Cognitive Behaviour Therapy: A Guide for the Practising Clinician

Aimed at practising cognitive behavioural therapists, ‘Cognitive Behaviour Therapy’ offers eleven chapters of the newest developments in applying CBT to work with particular client populations.

Rating: 4.5

Cognitive Behaviour Therapy: A Guide for the Practising Clinician

By , 2002. ISBN 1583911049. Brunner-Routledge. xiv + 330 pages.

New Developments in Cognitive Behavioural Therapy

By its very nature, cognitive behavioural therapy evolves and develops over time, as growing empirical data and clinical experience with specific client populations suggest new tools and techniques, as well as new theoretical constructs, that can usefully be applied within the overall model of CBT. Intended for the cognitive behavioural therapist in practice, this collective volume edited by Gregoris Simos aims to cover some of these specific new developments in CBT treatment approaches.

Most of the chapters do an excellent job of keeping this target squarely in their sights, offering material that will be of immediate use to practising therapists who are already well versed in the cognitive behavioural approach but who will appreciate notes on applying CBT in specific contexts. I found Newman’s chapter on cognitive therapy for bipolar disorder especially interesting and useful for its sound recommendations for working with this challenging population. Other chapters provide useful insights on working with clients suffering from obsessive-compulsive disorder and those suffering from panic disorder. A chapter by Freeman and Jackson on suicidal behaviour is especially valuable for its practical tone, although the discussion sometimes moves along perhaps a little too easily, glossing over many potential difficulties.

A chapter on cognitive behavioural treatment for eating disorders, by Garner and Blanch, also merits this criticism, but even more so. Many chapters might be useful in and of themselves for a competent and confident cognitive behavioural therapist looking to develop their abilities to work effectively with the client group in question. For example, the chapter on depression (discussed below) makes a solid introduction, in and of itself, to working with depressed clients. The sheer volume of material that would have been required to cover eating disorders adequately, however, prevents the chapter by Garner and Blanch from fulfilling anything at all like that sort of role. To put it differently, unless you already know a great deal about working with clients suffering from eating disorders, I don’t think this chapter will help much.

‘Standard’ CBT, Too

Two chapters actually strike me as particularly solid examples of ‘standard’ cognitive behavioural theories and methods applied to specific populations: Kuehlwein’s opening chapter on depression and Dattilio’s chapter on couples and families. Given that cognitive therapy was first developed by Beck in the 1960s with depression in mind, and that depression probably represents the area where CBT has reached its greatest level of development and maturity, it shouldn’t be too surprising that Kuehlwein’s chapter seems to me to hold little that is particularly new. Dattilio’s chapter, on the other hand, while still drawing on now familiar CBT fare, is novel in that it explores applications to a group which has been much less well studied specifically in a CBT context, as well as investigating connections with some of the other approaches to work in this area.

Cognitive Behavioural Therapy and Clinical Application

Two other chapters, one by Young on schema-focused therapy for personality disorders and one by Morse on cognitive therapy for borderline personality disorder, significantly push the edges of CBT into comparatively new areas. While certainly useful, however, I personally found Young’s chapter disappointing, as it offers a profusion of theoretical entities and categories whose primary purpose seems to be theory-building, rather than actual clinical application. (Few of the clinical applications Young discusses actually make any reference to specific categories of schema laid out earlier in the chapter, reinforcing the impression that they play little role in real clinical work.)

I found myself disappointed in a different way with the chapter by Henin, Warman and Kendall on cognitive behavioural therapy with children and adolescents — not because it is somehow bad material, but because it doesn’t address the actual practice of working with children and adolescents in the same sort of way that other chapters address the actual practice of working with other groups. Rather, the chapter primarily reports on research findings concerning CBT and specific disorders such as obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, depression and attention-deficit hyperactivity disorder.

The book is also not without occasional ‘where did that come from?’ moments. For example, in discussing diaphragmatic breathing and progressive muscle relaxation techniques for generalized anxiety disorder, authors Newman and Borkovec suggest that “To help clients ensure that they are breathing from their diaphragm, they can place one hand on their diaphragm below their belly button and the other hand on their chest” (p. 155). While it’s easy to see that the exercise does achieve the authors’ desired effect, it’s also the case that for most people it is flatly impossible to place a hand on their diaphragm below their belly button!

Conclusion

Overall, however, the book certainly achieves its aims; my criticisms above notwithstanding, this is solid work, and I think it would be a valuable addition to the library of almost any cognitive behavioural therapist. While the book doesn’t promote itself as such, I also believe it would make an excellent resource for students, who will find that for the most part, each discussion grounds itself well in the cognitive behavioural literature and the well established body of cognitive behavioural theory.

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