Grappling With Difficult Issues in Clinical Practice: A Refreshing and Well-Balanced View of the Cognitive–Behavioral Approach to Case Formulation

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Reviews the book, Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases, edited by Nicholas Tarrier (see record 2006-09805-000). The book's approach to case formulation from a cognitive-behavioral perspective is framed by the first few chapters, which present a delightfully even-handed description of the history and role of case conceptualization in cognitive-behavioral theory, practice, and research. As the book points out, case conceptualization is an essential step between making a formal Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) diagnosis and choosing effective interventions. The argument is presented that DSM-IV-TR diagnoses are not sufficient for choosing effective interventions, as there is substantial variability between patients in symptom presentation and maintaining factors. One difficulty with cognitive-behavioral case conceptualization is that the therapist does not have access to the set of circumstances that provided conditioning for the behavior, neither does the therapist have direct access to the environment in which the patient's symptoms are maintained. The book then moves on, with chapters on individual disorders providing a detailed overview of research on the cognitive bases of and case conceptualization for anxiety, depression, complex posttraumatic stress disorder, schizophrenia, bipolar disorders, personality disorders, complex eating disorders, medically unexplained symptoms, insomnia, and self-harm. The book trails off with a chapter on conceptualization and formulation in supervision, leaving the reader with regret that there was not a final chapter providing an overarching summary of the book and pointing out future directions for theory and research. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

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