Key Competencies in Brief Dynamic Psychotherapy: Clinical Practice Beyond the Manual

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Overview

This unique book identifies the core competencies shared by expert therapists and helps clinicians-specifically those providing brief dynamic/interpersonal therapy-to develop and apply these competencies in their own work. Neither an abstract theoretical guide nor a cookbook of particular techniques, the book illuminates the ways one learns to engage in effective therapeutic inquiry, intervene flexibly and creatively, and improvise-on a basis of sound theoretical and clinical knowledge-to facilitate progress toward therapeutic goals. Important psychotherapy research findings are interwoven with rich descriptions of the skilled therapist's mental processes and moment-to-moment experiences. The volume's highly accessible style, wealth of illustrative examples, and fresh insights on how learning can be enhanced for both therapist and client make it an ideal professional resource and text.
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Editorial Reviews

PsycCRITIQUES

"A refreshing overview and critique of the broader domain of brief psychodynamic psychotherapy and research....The book is extremely well written, and Binder has the unique ability to provide a bird's-eye view of the central issues facing the field, while demonstrating an accomplished understanding of the critical contemporary research. Binder is one of the few scholars in the field who have the ability to review psychotherapy research in sufficient detail and to do so in a way that is both meaningful and applicable to the practicing clinician."--PsycCRITIQUES
Bulletin of the Menninger Clinic

"Offers practical suggestions for going beyond manualized approaches to treating specific disorders to skillful means of engaging patients in a therapeutic process that fosters insight into cyclical maladaptive interpersonal patterns and promotes behavioral change. This volume represents a generous sharing of the wisdom gained by a master therapist and seasoned researcher of psychotherapy."--Bulletin of the Menninger Clinic
Psychologist-Psychoanalyst

"This is an excellent book for therapists in training, written by a gifted teacher, clinician, and psychotherapy researcher. His focus on helping inexperienced clinicians quickly learn the mental processes and intervention strategies of experienced therapists captures exactly what beginners need to know. While there is an emphasis on brief treatment, his scope is unlimited; he presents ideas that will help therapists read into depths of unconscious mental processes, and to constantly revise and improve formulations made during the opening hours of treatment....far better than a treatment manual...not as foreboding for trainees as a detailed and complex clinical textbook would be. I highly recommend Dr. Binder''s book for training institutions."--Psychologist-Psychoanalyst

Transactional Analysis Journal

"I recently received a book to review that I want all my therapist friends and colleagues to know about. It is so full of practical gems and so deep in scholarship that I went agog over something on nearly every page."--Transactional Analysis Journal
Canadian Journal of Psychiatry

"Well written and thought-provoking. It should appeal to all psychotherapists, regardless of their orientation and experience level. It is a good buy at the price."--Canadian Journal of Psychiatry
Journal of Clinical Psychiatry

"Should be particularly useful to those, like me, who know little about brief dynamic therapy and for whom Binder dispels many misconceptions about how valuable, incisive, and sensible it can be. For those more conversant with this approach, their techniques can be refined and enhanced by this book. For students and, perhaps, for their teachers most of all, this thoughtful and provocative treatise should enrich their perspectives and help reset their priorities."--Journal of Clinical Psychiatry
Psychodynamic Practice

"The book is well written and timely. It is laced with cogent clinical examples, raises a number of interesting questions and...it is not afraid to question a number of our widely held accepted assumptions and beliefs....The book is an interesting account of the development of the relational interpersonal model within a managed care and manualized treatment environment. It succeeds in rescuing clinical expertise from the ubiquitous manual and readers will find a lot to reflect on, and perhaps to take issue with, not least is the discussion of how a managed care context might affect both clinical process and clinical judgment."--Psychodynamic Practice
Journal of Nervous and Mental Disease

"Richly illustrated with clinical case vignettes....Valuable for therapists doing brief psychotherapy seeking a practical, descriptive, and authoritative frame....Includes the rarely treated subject of training of psychotherapy supervisors."--Journal of Nervous and Mental Disease
From the Publisher

"Don't let the title fool you--this is a book of great relevance to all psychotherapies regardless of length, theoretical orientation, or practitioner experience. While most books focus on specific theoretical approaches, specific disorders, or both, this is one of the few that highlights core therapeutic skills. Student readership should be extremely high for this book. I could very well see using it in my graduate-level course on brief therapy for both psychology interns and psychiatric residents, and I will recommend it to my colleagues who teach more general psychotherapy courses. The material is written without the use of jargon, demystifying the therapeutic dialogue in an accessible style that will be easily understood by students with minimal clinical experience."--Hanna Levenson, PhD, Levenson Institute for Training, San Francisco

