Expectation

The Very Brief Therapy Book

By: Rubin Battino


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Size: 234mm x 156mm

Pages : 208

ISBN : 9781845900281

Format: Hardback

Published: May 2006


This immensely powerful and practical book is about utilising the power of expectation in working with clients. It is the author's contention that creating an environment where the client expects to change is the foundation of doing effective very brief therapy. His own private practice is one where he rarely sees clients more than one or two times. Clients know in advance that this is the way that he works, and so their expectation is that during this session they are going to get down to the hard stuff, and resolve their concerns insofar as it is possible. This means working as if each session were the last one. This book is about all of the things that are designed to work in a single-session mode. This is not to say that some clients will need many more sessions but creating the expectation that each session will be the last creates an impetus towards change that is vital in the therapeutic process.

After presenting the basic outline of this approach, the book details (chapter by chapter) the specific approaches that the author finds most useful in his work. These include Ericksonian hypnosis and psychotherapy, solution-focused brief therapy, reframing, Rossi's fail-safe methods, and ideomotor signalling. In addition, metaphor, guided metaphor, and narrative therapy are utilized, as well as many other methods.

Battino has put in one place a collection of rapid and effective approaches to doing therapy. The emphasis is on the expectation of both the client and the therapist that rapid, lasting change is possible.


Picture for author Rubin Battino

Rubin Battino

Rubin Battino MS has a private practice in Yellow Springs, Ohio. He is an Adjunct Professor for the Department of Human Services at Wright State University, and has over twenty five years of experience as a facilitator of a support group for people who have life-challenging diseases and for caregivers. He is a Fellow of the National Council for Hypnotherapy (UK), and also a Fellow of two chemistry societies. Other publications by Rubin include: Healing Language. A Guide for Physicians, Dentists, Nurses, Psychologists, Social Workers, and Counselors; Howie and Ruby. Conversations 2000 - 2007;, That's Right, Is it Not? A Play About the Life of Milton H. Erickson, MD, and Using Guided Imagery and Hypnosis in Brief Therapy and Palliative Care.

Click here to listen to Rubin's interview with London School of Clinical Communications and Hypnosis.


Reviews

  1. If you're interested in brief therapy, solution focused therapy, motivational interviewing and NLP then this is a great resource. It summarises each approach and then gives examples of practical ways to apply these with clients. It is clear that the author has used these techniques himself and his refreshing enthusiasm and expertise shines through his descriptions of each technique that can help people move forward in their lives. He also balances this enthusiasm with references to the original sources of the approaches which helps direct the reader to more detailed descriptions of any techniques of particular interest.
  2. The ways in which most clients use therapy has long been at odds with the most popular theories of therapeutic change. As anyone who has been in therapeutic practice knows, clients tend to come to therapy in much distress and leave therapy after just a few sessions. Many theoretical paradigms have suggested that such clients cannot possibly be getting substantial benefit from their therapeutic encounters, arguing that change comes about through processes which require more time and effort than such brief encounters can provide. Recent research, however, has confirmed that therapy is remarkably effective and that treatment modality contributes very little to the positive change which clients experience.(Wampold, 2001) This same research clearly demonstrates that the most important components of therapy, primary among them, the expectation for change, can be reasonably mobilized in very few session, indeed, validating the sense that the many patients who enter therapy for very brief periods are truly benefiting from their therapeutic investments.

    Rubin Battino has written a lucid introduction to the craft of very brief therapy which makes a virtue of the necessity of working with clients in very brief therapeutic encounters. The book is arranged as both an introduction to the research which validates the approaches behind brief therapy, and as a primer to the many techniques different clinicians have developed for working with patient expectation for improvement. As he makes clear in his introduction, Battino recognizes that what the field calls "brief therapy" has changed over the years, first denoting fifty sessions of treatment, then fewer, until it now tends to be in general currency as a description of treatments lasting 8-12 sessions. Battino, in contrast, refers throughout his book to "very brief therapy," by which he means treatment encounters lasting 1-2 sessions, in which patient expectations of rapid change are used to facilitate immediate therapeutic work.

