Clinical Strategies

for Becoming a Master

Psychotherapist

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Clinical

Strategies for

Becoming

a Master

Psychotherapist

EDITORS

Dr. William O’Donohue

Dr. Nicholas A. Cummings

Dr. Janet L. Cummings

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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

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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

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Clinical Strategies for Copyright � 2005 by Elsevier.Becoming a Master Psychotherapist All rights reserved.v

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

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vi Contents

6

Effective Understanding and

Dealing with Manipulation

Michael G. Wetter, Jack Wetter

References 93

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

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Contents vii

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

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viii Contents

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

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Contents ix

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

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x Contents

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

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Contents xi

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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 Psych-

ology, Reno, NV 89557-0062

Michael G. Wetter (87), The Permanente Medical Group, Medical Office Build-

ing, Union City, CA 94587

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Clinical Strategies for Copyright � 2005 by Elsevier.Becoming a Master Psychotherapist All rights reserved.xiii

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

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xiv List of Contributors