"A superb, innovative contribution to the literature on time-limited dynamic psychotherapy, and one that is destined to become a classic. At the core of this volume is the assertion that therapeutic expertise consists of the ability to improvise and respond spontaneously and flexibly to the demands of the specific context, and Binder does a brilliant job of spelling out what he terms 'core competencies,' or the generic performance skills possessed by expert therapists. In the process, he also does the field an important service by updating the time-limited approach he developed with Hans Strupp, drawing on both developments in contemporary psychoanalytic theory and important findings emerging from psychotherapy research. The writing is lucid and masterful and the thinking is seasoned and clinically mature. This book will be of interest to a broad readership, and will make a valuable text for graduate-level courses in brief dynamic therapy or basic clinical skills."--Jeremy D. Safran, PhD, Department of Psychology, New School University

"This volume offers an in-depth examination of the components of effective brief dynamic treatment. It is thoughtfully researched and well written. Its scope makes it ideal for either clinicians or researchers, whether they are just coming into the field or have many years of experience. The book will also be useful as a text in graduate programs teaching brief therapy or examining psychoanalytic treatments. A valuable contribution."--Simon H. Budman, PhD, Department of Psychiatry, Harvard Medical School

"Binder’s book makes a substantial contribution to our understanding of expert psychotherapy practice. It is a rare privilege to so closely observe how a master clinician and supervisor works with his clients. Included are detailed and extraordinarily vibrant examples of brief dynamic therapy that both captivate and stimulate the reader. There are many unusual and excellent aspects to this book: it clarifies important psychodynamic concepts, includes supportive findings from cognitive science and therapy research, and provides supervisors and teachers with detailed illustrations on how to teach, learn, and apply higher-order therapeutic competencies across different therapeutic systems."--Jacques P. Barber, PhD, Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania School of Medicine

Journal of Critical Psychology

"Combin[es] a refreshing recognition of the complexities of therapeutic work in critical practice, with a clear underpinning from psychological theory and recent research into psychotherapy....The competencies that Binder outlines will be of relevance and interest to those working with a wide variety of theoretical frameworks and his flexible and undogmatic approach will appeal to all those who feel discouraged by the certainties of some of those who argue for therapy to always be 'evidence-based' (but who often ignore so much of the complexities and contradictions of that evidence."--Journal of Critical Psychology, Counselling, and Psychotherapy
Psychologist-Psychoanalyst APA Division 39 Newsletter

"This is an excellent book for therapists in training, written by a gifted teacher, clinician, and psychotherapy researcher. His focus on helping inexperienced clinicians quickly learn the mental processes and intervention strategies of experienced therapists captures exactly what beginners need to know. While there is an emphasis on brief treatment, his scope is unlimited; he presents ideas that will help therapists read into depths of unconscious mental processes, and to constantly revise and improve formulations made during the opening hours of treatment....far better than a treatment manual...not as foreboding for trainees as a detailed and complex clinical textbook would be. I highly recommend Dr. Binder's book for training institutions."--Psychologist-Psychoanalyst APA Division 39 Newsletter
From The Critics
Reviewer: Gary B Kaniuk, Psy.D.(Cermak Health Services)
Description: This book describes competencies related to brief dynamic psychotherapy. It goes beyond being simply a cookbook of techniques, discussing how the therapist uses intuition and common sense. The author emphasizes the importance of procedural as well as declarative knowledge.
Purpose: According to the author, the purpose "is to reduce the extent to which these essential characteristics get buried during training and to accelerate their recovery, when needed. It aims to accomplish these goals by reducing the gap between the way competent therapists actually think and act while they are conducting psychotherapy and the way their thoughts and actions are formally depicted." The book definitely meets the author's objectives.
Audience: According to the author, "for students who already have learned basic psychodynamic therapy concepts and principles, this book is meant to serve as a guide on how to apply these concepts and principles practically and in a time-limited format. Practicing therapists may find this book to be a useful aid in fully recovering and using their common sense, technical flexibility, and interpersonal skills in their practice of therapy." Dr. Binder is professor and department head of the clinical psychology program at the Georgia School of Professional Psychology of Argosy University, Atlanta. He has been involved in both inpatient and outpatient clinical settings and has published extensively on brief psychotherapy and psychotherapy training in the last 30 years.
Features: The book describes five clinical competencies that are associated with good dynamic-interpersonal psychotherapy including: competency in understanding personality functioning and therapeutic process; competency in problem formulation and focusing; competency in tracking a focus; competency in applying technical strategies and tactics flexibly and creatively; competency in relationship management. The book's clinical illustrations are extremely helpful. Chapter 9 on training describes how psychotherapy can be taught to trainees. Dr. Binder writes passionately of the importance of transferring theoretical knowledge to applied, procedural knowledge with patients. He feels that training programs should be revamped, linking education much more closely with practice.
Assessment: This is an excellent book. It is very readable and thoroughly describes the five competencies introduced in the first chapter. It is geared toward those interested in dynamic psychotherapy, but therapists of all traditions will benefit from Dr. Binder's years of wisdom and practice. One can sense his earnest desire to train future generations of therapists with his no-nonsense, practical approach.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9781609181680
  • Publisher: Guilford Publications, Inc.
  • Publication date: 11/26/2010
  • Edition description: New Edition
  • Pages: 292
  • Sales rank: 947,817
  • Product dimensions: 6.00 (w) x 8.90 (h) x 0.80 (d)

