Beginnings

How does the therapist begin psychotherapy? How, that is, does she conceptualize the needs of the patient while simultaneously enlisting him or her as an active partner in formulating an individualized working plan? And how should supervisors teach the skills needed to make the intake procedure truly the beginning of treatment? In Beginnings: The Art and Science of Planning Psychotherapy Mary Jo Peebles-Kleiger tackles these and other questions in an authoritative manner that draws on the cumulative experience of the outpatient department of the Menninger Psychiatric Clinic. Peebles-Kleiger outlines an approach that gives equal weight to the need for a diagnostic case formulation with specific treatment recommendations and the need to make the patient an active partner in the process right from the start. Clinicians of every persuasion will appreciate her sensitive, discerning grasp of the dyadic interaction of the inital sessions, when the therapist must refine preliminary hypotheses and simultaneously engage the patient in a process of discovery and self-reflection that lays the groundwork for the therapeutic alliance. Peebles-Kleiger's elegant synoptic discussions of the major categories of psychological dysfunction and the different treatment strategies appropriate to them are carefully calibrated, with actual examples, to the limits and opportunities of the first sessions. Of particular value is her unusual capacity to articulate patients' various difficulties in forming and maintaining an alliance, and then to show how such difficulties feed back into the clinician's interventions in the first few sessions. In this manner, she illustrates how potential treatment obstacles-- difficulties in affect regulation, in reality testing, in conscience formation, among others--can be assessed and subjected to trial interventions from the very start. Skilled in various psychodynamic and behavioral approaches, from psychoanalysis to hypnotherapy, Peebles-Kleiger consistently advances an integrative approach that cuts across specific modalities and combines sophisticated psychodynamic understanding with the fruits of empirical research. Both primer and sourcebook, Beginnings: The Art and Science of Planning Psychotherapy fills a niche in the literature so admirably that clinicians will find it indispensible in planning humanely responsive treatment in an increasingly complex therapeutic world.