eBook How Master Therapists Work: Effecting Change from the First through the Last Session and Beyond epub

What Jim Collin’s epic book Good to Great is to the business and leadership world, Len Sperry and Jon Carlson’s book, How Master Therapists Work (2014) is to the field of psychotherapy and counseling. Both books tell us with vivid accuracy what key qualities separate the best of the best from simply being good at what you do. Len Sperry, MD, PhD, ABPP and Jon Carlson PsyD, EdD, ABPP. and their subject matter are of great interest to me. The subtitle captures the heart of the book’s content and the quintessence of what I want to learn more about, Effecting Change from the First through the Last Session and Beyond. I felt very inadequate as I began practicum concurrent with starting the MAPC program in August, 2013 (still do). Adding the privilege of doing practicum in a real clinic right from the start with real clients resulted in a high motivation to learn quickly in order to be effective and helpful. One of my supervisors at that clinic, in her first formal assessment of me wrote in response to the category/rating: USES THEORIES APPROPRIATELY: RATING 4 (out of 5) “but unknowingly” (Fountain, 2013. p.4). My interest in acquiring tools, techniques, and knowledge of the counseling process was and remains very high. This book is a means toward that end.
Additionally, my primary supervisor at Lake Geneva Wellness Clinic was and is Dr. Jon Carlson, one of the authors. I have relied on his videos, other writings, and Socratic style of teaching during practicum and now internship. I have also relied on Dr. Sperry’s books on case conceptualizations (2012), diagnosis, and treatment formulations (1995). Rather than reading a book on a specific theory, I desired to read one that focuses on the counseling process, itself. This book has helped me become more effective in knowing how to help clients bring about change that lasts. Regardless of the theories I rely on or methods I employ, the principles in this book will apply.
Overall Description
Gerald Corey, (EdD, ABPP ) in one of the many endorsements of this book, aptly describes the work as “an excellent blend of research, theory, and interventions illuminating how change can occur” (Sperry & Carlson, 2014, endorsements). That is a fitting description of the nature of the book. The writers wed their own areas of expertise in research, theory, and application with descriptive commentary about each segment along the way. The case of Aimee, a 30-year-old single mother of two boys, aged 12 and 11 is the example that is presented complete with transcripts (DVD’s available through APA), commentary and analysis of her 6 sessions and an interview 7 years thereafter. Her history involving abuse and neglect are outlined at appropriate moments. In short, Aimee meets the criteria for Depressive Disorder NOS (p. 97), but her issues and maladaptive thinking and patterns involving caring for others rather than for herself, perfectionism, and patterns that increase her loneliness keeping her distant from others, are systematically surfaced, identified, and replaced with healthy patterns. She not only achieves first and second order change, but also the third order of change of becoming equipped to identify maladaptive patterns and alter them on her own.
The book is not a simple case presentation and analysis, but rather a clear teaching of what is involved in effecting change that lasts and how to do so in an efficient and effective manner. The primary purpose of the book is to provide a “cutting edge book about master therapists. It addresses concerns that are increasingly important for the practice of psychotherapy today. Who are the master therapists and how did they develop their expertise? What do they do? And, most important, how do they go about effecting significant change in their clients” (p. xxiii). Along the way contrasts and comparisons are made between what lesser experienced (or less proficient) therapists might do with what master therapists might do and why. The authors provide this overview:
Chapter 1 provides a grand tour of the landscape of psychotherapy as it is practiced today. It describes expertise in general and in regard to psychotherapy. It provides a profile of master therapists and how early life experiences and professional work settings have influenced the development of their own expertise. The text in chapters 2-8 is centered around the extended case example. It will help you understand all the aspects of the therapeutic process and how all the components of successful therapy fit together: the therapeutic alliance; assessment of the client’s change potential; clinician credibility; case conceptualization; interventions that foster first, second, and third order change; monitoring and evaluation; and termination. It sets the stage for better understanding the transcribed therapy segments and the two sets of commentaries. Chapter 9 lays out the necessary developmental tasks and strategies for progressing along the developmental trajectory of the master therapist (pp. xxiv-xxv).
Sperry and Carlson tell you what they are going to do, demonstrate it, comment on it (both from a research stand point and a dynamic one), but then take you to deeper levels in strategic places throughout the book. As expanded upon in the next section the importance and “how to’s” of achieving first order of change (reduction of symptoms, achieve stability), second order of change (replacing of maladaptive patterns), and finally third order of change (the client learns to identify and change maladaptive patterns, etc. on his or her own) are key to the therapeutic process (p.103). The authors come at this from various perspectives until it is made clear both in importance and how to achieve them.

