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Review of "The Case Formulation Approach to Cognitive-Behavior Therapy"

By Jacqueline B. Persons
Guilford, 2008
Review by Beth T. Cholette, Ph.D. on Jun 16th 2009
The Case Formulation Approach to Cognitive-Behavior Therapy

This book is part of a series of Guides to Individualized Evidence-Based Treatment edited by author Jacqueline Persons herself.  In her own work, The Case Formulation Approach to Cognitive-Behavior Therapy, Persons focuses on the use of empirically supported therapies (ESTs) in treatment.  She begins by describing the various elements of case formulation and the empirical support for using this method in cognitive-behavioral therapy (CBT).  Persons then spends the first several chapters reviewing the major types of CBT protocols, including cognitive theories, learning theories, and emotion theories; I expect that for most clinicians, this information will serve largely as a refresher of their graduate work.

In Chapter 5, Persons begins to address the actual case formulation process, starting with the pretreatment consultation and assessment process.  She introduces Angela, a client whose history and eventual treatment provides a comprehensive case example throughout the book (other brief case vignettes are presented as well).   Using Angela's presentation as a model, Persons reviews in detail the process of building the therapeutic relationship, developing a problem list, and setting treatment goals.  Subsequent chapters expand on the use of the therapeutic relationship in CBT, including managing potential problems such as therapy-interfering behavior and therapist errors, making decisions within the therapy session, and handling nonadherence and treatment failure.  Persons also places a strong emphasis on the importance of monitoring progress, encouraging monitoring at the start and end of each session, and during the session, as well as over the longer term.

Like CBT itself, this book is precise, well-researched, and well-supported.  At the same time, however, I fear that it might also be fairly impractical for the average clinician.  Persons herself acknowledges in her Preface that the approach she describes is "difficult to implement."  I think this is an understatement at best.  For example, for her pretreatment consultation, she recommends a minimum of 2 sessions, but possibility up to 3-4 appointments--in our current managed care world, how is this feasible?  In my own practice setting (a college counseling center), 3-4 sessions is the maximum number of visits that many of our clients choose to make.  For psychologists who are following a more strict CBT model, Persons's recommendations may make sense, but many of us have come to adopt a more eclectic approach.  Although cognitive-behavioral therapists are definitely likely to find this book to be extremely useful, I believe that Persons could have reached a wider audience by allowing for a greater range of therapeutic interventions within her approach.


© 2009 Beth Cholette



Beth Cholette, Ph.D., is a clinical psychologist who provides psychotherapy to college students at SUNY Geneseo. She is also a Top 100 Reviewer at Amazon.com and the official yoga media reviewer for iHanuman.com.