Meet the Author

Jeffrey L. Binder, PhD, ABPP, is Professor of Psychology in the Clinical Psychology Program of Argosy University/Atlanta (formerly the Georgia School of Professional Psychology). Dr. Binder has served as the director of an outpatient community mental health clinic, helped to develop a private psychiatric hospital, and has had a private practice in psychotherapy. He has been actively involved in practicing and teaching brief psychotherapy since the early 1970s and has presented and published extensively on the topics of brief psychotherapy and psychotherapy training. The book that he coauthored with Hans H. Strupp, Psychotherapy in a New Key: A Guide to Time-Limited Dynamic Psychotherapy, is a classic in the area of brief dynamic treatment. Dr. Binder is a Fellow of the American Psychological Association.

 

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Read an Excerpt

Key Competencies in Brief Dynamic Psychotherapy

Clinical Practice Beyond the Manual
By Jeffrey L. Binder

The Guilford Press

Copyright © 2004 The Guilford Press
All right reserved.

ISBN: 1-59385-058-1


Chapter One

The Key to Good Psychotherapy

There always has been a large gap between the way competent psychodynamic therapists conduct therapy in their real world practices and the way their conduct is formally depicted in the professional literature and at professional meetings. This gap was empirically demonstrated in the two-decade-long Menninger Foundation Psychotherapy Research Project (Wallerstein, 1989) and across theoretical models (Goldfried et al., 1998). What is most neglected in the formal conceptualizations of therapists' activities is their crucial reliance on common sense about living a satisfying and meaningful life, particularly in terms of interpersonal relationships. For competent and expert therapists, this common sense is refined over the years, through a multitude of personal and professional experiences. Another neglected characteristic of the conduct of good therapists is their technical flexibility-that is, their ability to respond constructively to the circumstances they face at the moment. A final essential characteristic of the competent therapist, often neglected in formal discussions, is good interpersonal skills; fortunately, this characteristic isreceiving more appropriate acknowledged, at least by some (Norcross, 2002). The most promising students in graduate therapy training programs arrive with a foundation comprised of these characteristics. All too often, however, our training methods then bury this foundation under a pile of knowledge about personality, psychopathology, and rules about how to conduct therapy that are either too vague to provide useful guidance or too rigid. For extended periods of time students are completely preoccupied by the theories and facts they are expected to learn.

Therapists who turn out to be competent or expert manage to develop a way of doing therapy, to some extent, in spite of their training. They recover their buried common sense and flexibility, which allows them to use their inherent interpersonal skills. At that point these characteristics have been refined by the acquisition of extensive clinical knowledge and accumulating clinical experience. Unfortunately, not all therapists move in this direction. They either lacked the characteristics or, for whatever reasons, have been unable to recover them, at least in the practice of psychotherapy.

The purpose of this book is to reduce the extent to which these essential characteristics get buried during training and to accelerate their recovery, when needed. It aims to accomplish these goals by reducing the gap between the way competent therapists actually think and act while they are conducting psychotherapy and the way their thoughts and actions are formally depicted. For students who already have learned basic psychodynamic therapy concepts and principles, this book is meant to serve as a guide on how to apply these concepts and principles practically and in a time-limited format. Practicing therapists may find this book to be a useful aid in fully recovering and using their common sense, technical flexibility, and interpersonal skills in their practice of therapy.

This depiction of how to conduct psychotherapy is based on over 30 years of psychotherapy practice and training and over 20 years of involvement in treatment and training research. The clinical theory used as a conceptual framework for discussing treatment is an integration of psychodynamic-interpersonal and cognitive aspects (discussed in Chapter 2). The treatment model also represents what has been called "assimilative integration" (Lazarus & Messer, 1991; Messer, 1992), which refers to reliance on a predominant theoretical framework, within which principles and techniques from other treatment models are incorporated.

