Clinical Strategies for Becoming a Master Psychotherapist

Clinical Strategies for Becoming a Master Psychotherapist

Clinical Strategies for Becoming a Master Psychotherapist EDITORS Dr. William O Donohue Dr. Nicholas A. Cummings Dr. Janet L. Cummings AMSTERDAM BOSTON HEIDELBERG LONDON NEW YORK OXFORD PARIS SAN DIEGO SAN FRANCISCO SINGAPORE SYDNEY TOKYO Academic Press is an imprint of Elsevier

Academic Press is an imprint of Elsevier 30 Corporate Drive, Suite 400, Burlington, MA 01803, USA 525 B Street, Suite 1900, San Diego, California 92101-4495, USA 84 Theobald s Road, London WCIX 8RR, UK This book is printed on acid-free paper. Copyright ß 2006, Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier s Science & Technology Rights Department in Oxford, UK: phone: (þ44) 1865 843830, fax: (þ44) 1865 853333, E-mail: permissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://elsevier.com), by selecting Support & Contact then Copyright and Permission and then Obtaining Permissions. Library of Congress Cataloging-in-Publication Data O Donohue, William T. Clinical strategies for becoming a master psychotherapist / William O Donohue, Nicholas Cummings, Janet Cummings. p. cm. Includes bibliographical references and index. ISBN 0-12-088416-X (alk. paper) 1. Psychotherapy. I. Cummings, Nicholas A. II. Cummings, Janet L. III. Title. RC480.033 2006 616.89 14 dc22 2005023305 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN 13: 978-0-12-088416-2 ISBN 10: 0-12-088416-X For information on all Academic Press publications visit our Web site at www.books.elsevier.com Printed in the United States of America 06 07 08 09 10 9 8 7 6 5 4 3 2 1

Contents List of CONTRIBUTORS xiii 1 The Art and Science of Psychotherapy William O Donohue, Nicholas Cummings, Janet Cummings Psychotherapy is not Entirely an Art 2 Psychotherapy is not Only a Science 4 Psychotherapy is both an Art and a Science 6 An Outline of the Problems Encountered in the Art of Psychotherapy 7 References 10 2 Enhancing Client Motivation to Change Paula L. Wilbourne, Eric R. Levensky Definition 12 Enhancing Motivation for Change 13 Assessment 18 Theoretical Underpinnings of Motivational Interviewing 19 The Practice of Motivational Interviewing 20 Summary 33 Recommended Reading and Online Resources 34 References 34 Clinical Strategies for Becoming a Master Psychotherapist v Copyright ß 2005 by Elsevier. All rights reserved.

vi Contents 3 The Therapeutic Alliance: Cultivating and Negotiating the Therapeutic Relationship Jeremy D. Safran, J. Christopher Muran, Michael Rothman Definition 38 Identification 39 Theory and Conceptualization 40 Case Formulation 42 Clinical Strategies 43 Key Mistakes 48 Case Study 49 Summary 52 References 53 4 Narrative Psychotherapy as Effective Story-Making: An Introduction Lois Parker Why a Narrative Approach to Psychotherapy? 55 Conceptualizing Psychotherapy as Active Story-Making 56 A Suggested Conceptual Framework 57 Suggested Clinical Practices for Narrative Psychotherapy 62 A Story Unfinished 68 Story-Making s Universe, or Narration s Neglect in Psychotherapy 68 A Story Retold 69 References 70 5 Recognizing and Dealing with Cultural Influences in Psychotherapy Melanie P. Duckworth, Tony Iezzi Definition of Culture and Other Terms 72 Recognizing and Dealing with Cultural Influences in the Client 74 Dealing and Recognizing Cultural Influences in the Therapist 76 Case Illustration 81 Summary 83 References 83

Contents vii References 93 6 Effective Understanding and Dealing with Manipulation Michael G. Wetter, Jack Wetter 7 Recognizing and Dealing with Transference George Stricker Definition 95 Detection and other Assessment Issues 98 Theory and Conceptualization 99 Impact on Case Formulation 100 Clinical Strategies 103 Key Mistakes and Miscomprehensions 107 Case Study 108 Summary 111 References 112 8 The Temporal Structure of Therapy: Key Questions Often Associated with Different Phases of Sessions and Treatments (Plus Twenty-one Helpful Hints) Michael F. Hoyt The Temporal Structure of Therapy 115 Some Questions to Consider at Different Junctures in Therapy 116 A Few Other Hints 119 References 125 9 Resistance as an Ally in Psychotherapy Nicholas A. Cummings A Definition: Patients have a Right to their Resistance 129 Who is Presenting What, and Why? 130 Initial Strategies for Working with Resistance 131

viii Contents Imperative Strategies for Working with Resistance 136 Different Strokes for Different Folks: Who is Presenting? 140 Summary 142 References 143 10 Enhancing Psychotherapy through Appropriate Entry Points Nicholas A. Cummings, Janet L. Cummings Entry Point: a Definition 146 The Landscape: Onion and Garlic Psychodynamics 146 Analyzable Onion Conditions 149 Analyzable Garlic Conditions 157 The Borderline Personality: A Category all its own 160 Onion and Garlic Nonanalyzable (Psychotic) Patients 161 Turning up the Heat With Garlic Patients 163 Summary 164 References 164 11 Dealing with Feelings of Depression Alvin R. Mahrer Definitions 167 Theory and Conceptualization 170 Case Formulation 171 Clinical Strategies 172 Key Mistakes and Miscomprehensions 181 Case Study 183 Summary 187 References 187 12 Designing and Assigning Effective Homework Richard Kamins Definition and History of Homework in Psychotherapy 189 Theory and Conceptualization: The Purpose of Homework 190 Clinical Strategies 192 Key Mistakes and Miscomprehensions 202

