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Eoin Stephens (Ireland)
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Fight Your Dark Shadow: Managing Depression with Cognitive Behaviour Therapy
Fight Your Dark Shadow: Managing Depression with Cognitive Behaviour Therapy
by Therrie Rosenvald
Edition: Paperback
Price: £19.89

4 of 4 people found the following review helpful
5.0 out of 5 stars An excellent resource, 24 Sep 2008
As a practicing counsellor and trainer of counsellors I frequently find myself recommending this book. It is an excellent resource for anyone who wants to understand the principles of Cognitive Behavioural Therapy in order to help either themselves or someone else who is struggling with depression. It is clearly and engagingly written, but its real strength lies in the power of the wonderful illustrations, which capture something which words cannot.

Although this is written as a self-help book, in my experience it can also be useful to therapists as a practical introduction to working with depression using CBT. In some cases, therapist and client can work together using the book as a resource. CBT is, after all, an educative process where therapist and client collaboratively discover what will work best for the client's improvement (indeed, all psychotherapy can be seen as a form of structured experiential learning). A book like this can be a useful map for a part of the journey.

Eoin Stephens


Facing the Shadow: Starting Sexual and Relationship Recovery: A Gentle Path to Beginning Recovery from Sex Addiction
Facing the Shadow: Starting Sexual and Relationship Recovery: A Gentle Path to Beginning Recovery from Sex Addiction
by Patrick J. Carnes
Edition: Paperback

4 of 4 people found the following review helpful
4.0 out of 5 stars Working with Sexual Addiction, 2 Nov 2007
It is becoming increasingly important for counsellors and psychotherapists to educate themselves about the issue of Sexual Addiction, which can be defined as out-of-control and damaging sexual behaviour in relation to Internet sex, prostitution, telephone sex, multiple affairs etc. Modern society provides a huge range of options for artificially enhanced, relatively impersonal sexual stimulation, and in our counselling practices we are more frequently meeting clients who may be addicted in some of these areas.

I recommend this new 2nd edition of Carnes' book as an introduction to the subject. Carnes has been the field leader in Sexual Addiction counselling since publishing "Out of the Shadows" in 1983, and the present book accessibly summarises his thinking about the problem, along with approaches for helping those who may be struggling with it. The main addition since the 1st edition is a more detailed exploration of the growing phenomenon of Cybersex (Internet sex) addiction.

Having been involved in the development of addiction treatment/recovery in the USA for many years, Carnes' thinking is a blend of influences taken from 12-Step programmes such as Alcoholics Anonymous and Sex & Love Addicts Anonymous, from Cognitive-Behavioural techniques such as written inventories and challenging core beliefs, and from relevant neurobiological findings. He has a deep understanding of the nature of Addictive Behaviours over and above the familiar example of Chemical Dependency, and his key contribution to the field may be his description of the Sexual Addiction Cycle, where Preoccupation leads to Ritualisation, which leads to addictive Acting Out behaviours; the Pain arising from this acting out can then be numbed by further Preoccupation, which closes the self-perpetuating cycle.

Carnes is also known for his Tasks approach to recovery. In this book he focuses on what he sees as the first 7 recovery tasks:

1. Breaking through denial
2. Understanding addiction
3. Surrendering to the process
4. Limiting damage
5. Establishing sobriety
6. Ensuring physical integrity
7. Participating in a culture of support

In earlier books he included Reducing Shame, which he now leaves until the second phase of recovery. My own experience, and those of many other therapists working with the Centre for Sexual Addictions, is that it is important to address the issue of shame and self-hatred at an early stage. Clients may see themselves and their sexuality in a very negative light, perhaps partly due to the negativity towards sexuality which has been a part of Irish culture, and may be in danger of trying to force themselves into the opposite extreme of complete avoidance and denial of sexuality (Carnes is alert to this danger, calling it Sexual Anorexia, and he has written an important book on the subject, entitled "Sexual Anorexia: Overcoming Sexual Self-Hatred").

Perhaps the main strength of this book is that it can be useful to both therapist and client alike, and while I have never worked through the whole book with any client, we can together make productive use of some of the handouts/exercises/inventories (for instance, the Consequences Inventory).

Eoin Stephens is Director of Education & Training at PCI College, and at the Centre for Sexual Addictions ([...] a division of the Institute for Behavioural & Mental Health ([...]


Formulation in Psychology and Psychotherapy: Making Sense of People's Problems
Formulation in Psychology and Psychotherapy: Making Sense of People's Problems
by Lucy Johnstone
Edition: Paperback

22 of 27 people found the following review helpful
5.0 out of 5 stars Case Formulation, 31 Oct 2007
Case Formulation is defined by Persons (1989, p. 37) as "...a hypothesis about the nature of the psychological difficulty (or difficulties) underlying the problems on the patient's problem list". Case Formulation in psychotherapy appears to have developed out of the longstanding medical practice of Diagnosis-plus-Treatment-Planning, especially in a psychiatric context. It consists of a hypothesis concerning the aetiology and maintenance of the client's presenting problem(s) and, consistent with this, a plan as to when, where and how to intervene, with a view to bringing about some reduction in troubling symptoms. In therapeutic practice, the case formulation guides and structures the course of therapy by unifying and prioritising presenting issues, influencing the choice and timing of interventions, and predicting possible problems.

