This
book review first appeared in The Independent Practitioner (AIP Journal) Summer, 2009, pp.15-16.
The BACP own the copyright and it is reprinted here with their
permission.
Beck’s
Cognitive Therapy: Distinctive Features
Routledge
2009
ISBN
978-0415439527 £9.99
This
book sets out to provide a concise account of Beck’s work against a background
of his personal and professional history.
It is divided into two parts.
There are 15 short chapters which examine Beck’s contribution to
explaining psychopathology, and then 15 more looking at Beck’s suggestions for
the best methods of treatment. Within
each chapter the author also attempts to view each topic in the light of
current research and of other relevant theoretical or pragmatic positions. He attempts a lot in a mere 166 pages.
I
enjoyed this book. The author
communicates well, and the combination of the lightness of his style, and the
corset imposed by the series editor, mean that the chapters deliver substance
without crushing with impenetrable weight.
I found the first half of the book to be the most rewarding. Wills gives a clear account of Beck’s
contribution to the evolution of CBT theory.
Throughout this section there is a definite sense of an empirical
pragmatist at work, slowly moving away from psychoanalysis, using patient
statements to build hypotheses, then testing these hypotheses and refining
theory, starting with depression and then moving into other areas of
psychopathology. Amongst other things
Wills explains the use of imagery, the development of the different levels and
types of cognition, the role played by emotion (the ‘Royal Road to cognition’)
and the interaction with behaviour.
The
second part of the book outlines the classic CBT ‘treatments’ – case
formulation, homework assignments, thought records, structured and
goal-oriented activities to challenge and rebuild thinking and behaviour. The importance of the collaborative relationship
is discussed at length. The strength of
this section is that the author does provide snippets of recent research that
either validate or question particular approaches, although the practical
implementation of the strategies are barely touched on.
Another
strength
of the book is the sense that judgements are informed
by the realism of a practising therapist.
For example, in the chapter on formulation as a means of developing
focus for therapeutic work, Wills spells out the need for great sensitivity to
the client’s particular situation in order to avoid robotic implementation of
theory (‘CBT by numbers’).
Although
I enjoyed the book I have a few reservations about it. First, in some ways, I was surprised by the
lack of the specifically distinctive material for Beck. If Aaron Beck is the gentle angel of
cognitive therapy, Alert Ellis is the rough diamond. Of course, such descriptions are unhelpful
caricatures, but as I read this book I found that, for me, Ellis was always
lurking in the background, and I could hear attendees on training courses
asking: “Apart from differences in personality, what are the theoretical and
practical differences between Beck and Ellis?”
We occasionally have a specific answer – in chapter 7, for example,
where the differences between Beck’s ‘dysfunctional thinking’ and Ellis’s
‘irrational beliefs’ are discussed . We also learn the reasons why Beck was less
profligate with time and depth than his erstwhile psychoanalytic
colleagues. However, for a lot of the
time Beck’s distinctiveness has to be implied.
However ably Beck is described, the backcloth needs more substance for
his distinctiveness (the title) to be more fully appreciated.
My
second reservation concerns not the book’s execution, but its conception. I do hope I am wrong, but I found myself
wondering if this was a book in search of a target audience. I could not quite work out who it was aimed
at. The cover claims that it will appeal
to both newcomers and experienced practitioners wanting a succinct guide. Readers generally interested in Beck will
want far more on his life and background.
Equally, hard core CBT therapists may be disappointed by its
introductory nature. However, those undergoing
initial training in CBT will need a much more developed and practical approach
– the book Wills co-authored with Diana Sanders (Cognitive Therapy:
Transforming the Image, Frank Wills & Diana Sanders, Sage 2004) would
better suit their needs.
What
the book does well is give a brief introduction to Beck’s development, his
originality, his rigour, his pragmatism, and his
relaxed attitude about the ownership of ‘his’ model. Therapists who have some experience of using CBT,
and who wish to have their understanding of one of the founders of their
espoused model strengthened, will probably find this an informative and
enjoyable read. Equally therapists from
other backgrounds who are not looking for a CBT manual, but who wish to be more
informed about the work of one of the three most cited authors in the
counselling and psychotherapy literature, will find this concise book very
helpful.
_____________