Co-Creating Change

Effective Dynamic Therapy Techniques


First prize in psychiatry, British Medical Association 2014


Written for therapists of all experience levels, Co-Creating Change shows what to do to help “stuck” patients (those who resist the therapy process) let go of their resistance and self-defeating behaviors and willingly co-create a relationship for change instead.

Dr Hilary Cass presents the BMJ First Prize in Psychiatry to Jon Frederickson
Dr Hilary Cass presents the BMJ First Prize in Psychiatry to Jon Frederickson

Co-Creating Change includes clinical vignettes that illustrate hundreds of therapeutic impasses taken from actual sessions, showing how to understand patients and how to intervene effectively. The book provides clear, systematic steps for assessing patients’ needs and intervening to develop an effective relationship for change.

Reviews for Co-Creating Change


Allan Abbass, MD
Professor of Psychiatry, Dalhousie University
“There is no debate. It is an awesome book and a gift to the fields of psychology and psychotherapy.”

F. Barton Evans and Judith A. Maris
Frederickson’s Co-Creating Change is the best book written on how to practice psychotherapy in many years. This is a masterpiece on conceptualizing and conducting highly effective dynamic psychotherapy. He offers us a literate and well-written synthesis of psychodynamic theory and affective neuroscience supporting his meticulous application of theory to practice. Unlike so many psychotherapists, Frederickson shows us what he does through carefully crafted case examples. There may be no better place to start psychotherapy training.” Psychiatry 79:335-338, 2016

David Malan D.M. F.R.C.Psych.,
Author of Psychotherapy and the Science of Psychodynamics
“This book is a brilliant master class. It demonstrates how to work collaboratively with patients, safely, compassionately and effectively to achieve successful outcomes. Outstanding clarity and the mastery of material are its hallmarks, using experience distilled from analysing therapy sessions.
Each technique is illustrated with relevant vignettes, analysing what is happening with the patient and also the rationale for the intervention being made.  A clear outline of principles and reasons for each intervention, and the inclusion of common mistakes, danger signals and ways to avoid trouble, adds immensely to the book’s value.
This excellent and very readable book enables all therapists to become much more proficient and focused on what they are doing and why. It is an invaluable resource for all therapists and an absolute ‘must have’ for all students.”

Stephen E. Finn, Ph.D.
Founder, Center for Therapeutic Assessment, Austin, Texas
“There are many books on short-term psychotherapy, but Co-creating Change stands out. The clarity of Frederickson’s thought and writing is striking, and the multiple clinical transcripts are inspiring, helpful, and often tremendously moving. No one does a better job explaining how and when to focus on emotions, anxiety, and defenses, or in integrating psychotherapeutic technique with the latest research on neurobiology, attachment, and emotion. Co-creating Change deserves to be read by both novice and experienced psychotherapists alike.”

Stanley B. Messer, Ph.D. 
Dean and Distinguished Professor
Graduate School of Applied and Professional Psychology
Rutgers University
“This is the clearest and most clinically useful exposition of Davanloo’s Short-term Dynamic Psychotherapy on the market. It is chock-full of compelling, verbatim, clinical vignettes that bring the reader directly into the session in a wonderfully engaging and evocative way. Woven into the therapy excerpts are Frederickson’s explication of the many varieties of defense and how they can be helpfully responded to by the therapist. Practitioners of all forms of psychodynamic therapy will profit greatly by delving into the pages of this outstanding volume.”

Stephen W. Porges, PhD
Author of The Polyvagal Theory
“Co-creating Change is an insightful and well written guide to enable the therapist to build an effective collaboration to lead the client into an awareness of the bio-behavioral shifts that constitute feelings.  The book is a road map with excellent examples of how the therapist can ‘co-create’ a therapeutic alliance to stop the suffering by enabling the client to become aware of feelings.”

