Guidelines for the Systematic Treatment of the Depressed Patient

Abstract

LARRY E. BEUTLER, JOHN F. CLARKIN, AND BRUCE BONGAR: Guidelines for Systematic Treatment of Depressed Patient. Oxford University Press, New York, 2000, 455 pp., ISBN 0-19-510530-3. Guidelines for Systematic Treatment of Depressed Patient is first in a series of guidebooks whose goal is to provide mental health practitioners a framework to treat individuals with depressive disorders. It is written by three highly respected academic psychologists: Larry E. Beutler, editor of Journal of Clinical Psychology, and Professor at UC Santa Barbara; John F Clarkin, Professor at Cornell's Weill Medical College; and Bruce Bongar, Professor at Pacific Graduate School of Psychology. The volume is organized into six parts. In its 14 chapters work undertakes a scholarly review, largely of psychology literature, of state of art of treatment of depression. It presents senior author's life work, developing his theoretical approach to evaluation, treatment, and ongoing assessment of individuals with depression who seek comprehensive psychotherapeutic treatment from mental health professionals. Part I sets context by reviewing need for treatment guidelines in mental health and two already established U.S. depression guidelines: The Agency for Health Care Policy and Research (AHCPR) 1993 Depression Guidelines for Primary Care and American Psychiatric Association's 1993 Practice Guidelines for major depressive disorder in adults. Part II (one third of text) develops authors' theoretical framework that guidelines for treatment-relevant assessment must be viewed through lens of a traitlike dimensional (as opposed to categorical) approach to patients. In Chapter three, one of book's two strongest chapters, using a comprehensive and scholarly review of literature (including 57 pages of Tabular review of hundreds of studies) authors identify six patient qualities/dimensions critical for selecting and assessing treatment: functional impairment, subjective distress, perceived social support, problem complexity/chronicity, level of resistance, and coping style. Throughout rest of work, ten general classes of psychotherapeutic interventions are discussed in context of these six dimensions. Chapter four introduces authors' theoretical framework, Systematic Treatment Selection (STS), on which proposed comprehensive interventions are based. The STS model and two illustrative case examples are presented along with: (1) a comprehensive, but impractical, method of identifying and assessing dimensions, relying heavily on psychological testing; and (2) a system for using decision-tree logic to derive treatment planning, with available computer-assisted procedures. Despite authors' disclaimer that, the current guidelines were not developed to comply with political agenda or dictating philosophies of any specific group (p. …