Object Relations Brief Therapy: The Therapeutic Relationship in Short-Term Work

Most psychotherapists are eclectic. They read or attend conferences, present a brand-name approach, and put together a quilt of practices. Some then find a pattern that works well with many patients and report their integration in a book. Frequently, these books simply present a new brand-name approach to an old issue. This book, however, belongs to a different category; it is an excellent example of how to introduce a general theory to the field.

Why, then, call it “object relations brief therapy”? There are good reasons to do so. The field is huge; no one book can attempt to cover it. This particular approach focuses on short-term work and, within that frame, focuses on making maladaptive relationships successful. The author's attention to efficiency helps even skilled therapists review how to sharpen their focus in time-limited situations. Therefore, the title of the book is an apt description of the book's content.

One of the splendid features of this work is the author's emphasis on in-depth rather than superficial problems. The concepts of self and of roles in relationships are handled with appropriate complexity. The topic of self is discussed with regard to the multiple states of self and other conceptualizations that each person may manifest. Stadter also clearly defines the difference between rationing sessions and well-formulated work. Managed care, which represents the former, often “makes the holding environment of the therapy unstable and often causes the patients to feel unsafe.” The latter can lead to change that endures well past the point of a planned termination.

Stadter's historical review is masterful: although it occupies the first third of the book, it is not an unreadable tour de force of all references but an apt sampling of what he calls “generations.” The first generation includes Freud, Alexander, and French; the second, Malan, Davanloo, Sifneos, and Mann; the third, Horowitz, Strupp, and Binder, plus a pragmatic grouping of Balint, Winnicott, Bloom, Budman, and Gurman. Stadter's approach to personality disorders is aptly attenuated to his purpose, yet it is both clear and clinically sophisticated.

The vignettes are excellent teaching examples, and the book is recommended for use in training mental health professionals for brief psychotherapy. It is comparable to Personality Styles and Brief Psychotherapy (1), which has more on personality disorders and systematic formulation. Object Relations Brief Therapy is more recent, covers a wide gamut of cases, and has more historical review and focus on current issues of managed care.