Contents ix Case Studies 203 Summary 205 References 206 13 Skills Training: How the Master Clinician Understands and Teaches Competencies William O Donohue Background: Why are Skills Necessary? 212 Potential Advantages of a Skills Training Approach 214 The Major Clinical Questions in Skills Training 218 Technology, Dissemination, and Skills Training 219 Summary and Conclusions 220 References 221 14 Using Tasks in Ericksonian Psychotherapy Jeffrey K. Zeig Setting Goals in Therapy 223 Setting Goals in Ericksonian Therapy 224 Gift Wrapping 225 A Taxonomy of Tasks 226 Additional Considerations 235 Summary 236 References 238 15 Using Acceptance in Integrative Behavioral Couple Therapy Christopher R. Martell, David Atkins Definitions 240 Detection and other Assessment Issues 241 Theory and Conceptualization 242 Impact on Case Formulation 242 Clinical Strategies 243 Key Mistakes and Miscomprehensions 254 Case Example 255 Summary 258 References 258

x Contents 16 Short-Term Dynamic Psychotherapy Goes to Hollywood: The Treatment of Performance Anxiety in Cinema Leigh McCullough, Kristin A. R. Osborn Short-term Dynamic Psychotherapy 262 Case Illustrations 267 Clinical Issues and Summary 273 References 275 17 The Importance of Novelty in Psychotherapy Brett N. Steenbarger Defining the Issue 278 Theory, Conceptualization, and Assessment 279 Impact on Case Formulation 280 Clinical Strategies 282 Key Mistakes and Misconceptions 286 Case Study 286 Summary 288 References 288 18 Interruption Replaces Termination in Focused, Intermittent Psychotherapy throughout the Life Cycle Nicholas A. Cummings Step 1: Diminishing The Transference Through a Therapeutic Partnership 294 Step 2: Raising the Intensity of the Treatment Experience 295 Step 3: Clinical Strategies for Implementing the Interruption 298 Half a Century of Experience 300 Case Illustrations 302 Summary 307 References 307

Contents xi 19 Suicidal Patients: The Ultimate Challenge for Master Psychotherapists Janet L. Cummings Outmoded Attitudes (or Misbeliefs) 310 The Suicidal Process 313 Interventions for Lethal Stage 3 Patients 316 Managing Lethal Paranoid Patients 318 Interventions for Nonlethal Patients 320 Case Illustration: Destiny 325 Summary 327 References 328 Author Index 329 Index 337

List of Contributors William T. O Donohue (iii, 1, 209), University of Nevada Reno, Department of Psychology, Reno, NV 89557-0062 Nicholas A. Cummings (iii, 1, 129, 145, 291), University of Nevada Reno, Reno, NV 89503 Janet L. Cummings (iii, 1, 145, 309), The Nicholas & Dorothy Cummings Foundation, Scottsdale, AZ 85281 Paula L. Wilbourne (11), Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025 Eric, R. Levensky (11), University of Nevada, Reno, Department of Psychology, Reno, NV 89557-0062 Jeremy D. Safran (37), New School University, Department of Psychology, New York, NY 10003 J. Christopher Muran (37), Beth Israel Medical Center, Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences New York, NY 10003 Michael Rothman (37), Beth Israel Medical Center, Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences New York, NY 10003 Lois J. Parker (55), University of Nevada Reno, Counseling and Career Services, Reno, NV 89557 Melanie P. Duckworth (71), University of Nevada Reno, Department of Psychology, Reno, NV 89557-0062 Michael G. Wetter (87), The Permanente Medical Group, Medical Office Building, Union City, CA 94587 Clinical Strategies for Becoming a Master Psychotherapist xiii Copyright ß 2005 by Elsevier. All rights reserved.

xiv List of Contributors Jack Wetter (87), Diplomate and Fellow in Clinical Psychology, American Board of Professional Psychology, Los Angeles, California 9002 George Stricker (95), IAPS Derner Institute, Hy Weinberg Center, Garden City, NY 11530 Michael Hoyt (113), Kaiser Permanente Medical Center, San Rafael, CA 94903 Alvin R. Mahrer (167), University of Ottawa, Centre for Psychological Services, Ottawa, ON, K1N 6N5 Richard Kamins (189), Magellan Health Services, Public Sector Solutions, Greenwood Village, CO 21046 Jeffrey K. Zeig (223), Milton H. Erickson Foundation, Phoenix, AZ 85016 Christopher R. Martell (239), University of Washington David Atkins (239), Fuller Graduate School of Psychology Leigh McCullough (261), Harvard Medical School, Dedham, MA 02026 Kristin A. R. Osborn (261), P.O. Box 474, Dover, MA 02030 Brett N. Steenbarger (277), 23W268 Kimberwick Lane, Naperville, IL 60540