Intensive Short-Term Dynamic Psychotherapy: Theory and Technique • Handbook of Solution-Focused Brief Therapy

Contrasting approaches to the goal of effective short-term psychotherapy are presented in two new books by authors who follow in the footsteps of the originators of the approaches.Intensive Short-Term Dynamic Psychotherapyis a detailed account of the psychoanalytically oriented approach pioneered by Habib Davenloo. In contrast, theHandbook of Solution-Focused Brief Therapyis a compendium of articles by various authors about a technique that was originally developed by Steve de Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin.

Freudian therapists, if they can envision a more active role, might learn new techniques from the first book; therapists influenced by the client-centered work of Carl Rogers would prefer the other book. Eclectic therapists like myself, struggling to make sense of short-term therapy, will find ideas in both books to apply in daily clinical practice.

The Della Selva book makes Davenloo's approach understandable and attractive. The goals and understanding of traditional, long-term psychoanalysis are not abandoned. Instead, the whole process is speeded up, with active therapist confrontation and transference interpretations beginning in the first session. Abundant clinical examples and vignettes illustrate that the process is orderly and not psychoanalysis gone wild.

Yet the approach is not for the casual or inexperienced therapist. The cases illustrate patients' getting very angry with therapists who, according to the technique, challenge customary defenses immediately on meeting the patient. The three-session "therapy trial" to distinguish who is amenable to this approach is clearly essential.

Also, Della Selva's casual comment about coincidentally taking a course in physical defense while learning the Davenloo approach in graduate school may be more relevant than she lets on. The mainstay of treatment is working through two "triangles": the triangle of conflict and the triangle of the person. The first triangle refers to the workings of anxiety, intrapsychic defenses, and impulses-feelings, and the second triangle clarifies the role of past genetic figures, current figures, and transferences.

TheHandbook of Solution-Focused Brief Therapymeans what it says in the title, and the methods described are in direct contrast to the above technique. The focus is not on the problems that clients bring to the encounter but on the solutions, even positive changes that may have occurred before the first session. The experts are the clients rather than the therapists.

Therapists employ specific techniques to unlock the strength and personal knowledge that clients, no matter how stuck they are at the moment, have within themselves. The "miracle question" asks how clients would know and act if, by some miracle, the problems that brought them to therapy were solved. Other questions ask clients to find examples of progress and grade that progress. "Identify what works for you and do more of it" is the focus. If the techniques are simple, not so clear are the claimed benefits and the supposed wide applicability. Different chapters explain how populations as diverse as psychiatric inpatients, schoolchildren, and spouse abusers can be helped by a solution-focused, short-term approach.

I do have one major complaint about the solution-focused book. The first chapter, entitled "Rethinking Our Assumptions," is confusing, at least for any reader who is not already familiar with the solution-focused approach. Everything is relabeled; therapists become "personal consultants," and nouns become verb forms, such as "goaling" and "storying." This attempt to develop a new language struck me as pretentious. Instead, authors might do better to more carefully define the words we already use. For example, both the Della Selva book and the solution-focused book claim to describe short-term therapy, but "short-term" means 40 sessions to Della Selva and three to four sessions to the solution-focused authors.

Further progress in the field of short-term therapy may come from contrasting one approach with another. These books are a good place to begin. For example, if an active, confronting therapist is the ideal inIntensive Short-Term Dynamic Psychotherapy, then the ideal therapist is just the opposite in Solution-Focused Brief Therapy,where the emphasis is on empowering the client. Both approaches may have utility with different patients or in different phases of therapy.

As I read the books, I found myself subtly changing my approach to certain difficult patients, sometimes working with the Della Selva triangles, and other times asking the solution-focused "miracle question" or asking patients to find exceptions to their failures and to grade their own progress. Clearly, both books had an impact on my everyday practice, and short-term therapy seems a bit less daunting.

Dr. Pomerantz is in private practice in Longmeadow, Massachusetts, and is a lecturer on psychiatry at Harvard Medical School.