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by J. Scott Fraser and Andrew D. Solovey
American Psychological Association, 2007
Review by Rosemary Cook on Oct 14th 2008

Second-order Change in Psychotherapy

Research has determined that psychotherapy does indeed work. The question at hand now is "How does it work?" The authors of this book submit that the answer to this question has ramifications for all those involved in the practice of psychotherapy including professors, students, policy makers, insurance providers, and practitioners of all sorts.  To answer the question the authors set out to provide a theoretical framework that cuts across all of the therapeutic approaches that have been empirically shown to be effective. 

In the past, those claiming to answer the question of how psychotherapy works have polarized into two opposing groups.  These are referred to as the "best practice" group and the "common factors" group.  The best practice group argues for specific therapy protocols for specific therapy populations, whereas the common factors group maintains that a positive client-therapist relationship, among other factors, is most significant in issuing forth positive change in therapy.  Since each side presents a compelling argument the authors were (themselves) compelled to find a unifying factor that each side might share.

In Greek mythology, the golden thread helped the warrior Thesus safely find his way to the center of a labyrinth and back.  The tread traced his pathway through seemingly endless disorienting corridors in which his movement was (at times) contrary to intuition.  Today there are a large and growing number of different, purportedly effective psychotherapies.  However, their differences in approach and suggested mechanisms for change appear to contradict each other, creating a modern-day labyrinth for all those interested.  What makes these treatments effective? What do they have in common? What pathways do they share, and what thread, if any, connects them?  Those encountering this dilemma cry out for a modern golden thread to find their way (pp. 8-9). 

The authors contend that "second-order change" is that golden thread.  They submit that the unifying perspective on "change" unites all effective psychotherapy.  "First order change is defined as a class of resolutions that do not change a problem or make a problem worse.  In Contrast, second-order change is a change of those first-order resolutions, which results in a resolution of the problem" (p. 15).   First-order change is related to stability, while second-order change is related to transformation. 

Clearly, there is more to these brief definitions, and the authors do a fine job at preparing a presentation that could have gone way beyond the scope of this book.  But, Frazer and Solovey draw upon their extensive clinical and theoretical backgrounds to offer this unifying theory.   And by keeping the subject concise they make their point clear, understandable, and practical. 

Each clinical chapter follows a format where the authors formally define a problem to be addressed, and then analyze the "best practice" recommended for the clinical scenario, including a synopsis of the practical goals, steps, and research supporting it.   Then, they examine the situation showing how second-order change operates as an underlying pathway to improvement in that therapeutic setting.  In this way, case examples and comparisons with current therapeutic approaches place "second order" change in a practical light.  Beyond this, the text offers recommendations for making the second-order shift in both practice and policy.

While dealing with a fairly high-minded meta-analysis of psychotherapy, the authors have managed to keep this text at a very readable level (i.e., college level).  Professors and researchers of clinical psychotherapy might benefit from reading this book.  It would make a worthy addition to any graduate level clinical course.  Given the unifying principle of second-order change, students might refrain from getting caught-up in the undue process of determining a best-practice approach to therapy, and thusly focus their attention on the process of change that is so essential to effective psychotherapeutic treatment.  However, it is this reviewer's opinion that reading this book would benefit researchers, practitioners, and students alike.  I will read it again, and I will probably refer to it often.  

© 2008 Rosemary Cook

Rosemary Cook is a Psychotherapist in private practice living on Long Island, NY.