ReviewOnBecomingElkins

Psychotherapy © 2011 American Psychological Association2011, Vol. 48, No. 3, 311–312 0033-3204/11/$12.00 BOOK REVIEWOn Becoming a Better Therapist by Barry L. Duncan. Wash- endeavor. In short, if we wish to become better therapists, we must ington, DC: American Psychological Association, 2010, allow our clients to be our teachers. In line with the book’s 211 pp. ISBN: 1433807572. Hardcover, $49.95 List, $39.95 practical focus, Duncan presents two client feedback measures, APA Member describes how to use them, and encourages therapists to begin using the measures in their clinical work and to plot their own improvement as therapists over time. How to Become a Better Therapist is an important contribu-Reviewed by David N. Elkins, Pepperdine University tion to the field of psychotherapy. The book is well organized DOI: 10.1037/a0023199. and clearly written. By design, the language and style are casual, yet the author cites research to support his ideas and The aim of Barry L. Duncan’s On Becoming a Better Therapist provides references for readers who may want more details.is to provide practical, research-based guidance on how to become Although it is not a “how-to” book in the usual meaning of thata more effective therapist. The foreword was written by Michael J. term, the book does provide therapists with everything theyLambert and the book was designed for those who are on the front need to begin the program of therapist improvement. Duncanlines of providing psychotherapy services. Duncan, who has writ- includes numerous case examples to illustrate major points. Theten over 100 professional articles and 15 books, is director of the scholarly yet practical focus of the book will appeal to those“Heart and Soul of Change Project” and codeveloper of the Out- who work with clients on a day-to-day basis whether they arecome Rating Scale (OSR), Session Rating Scale (SRS), Child seasoned clinicians or beginning students.ORS, and Child SRS. These are rating scales designed to gather The book has seven chapters. Chapter 1, “So You Want to be aclient feedback in each session so that therapists can make adjust- Better Therapist,” lays the foundation for the remainder of thements to their therapeutic work on the basis of the clients’ ex- book by citing research to show which factors determine thera-pressed needs. On Becoming a Better Therapist is based on Dun-can’s view that client feedback provides the most powerful source peutic success and how therapists can improve their therapeuticfor therapist improvement. success by monitoring their therapeutic work by gathering client According to Duncan, one does not become a more effective feedback. Chapter 2, “Just the Facts, Ma’am,” describes the basictherapist by developing better treatment protocols or by becoming program for therapist improvement and shows therapists how tomore proficient at administering existing ones. Instead, Duncan begin using the approach immediately in their clinical work. Chap-builds his program for therapist improvement on the foundation of ter 3, “How Being Bad Can Make You Better,” focuses on thosehis earlier works, including The Heart and Soul of Change, now in clients who are not benefitting from therapy and shows therapistsits second edition, which summarized evidence that therapeutic how to turn these cases around. Chapter 4, “Getting in the Zone,”effectiveness is due primarily to the activation of a set of common encourages therapists to take their professional development seri-factors found in all successful therapies along with a quality ously and to make becoming a better therapist an ongoing focus.client–therapist relationship that serves as a foundation for the Chapter 5, “ The Heart and Soul of Change,” shows therapistsclinical work. In an era when most clinical scientists and practi- how to become more effective by focusing on two of the mosttioners focus on “silver bullet” treatment protocols to increase powerful determinants of change—the client and the therapeutictherapeutic effectiveness, Duncan cites research to show that mo- relationship. Chapter 6, “Wizards, Humbugs, or Witches,” is aboutdalities and techniques have relatively little to do with effective- the therapist’s identity. The chapter encourages therapists to reflectness, whereas client factors, therapist differences, and the alliance on their professional identities and to develop a description ofare major determinants of outcome. As Duncan puts it, “Amid themselves and what they do that truly fits with who they are andexplanations and remedies aplenty, therapists courageously con- what they believe about therapeutic work. Finally, Chapter 7, “Fortinue the search for designer explanations and brand name mira- the Love of the Work,” provides a final word to encourage ther-cles— disconnected from the power for change that resides in the apists to reflect on their continued development as clinicians in thepairing of two unique persons, the application of strategies that context of the controversial issues that characterize our profession.resonate with both, and the impact of a quality partnership” (p. 11). Two criticisms of the book— or perhaps they are simply con- According to Duncan, if we wish to become better therapists, we cerns—seem pertinent. First, although Duncan’s focus on themust place more emphasis on “practice-based evidence” (PBE). client’s experience and feedback is a breath of fresh air in aPBE refers to the systematic gathering and evaluation of client profession that accords too much power to therapists and too littlefeedback as the primary system for guiding and improving treat- to clients, the book swings so far in the other direction that it runsment. Duncan cites research that shows that therapist effectiveness the risk of making the same mistake on the client side of theimproves dramatically when clients complete feedback measures equation. Therapy is a collaborative venture, and both the clientin each session and therapists use that feedback to tailor the and therapist have something important to contribute. Therapiststreatment to the individual client. The central message of the book, have a great deal of knowledge about personal and interpersonaland perhaps its most unique contribution, is that respect for the problems and much experience with therapeutic processes. Thus,client’s experience must be placed at the center of the therapeutic the therapist’s role extends beyond gathering client feedback and 311

312 BOOK REVIEWtailoring treatment to the client’s ideas. Nothing would have been and a helpful guide to becoming a more effective therapist. Fortaken away from the client’s power if this issue had been discussed those would like more information about Duncan and his work,in more depth. Second, related to the first concern, the book does the following sources are recommended: Duncan and Millernot adequately address those situations in which the client’s ideas (2006); Duncan, Miller, and Sparks (2004); and Duncan, Miller,about the treatment might be problematic. For example, what Wampold, and Hubble (2010). The Website for the “Heart andwould a therapist do with a religious client who believes in demons Soul of Change Project” is http://www.heartandsoulofchangeand asks for an exorcism ritual? Or, less dramatically, what would .com.a therapist do if a client, who views the therapist as the father ormother she never had, asks to be held at each session? Thus, Referencesalthough Duncan is right that clients often know a great deal abouttheir difficulties and the kind of treatment that would be most Duncan, B., & Miller, S. (2006). Treatment manuals do not improvehelpful, it is also true that clients sometimes have ideas about their outcomes. In J. Norcross, R. Levant, & L. Beutler (Eds.), Evidence-problems and the treatment that are naıve, mistaken, or seriously ¨ based practices: Debate and dialogue on the fundamental questions (pp. 140 –149). Washington, DC: American Psychological Association.problematic. In these situations, the therapist’s input and guidance Duncan, B., Miller, S., & Sparks, J. (2004). The heroic client: A revolu-are critical. Duncan probably would agree with these concerns, but tionary way to improve effectiveness through client directed outcomethe book would have been stronger if he had addressed these issues informed therapy (rev. ed.). San Francisco, CA: Jossey-Bass.in a direct manner. Duncan, B., Miller, S., Wampold, B., & Hubble, M. (Eds.). (2010). The Overall, On Becoming a Better Therapist, written by one of heart and soul of change: Delivering what works in therapy (2nd ed.).the most perceptive clinicians of our day, is an excellent read Washington, DC: American Psychological Association.

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ReviewOnBecomingElkins

by Barry Duncan on Mar 25, 2012

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