    The most useful part of Battino's book is the first four chapters. In them he marshals the research that forms the basis of his argument, and discusses the general shape of a brief therapy encounter. Appropriately he does this by first examining Bruce Wampold's crucial book, The Great Psychotherapy Debate, in which Wampold uses meta-analysis to prove not only that psychotherapy is remarkably effective, but that that effectiveness comes from general rather than specific factors. Battino does a good job of extracting the most salient points from Wampold's argument, highlighting the freedom from a medically dogmatic approach to treatment which results from Wampold's data. Battino also takes from Wampold validation for his project, as Wampold's data clearly shows that client expectation, or hope, for improvement is a determining factor in subsequent change.

    Battino also uses the first chapter to introduce the work that Duncan, Miller, et al. have done on the role of client expectations and resources for change. One of Battino's central theses is that clients enter therapy with not only the expectation for change, but the wherewithal to pursue that change themselves once the clinician has helped to facilitate such self-healing. Battino refers to the work that Duncan, Miller and their colleagues have done to bolster this contention, and the argument is persuasive.

    Battino goes on to further discuss the importance of expectation in the role of change. He properly links the notion of expectation to medical discussions of the placebo effect, and shows how integral to the client experience of therapy the hope for change is. This segues into a discussion of basic strategies for working with clients that mobilize expectation as their core approach. Among these, using "as-if" thinking and reframing are outlined at some length. Both contribute to a larger introduction to the centrality of focusing client thought and attention on the positive aspects of their lives and the positive change that they want to see occur. Whether used in solution-focused therapy, or narrative therapy (both discussed later in the book), or in some other modality, attention to the positive aspects of a client's experience is central to helping to bolster hope and foster an expectation of change.

    Chapters three and four focus on the ways in which clinicians foster rapport with their patients. Chapter three examines some of the linguistic and physical cues that indicate to patients that we are in alliance with them, while in the fourth chapter Battino talks about some of the language and language strategies that he has found most helpful in working with clients during very brief therapy encounters. Battino here demonstrates his allegiance to Eriksonian hypnotic techniques, which forms the backdrop for much of this book. While his understanding of the technique seems thorough and laudable, that very understanding introduces the major weakness of this book, which is that it's introductory, and in many places cursory, nature does not leave room for adequate explanation. His chapter on the language of brief therapy describes over 30 different techniques for using language in under 15 pages, providing the merest gloss on many of them. The reader unfamiliar with these techniques is unlikely to gain any real understanding from their treatment here, although the extensive citation makes it clear that the issue is that Battino is too familiar with these techniques to realize that he may not be imparting enough information. (An example of this: Introducing his discussion of these techniques, Battino writes "Much is owed to NLP for this organization," (p.38) as if it were transparently evident that NLP refers to Neurolinguistic Programming. Granted, there is a chapter devoted to NLP later in the book, but this first introduction of the material is not properly fleshed out.)

    The rest of Battino's book is fascinating and frustrating in equal measure. In about 15 brief chapters he covers twice as many sets of therapeutic techniques, ranging widely through the work of Bill O'Hanlon, Jay Haley, Milton Erickson, and Ernest Rossi. He also covers metaphor therapies, NLP, some aspects of hypnosis, as well as several other approaches. While these chapters provide some interesting introductions, they are written more as refreshers on the techniques he finds so helpful, and as such, suffer from not explaining in adequate detail the methods that they recommend. Overall, however, these chapters form a valuable and remarkable compendium of some of the techniques best suited to helping clients make significant shifts in the way they are conceptualizing the problems which have brought them into treatment. Coupled with Battino's extensive bibliography, they serve as an invitation to further study.

