How to Practice Brief Dynamic Psychotherapy: The Core Conflictual Relationship Theme Method

Article excerpt

HOWARD E. BOOK, M.D., D.PSYCH.: How to Practice Brief Dynamic Psychotherapy: The Core Conflictual Relationship Theme Method. American Psychological Association, Washington, DC, 1997, 181 pp., $39.95, ISBN 1-55798-46-54.

Dr. Book is psychoanalytically oriented. Seeing the increasing demands for psychotherapy from clients and for cost containment from third-party payers, he turned to investigating the brief psychodynamic psychotherapies and adopted the wellknown time-limited approach developed by Luborsky, identified as "The Core Conflictual Relationship Theme Method," that seems to bring not only symptom relief but some significant characterological change as well. This work by Book serves as a fine introduction to this mode of doing brief psychotherapy, as Luborsky himself recognizes in the Foreword.

Book helped establish a Brief Psychodynamic Psychotherapy Training Program at the University of Toronto. He is Coordinator of Brief Psychotherapy Training for psychiatry residents and Director of the Post-Graduate Training Program in brief psychodynamic psychotherapy at the Clarke Institute of Psychiatry in Toronto. He has a private practice where he does brief and long-term psychotherapy and supervises therapists.

His dedication and skill as a teacher are evident in his structuring of this book, which he correctly describes as "a user-friendly, readable, clinically focused" presentation of this method. In an Introduction and Part I, he uses clinical vignettes to sketch out the strengths and weaknesses of brief approaches, the inclusion and exclusion criteria for the selection of suitable patients, the particular countertransference issues that emerge, and the use of supportive and expressive techniques derived from all dynamic therapies that are applied in a particular blend tailored to this mode of treatment. Following Luborsky, he demonstrates techniques that help guide patients into portraying their symptoms and distress within the context of specific interactions or "relationship episodes" they have had with others. He demonstrates how therapists can "scan for overarching themes" within these episodes and then "bundle" them together, while using an "experience near" attentiveness rather than a psychodynamic oriented one, to discover that the themes often share a fundamental "Core Conflictual Relationship Theme" that defines precisely the "circumscribed area of maladaptive interpersonal functioning" that is most problematic for each patient and on which then the time-limited therapy can most fruitfully focus.

Part II is a detailed case study of Book's evaluation, 16 treatment visits, and follow-up interview of a woman client who had severe problems by being excessively compliant. He provides essential details of the client's and of his own communications. He comments on why he said what he said and how he concludes that what he said was successful or not. Laying himself out quite openly, he demonstrates his confidence and enthusiasm for this method and in the success of this particular treatment course. And indeed the patient felt she had been helped.

The psychoanalytic ear of some readers may find that things are overall a bit too pat and wrapped up so neatly that the full range of complex processes embedded within the interactions between him and his client are not fully captured. Shortcuts can be treacherous. Yet, this material is instructive just because of this. For the work demands of each reader to probe on his or her own for what is "really" going on between these two.

For example Book proposed the time-limited therapy contract in a dialogue that went as follows (pp. …