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Facing the Challenge of Liability in Psychotherapy: Practicing Defensively Hardcover – Dec 13 2006


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Hardcover, Dec 13 2006
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Product Details

  • Hardcover: 288 pages
  • Publisher: Jason Aronson, Inc.; Second Edition edition (Dec 13 2006)
  • Language: English
  • ISBN-10: 0765703866
  • ISBN-13: 978-0765703866
  • Product Dimensions: 2 x 15 x 22.5 cm
  • Shipping Weight: 476 g
  • Average Customer Review: 1.5 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Bestsellers Rank: #2,490,779 in Books (See Top 100 in Books)
  • See Complete Table of Contents

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Format: Hardcover
This writer has created a tome which has the potential to scare the living daylights of any therapist trying to work with clients . His focus on practicing defensively seems to overlook the obvious fact that such a posture taken with clients from the outset is oxymoronic. Clients come to therapists with the need and expectation of a therapeutic alliance. No one call ally themselves with an individual whose initial and ongoing posture is one of self-protection, defensiveness, and guardedness.
Hedges' comments regarding transference issues as the basis for complaints and his over-emphasis on these as the source of dissatisfaction in clients leads any knowledgeable reader to wonder to what extent his own strong countertransference issues related to clients of ANY kind are at work in his writing OR in his actual practice. His hostility toward clients and toward administrative/licensing boards is overt and interferes with his ability to provide balanced clarity in dealing with the issues he discusses.
In my opinion, any therapist who adopts his vantage point for approaching clients will soon have no clients. Clients have an intuitive sense regarding their therapists' perceptions of them. Being handed stacks of legal papers to sign and a myriad of other documents designed to protect the therapist (of course, under the guise of protecting both) at the outset of therapy precludes the possibility that any meaningful work will get done or any therapeutic alliance could be formed. Clients are not a stupid as he appears to suppose.
While the issue of practicing with common sense about legal and administrative issues is important, Hedges' approach focuses only on negative, confrontive, and overtly hostile interactions with clients--to the detriment of all concerned.
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Format: Hardcover
This writer has created a tome which has the potential to scare the living daylights of any therapist trying to work with clients . His focus on practicing defensively seems to overlook the obvious fact that such a posture taken with clients from the outset is oxymoronic. Clients come to therapists with the need and expectation of a therapeutic alliance. No one call ally themselves with an individual whose initial and ongoing posture is one of self-protection, defensiveness, and guardedness.
Hedges' comments regarding transference issues as the basis for complaints and his over-emphasis on these as the source of dissatisfaction in clients leads any knowledgeable reader to wonder to what extent his own strong countertransference issues related to clients of ANY kind are at work in his writing OR in his actual practice. His hostility toward clients and toward administrative/licensing boards is overt and interferes with his ability to provide balanced clarity in dealing with the issues he discusses.
In my opinion, any therapist who adopts his vantage point for approaching clients will soon have no clients. Clients have an intuitive sense regarding their therapists' perceptions of them. Being handed stacks of legal papers to sign and a myriad of other documents designed to protect the therapist (of course, under the guise of protecting both) at the outset of therapy precludes the possibility that any meaningful work will get done or any therapeutic alliance could be formed. Clients are not a stupid as he appears to suppose.
While the issue of practicing with common sense about legal and administrative issues is important, Hedges' approach focuses only on negative, confrontive, and overtly hostile interactions with clients--to the detriment of all concerned.
Read more ›
Was this review helpful to you? Yes No Sending feedback...
Thank you for your feedback. If this review is inappropriate, please let us know.
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Format: Hardcover
I found the Paul G. Mattiuzzi, Ph.D. review helpful, but a little extreme in the manner similar to his complaints about L. E. Hedges. These are confusing times for the practice of psychotherapy and a discussion of the problems that one can face, including models for addressing some of those problems, contributes to the effort to produce a more tempered solution for our changing profession. Therapeutic manuals and manual- oriented software like Therascribe are other examples of similar guide-driven change, but these tools require a tempered approach too. In other words, if you can see the opposing poles, it is a little easier to find a middle ground.
I would hope that the professionals that look at this book would realize that it does not obsolete professional consultation. As Dr. Mattiuzzi's colleague sought him out, I have often used these sample documents as an example to stimulate discussions with colleagues. In all cases, we usually come up with a modified solution suited to the given situation, but the sample document gave us a good starting place. Blindly applying these documents would be as disastrous as not addressing our new practice demands at all. Solo practice needs to be safer and more efficient for the consumer and the practitioner. If people find any of the sample pages on Amazon interesting, consider sharing the expense of this book among a group of colleagues.
Was this review helpful to you? Yes No Sending feedback...
Thank you for your feedback. If this review is inappropriate, please let us know.
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Format: Hardcover
I recently spoke with a colleague who was seeking advice about responding to a request for information from an attorney about a former patient. The psychologist was somewhat distressed by the inquiry. I saw it as a routine matter. She mentioned that she had read a book, which is the subject of this review, and that it had given her great reason to worry about liability.
I knew the author�s name and decided I should read his book.
The author makes some interesting points and provides some useful information. I would suggest, however, that on the whole, this text it is not to be trusted.
Described on the dust jacket as a comprehensive handbook for all therapists, �Practicing Defensively� is more uniquely focused on the challenges faced by clinicians who do long-term depth and dynamic work with seriously disturbed patients. It primarily addresses the threat of false accusations and licensing board actions. Included are a number of forms which can be copied from an accompanying CD. Many are standard, some are unique (e.g., �consent to feed my children during therapy�).
The text first gives reason for pause in a discussion about how to respond to a subpoena. A forceful, cautious and defiant response is advocated, but no consideration is given to the context or circumstances surrounding the request. It is suggested that the Supreme Court�s 1996 Jaffee decision be cited (Jaffee was the first Supreme Court ruling to recognize a psychotherapist privilege), but the case is miscited, the facts are misstated, and the ruling is misinterpreted.
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Most Helpful Customer Reviews on Amazon.com (beta)

