The recommendation of Cognitive Behavioural Therapy (CBT) as treatment of choice in mental and physical health has been prolific. It is thus now improbable that therapeutic practice at any level within the NHS or private health sector negates the need to have a basic grasp of what constitutes a CBT intervention. This noted, the plethora of texts and research published relating to CBT have generally taken the form of simplified manuals designed to be either entry level for both client and practitioner, such as Greenberger and Padesky (Reference Greenberger and Padesky1995) Mind over Mood or specific intervention manuals geared toward experienced clinicians, such as Wells' (Reference Wells1997) Cognitive Therapy of Anxiety Disorders or Beck's (Reference Beck1995) Cognitive Therapy: basics and beyond.
With this in mind, a publication written to perhaps satisfy the niche between these polarized stand points is a timely addition to the field: co-authored by one of the editors of an essential companion to mental health, CBT for Psychiatry (Hawton, Salkovskis, Kirk and Clark, Reference Hawton, Salkovskis, Kirk and Clark1989), it is initially difficult to disentangle expectations of the authors from a true critical appreciation of this text. However, it is evident early on that this introduction comprehensively encapsulates many aspects of the skills and applications of CBT, with an additional impression of process issues within therapy.
A brief and accessible overview of the emergence of CBT and its distinct characteristics is embedded within the wider psychological context, providing a firm basis for introducing the concept of CBT. Readers are addressed directly throughout the text and prompted to generate examples and reflections in relation to the issues discussed, thus gently socializing the reader to the treatment model and neatly modelling the beginnings of a CBT therapeutic intervention. Clear and coherent rationale of the approach underpins chapters that range from “The therapeutic relationship” and “The wider applications of CBT” to specific cognitive and behavioural techniques. A strong evidence base is drawn from the broad field of psychotherapy, referencing material by the likes of Teasdale, Safran and Beck, whilst firmly maintaining integrity to the CBT model.
Chapters on “Assessment and formulation” and the “Socratic method” outline helpful stock phrases and treatment protocol for the less confident clinician, and illustrate the point for clients or allied professionals who may be new to the approach. An enlightening subsection, “Myths about CBT”, attempts to debunk and review issues concerning the relevance of the therapeutic relationship, the perception of CBT as mechanistic, and the fairly prevalent assumption that CBT is only for “straightforward” clients who wish to dissipate current symptoms and actively “deny” or “repress” salient emotional experience. This quest of myth quashing does much to demystify popularist ideas of CBT (albeit briefly), although the recommendation of offering more sessions to those deemed less emotionally literate would do little to sway belief that CBT is only for the “psychologically minded”. Throughout the text, psychological language commonly used within psychotherapy, such as “transference” and “the unconscious”, is translated and explained within a cognitive framework, acknowledging the contribution of other approaches whilst striving to illustrate the depth and complexity of this approach.
In relation to the practical applications and implications of working therapeutically, chapters are dedicated to measurement and evaluation of therapeutic interventions as well as reviewing alternative treatment delivery options. In keeping with the evidence-based approach of the book, these chapters present clear rationale and method for monitoring and evaluating clinical effectiveness, and troubleshoot common methodological difficulties associated with these necessary tasks.
The importance of supervision is interwoven throughout the chapters, often deferring difficult decisions and complex cases to the safety and shared responsibility of the supervisory relationship. To draw these strands together, the closing chapter on “Using supervision in CBT” offers a concise overview of modes and methods of supervision and highlights difficulties and disparities that may be faced within this complex relationship.
This book has been published at the optimum time when references to CBT are ubiquitous, and understanding the principles of this widely publicised intervention is essential. Although billed as an “introduction” to CBT skills and applications, this under-sells it somewhat. A fine balance of the evidence base, therapeutic reflections and the practicalities of the key components of intervention promotes this text to a higher level of sophistication. Westbrook et al. simplify and enhance understanding of the approach, inducting the reader into the common quandaries and complexities of interpersonal interactions, when one of two is assuming the role of a clinician in a position of power.
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