Book Review: Cognitive-Behavioural Therapy: The Case Formulation Approach to Cognitive-Behavior Therapy

Abstract

The Case Formulation Approach to Cognitive-Behavior Therapy Jacqueline B Persons. New York (NY): The Guilford Press; 2008. 273 p. US$35.00 Reviewer rating: Excellent Cognitive-Behavioural Therapy Trainees new to cognitive-behavioural therapy (CBT) often worry about their capacity to do the technical interventions for which CBT is best known. How does one use a thought record to change key assumptions? What is an exposure hierarchy, and how is it made? What is the best way to carry out behavioural activation? When they begin treating patients with CBT, they soon discover that the tough part of CBT is not really technique, but rather the choices the therapist makes during the therapy: choosing what to target, choosing when to do so, choosing which interventions would be the most fruitful. This book focuses on the decision-making tasks1' l(1 the therapist must make in the course of therapy. The case formulation approach to CBT is in contrast to the manual ized CBT protocols featured in research trials (those same trials, it must be said, that have established the evidence of CBT's efficacy in emotional disorders). Research trials typically treat highly selected groups with a single diagnosis, while the average therapist in practice is faced with patients with comorbidity, not otherwise specified diagnoses, or diagnoses for which there are no protocols. Further, the burgeoning number of treatment approaches to common disorders makes it hard for any therapist to know how best to treat their patient. The case formulation approach involves making a comprehensive list of the patient's problems, and developing hypotheses about how these problems relate to each other and to putative underlying mechanisms. These hypotheses are derived from the principles of the cognitive, learning, and emotion theories which currently underpin most empirically supported treatments for emotional disorders. The case formulation chosen will then guide the treatment targets and interventions, and guide the therapist in the management of the minute-to-minute interactions in therapy. An example: the case of lateness for a session can be understood in many different ways, depending on the person's case formulation. The patient with underlying beliefs relating to worthlessness (my needs don't matter) may have found it difficult to break away from a telephone conversation that will make her late for her appointment (cognitive theory). …