This book addresses the growing interest in this idea amongst counsellors and psychotherapists as well as psychologists and psychiatrists. The principal authors, both clinical psychologists, suggest that "Although it is arguably central to the implementation of any psychological intervention, it has until recently been a neglected area of research, training and publication" (p. 1).

They look at a variety of definitions of Case Formulation, and conclude that "...the common elements are that a formulation provides a hypothesis about a person's difficulties, which draws from psychological theory" (p. 4), and that its primary function lies in "...helping to select and guide the interventions" (p. 7).

Looking at case formulation from a variety of perspectives, including Cognitive-Behavioural, Psychodynamic, Systemic, Social Constructionist and Integrative, the authors explore such themes as

* Formulation and Collaboration
* Formulation and Reflective Practice
* Formulation and the Therapeutic Relationship
* Formulation and Context
* Formulation and Integration
* Formulation and Diagnosis
* Formulation, Evaluation and Evidence.

The authors apply the Case Formulation approach to two case studies from the perspective of each of these different schools. This brings the book to life, and makes it an interesting exploration of the current state of the various schools, along with the possibilities for integration.

The process of Case Formulation is of course not carried out explicitly in all forms of counselling/therapy. Rogers, for instance (1951, p. 223), considers that "a diagnosis of the psychological dynamics is not only unnecessary but in some ways is detrimental or unwise." He is concerned that the process of making a diagnosis leads to an inequality in the power dynamic between counsellor and client. However, all therapeutic intervention must presumably be based on some hypothesising and planning of the type outlined above, even if it remains implicit.

In contrast, Cognitive Behavioural Therapy, in my experience, is very comfortable with the Case Formulation process. At its simplest level a CBT formulation focuses on Negative Automatic Thoughts which are locked into vicious cycles with dysfunctional emotions, behaviours and somatic symptoms. It can also be expanded to include more ongoing dysfunctional underlying cognitions in the form of Assumptions and Core Beliefs.

According to Persons (1989) a cognitive case formulation should be

* arrived through collaboration between the therapist and the client
* readily understandable by clients
* grounded in empirical research
* open to disconfirmation
* parsimonious.

Johnstone & Dallos also outline the Case Formulation approach from a Psychodynamic perspective (focusing on Defenses, Capacity for Insight, Ego Strength, Capacity for Emotional Self-Regulation, Modes of Relating), and from a Systemic perspective (Deconstructing the Problem, Problem-maintaining Patterns and Feedback Loops, Beliefs and Explanations, Transitions, Emotions and Attachments, Contextual Factors).

Most interesting in relation to the theme of this issue of Éisteach, however, is their exploration of

* The Social Constructionist approach, which they see as "...a process of ongoing collaborative sense-making rather than one of developing objective or semi-objective descriptions..." (p. 102).
* The Social Inequalities approach, which focuses on questions such as who has power in relationships, and what discourses are at work in a particular case.

Overall, this is a timely, thought-provoking and useful book, for both students and experienced therapists.

References:
Persons, J.B. (1989) Cognitive Therapy in Practice: A Case Formulation Approach. New York: W.W. Norton.


Overcoming Obsessive-Compulsive Disorder: A Books on Prescription Title (Overcoming Books)
Overcoming Obsessive-Compulsive Disorder: A Books on Prescription Title (Overcoming Books)
by David Veale
Edition: Paperback

37 of 40 people found the following review helpful
5.0 out of 5 stars For therapists and clients, 30 Oct 2007
This book is part of a very useful series published by Robinson, each of which looks at applying CBT to a particular area of Mental Health (Anxiety, Depression, Low Self-Esteem, Anger & Irritability etc). Each book is written by a leading practitioner/researcher in the particular area of concern. Having now worked with CBT for many years, I believe that it is at its most useful when dealing with some of these specific Mental and Behavioural Health issues.

Although they are written as self-help books, in my experience they can also be useful to therapists as a practical introduction to working with a problem area. In some cases, therapist and client can work together using the book as a resource. CBT is, after all, an educative process where therapist and client collaboratively discover what will work best for the client's improvement (indeed, all psychotherapy can be seen as a form of structured experiential learning). A book like this can be a useful map for a part of the journey.

In this particular book, David Veale and Rob Willson outline the nature of OCD and the CBT approach to working with it. They point out that the use of the word "obsession" in everyday usage is different from its meaning in the context of OCD. Here it refers to any distressing thought, image or urge, "...associated in the person's mind with the power to prevent harm occurring" (p. 10). Such obsessions are therefore associated with Safety-seeking Behaviours (an important concept in the CBT of any Anxiety Disorder) which tend to maintain the obsession.

Other important concepts described are
* The over-importance of thoughts.
* Inflated responsibility & Magical thinking.
* Overestimation of danger.
* Perfectionism.
* Attention biases.

In relation to recovery from OCD, the main approach described is that of Response Prevention, which has been well established in the evidence base for quite a long time as one of the most effective ways of working with these issues. Veale and Willson sum up the process as follows:
1. Develop a hierarchy of triggers
2. Face your fear
3. Make exposure long enough
4. Make exposure frequent enough
5. No anxiety-reducing strategies
6. If you do a ritual, repeat the exposure
7. Monitor progress

Other approaches described include the "Theory A & Theory B" approach, where different possible interpretations of the client's thoughts and feelings are tested using behavioural experiments, and Mindfulness Meditation, which is now being incorporated into CBT approaches to a number of problems, including Chronic Pain and Depression.

The authors also include some useful forms in the appendices, in relation to both assessment and treatment.


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