Learning Cognitive-Behavior Therapy
The third chapter by Wright, Basco, and Thase (2017) discusses the strategies for assessing patients to decide whether they are suitable for cognitive-behavior therapy (CBT). Furthermore, the authors present the elements that help one to initiate and plan CBT for individual patients. In the first part of the text, Wright et al. (2017) list different indications and contraindications for the use of CBT (optimism about therapy’s success, acceptance of responsibility, and others). The scholars list and describe a variety of factors that make people more receptive to CBT. It should be noted that all dimensions that help or limit the effect of CBT are explained in detail with examples. Wright et al. (2017) also provide a number of conditions (dementia, antisocial personality disorder, and others) which are incompatible with this approach.
The second major point is the case conceptualization flowchart that demonstrates all pieces of information that one has to collect to create a treatment plan for the patient. With two case studies, Wright et al. (2017) show how these elements assist a clinician in developing a hypothesis and making concrete goals. Finally, the scholars point out that the data used for case formulation is not static and may change with time, prompting one to review the treatment plan and adjust it accordingly.
The mentioned above examples review cases of patients with anxiety and depression. Both vignettes employ the same technique of case conceptualization (formulation). The used worksheet contains pertinent patient data as well as an examination of three relevant scenarios. Here, the technique of analyzing automatic thoughts is presented to help patients and the clinician to see which particular behaviors and ideas have to be addressed with CBT.
The detailed explanation of each factor and step in assessing patients for CBT is the primary strength of this chapter. Wright et al. (2017) focus on the positive indicators for CBT, providing one with a clear picture of which cases will benefit from this approach. They also mention that all information is suitable for a short CBT program – this detail is vital for professionals new to the methodology. Moreover, the two provided vignettes present the most common conditions treated with CBT, and they include not only the information collected by doctors but also its analysis and conclusions (hypothesis and treatment plan). All techniques are referenced and linked for easy access, and minor elements of the worksheet are explained.
A potential weakness of this text is the lack of examples of case conceptualization for unusual or non-standard cases. While it is apparent that the authors focused on explaining the basics of CBT conceptualization, some mention of dealing with various uncommon situations could benefit the reader. Thus, the solution would be to create an additional vignette that would review a case of a person with complex conditions that are still approachable by CBT.
Overall, the chapter provides essential knowledge about strategies to assess patients’ eligibility for CBT and elements that are necessary for treatment planning. It presents the information is a concise and structured way, moving from patients’ characteristics to their analysis and clinicians’ further actions. The discussed examples show two of the most common conditions which are addressed using the same number of techniques. This allows one to see the versatility of CDT case formulation and note the strategies that doctors use to design individual plans.
The Case Formulation Approach
The fifth and sixth chapters by Persons (2008) extensively cover the process of case formulation and goal setting for patients starting CBT. The author takes a personal approach by guiding a reader through every step in building a relationship with the patient and designing an individual treatment plan. In the first of the two chapters, Persons (2008) discusses the stage of pretreatment and objectives that each clinician should complete before moving into the next phase. During pretreatment, a therapist has to start building a therapeutic relationship, obtain a diagnosis, develop an initial case formulation and a treatment plan, and inform the patients about the assessment’s results to obtain their agreement (Persons, 2008). Each goal is explained, and all challenges that may arise on these steps are acknowledged.
The author lists a variety of techniques in several vignettes, most of which consider the full process from the first meeting with the patient to the completion of the initial treatment plan. Significant attention is devoted to case formulation approaches, particularly the step of developing the hypothesis. Persons (2008) suggest selecting an anchoring disorder, choosing an EST for the disorder, and individualizing the template to fit a patient. Moreover, Persons (2008) lists learning, cognitive, and emotion theories and applies each one, as well as their combination, in examples. As a result, the reader gets acquainted with many approaches to assessing and planning for CBT.
The main strength of this text is its attention to detail and a narrative that guides the reader from one step to another. Every process related to the assessment is described and explained. Notably, Persons (2008) provides a rationale for every decision and shows why some small actions play a prominent role in CBT. Moreover, the abundance of examples and their analysis is another advantage of this work – complex cases related to depression, PTSD, anxiety, and MDD are discussed, and the author explains why a specific anchor disorder is chosen in each situation.
A potential weakness of the reading is the lack of a structured and systematic view of the main points and models. As the author chooses a narrative approach, it may be difficult for the reader to derive the most relevant information from the text. Persons (2008) also fails to provide templates that would assist clinicians unfamiliar with CBT assessment processes to develop a standard for working with patients in pretreatment.
The detailed first conversation with the patient presented in the case of Angela may lead one to adopt a formulaic process of talking to patients or limit one’s view of how first meetings can occur. To mitigate these problems, the text needs to contain a separate section with some key points, summaries, and worksheets. Moreover, a shorter description of prominent techniques and their distinction from the rest of the text can help focus one’s attention on the crucial knowledge.
To conclude, the discussed above reading painstakingly explains each action that a therapist has to complete during CBT pretreatment. It offers a rationale for every action and creates a thoughtful narrative of one’s approach to talking to patients. While it is abundant with useful information and examples, it fails to highlight the essential knowledge that can be derived from each segment. Nonetheless, it provides an insight into the pretreatment process and offers a variety of solutions and methods.
Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York, NY: Guilford.
Wright, J. H., Basco, M. R., & Thase, M. E. (2017). Learning cognitive-behavior therapy (2nd ed.). Arlington, VA.: American Psychiatric Publishing, Inc.