Amazon.com: 5 reviews
9 of 10 people found the following review helpful
Bad and dangerous advice Aug. 2 2001
By Paul G. Mattiuzzi, Ph.D. - Published on Amazon.com
Format: Hardcover
I recently spoke with a colleague who was seeking advice about responding to a request for information from an attorney about a former patient. The psychologist was somewhat distressed by the inquiry. I saw it as a routine matter. She mentioned that she had read a book, which is the subject of this review, and that it had given her great reason to worry about liability.
I knew the author�s name and decided I should read his book.
The author makes some interesting points and provides some useful information. I would suggest, however, that on the whole, this text it is not to be trusted.
Described on the dust jacket as a comprehensive handbook for all therapists, �Practicing Defensively� is more uniquely focused on the challenges faced by clinicians who do long-term depth and dynamic work with seriously disturbed patients. It primarily addresses the threat of false accusations and licensing board actions. Included are a number of forms which can be copied from an accompanying CD. Many are standard, some are unique (e.g., �consent to feed my children during therapy�).
The text first gives reason for pause in a discussion about how to respond to a subpoena. A forceful, cautious and defiant response is advocated, but no consideration is given to the context or circumstances surrounding the request. It is suggested that the Supreme Court�s 1996 Jaffee decision be cited (Jaffee was the first Supreme Court ruling to recognize a psychotherapist privilege), but the case is miscited, the facts are misstated, and the ruling is misinterpreted. The author goes on to note that if records must be produced, they should be taken directly to �the judge,� and sealed with a warning reading in part: �anyone daring to break this seal violates 2000 years of Roman and Anglo Saxon Law which guarantees sanctuary and privacy to all citizens.� My guess is that this warning might be dismissed as an eccentricity. But I think it is more likely to be viewed as odd, immature, or unprofessional.
Additional examples of questionable advice are included. For example, the precise elements of privilege and confidentiality for minors seem to be misunderstood. A standard form for authorizing the release of information does not appear to be well drafted: it unnecessarily authorizes two-way communications, omits the signature of a witness, includes any information desired, and sets the expiration date at five years. At a clinical level, it is suggested that the only way in which symptoms from early trauma can be resolved is by causing them to be relived or reexperienced in therapy.
What is of most concern about this book is the attitude adopted towards licensing boards. It appears that no legitimate purpose for a board�s existence is recognized. Instead, the author endorses the proposition that we �need to remain in a constant watchdog and adversarial position.� He says that we must �stand against unfair enforcement and unwarranted intrusion by the state into our professional affairs,� and that �the rule is not to believe anything state boards put out because it is all so highly subject to political and financial motivation.� It is said that those who sit on licensing boards and ethics committees have been �seduced ... into naive and nonsensical moralizing� and that their efforts �can only lead to endless travesties of justice.� They are accused of �careless prosecutions� which are �heavily biased in favor of conviction.�
A centerpiece for this book is the author�s discussion of his reaction to a complaint against a colleague and the subsequent investigation. He sets the tone for the experience by recounting a dream about Nazi atrocities, the smell of burning flesh, and jack booted thugs knocking on doors. He describes an �administrative monster (that) continues to grind out injustices that destroy (the) lives of my professional colleagues,� the �farce of administrative justice,� and the �needless damage (caused by) board stupidity.� Before it was even investigated, the author knew that the complaint was unjustified. After all, the clinician had discussed the case for years in conferences with many colleagues. She was known as �Howard�s case from Hell,� and was described by the author as �a woman who undoubtedly would have been burned at the stake as a witch.� In preparing to fight for his colleague, the author railed against the �f---ing boards,� noting that �those state guys all have a police mentality - blind, ignorant, vindictive. They are dangerous.� The anti-climax to the story is that the complaint was dismissed as soon as it was investigated.
I read this book because I believed it caused a colleague to worry needlessly, and invited her to respond incorrectly to a potentially delicate situation. I would suggest more generally that it would be a risk to rely upon this tract for anything more than its basic warning: be careful, practice defensively. Common sense would provide a better guide than much of the advice offered. Rather than protecting a clinician, I would suggest that adopting the author�s attitude and perspective is more likely to lead to errors, mistakes and misjudgments, for which the liability might be real.
4 of 5 people found the following review helpful
Facing the need to be defensive Jan. 25 2002
By Amazon Customer - Published on Amazon.com
Format: Hardcover
I found the Paul G. Mattiuzzi, Ph.D. review helpful, but a little extreme in the manner similar to his complaints about L. E. Hedges. These are confusing times for the practice of psychotherapy and a discussion of the problems that one can face, including models for addressing some of those problems, contributes to the effort to produce a more tempered solution for our changing profession. Therapeutic manuals and manual- oriented software like Therascribe are other examples of similar guide-driven change, but these tools require a tempered approach too. In other words, if you can see the opposing poles, it is a little easier to find a middle ground.
I would hope that the professionals that look at this book would realize that it does not obsolete professional consultation. As Dr. Mattiuzzi's colleague sought him out, I have often used these sample documents as an example to stimulate discussions with colleagues. In all cases, we usually come up with a modified solution suited to the given situation, but the sample document gave us a good starting place. Blindly applying these documents would be as disastrous as not addressing our new practice demands at all. Solo practice needs to be safer and more efficient for the consumer and the practitioner. If people find any of the sample pages on Amazon interesting, consider sharing the expense of this book among a group of colleagues.
A "how to" for harmful psychotherapy June 14 2010
By Sue - Published on Amazon.com
Format: Hardcover Verified Purchase
Lawrence E. Hedges expresses such antagonism toward the psychotherapy client who files a complaint, he describes her as she who "undoubtedly would burned at the stake as witch" and equates the investigation to the "Nazi Gestapo in high black boots knocking on doors in the middle of the night." His mix of historical metaphors is only one example of the rant here.