    Battino does not discuss the ethics of solution focused brief therapy techniques, which is a shame. A strong argument can be made for the clinical ethical imperative for facilitating change for our clients as quickly as possible. Therapeutic techniques which place a premium on time spent versus change engendered may be not only doing a disservice to client expectations, but may be actively getting in the way of our clients living the lives which they desire and are entitled to live. While the research presented by Wampold suggests that all therapeutic techniques are about equal for helping clients to improve during therapy, that same research should force us to question whether or not all techniques are appropriate for all clients. Rubin Battino's book, despite its brevity and some of the flaws which that engenders, is a welcome reminder that there are as many ways to work quickly for client change as there are clients.
  3. The power of human expectation in physiological intervention, as demonstrated by the placebo effect, is widely documented and accepted in the medical world. In this book, Rubin Battino offers a compelling and heartfelt argument for introducing the concept of expectation into a psychotherapeutic context, specifically 'very brief therapy', where both the client and therapist embrace high expectations of a successful outcome, from as little as one session.

    However, this is far from a one-idea book. Rubin Battino takes the reader on a whistlestop tour of a diverse and challenging range of techniques and approaches that have been of inspiration to his own practice, including the use of the metaphor and hypnosis, ordeal therapy, nature-guided therapy and solution-oriented therapy.

    Rather than offering a definitive guide to very brief therapy, this book is more usefully viewed as a 'tapas' of thought-provoking material, allowing readers to get a feel and flavour for various methods and offering useful direction for those who wish to learn more. Those who are seeking a comprehensive step-by-step guide to very brief therapy may be disappointed. Equally, whilst therapists working across a number of traditions may gather inspiration from the views and tools offered in this book, Battino's focus on clinical hypnosis may, at times, limit the transferability of its contents beyond therapists who are in a similar field of practice.

    Nevertheless, the book is written in an informal, warm and accessible style. The author's considerable practical and theoretical expertise and enthusiasm is evident throughout, making this a valuable addition for anyone interested in this field of practice..'. even those with the highest of expectations!
  4. Can change occur in a single session of therapy? Rubin Battino says, yes, it can, if both the therapist and client expect it. That's why Battino always conducts every therapy session "as if each session is the last one" in which he will see the client. In his latest book, Expectation, he writes that the crucial ingredient in the success of brief therapy is the expectation, on the part of both the therapist and the client that rapid, meaningful change is possible and will occur, even in just one session.

    Battino writes that brief therapy offers a departure from the medical model of psychotherapy. The medical model is ill-fitted to psychotherapy because there is no direct correspondence between diagnosis and treatment. People who seek help from psychotherapists are not diseased; they are troubled and present concerns that can often be remedied without months or years of analysis or soul-searching. Battino advocates replacing the medical model with a contextual model in which the efficacy of treatment procedures is based on the meaning attributed to those procedures.

    Battino draws from Moshe Tolman's 1990 book, Single Session Therapy"a synopsis of a groundbreaking study of a California mental health organization in which the majority of psychotherapy patients reported benefit from a single session. Battino also cites the work of others, all of whom believe that people can solve their problems, when therapists offer client-centered rapport, a focus on the client's outcome, and a recognition of the clients unique personality traits, circumstances, strengths, and capabilities.

    Hope imparts curative powers and gives people the strength to endure and overcome adversity. Battino reminds us that "Hope and expectation are inextricably connected." We are all familiar with the placebo effect. In the same way, the expectation of change becomes a fulfilling prophecy. It is the game of "as if" that often makes imagined possibilities into real results.

    Reframing can facilitate expectations as well, by changing the meaning of events and symptoms. Reframing helps people to interpret reality in new ways and grasp new possibilities.

    Battino devotes a chapter to the value of rapport in creating a "therapeutic alliance" with the client. He gives an excellent summary of hypnotic language patterns ("the precise use of vague language") in brief therapy. Ericksonian hypnotherapists will enjoy his chapter on this subject, especially Battino's discussion of confusion techniques, metaphor, and "expectational language"(suggestions, implications and presuppositions phrased to enlist the client's cooperation and/or advance the client toward the outcome). Battino posits that all types of therapy involve trance-work in one way or another.

