Cognitive Therapy in the Trenches

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Cognitive Therapy in the Trenches Clinical Applications of Cognitive Therapy. Arthur Freeman, James Pretzer, Barbara Fleming, and Karen Simon. Plenum Press, 1990.

This is one of the most useful books I have read in a long time! Freeman and his colleagues set out to write a book that would help practicing clinicians use the principles and techniques of Cognitive Therapy in their work with clients. In my view they have succeeded admirably. This is not a book to read once, but a reference work to be consulted repeatedly as one encounters unexpected difficulties with clients exhibiting a variety of problems. In addition, it provides a nice background to the basic principles of Cognitive Therapy, although at a level that presupposes some familiarity with the model. But the real strength of the book is its detailed descriptions of Cognitive Therapy techniques and their application to the solution of clinical problems, laced with numerous clinical examples.

The book is organized into four sections. The first section consists of one introductory chapter outlining the basics of Cognitive Therapy, including general principles and processes, complexities encountered, and misconceptions of Cognitive Therapy. Although this chapter is written at the introductory level, some familiarity with Cognitive Therapy through previous reading is helpful in putting this material in perspective.

Particularly helpful in this chapter is the section on the structure of a typical Cognitive Therapy session. The section on misconceptions is obviously a response to critiques of the model over the years. While some of the misconceptions seem to have arisen because of misunderstandings of the initial writings on Cognitive Therapy, I felt that some of the issues discussed in this section (e.g. "Cognitive Therapy ignores the past") represent an implicit expansion of the original Cognitive Therapy model.

The second section consists of five chapters on the clinical practice of Cognitive Therapy. There are chapters on clinical assessment, cognitive and behavioral interventions, and separate chapters on the treatment of depression, suicidal behavior, and anxiety, respectively. All chapters are characterized by detailed descriptions of techniques and numerous clinical examples illustrating the use of these techniques. Most of the assessment techniques are interviewbased, although there is a short section on traditional psychological testing. The authors are kinder to these traditional techniques than I might have thought, although there is a pronounced preference for interview-based methods. The next chapter, on cognitive and behavioral interventions, is one of the most useful in the book. The authors have described in detail many techniques (e.g., Guided Association/Guided Discovery, Externalization of Voices, Replacement Imagery, Behavioral Rehearsal), each description being illustrated with a sample client/therapist dialogue snippet Some of these techniques (e.g., decatastrophizing) are familiar from previous writings on Cognitive Therapy, while others (e.g., refocusing, considering the pros and cons) seem to have been adapted from other therapeutic systems and "cognitivised." Still others (e.g., inducing dissonance) seem to have been derived from experimental psychology. All in all, however, this chapter provides a rich cornucopia of therapeutic interventions and merits repeated reading.

The next three chapters on depression, suicidal behavior, and anxiety are similar in style. Each chapter consists of three sections. The first is assessment, which uses the DSM-III-R criteria as an organizing principle. The next section is conceptualization, where such topics as the origin of the disorder and cognitive assumptions/distortions are discussed. I was particularly impressed with the authors' attempts to integrate a cognitive conceptualization of these disorders with conceptualizations drawn from other models.

The third section, strategies for intervention, provides detailed descriptions of cognitive and behavioral techniques for treating the disorder, with brief clinical examples provided for most techniques. …