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The Heroic Client: Doing Client-directed, Outcome-informed Therapy Hardcover – 22 Apr 2000

5.0 out of 5 stars 2 customer reviews

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Product details

  • Hardcover: 320 pages
  • Publisher: John Wiley & Sons (22 April 2000)
  • Language: English
  • ISBN-10: 0787947253
  • ISBN-13: 978-0787947255
  • Product Dimensions: 16 x 2.6 x 23.9 cm
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
  • Amazon Bestsellers Rank: 528,913 in Books (See Top 100 in Books)
  • See Complete Table of Contents

Product Description

Review

"The Heroic Client calls forth a therapeutic union between therapist compassion and accountability with client wisdom. This book inspires us to re–remember why we became therapists in the first place." (Stephen Madigan, director of training, Toronto Narrative Therapy Project, and managing editor, www.planet–therapy.com)

"Warning: If you′re addicted to long letters of appreciation touting your clinical prowess, this book will be hazardous to your mental health. Duncan and Miller will show you how to harness your clients′ expertise and make therapy a more collaborative, outcome–oriented experience. But fasten your seatbelts, you′re in for a humbling ride!" (Michele Weiner–Davis, author, Divorce Busting)

"Few authors have captured and articulated the challenges facing practicing clinicians as well as Duncan and Miller. This is must reading for graduate students and novice therapists who are entering the field, thought provoking and stimulating reading for seasoned professionals." (Michael J. Lambert, Brigham Young University)

"...an inspiring and timely book..." (The New Therapist, October 2000)



"...an inspiring and timely book..." (The New Therapist, October 2000)

From the Inside Flap

Psychotherapy has for too long relegated the client to a minor role in the drama of therapeutic healing. Moreover, in today′s system of managed care, the client is marginalized further as the field is increasingly medicalized and supervised by those interested only in the bottom line. The result: clients are depersonalized by diagnostic labels that have predetermined limits to care, leaving them with few options for meaningful individual treatment. And this system often forces therapists of all disciplines to forgo new or alternative treatments, leaving them enslaved to follow practices in which they no longer believe. It′s time for a radical change.In The Heroic Client, Barry Duncan and Scott Miller–cofounders of the Institute for the Study of Therapeutic Change–outline the steps to revitalize psychotherapy by harnessing the client′s own powers of regeneration and enlisting the client′s own perceptions, and thereby making treatment more effective and accountable. This innovative approach advocates for the client′s voice in all aspects of therapy and shows how to tailor both relational stances and treatment approaches to each client′s personal goals. The authors present a simple, valid, and reliable way of legitimizing therapy to third–party payers using client feedback about the process and outcome of therapy.Based on extensive clinical research and field–tested experience, The Heroic Client will challenge therapists to rethink the process of therapy, recast clients in their rightful roles as heroes and heroines in their own therapy, and help therapists establish an approach beyond the limits of the medical model. Timely, highly readable, and thought–provoking, The Heroic Client will change the way therapists do therapy.[head]The book that will lead psychotherapy out of the Stone Age and into the age of The Heroic ClientIn this controversial book, psychologists Barry Duncan and Scott Miller, cofounders of the Institute for the St

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Top Customer Reviews

Format: Hardcover
Barry Duncan and Scott Miller are with Marc Hubble directors of The Institute for the Study of Therapeutic Change (...). These people play an important role in improving and renewing therapy. In this book, the authors explain how therapy has for too long been been neglecting, ignoring, and depersonalizing clients, by its over-emphasis on methods and techniques, by following the medical model, by its emphasis on pathology, by hegemony of biological approaches, and so on.
The authors first debunk the myths of:
1) PSYCHIATRIC DIAGNOSIS:
a) it lacks reliability,
b) it lacks validity,
c) it puts the blame on the client, and
d) it is often motivated by self-interest, fueled by greed, and blows with the winds of fashion,
2) DRUG TREATMENT OF MENTAL PROBLEMS:
a) they work no better than therapy in the short term
b) changes brought about by medication are less likely to persist over time
c) there often are severe adverse effects,
d) drug studies often look better than they are because they rate improvement by looking to clinicians' perceptions, not clients'
e) the relationship between drug companies and psychiatry is an unholy alliance, making most of the drug-effectiveness research very suspect
3) THE MAGIC APPROACH:
a) there is no special magic silver bullet approach which is much better than another approach
b) the role of the competence and experience of the therapist is rather unimportant
According to the authors, four decades of outcome research have shown that there are four main factors of change, being:
1. Client factors (percentage contribution to positive outcome: 40%).
2. Relationship factors (percentage contribution: 30%).
3. Hope and expectancy (percentage contribution: 15%).
4.
Read more ›
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Format: Hardcover Verified Purchase
I havent had time to read thjis yet but i have scanned it and think it will be very useful in my work.
Came in good time and in good order
Thanks
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Most Helpful Customer Reviews on Amazon.com (beta)

