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BookREVIEW: Two Are Better Than One

Case Studies in Brief Successful Therapy

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Seymour Hoffman, Mondial 2011, pp132

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Reviewer: Hava Ben Shalom

“Two are better than one for they get a greater return for their labor” (Eccleciastes, 4:9).This quote from the foreword of this slim volume precedes the eleven chapters that describe in an absorbing manner the effective treatment by the author and his co-therapists of individuals, families and groups with a variety of symptoms, diagnoses and presenting problems, including anorexia, selective mutism, borderline personality and phobias.

The book is divided into two parts: Part One presents case studies of the treatment of individuals, families and groups by two therapists using a dialectical co-therapy approach while Part Two describes the brief successful interventions of consultants in cases of treatment impasses. The Dialectical Co-therapy approach involves two therapists who, from the beginning of therapy, take opposing views and roles in regard to the patient(s) until significant change is realised. The rationale and description of the treatment approach is clearly explained and detailed and one is readily impressed with its simplicity, parsimony and ability to achieve positive results in a relatively brief period of time; this buttresses the author’s claim that, in spite of the involvement of two therapists, the approach is economical. One can add that since co-therapy is frequently done by a senior and a junior therapist (eg psychology interns, young social workers, psychiatric residents etc)  a unique and rich learning experience is also being provided.

In the Dialectical Co-therapy model presented by the author, the specific polarities that each patient experiences, that are at the root of their symptomatic behaviour, are identified and mirrored by the co-therapists’ complementary roles/interventions. As one dialectic is resolved, the method continues to focus on others that may emerge until change, growth and symptomatic relief are achieved.

The orientation is eclectic and the interventions are highly creative, flexible, daring and frequently unconventional. It is possible that therapists of specific persuasions will be critical of the manipulative aspects of the interventions. However, it is difficult to argue with success. What is unfortunately lacking are examples of treatment failures with this approach and specific guidelines to determine when this treatment approach is indicated.

The case histories are brought together here in a manner that summarizes the philosophy and theory of this approach with great clarity. Because the case histories are written up in sufficient detail with accompanying succinct explanations, the scope of this work and its application comes through in a highly readable and very edifying manner.

This slim volume is a pleasurable and easy read. Any practicing therapist will find themselves challenged to think of their own cases in new ways as they read the rich case material and the accompanying clinical rationale presented.

Hava Ben Shalom has an MA in Clinical Psychology and works at the Mental Health Clinic in Bnei Brak, Israel.