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Book Reviews   |    
Beyond Technique in Solution-Focused Therapy: Working With Emotions and the Therapeutic Relationship
Reviewed by Michele Reiter, M.S., L.I.C.S.W.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.2.201
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by Eve Lipchik; New York, Guilford Press, 2002, 230 pages, $33

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This book covers the theory and application of solution-focused therapy and enhances them with an emotion-centered brief treatment approach. The author, Eve Lipchik, is describing "good" therapy, which focuses on the client and therapist, listens for strengths and exceptions, and inquires about meaning only as it directly relates to a solution-focused process. It is filled with poignant, intentionally asked, quite interesting questions that even seasoned clinicians can use, including standard solution-focused therapy, such as "miracle" questions—questions that elicit what has and has not worked in the past or gather "history" and keep the therapeutic process moving along—and circular questions, which ask the "opinions" of others: "If we asked your father, what would he say?"

The theory of solution-focused therapy, practical and basic, reminds us that each client has strengths and is unique; nothing is "negative," and "resistance" is a negative concept; small change can lead to larger change, and people cannot be changed but can only change themselves. Ms. Lipchik also "reminds" us to put emotions and the therapeutic relationship back into the work, to take our time, and to ask "feeling" questions. Can it be that, in this age of managed care and brief treatment, we have forgotten these most basic tenets of good treatment?

Lipchik suggests the return to structural family therapy techniques, such as the "team" behind the mirror or taking a break at the end of each session and returning with a formulated summation of the session and some homework for the client. Although I have used both these techniques in the past, I find the suggestion less than practical for the realities of current private practice. Solution-focused therapy may risk becoming too formulaic, especially in early sessions, much like using a standard opening in a chess game, which does not guarantee the desired outcomes. Ms. Lipchik veers from standard solution-focused therapy by pointing out that it is not always possible to formulate defined goals during the first session. Indeed, even solution-focused therapy takes time.

This book might be considered a useful primer. Its ample use of process case examples illustrates the applications of basic relational theory, including establishing trust, asking questions that can lead to goal clarification, and focusing solutions. I found myself enjoying the review of concepts, interactions, and techniques that have become second nature, like going through old photo albums, reviewing familiar scenes in order to reconnect viscerally with them.

Ms. Lipchik is clearly a compassionate and competent therapist and teacher. Her clients, students, and colleagues are fortunate to encounter a therapist with such exquisite instincts. Indeed, she makes the work seem easy. She covers many applications of solution-focused therapy with a broad brush—topics such as handling conflict in sessions and using psychoeducational techniques, touching on change theory as well as Eastern philosophical and spiritual thought. A particularly interesting chapter deals with working with clients who have come to therapy involuntarily. Ms. Lipchik demonstrates that forming a therapeutic alliance is both necessary and possible even in the most difficult of circumstances.

Yet, as a therapist who is accustomed to working with people with co-occurring disorders, I part company with Ms. Lipchik in her willingness to gloss over a substance use problem until the client is "ready" to discuss it. This notion, I believe, unnecessarily prolongs the therapy and renders it less useful than would confrontation of difficult subjects such as substance abuse or uncontrolled anger and working with the client to curb these behaviors up front. Overall, the book tries to cover too many applications. Nevertheless, it is a helpful text, accessible, well written, and worth reading.

Ms. Reiter is a psychotherapist and consultant in private practice with a specialty in treating persons with co-occurring disorders.




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