Review of The Heroic Client

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......