Amazon.com: HASH(0x91f3e624) out of 5 stars 23 reviews
93 of 95 people found the following review helpful
HASH(0x920801bc) out of 5 stars To a different approach to helping people 21 Nov. 2001
By Coert Visser - Published on Amazon.com
Format: Hardcover Verified Purchase
Barry Duncan and Scott Miller are with Marc Hubble directors of The Institute for the Study of Therapeutic Change (...). These people play an important role in improving and renewing therapy. In this book, the authors explain how therapy has for too long been been neglecting, ignoring, and depersonalizing clients, by its over-emphasis on methods and techniques, by following the medical model, by its emphasis on pathology, by hegemony of biological approaches, and so on.

The authors first debunk the myths of:

1) PSYCHIATRIC DIAGNOSIS:
a) it lacks reliability,
b) it lacks validity,
c) it puts the blame on the client, and
d) it is often motivated by self-interest, fueled by greed, and blows with the winds of fashion,

2)DRUG TREATMENT OF MENTAL PROBLEMS:
a) they work no better than therapy in the short term
b) changes brought about by medication are less likely to persist over time
c) there often are severe adverse effects,
d) drug studies often look better than they are because they rate improvement by looking to clinicians' perceptions, not clients'
e) the relationship between drug companies and psychiatry is an unholy alliance, making most of the drug-effectiveness research very suspect

3) THE MAGIC APPROACH:
a) there is no special magic silver bullet approach which is much better than another approach
b) the role of the competence and experience of the therapist is rather unimportant

According to the authors, four decades of outcome research have shown that there are four main factors of change, being:

1. Client factors (percentage contribution to positive outcome: 40%).
2. Relationship factors (percentage contribution: 30%).
3. Hope and expectancy (percentage contribution: 15%).
4. Model and technique (percentage contribution: 15%).

Some conclusions:
1. Thoughts, ideas, actions, initiatives, traits of clients are the most important predictor of therapy success!
2. Next to what the client brings to therapy, the client's perception of the therapeutic relationship is responsible for most of the gains resulting from the therapy.
3. Models and techniques are much less important than generally thought.

The authors advocate a new and refreshing approach characterised by:
1) Client-directedness. Clients' beliefs, values, theories and goals are repected, close attention is being paid to clients' initiatives, interventions and perceptions. Much attention is given to establishing the quality of the relationship, and to monitoring the clients' perception of the quality of the relationship.
2) Outcome informedness. Progress is measured from session to session using paper and pencil questionnaires. By the way: the client's experience of meaningful change in the first few visits is emerging as one of the best predictors of eventual treatment outcome.

