This book must be one of the most comprehensive resources for CBT group programmes. Free has taken great trouble to incorporate a vast amount of information into the programme and has integrated trends in cognitive therapy over the last 30 years. The first cognitive therapy group programme developed by Free in 1999 was primarily a treatment for depression. Since then the programme has been developed to be an effective treatment for anxiety, depression, and anger problems. Free has developed the programme to conform to a number of trends evident in the provision of psychotherapy. These are: the provision of therapy in groups, the use of manual-based therapy, the use of a psycho-educational approach to psychotherapy, and tailoring the presentation of therapy to the needs and preferences of the client.

He begins by describing the theoretical foundations behind his programme, which has progressed from Beck's model to include the work of Ellis (rational emotive therapy) and the emphasis on absolutism. He includes schema approaches (Young, 2003) and early maladaptive schema. He also includes the English cognitive therapists (Clark, Wells, and Salkovskis) particularly around beliefs about bodily sensations and beliefs about strategies used to control bodily sensations.

The programme provides session by session protocols (available to purchasers as PowerPoint presentations) with handouts, screening questions and information for referrers on CBT. The programme is divided into 25 one-hour long sessions in five modules of 4–6 sessions. Module one (5 sessions) looks at “challenging surface beliefs and processes”. Module two (in 5 sessions) explores “beneath the surface” namely an individual's negative belief system. This covers schemas, downwards arrows, parenting styles, a master list of beliefs and developing individualized “cognitive diagnosis” i.e. cognitive formulations. Module three (4 sessions) then moves on to “testing beliefs” using adversarial analysis, investigatory analysis and scientific analysis. Module four looks at “changing your thinking and feeling” using countering techniques, propositional perceptual shifts, emotional shifts, schema rebalancing and imagery, strong-nurturing, self imagery, re-parenting and letter writing. The last module addresses “countering your counterproductive behaviour”.

Free is a CBT purist and in describing the sessions on “logical errors and appropriate logic” he states that the aim is to try to “change thinking by changing the logic of our thinking and to make it more accurate. The result is an alternative rational or logical, or objective, or true, thought or belief rather than the negative illogical, irrational automatic thought”. Whilst reading this I wondered whether to many therapists this terminology can now appear outdated and unhelpful for our clients. Many therapists now would baulk at using the term “irrational” and use a more gentle approach e.g. unhelpful. Therapies now often incorporate mindful/acceptance strategies and a lot of the work on “challenging irrational thoughts” perhaps is not carried out in such an ardent manner by contemporary CBT therapists.

An exclusion criterion for the programme includes “reading difficulties”. The demands for a high level of intellectual understanding became apparent as I read through the programme. Despite the session-by-session guide, this is not a book that can just be picked up and delivered in a manualized way by non-experienced practitioners. Group facilitators would need to have an excellent grounding in CBT, be able to explain highly complex concepts within a group context, and take a lot of time in preparing materials for the specific needs of the group. I was left wondering how this level of complex formulation work can take place in a group setting. Free comments that some clients need extra individual sessions to be able to keep up with the pace and demands of the group. The programme is very academic, intellectually and conceptually demanding, and I would be very interested to see how it is received in practice.

I would recommend the book as a very useful resource for planning a CBT group but I would add a word of caution that a lot of thought would need to be taken in how the materials are delivered and presented in an understandable and helpful manner.