A Hard Ad to Swallow

Abstract

A Hard Act to Swallow Adaptive Counseling and Therapy: A Systematic Approach to Selecting Effective Treatments. G. S. Howard, D. W. Nance, and P. Myers. San Francisco: Jossey-Bass, 1987. (213 pp.) PLOT..... Adaptive counseling and therapy (ACT) is an adaptation of Paul Hersey and Kenneth Blanchard's (1977) situational leadership theory to the practice of psychotherapy. For them, leadership style should be determined by the taskrelevant maturity of the workers. They hypothesize that a curvilinear relationship exists among the variables of leader task behavior, leader relationship behavior, and subordinates' maturity, which in ACT are renamed therapist's directive behavior, therapist's supportive behavior, and client's readiness for the therapeutic task. The best therapist style, the authors theorize, can be determined by assessing the client's readiness for the therapeutic task under consideration and then applying the appropriate therapist directive behavior and therapist supportive behavior. No data are presented for the validity of the Hersey-Blanchard theory. ACT uses a 2 X 2 categorization of therapist behavior with two levels of Support (high/low) and two levels of Direction (high/low). Low Support/High Directiveness is "telling" therapist style, High Support/High Directiveness is "teaching," High Support/Low Directiveness is "supporting," and Low Support/Low Directiveness is "delegating." The authors then develop the idea that client readiness, the three components of which are willingness (motivation), ability (competence), and selfconfidence, can be ranked in four levels. These four levels correspond to the four therapist styles (above), with the least ready clients needing "telling," and the most ready clients needing "delegating." The authors present a rank ordering of probable success of therapist styles, ways to assess one's therapeutic style and adaptability, and ways to add to one's style repertoire. As a help to readers in learning what their styles are, the authors present their "Therapist Style Inventory/' whose twelve items are therapy vignettes with multiple choices representing the four therapy styles (telling, teaching, supporting, and delegating). CBT'S ROLE IN ACT Naturally, I was intrigued by ACT's claim to be applicable independent of therapists' brands of therapy (if any) in assisting them in selecting the most appropriate treatment plans. The authors say, "Each therapy works best with a certain type of client or client problem" (p. 53). Another way to put it, based on the examples the authors give to illustrate their theory, the least ready (psychotics, institutional types, delinquents, and the chemically dependent) need cognitive and behavioral approaches like those of Ellis and Skinner and AA, and the most ready (executives, for instance) need psychodynamic therapy, maybe even psychoanalysis. This elitist psychodynamic viewpoint-the higher functioning the client, the more psychodynamic the appropriate therapy-was evident throughout the examples the authors gave from their own therapy cases. For example: Therapist: How do you think being the only daughter has affected you? Rachel: I don't think it did. Therapist: Take a few minutes and really think about that. Rachel: (Long pause) Um, I was going to say it didn't again. I think I resent men for keeping me from doing some things. And, I, uh, have a few unusual interests-male kinds of interests. I work on my own car you know, like a mechanic, and I am into hang gliding as a hobby. And, um, even my job, I guess, is sort of male-like, (p. 160) Only with a hallucinating psychotic (p. 175) did the authors resort to cognitive-behavior therapy. Thus, I see ACT's authors as unsystematic eclectics, mainly operating from the basis of psychodynamic theories, and as such, doing so far less effectively than, say, Bernard Beitman (1987), who honestly calls himself ". …