Les Greenberg, Ph.,
Author Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings and Emotion Focused Therapy
“An incredibly useful book, showing you how to work in a highly focused manner on emotion, especially unacknowledged anger. You can learn how a therapist actually works by focusing on feeling and on anxiety about and defenses against feeling. Offers a crystal clear and highly practical presentation of contemporary brief dynamic therapy techniques with plenty of transcript examples. Good for new and advanced practitioners of any therapeutic profession or orientation and for students.”

Jaak Panksepp
Baily Endowed Professor of Animal Well-Being Sciences, Washington State University
Author : Affective Neuroscience (1998) and Archaeology of Mind (2012)
“Frederickson integrates the emerging brain sciences of affective feelings and the dynamics of the inner life with a detailed analysis of how to manage clinical relationships. With a rich blend of emerging understanding of our brains’ emotional processes, brought to life in skilled therapeutic engagements, we are led to experience how the strengths and weaknesses of clients can be steered toward harmonious ways of living. Anyone interested in the breadth and depth of mental life will find this to be an exceptional guide to therapeutic progress.”

Marion Solomon, Ph.D.
Co-author of Love and War in Intimate Relationships: Connection, Disconnection, and Mutual Regulation in Couple Therapy
“This book synthesizes research and theory in a clear and straightforward way, compatible with modern ideas from the fields of neuroscience, attachment theory, interpersonal communication, and developmental theories.  Change requires a well-equipped store of knowledge about ways to confront anxiety and defenses.  This is exactly what Co-Creating Change offers.  It is a practical guide for change through the dyadic relationship; an integrated model to help people break the chains of their suffering.”

Patricia Coughlin, Ph.D,
Faculty, University of New Mexico; Author:<Intensive Short-term Dynamic Psychotherapy
“Co-creating Change is an invaluable source book for all therapists wanting to do work that is highly collaborative and deeply affecting.
From a solid base in theory and research, Jon Frederickson deals with the nitty-gritty of therapy, outlining treatment strategies and interventions that can help therapists increase their effectiveness across a wide spectrum of patients.”

Jeffrey J. Magnavita, Ph.D., ABPP
Past President (2010) of the Division of Psychotherapy, American Psychological Association
Lecturer in Psychiatry, Yale University
“Jon Frederickson’s new volume Co-Creating Change: Effective Dynamic Therapy Techniques is a must read for every practitioner of psychotherapy. This may very well be the most cogent and compelling distillation of the technical processes of dynamic psychotherapy. Clearly written, with abundant case material and patient-therapist vignettes, Frederickson illuminates the process of dynamic psychotherapy with concise descriptions and clinical decision trees, which serve as excellent clinical guides for any psychotherapist regardless of their theoretical orientation.”

Michael Stadter, PhD
Faculty, International Psychotherapy Institute and Washington School of Psychiatry; Author: Presence and the Present: Relationship and Time in Contemporary Psychodynamic Therapy
“Co-Creating Change can serve both as a scholarly text and as a remarkable clinical guide. I found Frederickson’s integration with neuroscience, numerous clinical interchanges, moment-to-moment attunement, and work with fragile and highly resistant patients to be especially valuable.”

Antonio Pascual-Leone, Ph.D., Clin. Psych.
Director of the Emotion Change Lab, University of Windsor
Co-author of Emotion Focused Therapy for Complex Trauma
“A fascinating contribution to working with emotion in psychotherapy. Frederickson opens up contemporary psychodynamic theory, putting it in concrete terms for therapists of all orientations. Written in a personable and highly accessible style, this book is chock-full of concise and practical illustrations for moment-by-moment intervention! This volume invites the curious reader into fresh dialogues on psychotherapy integration.”

Susan Warshow, MSW
Founder of the Deft Institute
“A tour de force…This book covers a dazzling sweep of topics indispensable to a clinician hoping to do profoundly transformational work. I only wish I’d had this available as I was struggling to manage difficult, rapidly occurring defenses and significant anxiety reactions.  Jon’s style is warm, personal and exceedingly clear, and he equips the therapist with detailed interventions to handle every confounding defense, manifestation of anxiety, or problem that can present itself in a therapist’s office.
This is the most detailed, clear, and all-inclusive treatment manual I have had the pleasure to read. And unlike many scholarly texts, this one is enjoyable to read!”