This book repetitively argues that "successful" psychotherapy renders its client so engulfed and irrational that she merits no voice or credibility assessing their own care. Most client complaints are unfounded, he argues, and the practitioner constantly must be vigilant toward witch-like clients given to legal grievance.

This book reads as absolute in its recipe for healing the human mind. It insists (page 66) "The information about deeply ingrained patterns of clients' very early emotional relationships that is required for successful psychotherapeutic work is only available through the revival of transference memories as they are actively relived in the here-and-now trust relationship of the present with the therapist." Hedges includes "relationship traumas" from the "last trimester of intrauterine development" in this healing.

This lays the groundwork for Hedges to blame resistance or "psychotic transference" as the delusional forces behind misconduct complaints. He posits "Trust relationships such as psychotherapy invite intimacy and connection that in turn gradually stir up primordial terror." In this equation, trust begets terror.

Hedges' depicted client is too infantilized and dependent to offer an accurate account or evaluation of her own therapy. One can only conjecture how the poor woman, who once was competent enough to pay the bills for sessions, copes the other 167 hours a week she isn't in treatment. Furthermore, this process is too arcane for even an ignorant (his word) "outsider" on a state review board to understand.

I read this book as an elaborate rationalization for pathologizing client complaints and discrediting any attempt to protect the consumer. It overlooks whether encouraging a regressed, over-idealizing client might create its own difficult-case consequence as the client tries to right the power imbalance.

For all his paternalism, certitude and contempt, Hedges has no room in this polarizing book for any client viewpoint. Nor does he explore what might be a defense against psychotherapy breakdown--actually listening to the client.