    A Compendium of Brief Therapy Approaches

    The remaining two-thirds of Expectation is a compendium of brief therapy approaches suitable for a single session. The common element of all is that both the client and the practitioner maintain the expectation of a positive result. Battino describes a dozen types of brief therapy and often presents several methods or variations within each type. Here is a sampling:
    1. Jay Haley's Ordeal Therapy: The client is assigned an ordeal; the expectation being that the client will learn something worthwhile from the experience and, with that knowledge or skill, solve his problem. A well-designed ordeal must be a) more severe than the problem, b) related to the symptom, c) a healthy or beneficial behavior, d) within the client's range of capability, e) safe, and f) linked to the occurrence of the symptom.
    2. Ambiguous Function Assignments: The client agrees to carry out a task, with the understanding that doing so will create new thinking and lead to new behaviors. Examples are to carry an object, climb a mountain, take a walk in the woods, read a particular book or poem, visit a museum, write a letter, etc. The assignment evokes the client's curiosity, and causes her to take some action in regard to the problem at hand.
    3. Rituals and Ceremonies: The client and therapist design a ritual or ceremony to signify an end to a problem, the beginning of a change, or the celebration of an accomplishment. The ritual or ceremony attaches meaning and significance to the client's progress.
    4. The Miracle Question: The client is invited to describe how his life is different, after "a miracle has occurred" and the problem is solved. This method is a hallmark of "solution-oriented" therapy.


    Other approaches include Erickson's Utilization approach, Burn's Nature-Guided Therapy, Metaphor, Rossi's Rapid Methods of ideomotor signaling, Neuro-Linguistic Programming, Narrative Therapy, and Derks' Social Panorama.

    The Author

    Rubin Battino is an adjunct professor at Wright State University in the Department of Human Services and President of the Milton H. Erickson Society of Dayton, Ohio. He has a private practice and serves as a facilitator of The Charlie Brown Exceptional Patient Support Group at Dayton.

    ConclusionBattino expresses what many practitioners have suspected for a long time. It isn't our methods or disciplines that matter; it's the relationship we maintain with clients, our confidence in what we do, and our faith in our clients---these are what truly matter in counseling and psychotherapy.

    This book is such a handy reference tool, it should be on the desk of every brief therapy practitioner. Battino continues to inspire and teach with candor, elegant simplicity, and an obvious passion for his subject matter. Expectation is a welcome addition to Battino's previous books on guided imagery, healing metaphor, and Ericksonian hypnotherapy. Once more, thank you, Rubin, for sharing with your readers how you do your work!
  5. This practical book is about utilizing the power of expectation when working with clients. It's Rubin Battino's idea that creating an environment where the client expects to change is the foundation of doing effective very brief therapy. In his own private practice where he rarely sees clients more than once Or twice. Clients know in advance that this is the way he works, and so their expectation is that during each session they are going to get down to the hard stuff and, resolve their concerns, insofar as that is possible. This means working as if each session is the last one. So, this book is about all of the things that are designed to work in a single-session mode. He reviews a number of therapies including Erickson and Very Brief Therapy and Solution-Orientated Approaches.
  6. This book provided an easily readable introduction to the body of work available on the subject of Brief Therapy. Battino covers many of the central themes in the subject and directs the reader to other texts for them to explore for greater depth of understanding. He has drawn on a variety of authors and explained their approaches in a way that encourages thought and a desire for further exploration.
  7. In 180 pages, Battino describes how he used the power of expectation in his therapy with clients, working as if each session were the last. After presenting the basic outline of how he works, he details, chapter by chapter, specific therapeutic approaches that he personally finds most useful. These include rapport, hypnotic language, metaphor and hypnosis, solution-oriented approaches, narrative therapy, Ericksonian very brief therapy, Haley's ordeal therapy, Burns's nature-guided therapy, Kopp's metaphor therapy, Rossi's rapid methods, NLP approaches and provocative therapy.
  8. Rubin Battino has written some amazing therapy books. None more so than his co-authored Ericksonian Approaches: A Comprehensive Manual (Crown House), which features highly on many a therapist's and training school recommended reading lists. In comparison, Expectation is half the price of the aforementioned and a third of its pagination. Nonetheless, it's a very useful and concise introduction for anyone - from novice to experienced therapist - interested in the various schools of thought on Brief Therapy.

