Treatment Planning for Psychotherapists

Full text

Treatment Planning for Psychotherapists
by Richard B. Makover, M.D.; Washington, D. C., American Psychiatric Press,
1996, 239pages, $35
James E. Sabin, M.D.
BOOK REVIEWS
PSYCHIATRIC SERVKES . October 1997 Vol. 48 No. 10 1343
maintenance treatment should be at
a lower dose than for acute treat-
ment. Another section proposes rou-
tine use ofloading doses of tricyclics,
lithium, and vaiproate in the inpa-
tient setting. However, in the final
chapter on geriatric patients, the
medication recommendations seem
particularly sound.
In summary, this book is highly
recommended for clinicians and me-
viewers working in managed care
networks. Its use could indeed maxi-
mize treatment outcomes.
evinces a deep understanding of the
major approaches to therapy and sug-
gests practical ways in which they can
be combined in a thoughtful and
planned manner.
This humane, practical, clinically
informed book takes us a long way to-
wand understanding what ethical
managed care would look like.
Reference
1. Bennett MJ: Is psychotherapy ever nied-
ically necessary? Psychiatric Services 47:
966-970, 1996
This is not a heady era for psy-
chotherapy. In training programs,
psychotherapy is taught less often,
less extensively, and less well than in
the past. Managed care has imposed
stringent criteria for defining “mcd-
icaily necessary” psychotherapy, mak-
ing third-party payment for psy-
chothemapy more difficult to obtain
(1). In this environment, Richard B.
Makover’s carefully conceptualized
book about planning psychothemapcu-
tic treatment is the right book for the
night time.
In the course of extensive experi-
ence as a teacher and consultant,
Makoven has developed an unusually
clear system for planning psychothcn-
apeutic treatment and checking to see
if it is still on track. In the book he
presents his system in a way that will
be useful to a varied audience-
trainees learning the art and science
oftherapy, teachers seeking to expand
their educational repertoire, and cx-
penienced clinicians who want to
sharpen their skills at doing time-ef-
fective treatment and getting it coy-
cred by insurers.
Makovem describes his approach to
treatment planning as “top down,” by
which he means that well-planned
treatment starts with a clear formula-
tion of the outcome the clinician and
the patient want the treatment to
achieve. From this understanding of
Di Sabin is associate clinical professor of
psychiatry at Harvard Medical School and
codirector ofthe Centerfor Ethics in Man-
aged Care at Harvard Pilgrim Health Care
and Harvard Medical School in Boston.
the objectives for the treatment, the
clinician derives a clinical strategy for
achieving the desired results. This
clinical application of the familiar
management-by-objectives approach
might seem so obviously sensible that
it would not require extensive re-
statement. However, as Makoven ob-
serves, there has been a tendency in
psychotherapeutic education to con-
fuse the psychoanalytic technique of
conducting interviews in a nondirec-
tive fashion with an nondirective and
often overly vague overall approach
to structuring the treatment process.
A summary will not do justice to
the richness and subtlety of the book
because Makoven makes his points
through clinical examples. In his ap-
proach, planning starts by formulat-
ing a specific, achievable “aim” that
includes “no more than what the pa-
tient wants from therapy and what the
therapist is able to provide.” Next
comes articulation of “goals,” which
Makover defines as the concrete ob-
jectives that-if achieved-will allow
the aim of treatment to be fulfilled.
Only after formulation of aims and
goals does the clinician choose the
therapeutic techniques (“strategies”)
and practical moves (“tactics”) that
will be applied.
From one perspective, it is unfortu-
nate that Makover chooses to call his
approach “top down” planning. In or-
ganizational literature, “top down”
refers to a Icadem- on managem-cen-
tened approach; however, Makovem’s
method of planning is determinedly
collaborative or-to use a current
buzzword-”customen centered.” He
Essential
Psychotherapics:
Theory and Practice
edited byAlan S. Gurman, Ph.D.,
and Stanley B. Messer, Ph.D.; New
York City, Guilford Press, 1995,
S34pages, $55
Katherine G. Kennedy, M.D.
Alan Gurman and Stanley Messer
have aimed to create a primary
reference that overviews the major
schools of psychotherapy. They have
endeavored to collapse the several
hundred contemporary forms of psy-
chotherapy into a dozen distinct
methods of theory and practice that
they define as “essential.” “Essential
psychothemapies, in our view, are
those that form the conceptual and
clinical bedrock of the field [and are]
indispensable in the training and ed-
ucation of psychotherapists,” the cdi-
tons write.
These 12 approaches are traditional
psychoanalytic psychotherapy, rela-
tional approaches to psychoanalytic
psychotherapy, person-centered psy-
chothemapies, behavioral therapy, cog-
nitive therapy, existential-humanistic
psychotherapy, gestalt therapy, trans-
actional analysis, the family therapies,
transtheonetical psychotherapy, the
brief psychotherapies, and the group
psychotherapies. Soliciting chapters
Dr. Kennedy is assistant clinical professor
in the Yale University department of psy-
chiatry and medical education coordina-
tor at the Connecticut Mental Health Cen-
ter in New Haven.