Two thoughts come up after having read this book. First, this book is refreshing indeed and a shock to the therapy system. Second, the ideas ventilated in this book might be relevant for work outside the therapy field as well. Consider for instance what management consultancy and managing coaching could learn from this......
31 of 32 people found the following review helpful
HASH(0x912f403c) out of 5 stars an 11th hour reprieve for both client and therapist 2 May 2000
By john mann lcsw - Published on Amazon.com
Format: Hardcover
For many years,both clients and therapists alike have been encouraged, rewarded,and more recently pressured into trying to squeaze themselves into what all too often becomes an ill-fitting medical model box.This box sometimes fits the needs of particular client and therapist,but most of the time one or both of the participants in this drama become disenchanted/disheartened and they remove themself from the interaction either physically ( drop out of therapy - leave the profession ) or emotionally ( burn-out/become bad therapists ).The work of Scott Miller,Barry Duncan,and others have, over the past few years, served to help breath some much needed life into the helping professions...particularly that of psychotherapy.Their most recent book,The Heroic Client, is, with the benifit of hindsight, a logical extension of their previous works/philosophy.This is a book for therapists who work in the proverbial trenches on a day to day basis.It speaks to the everyday concerns of therapists...how to be of help to others, and still like yourself in the morning...and actually want to get up in the morning to do it all over again.This book encourages therapists to surrender their hardwon professional ego/identity in the higher service of helping others discover who they are and what they want versus us trying to " encourage " our clients to learn to want what we think they should want( to be ).I for one though compassionate/sensitive etc. have done more than my fair share of theraputic manipulation over the past 23 years as a social worker.This book nurtures an impulse I've had growing inside of me for years to leave behind the illusion of security of the medical model of mental health ( does that not qualify as an oxymoron?)for the more exciting and potentially liberating process of working in a more colaborating fashion with my clients.This books medium ( no distancing professional jargon;an abundance of enlighting humor; easy to read; it's brevity;and willingness to tackle the difficult and politically incorrent issues like the limits of psychopharmacology )is very much in concert with it's message.I highly recommend The Heroic Client for both therapists and those who are considering going into therapy as a client.
24 of 24 people found the following review helpful
HASH(0x90672a50) out of 5 stars A Scientific Approach to Change 25 Mar. 2004
By Brian W. DeSantis - Published on Amazon.com
Format: Paperback
In the thorougly revised edition of the "Heroic Client", Duncan, Miller, and Sparks now advocate "A Revolutionary Way to Improve Effectivness." They invite mental health professionals, of any discipline, to partner with clients in all aspects of their care and abandon the search for the best therapeutic process or evidence-based therapy, and instead, focus on client-based outcome feedback to improve effectivness by an incredible 65 percent!
As in the previous edition, the strength of the authors' arguments for practicing "Client-Directed, Outcome-Informed Therapy" lies in their comprehensive and enlightening review of the science behind "what works" in psychotherapy. The revised edition updates the reader on the latest empirical findings targeting the limitations of applying the medical model toward resolving human problems-namely the myth of psychiatric diagnosis, the myth of evidence-based practice, and the myth of the magic pill. The sections examining the science of evidence-based practice and the ethics and science of using medications (especially for children) are significantly expanded, thought provoking, and timely. Also of significance, in the revised edition is the authors' unvailing of their own empirically tested process (Session Rating Scale-SRS) and outcome (Outcome Rating Scale-ORS) measures which have adequate psychometric properties, and of equal importance, are designed to be feasible for clinical settings. Using the SRS and ORS together, the authors report that their outcome management system offers the only system currently available which tracts both outcome and the alliance in a practical manner. Finally, as in the original text, Duncan, Miller, and Sparks intersperse case examples throughout their book to demonstrate the application of their approach to helping people change.
The revised edition could stand alone, without the reader needing to read it's predesesor. The only dissappointment to this reviewer was the mention in the first edition of The Nova Southeastern University (NSU) Pilot Project- Duncan and Miller's proposed solution to address some of the problems associated with conducting outcome research in the clinical setting. In the original "Heroic Client", they stated that results were preliminary because the study was still underway at press time and that two replications were planned. Unfortunately, the revised edition does not revisit this promising study.

