought of as short-term Kohutian therapy). What I found most interesting was the inclusion in this volume of a chapter by Francine Shapiro on EMDR, which uniquely (but accurately, IMO) places EMDR in the short-term psychodynamic camp. I consider it a positive step to recognize that EMDR is the most non-intrusive (meaning non-interpretational) of the STPPs. Shapiro's language of "large T and small t traumas" fits in seamlessly with the primary theoretical underpinnings of these STPPs; namely, attachment theory and the developing infant/child.
Among other highlights in the book are chapters by David Malan, the pioneer in outcome research for STPP, and a fascinating chapter by Neborsky and Soloman offering the "missing link" in attachment theory (the "PASO", or primitive aggressive self organization). I would like to see more research demonstrating the ubiquity of the PASO, with it's emphasis on helping the client to experience repressed primitive rage in the therapy. It seems to be the shared opinion of several of the authors (though not necessarily Shapiro) that it is the reexperiencing of the anger component of the PASO that is necessary for optimal therapy outcome.
Nonetheless,I highly recommend this book to all practicing psychotherapists interested in increasing their effectiveness with their clients. By providing an alternative to Davanloo's confrontive style of STPP, the authors perform the valuable service of broadening both the clients and the therapists for whom STPP is indicated.

The recent no-name reviewer from Atlanta who attacked Short-Term Therapy for Long-Term Change's lack of research must have bought some bootleg copy that omitted its hundreds of endnotes and citations. Its dozens of pages of transcribed therapy sessions will hardly be dismissed as "anecdotes" by any mindful reader. The book's six contributors are tops in their fields. Calling them "cheerleaders," as no-name does, is a whooper bordering on delusion. This book is the best available overview of the latest breakthroughs in short-term psychotherapy available.

The problem with using advoates as authors is that you only get one side of the story. In the case of EMDR, for instance, there is research that says a) the eye movements are unnecessary and b) its effects do not last as long as Cognitive-Behavior Therapy based exposure procedures. This really undercuts the second part of the title of this book "for Long-Term Change". Stories and anecdotes are often entertaining but for true treatment help see a professional who reads the scientific research and is not a cheerleader for every fad that comes along.