Book Review: Cognitive Behavioral Therapy for Clinicians

BOOK REVIEW

Cognitive Behavioral Therapy for Clinicians

by Donna M. Sudak; Philadelphia: Lippincott Williams & Wilkins, 2005 180 pages • $39.95 (paperback)

Reviewed by Michael E. Thase, MD

The model of cognitive-behavioral therapy (CBT) developed by Aaron T. Beck, MD, is widely considered to be the most influential development in psychotherapy in the latter half of the 20th century. It therefore may come as a surprise that, whereas there is no shortage of books on cognitive therapy (CT, the name preferred by Dr Beck), there continues to be a shortage of well-trained cognitive therapists, particularly outside urban centers and within public/community mental health settings.

The aim of Cognitive Behavioral Therapy for Clinicians, by Donna M. Sudak, MD, is to facilitate practitioners learning to use CT. This slender volume (180 pages, including text, appendices, and suggested readings) provides a concise introduction to CT and--one hopes--will whet the appetites of clinicians, encouraging them to take the next necessary steps to becoming competent cognitive therapists. For clinicians who do not want to learn how to use the therapy in practice, the book provides an efficient way to obtain an accurate and up-to-date overview of CT.

The book, part of the Psychotherapy in Clinical Practice series, contains 12 chapters, divided into 3 sections: "Foundations of Cognitive Therapy," "The Therapeutic Process and the Therapeutic Relationship in Cognitive Therapy," and "Cognitive Models of Common Psychological Disorders." Eschewing detailed summaries of the voluminous research on cognitive models of psychopathology and controlled treatment trials, Dr Sudak writes well and covers the essentials, with an apparent target audience of busy practitioners who care little about issues such as discriminant validity, alpha levels, and statistical power. The book's explicit message is that CT works and learning how to use it can improve the outcomes of patients.

The intellectual and emotional centerpiece of the book is case conceptualization, illustrated by the treatment of 3 fictional (but conceivable) patients. After a relatively cursory lead chapter on the history of CBT, each subsequent chapter interweaves didactics with illustrative case vignettes from "Mr White," "Ms Green," and "Ms Gray," who have sought treatment for chronic depression and panic disorder, as well as the amalgam of long-standing interpersonal difficulties, emotional dysregulation, and repeated self-injury that make up borderline personality disorder. As these patients progress--and sometimes stumble--in therapy, the reader can see that CT is a comprehensive system of therapy that builds on core therapeutic values by using a wide range of reliable methods to produce cognitive and behavioral change.

I have only a few minor issues with the book. First, although Dr Sudak does a nice job of sorting out some of the definitional and operational distinctions among various models of CBT, this book is primarily about Dr Beck's model of therapy--CT--despite the title.

A second issue is that, since Dr Sudak is a psychiatrist, I wish that she had spent more time describing applications of CBT in treatment of patients who have schizophrenia and bipolar disorder. A reader who does not know the literature would walk away from this book with the impression that CBT is just an adjunct to facilitate medication adherence, which is only a small part of its usefulness. Finally--although hardly the author's fault--the book is pricey for a small paperback and therefore is likely to be beyond the budget of many graduate students and trainees. Unfortunately, this may result in a missed opportunity to facilitate a connection with the next generation of therapists. Despite these shortcomings, this is an excellent brief description of CT that would be perfect for an introductory course on psychotherapy.

Disclosures:

Dr Thase is professor of psychiatry at the University of Pittsburgh Medical Center and the Western Psychiatric Institute and Clinic in Pennsylvania.