As I consumer, I reacted to this book in horror: it's an arrogant blueprint for harming lives. I hope any practitioner reads this book critically, as a "how not to" rather than a "how to."
4 of 7 people found the following review helpful
Rampant paranoia pitting therapists against their clients April 26 2002
By A Customer - Published on Amazon.com
Format: Hardcover
This writer has created a tome which has the potential to scare the living daylights of any therapist trying to work with clients . His focus on practicing defensively seems to overlook the obvious fact that such a posture taken with clients from the outset is oxymoronic. Clients come to therapists with the need and expectation of a therapeutic alliance. No one call ally themselves with an individual whose initial and ongoing posture is one of self-protection, defensiveness, and guardedness.
Hedges' comments regarding transference issues as the basis for complaints and his over-emphasis on these as the source of dissatisfaction in clients leads any knowledgeable reader to wonder to what extent his own strong countertransference issues related to clients of ANY kind are at work in his writing OR in his actual practice. His hostility toward clients and toward administrative/licensing boards is overt and interferes with his ability to provide balanced clarity in dealing with the issues he discusses.
In my opinion, any therapist who adopts his vantage point for approaching clients will soon have no clients. Clients have an intuitive sense regarding their therapists' perceptions of them. Being handed stacks of legal papers to sign and a myriad of other documents designed to protect the therapist (of course, under the guise of protecting both) at the outset of therapy precludes the possibility that any meaningful work will get done or any therapeutic alliance could be formed. Clients are not a stupid as he appears to suppose.
While the issue of practicing with common sense about legal and administrative issues is important, Hedges' approach focuses only on negative, confrontive, and overtly hostile interactions with clients--to the detriment of all concerned. Any therapist who seeks to help clients knows that taking such a legalistic approach and allowing it to pervade every interaction with clients would be counterproductive.
As one reads this book, one is struck by the intense frustration and anger which pervades its pages. It leads one to ask the questions--what infantile traumas have yet to be dealt with in therapy by this author? or, as the famous commercial used to say, "what's his beef?"
Let us hope another author can approach this subject without Hedges' open hostility and paranoia toward clients so that balanced methods can be developed to address relevant issues without defeating the entire purpose of the therapeutic process. Only a therapist who has completely given up on the healing aspects of therapy would take this book seriously. And for those who have given up, why not turn to a line of work that doesn't require such vigilance and paranoia on a daily basis?
2 of 4 people found the following review helpful
Rampant paranoia pitting therapists against their clients April 26 2002
By A Customer - Published on Amazon.com
Format: Hardcover
This writer has created a tome which has the potential to scare the living daylights of any therapist trying to work with clients . His focus on practicing defensively seems to overlook the obvious fact that such a posture taken with clients from the outset is oxymoronic. Clients come to therapists with the need and expectation of a therapeutic alliance. No one call ally themselves with an individual whose initial and ongoing posture is one of self-protection, defensiveness, and guardedness.
Hedges' comments regarding transference issues as the basis for complaints and his over-emphasis on these as the source of dissatisfaction in clients leads any knowledgeable reader to wonder to what extent his own strong countertransference issues related to clients of ANY kind are at work in his writing OR in his actual practice. His hostility toward clients and toward administrative/licensing boards is overt and interferes with his ability to provide balanced clarity in dealing with the issues he discusses.
In my opinion, any therapist who adopts his vantage point for approaching clients will soon have no clients. Clients have an intuitive sense regarding their therapists' perceptions of them. Being handed stacks of legal papers to sign and a myriad of other documents designed to protect the therapist (of course, under the guise of protecting both) at the outset of therapy precludes the possibility that any meaningful work will get done or any therapeutic alliance could be formed. Clients are not a stupid as he appears to suppose.
While the issue of practicing with common sense about legal and administrative issues is important, Hedges' approach focuses only on negative, confrontive, and overtly hostile interactions with clients--to the detriment of all concerned. Any therapist who seeks to help clients knows that taking such a legalistic approach and allowing it to pervade every interaction with clients would be counterproductive.
As one reads this book, one is struck by the intense frustration and anger which pervades its pages. It leads one to ask the questions--what infantile traumas have yet to be dealt with in therapy by this author? or, as the famous commercial used to say, "what's his beef?"
Let us hope another author can approach this subject without Hedges' open hostility and paranoia toward clients so that balanced methods can be developed to address relevant issues without defeating the entire purpose of the therapeutic process. Only a therapist who has completely given up on the healing aspects of therapy would take this book seriously. And for those who have given up, why not turn to a line of work that doesn't require such vigilance and paranoia on a daily basis?

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