{'fraction_non_alphanumeric': 0.02480752780153978, 'fraction_numerical': 0.001996007984031936, 'mean_word_length': 5.606403013182674, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Psychodynamic Approaches to Behavioral Change

Most practitioners of psychotherapy in the United States are self-identified as psychodynamic therapists. However, many have inherited with their training the notion (false, as it turns out) that psychodynamic therapy does not specifically address behavioral change. As a result, these practitioners know that behavioral change is important in helping the patient get better, but they are at a loss to explain how this change happens, and many are left saying vague things like “insight leads to change” or there is a “working through process.” It is into this impasse that Fredric Busch dives fearlessly in this much-needed book, Psychodynamic Approaches to Behavioral Change. Right away, Busch challenges the teaching that psychodynamic exploration is incompatible with focusing on behavioral change, showing the many ways in which paying close attention to the patient’s behavior (and the patient’s failure to change behavior) can further psychodynamic goals, particularly those related to pattern recognition (insight), defense analysis, and the exploration of transference, development, fantasy, and self or object representations. As Busch demonstrates how the exploration of behavior provides useful information about all of these issues, he reminds us of the arguments that ultimately legitimized the exploration of countertransference by stating that it provides useful information. After all, who can argue against knowing more? Most of Chapter 1 is devoted to understanding the objections often proffered against a focus on behavior, which Busch usefully outlines as horror of anything that resembles suggestion (dating back to Freud himself), disruptions in neutrality or abstinence, symptom substitution, or disruptions in the therapeutic relationship. Busch then goes on to say that, at the same time, psychodynamic psychotherapists are “increasingly prescriptive” (p. 7) in their approach, steered in this direction by the rise of psychopharmacology (on which Busch has written extensively), cognitive behavioral therapy, and good common sense. In Chapter 2, Busch gets more specific about psychodynamic factors that impede behavioral change, exploring developmental factors including rejecting punitive caregivers, traumatic experiences, angry feelings and fantasies of retaliation, defense mechanisms of reaction formation, passive aggression, or deficits in mentalization, to mention only a few. In Chapter 3, in anticipation of psychoanalytic fear and criticism, Busch turns to the risks that could be involved in focusing on behavioral change and shows how therapists might deal with them. In this chapter, Busch also talks about how focusing on behavior may lead to more active collaboration between patient and therapist. In Chapter 4, Busch addresses how to use psychodynamic techniques in addressing behavioral change, as he offers a framework for targeting behavioral change. Busch talks about the issue of giving the patient homework (which would upset most psychodynamic therapists) and argues that the effects of this offering should be a subject for study. The suggestion to give homework seems to be the natural culmination of much of Busch’s argument, introduced slowly but steadily, which is that the therapist needs to be more active in using all techniques. In Chapters 6 and 7, the author gets even more specific, addressing particular contributions to problematic behaviors, and identifies Marcia L. Verduin, MD, Book Editor