KATE F. HAYS Working It Out: Using Exercise in Psychotherapy Washington, DC: American Association, 1999, xxii + 281 pp. (ISBN 1-55798-592-8, US$39.95, Hardcover) In this well-organized book, Kate Hays presents exercise as a important component of a multi-modal approach to therapy. The overall content is differentiated into four major sections, in the first of which Hays establishes the value of exercise. She defines her terms and lays the foundations of her rationale within the context of empirical research demonstrating the body-mind connection. The reader is then walked through various theoretical and philosophical perspectives on both therapy and exercise, and is asked to reflect upon his or her own beliefs and views. The second section moves from theory to the use of exercise as a therapeutic tool. Describing therapists as agents for change, (p. 37) Hays provides a model outlining the stages of change and assumptions therein. It is in this section that she points out the challenges encountered in using exercise in psychotherapy and defines the myriad issues related to using this approach with non-exercising clients. These involve the issues of helping clients begin an exercise program within a therapeutic context, the type and amount of exercise, and factors affecting beliefs about the efficacy of exercise (e.g., personal, social, cultural, interpersonal). Outlined in the third section are the Psychological Benefits of Exercise with Specific Populations, overviewing many common clinical populations and specific exercise-based treatment recommendations. Populations include those individuals suffering from depression, anxiety, post-traumatic stress disorder, eating disorders, and substance abuse, as well as less commonly clinical populations, such as those dealing with lifestyle issues, lifespan issues, and issues idiosyncratic to athletes. Each chapter includes Practitioner Recommendations that direct the therapist on the appropriate use of psychological techniques for that population, specific issues that may be encountered, options for application of treatment, and anticipated effects of exercise as treatment. The fourth section, Caveats and Boundaries, is just that, an important collection of chapters that did not find a place elsewhere in the book (though chapter 18 might fit in the previous section). The construct of boundaries is stretched to include boundaries on the physical limits of exercise, boundaries on the interpersonal and ethical limits of therapists and clients, and the boundaries of the professional disciplines involved in the ongoing integration of exercise and therapy. The first chapter in this section speaks to issues of moderation versus overuse of exercise, provides an excellent overview of models of overuse, and introduces the reader to constructs such as exercise deprivation and exercise degradation. The next chapter covers ethical issues and competency, including confidentiality, dual-- role relationships, self-disclosure, non-erotic physical contact, and the different traditions' perspectives on the ethics of sexual contact with present or former clients. Issues of diagnosis and third-party payments are also addressed. Hays wraps up this section with the steps a practitioner might take in order to further explore the field of sport psychology. The final section of the book constitutes a glossary of exercise and sport psychology terms and a number of appendixes. These include an outline for the development and expansion of a therapy practice that involves exercise, the history of exercise and sport psychology, and an exercise-related intake assessment. There is no major notion in the book that is not supported by a wealth of references to the literature of sport psychology or to the general field of psychology itself. As an author, Hays is very objective in her willingness to state clearly what empirical evidence does or does not exist for her assertions, acknowledging self report for its qualitative value. …