    Battino qualifies his definition of 'brief' as being either a single session, at most, seeing the client up to three separate sessions. He says: "I rarely see my clients more than one or two times - usually it is just once."

    Before some of you think, this may be true for none but the simplest of issues, Battino also includes a caveat. That by the client accepting that one session should work for them, that single session translates into more meaningful work being done for the client. He was also says, his sessions have no time constraints, therefore, his 'single'session might last a long time.

    With 18 chapters in a relatively small tome, this book highlights a whole myriad of information, ranging from; rapport-building skills, offering advice on linguistic and postural pacing. Hypnotic language and some of the differences one might consider when adopting the'brief'approach,as well as skilfully introducing the reader to a plethora of interventions, ranging from Solution-Orientated Approaches and the work of de Shazer and Associates, Bill O'Hanlon's Inclusive Therapy, ideomotors responses, right through to NLP, and a great self explanatory section headed "When All Else Fails': As you would expect from Battino there is also a slew of Erickson-based approaches all presented in a very clear and narrative fashion.

    I found myself reading a chapter, using the provided references, looking for more information, and then going back to the book And I am sure that was the author's intention - to provide a comprehensive enough introduction to each method, that if so wished, the reader had the required references to find out more.

    If you are interested in Battino's own 'brief' style, then this book should probably feature high on your wish list. The almost encyclopaedic amount of knowledge, offering clear, well-written insights into many other approaches, only adds to its appeal. Okay, there is a little poetic licence used when defining the 'single session; but to be fair, Battino freely admits this and doesn't detract from the information given. Brief by name and brief by nature, nonetheless worth buying.
  9. The book's guiding principle is that building a therapeutic environment where the client expects to change is the key condition for effective, brief, work. In his own practice it is rare for Rubin to see a client more than once, and clients know this in advance.

    Such an approach will challenge the belief systems of many, not least among psychotherapists. Psychoanalysts are likely to burn him as a witch. Nevertheless, don't think that if your belief doesn't resonate with his that this isn't a book for you. It is so packed with ideas and pointers that you will gain a lot you can integrate into your style of working without needing to adapt the structure of your treatment planning.

    One of the things the book has inspired in me is to either dust off some books he's reminded me of, or buy some more. He samples freely from the work of Bill O'Hanlon, Lucas Derks, Jay Haley, Moshe Talmon - the list is extensive, and the samples all focus on techniques that emphasise brevity. After all, most problems can begin with a moment's experience, so why can't solutions? Why does the passing of time have to be an element of positive change beyond the opportunity to calibrate changes within you?

    Those of you who've seen Rubin speak will know what I mean when I talk of him as "spare'. There is nothing wasted about him, and his ability to focus on the quality of the moment with each client is something to aspire to, as is his spirit.

    Experienced therapists will find this book a delight, newcomers will find it to be an education; a starting point for exploring paths that lead off the beaten track. Both will find it a title they return to year on year, and find within it something fresh and something useful. Don't put this on a shelf, put it in a glass case in your therapy room with the instruction "break glass in case of emergencies'. It is bound to show you a way forward.

    That we have the likes of Gil Boyne, Brian Roet and Rubin as Fellows of the NCH provides us with a unique cachet that must enhance our reputation across the world. Long may they grace us with their experience and their spirit, and long may they avoid housework.
  10. A wonderful contribution to the field of Brief Therapy
  11. Rubin Battino has written a book that once again meets the superb standards of his previous works.

    Challenging preconceptions that therapy is a prolonged endeavour, Expectation is insightful and thought provoking and is a valuable reference manual for those seeking a solid grounding in very brief approaches to therapy. Rubin clearly explains his eclectic and pragmatic approach, one that has been drawn from a number of sources that allow him to complete the entire process of therapy in only one or two sessions.

    Another must have book from this respected author and therapist.

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