Analysis:
The book was written and is relevant and valuable to all levels of training and competency in the field of psychotherapy. From novice to master the research, practices, premises, and insights are needed especially in light of the current trends of today. The authors clearly succeeded in their intentions and exceeded my own expectations in regard to my level of experience and training. It has provided tools and techniques and the reasons behind them that are already being implemented in my sessions with clients. Making the intake session more than an informational session through being purpose driven (e.g. asking the client what he or she wants to change), the use of paradox, and helping the client leave with hope and something to do is basic but primary. The correlating of first and second order of change with short-term objectives and long-term goals in collaborative treatment planning put tangibility to a process that until now seemed vague and a mere paperwork drill at times. The case conceptualizations and the when, how, and why these are done are invaluable. The authors help us see the mindset that begins this process in the first session and just how that helps formulate accurate diagnoses and treatment strategies. The authors do not seek to present one model or theory, but rather an integrative approach. Carlson is one of the leading Adlerian therapists in the world today yet he demonstrated an integrative brief therapy with Aimee that resulted in lasting change. He appeared to establish the therapeutic alliance and trust early on and knew where to focus to discover pertinent history and effect dynamic change as well as the cognitive and behavioral. One practical tip was to catch the client being good helping him or her to see their own strengths and resources (p. 71). He apparently had Aimee and other clients fill out a simple pre-session questionnaire that asked: (1) What has been different since our last session? (2) What has improved? And (3) What do you want to talk about today? Again this was helping her treatment focus, but led into goal alignment which helps keep the session and client and therapist on track to keep coming back to their goals and objectives. Another example that was very helpful was to not get “rabbit trailed” when a client does not do his or her homework, but to seek to tie that in to either the surfaced maladaptive thinking or patterns as well as established objectives and goals and thereby maintain treatment focus (p. 78). Along with techniques the authors provide clinical understanding and classifications and then interventions. For instance when going into more depth about second order change they present explanation of several clinical conditions such as anxiety disorders, depression, and substance dependence (p. 104). Strategies and interventions to bring about second order change of maladaptive patterns such as: reversal; acceptance and blocking; framing, reframing, deframing, prescribing; prescribing; and predicting are presented and explained (pp. 105-106). Another point I want to highlight involves the in session “Decision Points” in chapter 7. This shows us in the transcriptions and commentaries how the therapist came to points in session that could have taken them off the treatment focus, but were used to maintain the focus. The therapist used an intervention of breathing and relaxation techniques to help her stabilize and then continue in the session. Rather than returning to the clinical aspects of her depressive anxiety the therapist chose to go on with the dynamic aspect and move toward empowering the client to make choices. Four decision points for the therapist were shown and how he was able to maintain treatment focus on their therapeutic goals (pp. 144-145). Lastly, the tips and tools for monitoring, evaluation, and termination in chapter 8 are very helpful and insightful. One principle that is aimed at instilling that third order of change and self-reliance is the “last” session with a client. Post treatment goals are talked through as is what has been accomplished along with any unfinished business (pp. 156 -174).

Final Assessment:
How Master Therapists Work is a contemporary classic. It is contemporary because it takes into consideration and elaborates on the context of psychotherapy today and evidence based practice. The “key elements of current psychotherapy theory, research, and practice, and their evolution: outcomes, treatments, therapeutic alliance, and client and therapist factors” (p. 2) are explained and considered in context. It is a classic because it is an outstanding work that appears to be one of a kind and of great value. One has only to read the vast array of the endorsements to see that. The authors presented the information in a manner that goes beyond facts and information to a level of understanding, application, and integration. The case study with commentaries, combined with further explanation and application in each chapter exemplifies this. They integrate, teach and draw the reader into the process and then come back and explore that from different vantage points, including that of the client. I did not find myself in disagreement. My interest was in the instruction and the processes being taught and demonstrated more so than the pathway to recognition of being a master therapist. My focus was on learning from the best of the best in order to learn how to do and be the best therapist I can be.
Conclusion:
How Master Therapists Work is a book to be studied, not just read. Hanna Levenson PhD, writes, “If you aren’t teaching a course where you can use this book, create one!” (Sperry & Carlson, 2014, endorsements). I would recommend this book and accompanying DVD’s be used in a major way in any counseling training program. It would have been extremely helpful to have had this book to study and apply in practicum and internship. I am very glad I have read it, but now I will study it and apply it.

References
Fountain, Erika (2013). Olivet nazarene university practicum assessment,
fall of 2013, p. 4.
Sperry, Len (1995). Handbook of diagnosis and treatment of the DSM-IV personality disorders.
Brunner/Mazel, Inc. New York, NY.
Sperry, Len & Carlson, Jon (2014). How master therapists work.
Routledge. New York, NY.
Sperry, L. & Sperry, J. (2012). Case conceptualization: mastering this competency with ease and confidence. New York, NY: Routledge.

Mastering the art of therapy is like mastering a musical instrument. It takes time, perseverance and practice. Both my wife, a graduate student in counseling, and myself, a licensed clinical counselor with over 25 years of professional experience, are benefiting from this book, especially its emphasis on case conceptualization, identifying maladaptive patterns, and providing corrective experiences. Len Sperry knows his stuff, having studied, taught, and practiced effective psychotherapy for over 40 years. Jon Carlson, as shown by the transcripts of a 6-session treatment intervention with a client with dependent personality disorder features, is an excellent example of a master therapist at work who keeps the momentum for change moving, until the client finally becomes her own therapist.

Very informative

As much a puff piece about the two authors and their accomplishments than about how master therapists work.