Nonetheless, Duncan, Miller, and Sparks offer a simple, yet compelling message which has tremendous ramifications for the training, practice, and the delivery of mental health services. They are not just whinning about "business as usual" nor do they advocate another theory or therapy method which falls short of empirical support. Instead, the authors remind therapists that we are in the business of change, and out of respect for our clients who seek our sevices and the third party payors who help reimburse it, we must translate empirical research into an approach that they so rightly state will be "effective, accountable, and just." Their alternative vision of the future of mental health is a must read for students and practitioners alike.
21 of 22 people found the following review helpful
HASH(0x920805f4) out of 5 stars Provocative Insights for Corporate Training and Development 10 Mar. 2004
By Tony Plant - Published on Amazon.com
Format: Hardcover
A provocative book that is relevant to the European market although it is written in the context of the US where psychotherapy practice is enmeshed in disputes about status and funding that can sideline the needs of the clients. US psychotherapy seems to be fragmented by internal battles about models and techniques, while fighting a general action to resist medical domination from perceived second-status to psychiatry, and the siren-like influence of Big Pharma and the financial pressures of managed care.
The Heroic Client is grounded in the authors' previous works (Escape from Babel and The Heart and Soul of Change) that identify and draw together the common factors of effective therapeutic change. Duncan and Miller provide a personal manifesto in this review, reflecting their philosophy and experience that therapy is more effective and accountable when the client's own resources and perceptions are included as key and directive. Coert Visser has provided an excellent summary of the content and conclusions in his review. Duncan and Miller argue convincingly for the necessity of changes to professional practice and a modification to the existing implicit contract between therapists and clients. They want to influence therapists, service consumers (clients) and third-party purchasers (managed health care in the US, and increasingly, Health Insurers in Europe and Fundholders in the NHS): "We empirically attack the medical model as it applies to the human dilemmas clients and therapists routinely face. We sound the alarm bells and put a call out to therapists and consumers to question mental health authority".
Coert Visser's review gives a comprehensive outline of the authors' use of research to undermine three powerful and pervasive beliefs in mental health today:
· The superiority of pharmacoptherapy over psychotherapy;
· The value of psychiatric diagnosis in either selecting treatment or predicting outcome;
· The superiority of any therapeutic method or technique over any other.
The political context for the book is current psychotherapy, its practice and associated conflicts in North America. However, there are many issues that are increasingly relevant to the emergent arena of coaching, and the practice of training. Human Resource professionals are increasingly responsible for purchasing counselling services for Employee Assistance programmes as well as buying corporate training that represents value for money. Beyond that, the extension of fund-holding to NHS Trusts and doctors' practices in the UK encourages the need for similar discussion, learning from the N. American experience of managed care that the authors characterise as, "a monster made in the field's own image - a hodge-podge of empirically dead practices pieced together and now running amuck and terrorizing the citizenry".
The extensive references to research evidence are persuasive, but it is a general weakness of the field that there are not enough authoritative meta-analyses to lend confidence to particular interpretations, including the authors'. The authors are persuasive in their advocacy for adopting the client's goals and informal 'theory of change' as key to forming a successful therapeutic therapeutic alliance and positively influencing the outcome. However, the book would have benefitted from a more general overview of research and a sense of the support/opposition for/to the authors' position.
The writing style is plain but can occasionally verge on the irreverent in a way that distracts from the power of the argument; similarly for the belaboured attempts at humour. The index is poorly organised and makes it difficult to track research findings. I would have welcomed a fuller discussion of the practicalities of matching therapy to a client's theory of change and world model (I didn't benefit much from the fullest example given which had been contrived for a general exercise and felt wrong in the context of the book).
As a Corporate Trainer and Performance Coach for individuals and teams I am constantly assessed by clients. Clients regularly give feedback on their perception of the quality of the relationship; and their expectations for meaningful change are reviewed at set-points in the training/coaching programme. As such, this practice does overlap with some of the authors' recommendations. However, my experience indicates that such comparisons and monitoring can be counter-therapeutic for some clients and can run counter to some European cultural preferences. I would like to have seen a discussion of this issue: even in a book that reflects the N. American experience because I feel that there can be a tension between the purchasers' need to see validated progress, and the clients' preferences.
Nonetheless, this book is essential reading for service providers, service consumers, and 3rd party financiers. It deals a significant blow to the prevailing orthodoxy of the Five D's of diagnosis, disorder, dysfunction, disease and deficit. It emphasises the humanity of the client and argues convincingly against the prevailing "fix the client" model of therapy, or the belief that successful outcomes in mental health can be predicted from a manual of Standard Operating Procedures derived from the 5 D's.
33 of 37 people found the following review helpful
HASH(0x920807a4) out of 5 stars A Heroic Book About Heroic Clients 9 May 2000
By Dr. Z. - Published on Amazon.com
Format: Hardcover
In The Heroic Client, Barry Duncan and Scott Miller consider the whole field of "mental health," the roles of client and therapist, and the central question of what helps in therapy. They address mental health mythologies that affect the practice of therapy, including a pervasive reliance on medication, diagnosis, the medical model and priveleging the therapist's expertise. The book asks us to reflect on why we have lost confidence in the person-to-person collaboration of talk therapy, curious in light of the fact that research continues to show that talk therapy is more effective and enduring than medication for most of the problems people bring to therapy.
Duncan and Miller present an exciting, well-researched and thought-provoking argument for client-directed, outcome-informed therapy, which they call "co-therapy." Based on the research on what makes for success in therapy, Duncan and Miller propose we place greater reliance on the theories of change, experiences and strengths clients bring and less on our preferred causal theories and techniques.
This is a courageous and challenging book. Every mental health professional and consumer should read it. It can make a difference. Tobey Hiller MFT and Phillip Ziegler, MFT, co-authors of Recreating Partnership: A Solution-Oriented, Collaborative Approach to Couples Therapy (W.W. Norton, 2001)
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