My strategy for minimizing the gap between how good therapists actually think and act and how I depict their performances is to avoid, or at least minimize, the use of clinical language to describe therapist performances. Although useful for dealing with clinical issues, the languages of clinical theories are ill suited for the job of adequately depicting the mental processes and actions associated with a complex skillful performance, such as that of conducting psychotherapy (Binder, 1993, 1999). As a more effective alternative, I rely on a theoretical framework and language from the cognitive sciences, as noted in the Preface. I employ a conceptual framework for understanding the generic skills that appear to underlie all domain-specific performances (Chi, Glaser, & Farr, 1988; Feltovich, Ford, & Hoffman, 1997; Schon, 1983). My approach is to focus on generic skills that appear to underlie and support the effective implementation of techniques associated with clinical theories and theory-guided models of treatment, particularly those of a dynamic-interpersonal model. Most people have acquired these generic skills, to some degree, because they are required for successfully managing the challenges of living, including managing interpersonal relations. These skills include recognizing recurrent interpersonal patterns, the disciplined use of curiosity, common sense, and selfreflection. The process of learning theory-guided therapy principles and techniques should allow trainees to preserve their relevant generic skills and facilitate the use of these skills to guide the implementation of techniques.

With sufficient practice, the novice therapist can develop into a practitioner who can implement treatment models in a competent manner. Master therapists, in contrast, are capable of transcending the technical parameters dictated by treatment models. They are able to improvise, which means they are able to further therapeutic progress by whatever creative means necessary, given the circumstances-which are often unforeseen. The ability to improvise is one of the essential features that characterizes experts, be they psychotherapists, physicians, professional actors, musicians, professional athletes, or representatives of any other performance domain. Throughout this book, I maintain a focus on what I consider to be therapeutically relevant generic skills as well as the general clinical skills derived from them. Mastery of these generic and general clinical skills is required to become a competent, and eventually an expert, therapist.

ASSUMPTIONS ABOUT EMPIRICALLY SUPPORTED TREATMENTS AND TREATMENT MANUALS

The idea that the foundation of competent and expert psychotherapy practice consists of the flexible deployment of various skills, culminating in technical improvisation, diverges from the view prevalent among health care policymakers. The pressure to reduce health care costs has motivated the various stakeholders in the health care system to develop strategies for delivering care more efficiently and, hopefully, effectively. The prevalent view is that efficiency can be maximized, as well as effectiveness, by precisely determining the disorder or problem and addressing it with a treatment or technical protocol that has been empirically found to resolve the disorder or problem with maximum efficiency and effectiveness. This view is most vigorously promoted by managed care organizations, which can increase their profits by reducing the expenditure of health care funds. Consequently, these organizations are constantly seeking practice guidelines that will increase at least the efficiency of health care treatments. The medical field has responded with various sorts of "evidenced-based" practice guidelines. In the mental health field, the American Psychiatric Association responded with treatment guidelines for several disorders and mental illnesses (e.g., unipolar depression, bipolar disorder, eating disorders, substance abuse (American Psychiatric Association, 1994). Organized psychology, through the American Psychological Association, responded to the psychiatrists' actions with its own Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures, which published-and continues to publish-a growing list of approved psychotherapeutic treatments for specifically designated categories of "disorders" (Chambless & Ollendick, 2001). These "empirically supported" treatments have produced positive outcomes under controlled research conditions across several studies and therefore are considered superior to treatments that have not been put to this kind of test.

Those who put their faith in the effectiveness of empirically supported therapies also tend to put their faith in the use of treatment manuals as the foundation for training therapists in the use of effective treatment methods. Treatment manuals were originally developed by psychotherapy research teams for the purpose of improving the internal validity of research studies by precisely explicating the technical principles, strategies, and tactics of a therapy model (e.g., Barlow & Cerny, 1988; Beck, Rush, Shaw, & Emery, 1979; Klerman, Weissman, Rounsaville, & Chevron, 1984; Luborsky, 1984; Strupp & Binder, 1984). Although these manuals usually originate as part of research protocols, increasingly they are being used as all-purpose texts for students and more experienced practitioners. In fact, their use is being promoted as a requirement for accreditation of clinical psychology training programs (Crits-Christoph, Frank, Chambless, Brody, & Karp, 1995). Treatment manuals have contributed to the formulation of a more precise language for describing and explaining technical strategies and interventions, and they are associated with increased therapist adherence to the techniques prescribed in the models being taught (Binder, 1993).

