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

By O'Kelly, John G. | Canadian Journal of Psychiatry, May 2006 | Go to article overview

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


O'Kelly, John G., Canadian Journal of Psychiatry


Key Competencies in Brief Dynamic Psychotherapy: Clinical Practice Beyond the Manual Psychotherapy Jeffrey L Binder. New York (NY): The Guilford Press; 2004. 290 p. US$35.00.

Reviewer rating: Excellent

In the present climate of managed care and 15-minute evaluations, where psychiatric practice is often reduced to a series of pharmacologie interventions, any new book addressing issues in psychotherapy training and practice is welcome. This is particularly true when the author has Dr Binder's well-established track record.

The book's subtitle, Clinical Practice Beyond the Manual, gives a clue as to the content of this intriguing and innovative book. Dr Binder quickly sets its tone by making the point that skilled psychotherapists often practise good therapy despite, rather than because of, their training. He observes that, in the interest of neutrality, the beginning therapist's already developed interpersonal skills are "parked at the door" and may not emerge, to be integrated into the therapeutic approach, until much later-if at all. Revisiting the use of manuals, he cogently reminds us that they were originally designed for research. Even in that setting, the most successful therapists did not slavishly adhere to them. They were able to improvise successfully within the constraints of the approach, where clinically warranted. Binder states that this ability to improvise is the hallmark of an expert therapist. It is no different from the way in which any other master craftsperson operates, be he or she a professional athlete or a jazz musician. Thus psychotherapy training should not churn out manual-trained automatons but should constantly strive to find an optimal blend of formal instruction for therapists that allows them to fully employ their positive personal attributes.

From the outset, Dr Binder states that his approach is broadly psychodynamic and interpersonal, borrowing from cognitive-behavioural approaches. In Chapter 2, he uses cognitive-behavioural approaches to introduce the reader to a set of skills designed to teach the neophyte therapist how to self-monitor and alter interventions "in the heat of the battle," as it were. As with the professional athlete or musician, this can be a tangible strategy to temper performance anxiety. In the context of therapy, this anxiety can be greatly intensified by countertransference. Because he comes from an interpersonal and, it seems, object-relations perspective, Dr Binder does not see a treatment impasse as exclusively arising from patient resistance. Rather, he sees it as a function of transference-countertransference enactments and devotes most of Chapter 5 to examining this important aspect of practice.

In the opening chapters of the book, Dr Binder lays out the psychotherapist's core competencies, and in successive chapters, he masterfully develops and expands on each. In so doing, he quotes extensively from the psychotherapy literature-with suitable Canadian content! His use of clinical examples, including exact dialogue, is particularly apt.

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