BookREVIEW: Thinking Out of the Box

“Thinking Out of the Box”: Unconventional Psychotherapy

Seymour Hoffman
Golden Sky Books

Reviewer Leah Rossman

This book contains case studies of unconventional and innovative psychological treatment approaches and models that the author and his colleagues have developed and applied in their clinical work over the last several decades with children and adults with a variety of disorders in different formats. The majority of the treatment interventions involve co-therapists using a dialectical co-therapy approach that capitalizes on the different and contrasting traits and roles of the co-therapists. In this approach, the therapists actively interact with each other and with their clients. They share their views, feelings and perceptions in front of the clients: they model selective behavior, they role-play, they intentionally take opposing sides on issues and sometimes participate in paradoxical interventions.

One therapist is supportive, nurturing and empathic, while the other is confronting and challenging. The former relates to the affective needs, wishes and fantasies of the client, emphasizes her positive attributes and her desire and capability to change and grow, while the latter relates more to the client’s negative aspects, obstacles and fears and is skeptical about her motivation and capacity for meaningful change; he is more goal and reality oriented and challenges the client to prove him wrong. This approach, according to the author, quickly and effectively promotes the uncovering of underlying conflicts and ambivalence and makes them more readily available for therapeutic work and resolution. (Hoffman, Gafni and Laub, 1994)

Dialectical interventions can be viewed as:

“treatment strategies that embody two antithetical moves in such a way that as the pendulum swings from one to another, change forces are mobilized and resistances neutralized. These interventions consist of two coordinated contrary movements that may be thought of as a thesis and an antithesis. Although sometimes the intervention aims at giving maximum power to one of the polar movements, at other times, it aims at   emerging synthesis.” (Omer, 1991).

The case studies described include the one time intervention of a phantom con­sul­tant and the use of a projective test in overcoming resistance.  Another highlights the involvement of a clergyman in dealing with pathological guilt while yet another describes flooding and desensitization in treating phobias and “dialectical letters”, which is an integration of dialectical co-therapy and narrative therapy amongst other unique treatment interventions. The interventions and rationale of the treatments are presented in a clear and interesting manner.

Also included in the book are articles describing an innovative approach to supervision, teaching treatment selection to clinical psychology interns, touch in psychotherapy and the creative use of a mobile chair in the treatment room.

The last chapter in the book is the lightest and most entertaining. There the author discusses the use of humor in psychotherapy and shares with us two highly embarrassing incidents that happened to him in his clinical work, which I will share with the reader.

  1. As a result of a heavy snowstorm, I arrived late at the psychiatric clinic in Brooklyn and much to my surprise my first appointment was anxiously waiting for me. As I entered the office, I impulsively blurted out, “You have to be crazy to come out of the house on a day like today.”
  1. It was my first year in Israel and at the last meeting of the adolescent therapy group that I was conducting with a co-therapist, I wanted to ask one participant if she felt she changed. Instead of saying in Hebrew, “Ha’im at hishtanet?” (“Did you change?”), I said, “Ha’im at hishtant?” (“Did you urinate?”) One can imagine the reaction of the group members to this faux pas.

I found this book reader-friendly, interesting, informative and a worthwhile read; I recommend it to clinical psychology students, trainees, and both beginning and seasoned psychotherapists who are interested in expanding their armamentarium of psychological tools, techniques and interventions in their clinical work.

Leah Rossman holds a PhD and is a psychiatric social worker in private practice. In the past she has lectured in colleges on psychopathology, published articles on psychotherapy in professional journals and supervised students in psychotherapy.

Hoffman, S., Gafni, S. and Laub, B. (1994) Co-therapy with individuals, families and groups. Northvale, New Jersey: Jason Aronson, Inc.
Omer, H. (1991) “Dialectical interventions and the structure of strategy.” in Psychotherapy, 28(4), pp563-571.


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