Solution-Oriented Therapy for Chronic and Severe Mental Illness

Here Robert Leahy has edited a lively casebook companion to his 1996 text, Cognitive Therapy: Basic Principles and Applications. If the strength of his first book was its sound presentation of the theory and methods of cognitive therapy, the strength of this second volume lies in the rich detail of case material provided by the masters-in-action, the 20 contributors who bring theory and method to life. This casebook displays the coming of age of cognitive therapy. It presents the versatility and creativity with which these seasoned therapists have learned to apply the essentials of cognitive therapy to a widening range of disorders (such as double depression, hypochondriasis, posttraumatic stress disorder, and substance abuse) and special populations (such as patients with sexual dysfunction, psychotic disorders, and HIV risk behaviors). Leahy has arranged the 20 chapters in three sections, covering theory, applications to disorders, and applications to special populations. Each chapter blends introductory background material with extensive case material that is likely to enlighten the advanced as well as the intermediate therapist. For example, Newman's chapter on substance abuse introduces the seven components of the substance abuse model and then follows their application through the artful treatment of “Della.” Leahy's chapter on resistance presents his “portfolio” approach to the cluster of obstructing automatic thoughts and schemas that too often thwart the best efforts at change. Greenberg shows how the essentials of treating depression can be adapted to address the personality issues that contribute to “double depression.” The section on special populations and issues stretches the conventional boundaries of cognitive therapy in several new directions. Epstein's chapter, Marital Conflict, introduces the concepts and the structure of cognitive therapy applied to marital relationships. This chapter may persuade the curious therapist to make the leap from cognitive therapy of the individual to cognitive therapy of the couple, but for guidance on techniques and applications to other intimate relationships the therapist will need to look further into the chapter' s references, which omit one of the major works in this area, Beck's Love Is Never Enough (1988)—forgivably, I suppose, since the rest of the volume is laced with references and tributes to Aaron “Tim” Beck. Leahy follows Epstein's chapter on marital therapy with Friedman's on sexual dysfunction, reaching more specifically into this dimension of couples therapy and demonstrating how cognitive therapy can modify the dysfunctional thoughts that accompany the most common forms of sexual distress. Countering the long-standing assumption that psychosis resists cognitive interventions, Karg and Alford's chapter, Psychotic Disorders, presents examples, refers to case reports, and cites a few small studies in support of the efficacy of cognitive interventions for disorders of thought content, thought process, and perception. This is an exciting chapter because it shows familiar techniques, such as “perspective taking,” operating in unfamiliar terrain. The terrain is more uncertain, of course, but the needs are great and the gains are particularly valuable where little else works, as in the modification of delusions. In a similar vein, the chapters on HIV risk behavior and physical disability take our cognitive therapy skills into new terrain. These excursions create a picture of cognitive therapy as the most versatile and resilient tool of all the recent innovations in the psychotherapy marketplace. There are several things that this casebook is not. First, it is not a book for beginners because it does not attempt to lay the groundwork for these interventions in any comprehensive fashion. Beginners should start with Leahy's first book, Cognitive Therapy: Basic Principles and Applications, supplemented by workbooks such as Burns's Feeling Good Handbook or Greenberger and Padesky's Mind Over Mood. Second, Practicing Cognitive Therapy is not a research text, nor does it attempt to defend its interventions with evidence from the research literature. Although each chapter contains from 7 to more than 60 selected references, providing ample guidance for further reading, this book aims at intermediate and advanced cognitive therapists interested in tuning up their techniques and broadening their range of applications. It does a good job of hitting this target.