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Psychotherapy

Review of "Co-Creating Change"

By Jon Frederickson
Seven Leaves Press, 2013
Review by Kyra Grosman, Psy.D. on Mar 4th 2014
Co-Creating Change

Jon Frederickson, the author of this eminently useful new work for clinicians interested in learning about the theory and practice of intensive short term dynamic psychotherapy, is a co-founder of the ISTDP Institute and co-chair of the ISTDP Training Program at the Washington School of Psychiatry, where he has taught for the past 25 years. His stated goal is to explicitly teach clinicians how to provide therapy, just as he was explicitly taught how to play music when he was training to become and worked as a professional musician. All of those years of teaching pay off for the reader, because this book is a master class in theory and practice. Although there are seemingly countless books written about psychodynamic psychotherapy, most do a poor job of describing how clinicians might actually effectively practice psychodynamically under the constraints most of us currently face: one (or at most two) sessions per week, and in therapies that are time-limited. (Short-term in this instance refers to therapies generally lasting less than a year). This book, in contrast, is both theoretically rich while providing concrete suggestions and ideas about how to incorporate ISTDP principles into one's own practice.   

Following in the tradition of Habib Davanloo, a Harvard University psychiatriest and trained analyst who pioneered ISTDP from the 1960s to the 1990s, Frederickson makes accessible to the new clinician both the theory and practice of ISTDP in a way that previous books written on the topic have not managed to do. His manual emphasizes the importance of taking an active stance in order to allow patients to experience avoided and unconscious emotion. In order to do this, he convincingly argues for the importance of helping pateints to correctly label their feelings and experience those feelings in his or her body. (A third step in Davanloo’s process, experiencing the bodily impulse, receives noticeably less thorough attention in Frederickson’s book). Although these steps are theoretically simple, in practice most patients are highly defended. Frederickson’s tome is an exhaustive treatise explaining, in moment-to-moment vignettes, how to help the patient along in this process. In contrast to other case write-ups in ISTDP, where transcripts of entire sessions are often provided, he provides numerous shorter snippets of dialogue and analyzes the provided dialogue line by line. 

One of the absolute strengths of this book is Frederickson’s ability to explicitly describe how bodily experiences of anxiety are manifested. In so doing, he provides information regarding easily observable bodily responses that can help the therapist help the patient regulate his or her anxiety. Anxiety regulation is of course important because we want the patient’s anxiety to remain at a level that is productive but tolerable. If a patient’s anxiety is too low, no significant work will happen. If it’s too high, the client will become flooded and overwhelmed. This is one example of the way Frederickson provides information that fully accessible and immediately applicable. I would say that this chapter alone is worth the price of the book.

At 532 pages, this book is fairly long, and there appear to be parts that are redundant. Re-reading the book gave me the sense that Frederickson has a clear plan in mind, and is playing variations on a theme in the later chapters. I am willing to believe that what seems like repetition, repetition, repetition is more than the rhetorical device of a teacher intent on repeating information until a (somewhat dull) student retains the information. However, even with two passes, the overall plan remained somewhat opaque.  

Frederickson makes frequent reference in his book to videos he has created, both on YouTube, which are free, and on his website, most of which are not. Although this constant self-promotion was initially off-putting, the videos he’s produced did indeed help to deepen my understanding of the material. After reading his book several times, I purchased some of his training materials on-line and am considering enrolling in a three-year training program through the ISTDP. It has literally been years since I have been as excited by a book that I’ve read about therapy as this one. This book is likely intended for early career therapists, but it is rich enough to be enjoyed by more seasoned practitioners as well. For clinicians interested in exploring the practice of intensive short-term dynamic psychotherapy, this book is a must-read.

 

© 2014 Kyra Grosman

 

Kyra Grosman, Psy.D. has a clinical psychotherapy practice in Manhattan. She may be reached by emailing kyra_grosman@yahoo.com or calling (646)418-6095.

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