Some Stories Are Better than Others: Doing What Works in Brief Therapy and Managed Care

Abstract

MICHAEL F. HOYT: Stories Are Better than Others: Doing What Works in Brief Therapy and Managed Care. Brunner/Mazel, Philadelphia, PA, 2000, 320 pp., $34.95, ISBN: 1-58391-041-7. This book is an omnibus of articles, essays, and interviews that deal with the clinical and ethical challenges facing therapists who provide brief therapy, especially those that must do so within the context of an omnipresent and sometimes intrusive managed care system. Michael F. Hoyt is a senior staff psychologist at the Kaiser Permanente Medical Center (an HMO) in Hayward, California and thus has had direct daily experience with the workings of managed care. In an early chapter, the author describes himself as a narrative constructivist and then proceeds to explicate a transtheoretical paradigm for conducting brief therapy that emphasizes the importance of developing an alliance with the patient, evoking the patient's resourcefulness, and creating, collaboratively, realistic goals. Alliance, according to Hoyt, can be especially fostered by matching methods to client motivation and readiness and by minimizing hierarchical power. Evoking clients' inner resources entails a painstaking search for their strengths and competencies and requires a listening posture that enables them to discover their own solutions. The mutual creation of therapeutic goals evolves from a collaborative unearthing of the clients' intentions, expectations, and preferences, as well as from the therapist's openness to the negotiation of therapeutic objectives. In his second chapter, Hoyt, evidently a golf buff, cleverly and humorously uses the sport of golf as a metaphor for enriching the reader's understanding of brief therapy. Enlisting certain principles learned from golf pros Arnold Palmer, Jack Nicklaus, and Tom Watson, Hoyt makes the plausible point that efficiency, purposefulness, preparedness, and an expectation of progress are the essential armamentarium of first-rate golfers and, to no lesser extent, effective brief therapists. In a chapter entitled Some Stories Are Better Than Others: A Postmodern Pastiche, Hoyt further develops the theoretical edifice of constructivism by drawing upon the writings of philosophers, novelists, poets, and psychological theorists. Within this theoretical framework emphasis is placed upon collaboration, intersubjectivity, and the empowerment of clients based upon the conscious eschewal of hierarchical power on the part of the therapist. This chapter contains a theoretical perspective and clinical recommendation with which I must quibble. The author (and other theorists he quotes) rather categorically extols the virtues of assisting clients to externalize their personal struggles. Hoyt empathetically explains that victims of oppressive social conditions and ravaging personal relationships can gain relief and an assuagement of guilt by recognizing that they are largely not to blame for their woeful lot. Here I am in total agreement. However, when Hoyt and his theoretical compatriots suggest, as they seem to, that externalizing necessarily enables clients to objectify their lives and reclaim autonomy, I think they overstate their point. For example, many therapists, including myself, recognize how often acolytes of astrology externalize their fears by attributing the vicissitudes of their lives to the position of the stars, thereby avoiding introspection, understanding, and responsibility, the essential capabilities that form the very bedrock of genuine autonomy. In short, whether we regard externalization as a defense mechanism or not (Hoyt evidently doesn't), externalizing, like most ways that help to protect and fortify ourselves, may serve us well or ill, depending upon a great many factors, such as the social context in which it takes place. …