Thomas Brod, MD,
Associate clinical professor of psychiatry, UCLA
“From the brilliant and beautiful opening paragraphs on accomplishment and suffering, Jon Frederickson carries us right into the process of effective psychotherapy. He tells us just what we want to know about theory of technique, but he never loses touch with our need to know what to do to convert our patients’ sticky places into centers of growth. He shows us how to keep going in the face of obstacles put up by the keen and hurt minds we encounter.  With Co-Creating Change, Frederickson, has created a classic resource on the most modern of psychotherapies, Intensive Short-Term Dynamic Psychotherapy.”

Theresa DiNuzzo, Ph.D. 
Former President, International Association of Counseling Services
“This valuable resource presents a masterful blend of theoretical knowledge and applied material in a clear, accessible style and format. It captures the essence of the therapy process deftly illustrated by therapist-patient scenarios and practical tools.  A ‘must-have’ for both aspiring therapists-in-training and seasoned practitioners who wish to hone their skills to effect lasting change.”

Key skills taught in the book

  • Identify and maintain an effective focus for change.
  • Co-create a relationship for change with patients who usually resist change.
  • Motivate the patient to engage in a relationship for change.
  • Generate more rapid change in patients.
  • Regulate anxiety when standard forms of anxiety regulation don’t work.
  • Help an externalizing patient develop an internal focus that will lead to personality change.
  • Help patients overcome somatizing disorders.
  • Help patients identify and relinquish self-defeating behaviors.
  • Help patients see and let go of defenses and resistances.
  • Prevent regressions in treatment.
  • Help patients with somatic disorders.
  • Help highly resistant patients become collaborative.
  • Treat destructive behaviors such as passivity, defiance, helplessness, and non-involvement.
  • Treat patients who blame others for their problems.
  • Work with dysregulated affects.
  • Overcomes defenses which block the therapy such as denial and projection.


Section 1: An overview of the basic components of the theory with numerous clinical vignettes showing how to put them into practice.

Section 2: How to work with fragile, depressed, highly anxious, and somatizing patients. In particular, it shows how to help patients who suffer from regressive defenses such as splitting, projection, and acting out. Each defense is described and then illustrated with a clinical vignette which shows how to assess and intervene effectively.

Section 3: Shows how to work with highly resistant patients who often fail in therapy. Many types of resistance and superego pathology are described, each illustrated by a clinical vignette which shows how to assess and intervene effectively. Hundreds of vignettes and interventions show you how to work with the wide range of patients in your practice.

Who should read the book

Therapists at all levels of experience who are looking to create lasting, positive change in their patients.

About the Author

Jon Frederickson, MSW, is a therapist in private practice in Washington, DC. He is cochair of the Intensive Short-Term Dynamic Psychotherapy (ISTDP) Training Program at the Washington School of Psychiatry, where he has been on the faculty since 1988. He was previously chair of the Supervision Training and Advanced Psychotherapy Training Programs at the school as well as chair of the Faculty Clinical Council.
He is the chair of the ISTDP Core Training Program at the Norwegian ISTDP Society and on the faculty of the Laboratorium Psychoedukacji in Warsaw and the Italian Experiential Psychotherapy Association in Treviso. He is also the author of several books, including The Lies We Tell Ourselves: How to Face the Truth, Accept Yourself, and Create a Better Life; Co-Creating Change: Effective Dynamic Therapy Techniques; and Psychodynamic Psychotherapy: Learning to Listen from Multiple Perspectives.
Jon gives clinical presentations ranging from half-day events to three-day sessions on many topics. He also runs training groups in the United States, Sweden, Denmark, Norway, Poland, and Italy. Each group meets four times a year for three years. Jon and his teachers offer intensive skill-based training for therapists.

Jon Frederickson is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to