Book review, Journal of Trauma and Dissociation, Volume 21, 2020 - Issue 1

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Review of Hendel, It’s Not Always Depression

Kayla M. Weiner

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         I really like to write book reviews but this book sat on the edge of my desk for months before I could bring myself to read it. Am I glad I finally did! Later I'll tell you why I resisted reading it.

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         The author has done something I don't think I have ever seen done quite so well. She has created a tool to make any therapist into an exceptional therapist. You may know a therapist who does not fit into any model but is revered and admired by her clients and colleagues as a singularly outstanding clinician. If you ask her how she does it, she will usually look at you with a blank stare. She might say, “I don't know.” or “It just comes to me.” Hendel makes very clear what one might do and why. She makes it possible for students, early career therapists, and seasoned clinicians to learn how to help someone at a very deep level. 

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         It has been my experience that if a client comes to me who appears to be filled with rage, there is often something else going on at a subconscious level. If I try to address the anger I don't get very far, she shows little improvement, articulating week after week all the reasons she is mad. If I get below the anger I often find hurt and/or a sense of betrayal. If a person comes in meek and passive who wants to be more assertive, it is likely little progress is made trying to help her learn to express herself. If I can get her to address her fear of her anger, she may be able to release that and move to a place of self-confidence and authenticity. If a person is very agitated, she may be harboring a great deal of guilt. Whatever is under the conscious mind, I see it as my job to get her to name it, move through it and proceed to a better place in her life.

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         Hendel has developed what she calls the “change triangle.” This technique is used to help a client listen to her body and discover core emotions.  She proposes that this method helps a client to connect to her authentic self: “The Change Triangle is a map to move us out of our defenses and put us back in touch with our core emotions. When we connect our core emotions, feel them, and come out the other side, we experience relief....When we are in touch with core emotions, our vitality, confidence and peace of mind increase. Biologically, our nervous system resets for the better.” (pp.7-8)

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         The triangle is pictured as an equilateral triangle with one tip down.  The upper left corner is labeled Defensiveness(which I might call presenting emotions), the upper right Inhibitory Emotions, and the bottom point Core Emotions. About 1/3 of the way from the bottom of the triangle is a gap labeled Blocked. The goal is to cross the blocked area, get to the core emotion and move into the “openhearted state of the authentic self” (p. 7).

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         Now comes the part that makes this book so beautiful.  Hendel presents several situations describing exactly how she speaks with a client. She includes conversations that are designed first to establish trust, and then help move the client from one corner of the triangle to the other with the ultimate goal of crossing the block from presenting to core emotion. She not only includes the dialogue but makes clear why she is saying what she is saying. She does this simply and directly and with deep compassion. Her work is unabashedly psychodynamic and feminist. She approaches the individual with respect of her place in the world and acknowledges how her interactions with the world have influenced her being.

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         This is a serious book. The cover and title and foreword do not reflect that fact. I resisted reading this book because it is presented as a self-help book; the type of book from which I usually shy away. There are worksheets and exercises designed to be used by an individual but I believe they can be better-used by a clinician helping a client. The process described is nuanced and complex and sophisticated. As you might guess: I highly recommend this book.

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Book review, Journal of Psychiatry Reform, 2018, 3 (5)

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It’s Not Always Depression– Working The Change Triangle To Listen To The Body, Discover Core Emotions, And Connect To Your Authentic Self

Alan Eppel, MD

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Hilary Jacobs Hendel is a highly accomplished psychotherapist practicing in New York City. You may have seen her articles in the New York Times or benefitted from her input as a consultant to the TV show Mad Men.  She came to psychotherapy through a circuitous route: first a degree in biochemistry, then a doctorate in dental surgery from Columbia University New York and a masters degree in social work. She underwent extensive training in psychoanalysis and  obtained certification. Subsequently she adopted the approach developed by Diana Fosha  which emphasizes the experience and processing of deep emotions ( grief, sadness, fear, anger, guilt, shame, and anxiety) in the psychotherapy sessions.

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This type of psychotherapy, known as Accelerated Experiential Dynamic Psychotherapy,  has moved beyond more conventional psychodynamic psychotherapies by giving priority to emotion processing rather than interpretations and transference work. The basic dynamic components remain relevant: working with defenses, being cognizant of transference and countertransference and perceptions of self and other. AEDP belongs to a school of experiential dynamic psychotherapies that includes Davanloo’s  Intensive Short-Term Dynamic Psychotherapy (ISTDP) and Short-Term Psychodynamic Psychotherapy.

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These therapies  stand in stark contrast to Cognitive Behavioural Therapy which places predominant emphasis on the impact of thoughts on behaviour.

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What is unique in this book is Hendel’s mission to take these psychotherapeutic tools and to present and rework them in a way that can be used by individuals on their own. This is a little bit like Penn and Teller showing us how a magic trick is really done! But she has a more important goal that is to bring these methods to a wide audience that may have little access to, or may not require, formal psychotherapy.

Hendel reveals herself to be a passionate and effective healer by relevant clear case examples that give a most enlightening  portrait of this therapeutic method.

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Equally disarmingly she is able to translate difficult techniques  into a self-help book. This is accomplished  by emotionally intense case examples and exercises that readers can practice using  the Change Triangle. The Change Triangle  is based on the work of Henry Ezriel, David Malan and others and embodies many complex psychotherapeutic ideas. Hendel has distilled these into an easily understood self-help approach. The genius of this book is the application of  formal psychotherapeutic interventions into a self-help toolbox.

It should be emphasized that this book will be of enormous value in educating  psychiatry, psychology and social work trainees. Experienced therapists will find lucid examples of the application of emotion focused experiential therapies that they can incorporate into their own practices.

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