A Practical Approach to Cognitive Therapy

A Practical Approach to Cognitive Therapy Cognitive Therapy in Practice: A Case Formulation Approach. Jacqueline B. Persons. New York: W. W. Norton, 1989 (224 pp.). $22.95, (hardbound). Persons presents a cohesive and systematic model for clinicians who want more than just a collection of techniques. An emphasis is placed on treatment interventions based on a thorough understanding of client functioning. A special emphasis also is placed on the problems and setbacks encountered in practice typically not mentioned in other therapy books. Two words from this book's title characterize it best, "in practice." In the initial chapter, Persons describes the case formulation model that serves as the foundation for subsequent chapters. According to this model, psychological problems exist at two levels: overt difficulties and the mechanisms underlying the overt symptoms. Overt problems are comprised of three components-behaviors, cognitions, and moods-and are considered to be interrelated in that a problem in one componentusually indicates problems are present in the others. Consistent with the cognitive therapy perspective, Persons proposes that root dysfunctional beliefs are the central underlying mechanisms that generate overt problems. Chapter two is devoted to the clinical use of what Persons terms the "problem list." A problem list is simply a comprehensive listing of all the client's difficulties. Developing the problem list is considered the first step in utilizing a case formulation approach. An emphasis is placed on identifying objective measures of the behavioral, cognitive, and affective components of each problem on the list. In the third chapter, Persons outlines the nuts and bolts of developing and validating the case formulation. She points out that a key task is to identify the central underlying mechanism that accounts for the overt problems experienced by the client. A case formulation has six components: (1) the problem list, (2) a hypothesized underlying mechanism, (3) an explanation of the relationship between the underlying mechanism and problems on the problem list, (4) antecedents to current problems, (5) hypothesized origins of the underlying mechanism, and (6) predicted obstacles to treatment based on the formulation. Persons states that the fundamental purpose of the case formulation is to serve as a "compass" for guiding treatment planning decisions, selection of intervention points, prediction of client responses, and management of unforeseen complications. Chapters four and five contain the usual assortment of behavioral change techniques such as modeling, role playing, scheduling, relaxation, rewards and punishment, exposure, stimulus control, and exercise. …