The use of treatment manuals as an innovative method for enhancing psychotherapy training was greeted with tremendous optimism (Luborsky & De Rubeis, 1984; Strupp, Butler, & Rosser, 1988). Evidence does indicate that manuals are useful training tools for decreasing variance attributed to therapists in controlled studies-which was, after all, their original intent (Crits-Christoph & Mintz, 1991). After two decades of experience in using manuals in controlled studies of therapy process and outcome, however, this training innovation has not resulted in the large increment in therapist competence or effectiveness that was anticipated (Addis, 1997; Henry, Schacht, Strupp, Butler, & Binder, 1993; Lambert & Bergin, 1994; Miller & Binder, 2002). Treatment manuals usually are designed to guide the therapy of specific, circumscribed problems by applying specific techniques. A controlled research context oversimplifies the complexity and ambiguity of clinical problems encountered in actual practice. Therefore, if manuals have not made a significant impact on therapists' performances in controlled research settings, it is highly unlikely they will have a noticeable impact on real-world practitioners. Indeed, a decade after publishing his optimistic view of the potential of treatment manuals to enhance therapy research and training, Strupp (Strupp & Anderson, 1997) expressed concern about the "blind acceptance" of manuals as an effective means of improving therapist performance.

The fundamental presumption in the promotion of empirically supported treatments is that correctly chosen technical interventions are the primary determinant of therapeutic change and positive treatment outcome. Furthermore, treatment manuals are the best method of disseminating information about these correct techniques. Nevertheless, over two decades of manual-guided psychotherapy process and outcome research "have not produced support for more superior treatments or sets of techniques for specific disorders" (Lambert & Ogles, 2004, p. 167). Furthermore, "little evidence exists that efficacious treatments are readily transportable [from controlled research conditions to real-world practice]. Similarly, little evidence supports the notion that specific techniques make a substantial contribution to treatment effects" (Lambert & Ogles, 2004, p. 176).

Although there may be a host of reasons for these findings, I want to focus on two. First, practitioners working in real-world contexts are unlikely to limit themselves to specific treatment protocols designed for isolated disorders, because most patients desire help for a mix of symptomatic, interpersonal, and environmental difficulties that defies the circumscribed diagnoses used to generate outcome criteria in controlled studies. Second, even in controlled treatment trials, where there is an attempt to standardize therapists' performances, there remains significant variability in competence and effectiveness across therapists and across patients for any given therapist (Beutler, 1997; Blatt, Sanislow, Zuroff, & Pilkonis, 1996; Garfield, 1997; Lambert & Okiishi, 1997, 1986). Luborsky and his colleagues (Luborsky, McClellan, Diguer, Woody, & Seligman, 1997) used an innovative research strategy that involved compiling data from sufficient numbers of therapists who have treated sufficient numbers of patients in research studies in order to use each therapist's caseload as the unit of measure. Accordingly, therapists' caseloads could be compared for relative treatment effectiveness. Significant differences in therapeutic effectiveness across therapists again were demonstrated, with some therapists identified as generally ineffective and others as generally effective. Even the most effective therapists, however, demonstrate noteworthy variability in effectiveness across patients, although they tended to be relatively more effective with difficult patients than were the less effective therapists (Najavits & Strupp, 1994). In sum, the argument can be made that what needs to be identified are not empirically supported treatments but empirically supported psychotherapists (Lambert & Ogles, 2004).

Regardless of the evidence, those who have advocated for the use of treatment manuals and empirically supported treatments have achieved a hegemony in public policy. How has this development come to pass? The turmoil around health care financing is one exacerbating factor. A more fundamental and enduring reason, however, is that the advocates embody a positivistic epistemology of clinical practice (both in the mental health and general medical fields) that has attained supreme influence with health care administrators-with the support of many researchers, educators, and practitioners. This philosophy of practice posits that "standards of care" associated with specific technical strategies and interventions should be developed for each disorder. These standards of care should be derived from the findings of treatment outcome research. It is presumed that deviations from these standards would produce inefficient and ineffective treatment (Elstein, 1997).

Continues...


Excerpted from Key Competencies in Brief Dynamic Psychotherapy by Jeffrey L. Binder Copyright © 2004 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

1. The Key to Good Psychotherapy
2. Competency 1: The Use of Theoretical Models of Personality, Psychopathology, and Therapeutic Process to Guide the Conduct of Psychotherapy
3. Competency 2: Problem Formulation and Treatment Planning
4. Competency 3: Tracking the Issue That Is the Focus of Therapy
5. Competency 4: Planning What to Do and Carrying It Out—The Therapeutic Inquiry
6. Competency 4: Planning What to Do and Carrying It Out—Implementing Change
7. Competency 5: Relationship Management
8. Termination, with Karishma K. Patel
9. Training
Epilogue

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