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The Practice of Brief Psychotherapy, Second Edition

Henry I. Spitz , M.D., F.A.P.A.

Key Words: Books Reviewed

Brief psychotherapy has been the subject of study as an innovative form of intervention in psychiatric practice for many years. More recently, additional interest has been spurred by health care reform initiatives and the managed mental health care movement, which have emphasized cost-effectiveness of psychological treatments. The prospect of time-limited, discrete modules of psychotherapy holds great appeal for those on the administrative and financial side of the managed care equation. For clinicians, the push toward brief therapies has been a mixed blessing. For many, it initiated a process of broadening practitioners' clinical skills to encompass the individual, group, and family techniques broadly subsumed under the rubric of brief psychotherapy. Others, however, resented and resisted an intrusion into their preferred patterns of practice that was motivated primarily by cost-containment concerns. Against this clinical and economic backdrop, a new book on brief psychotherapy is a welcome addition to the field.

This is the second edition of a text originally published ten years ago. Unfortunately, the notes on the flyleaf of this new edition promise a richness of coverage and a level of clinical guidance that it is doubtful anyone could deliver in a book of only 294 pages. Despite the overstated advertising, however, this is a serious work with many genuinely valuable attributes.

Dr. Garfield has enjoyed a long and distinguished career as clinician, author, journal editor, and scholar. The reader is immediately struck by his ability to present potentially complicated theoretical and technical issues in a deceptively simple style. He speaks in a down-to-earth and comprehensible manner that belies the degree of sophistication of the subject and the author. Reading the text is almost like attending a seminar given by a seasoned and sensitive clinician who knows how to reach his audience. The accessibility of the material as seen through Garfield's clinical prism is one of the book's outstanding features.

Garfield's point of view is integrative and eclectic and is not wedded to any particular school of psychotherapy. He subscribes to the belief that there are generic therapeutic factors common to many approaches and some that are uniquely the province of the individual practitioner. He is careful to delineate the common psychotherapeutic variables that have been shown to be of demonstrable value and to support them with summaries from the relevant research on the topic. His pragmatism is evident throughout the text; if something has been evaluated and deemed effective, Garfield is able to incorporate it into his schema of "brief" psychotherapy.

In an era of evidence-based medicine and mental health care accountability, Garfield's fluency with the research literature, not only on outcome but on elements as crucial as the therapeutic alliance, or who does well and who does poorly with brief therapies, or the distinction between effectiveness and efficacy of psychotherapies, are but a sampling of his commitment to documentation through research, which is present throughout the text.

It was surprising and disappointing that a book on brief psychotherapy written in 1998 contains no references to the body of work in the fields of group, family, and couples therapies. All of these disciplines regularly employ short-term interventions based on systems-derived, cognitive, behavioral, and brief psychodynamic models, but no mention is made of this important work. The inclusion of this material would complement the existing material, give the book more breadth, and make it more true to the spirit of its title, the "practice" of brief therapy.

The second edition as it stands is a good overview of the past, the present, and Garfield's view of the future of the field, which he hopes will move toward a position of informed eclecticism. Readers who are familiar with brief psychotherapy will find this text most useful as a quick review of the literature and techniques employed in brief individual psychotherapies. The book contains a generous number of vignettes used to augment theoretical or practical principles through case examples. The clinical material used in the vignettes shows not only the author's technical expertise, but also his ability to capture that which is most urgent for both the therapist and the patient at any given point in the course of brief psychotherapy.

Perhaps the best audience for this book is the reader who is new to the field of short-term psychotherapy. It is an excellent general orientation to a complex and expanding field. Dr. Garfield's unique facility for translating principles into practice in a soundly based and lucid style serves as an excellent model for those considering the expansion of their work to incorporate brief psychotherapy.

Footnotes

Dr. Spitz is Clinical Professor of Psychiatry in the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.

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