Start with 418 Therapies (APA Commission, 1984)

Abstract

Start with 418 Therapies (APA Commission, 1984) The Structure of Individual Psychotherapy. B. D. Beitman. New York: Guilford Press, 1987. (330 pp.) For those of us who have learned to gag at the term "eclectic," viewing it as meaning typically, "I have no theories/don't know or care what my theories are/am hiding my theories since I don't yet know what your theories are" (among job applicants), Bernard D. Beitman's scholarly text, "The Structure of Individual Psychotherapy," is a partial course of desensitization which makes the term more palatable, at least as he uses it. Associate professor of psychiatry at University of Missouri and trained in analytically oriented therapy, Beitman has become a leading light in the eclectic integrative therapy movement, and it is easy to see why. His book is enormously wide-ranging, often witty, engagingly (though wordily) written as the interior monologue of a seeker after truth in a manner pleasantly reminiscent of Freud, and chock-full of engrossing clinical material. Many of the case examples are fascinating, even riveting, representing the kinds of patients and reactions this reviewer does not get, but they all have the ring of authenticity. (OK, so we do not have to look far in figuring out why no one of the 4,000 or so clients I have seen has approached me sexually, but why can't I have had even one elective mute?!) Beitman instructively discusses these psychodynamic-type patients (for want of a better term), some of whom move into the therapist's neighborhood, perhaps making a bomb threat against the therapist's family here and there, who go psychotic when the therapist leaves town, and who may commit suicide with antidepressants. The nondefensive discussion of treatment failures and stalemates is an important feature of this book, since such material is lacking in most texts. One exception that comes to mind is the recently published, near paean to analytically oriented treatment failure, "Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy" (Wallerstein, 1986). Sift Contents Beitman begins with the obvious idea that we have plenty of types of therapy already and rapidly proceeds to sift from numerous therapies what he sees as commonly useful. According to his analysis, the structure of individual psychotherapy is made up of stages labeled engagement, pattern search, responsibility awareness, initiation of change, termination, and maintenance of change. Beitman sees good in practically every theory. When late in the book he calls himself". . . an existential-cognitive-behavioral-psychodynamic-systems therapist . . ." (p. 306), no reader will have cause for question. Beitman, whose theory is mammoth, does expectably attack antitheoretical Skinner a time or two, and in the process has gotten radical and methodological behaviorism backwards, but the blows are puny, and the terms "contingency management" and "reinforcement" repeatedly appear in his work. Readings in cognitivebehavior modification might enlarge Beitman's understanding of the shaping of rule-governed behavior (Jaremko, 1986). Beitman believes therapists are in business to influence patients, not just to facilitate, and he is often actively-directively at odds with silent and passive therapy/therapists. He sometimes reframes psychoanalytic interpretations in startling ways. For instance, "The presentation of evidence [by the psychoanalyst] for ongoing incestuous feelings serves to shame the patient into change" (p. 211, bracketed material added). In an example of being kind to be cruel, the usually benign Beitman decides to let passive therapists keep their delusions: The carefully placed reinforcers of accurate empathic statements, of certain nods or voice changes can produce responses without clear patient objection and rejection. If the therapist is unaware of the direct intent of these techniques, he or she does not have to feel guilty for "manipulating" the patient. …