email page    print page

All Topic Reviews
A Mood ApartA Sadly Troubled HistoryActive Treatment of DepressionAdolescent DepressionAdult Bipolar DisordersAgainst DepressionAgents in My BrainAmerican ManiaAmerican MelancholyAn Unquiet MindArtificial HappinessBeating the BluesBefore ProzacBeyond BlueBiological UnhappinessBipolar DisorderBipolar Disorder DemystifiedBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar ExpeditionsBlaming the BrainBoy InterruptedBritain on the CouchCalm EnergyCase Studies in DepressionChange Your ThinkingChronic DepressionComprehending SuicideConquering Postpartum DepressionConquering the Beast WithinCry Depression, Celebrate RecoveryDamageDepressionDepressionDepression 101Depression and GlobalizationDepression and NarrativeDepression Doesn't Always Have to Be DepressingDepression FalloutDepression in ContextDepression Is a ChoiceDepression SourcebookDepression, Emotion and the SelfDepression, the Mood DiseaseDepression-Free for LifeDetourDiagnostic Issues in Depression and Generalized Anxiety DisorderDown Came the RainDowning Street BluesDysthymia and the Spectrum of Chronic DepressionsEight Stories UpElectroboyElectroshockEssential Psychopharmacology of Depression and Bipolar DisorderExperiences of DepressionFacing BipolarFast GirlFatal AttachmentsGetting Your Life BackGod HeadHandbook of DepressionHandbook of DepressionHello to All ThatHelping Students Overcome Depression and AnxietyHow Everyone Became DepressedHow I Stayed Alive When My Brain Was Trying to Kill MeHurry Down SunshineI am Not Sick I Don't Need Help!Journeys with the Black DogLeaving YouLet Them Eat ProzacLife InterruptedLifeForce Yoga to Beat the Blues--Level 1LifeForce Yoga to Beat the Blues: Level 2Lifting DepressionLifting the WeightLincoln's MelancholyLiving Without Depression and Manic DepressionLong ShotLucy Sullivan Is Getting MarriedMadnessMaking Sense of SuicideMalignant SadnessManiaManicManic DepressionManufacturing DepressionMelancholiaMindfulness for Urban Depression: Tools for Relief from Stressful City LivingMindfulness-Based Cognitive Therapy for DepressionMood GenesMoody Minds DistemperedMy DepressionNatural Healing for DepressionNew Hope for Children and Teens with Bipolar DisorderNew Hope For People With Bipolar DisorderNew Hope for People with DepressionNight Falls FastNovember of the SoulOn DepressionOn the Edge of DarknessOne in ThirteenOrdinarily WellOut of the BlueOutsmarting DepressionOvercoming DepressionPerfect ChaosPotatoes Not ProzacProzac and the New AntidepressantsProzac BacklashProzac HighwayProzac NationProzac NationPsychotic DepressionPuppy Chow Is Better Than ProzacQuiet Your Mind & Get to SleepRaising a Moody ChildReasons to Stay AliveScattershotSelf-CoachingSightlinesSilencing the Self Across CulturesSilent GriefSongs from the Black ChairSongs Without WordsSpeaking of SadnessSpontaneous HappinessStudent DepressionSubordination and DefeatSuicidal Behavior in Children and AdolescentsSuicideSunbathing in the RainSurvival Strategies for Parenting Children with Bipolar DisorderSurviving Manic DepressionSwing LowSylvia Plath ReadsTalking Back to ProzacTaming Your Inner BratThe Aesthetics of DisengagementThe American Psychiatric Publishing Textbook of Mood DisordersThe Anatomy of MelancholyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe BeastThe Bell JarThe Best AwfulThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Blue Day BookThe Breakthrough Depression SolutionThe Clinical Science of Suicide PreventionThe CorrectionsThe Cruelty of DepressionThe Depressed ChildThe Depression CureThe Depression WorkbookThe Devil WithinThe Emotional RevolutionThe Family SilverThe Feeling Good HandbookThe Forgotten MournersThe Loss of SadnessThe Memory of LightThe Mindful Way through DepressionThe Mood CureThe Myth of Depression as DiseaseThe Naked Bird WatcherThe Nature of MelancholyThe Noonday DemonThe Pits and the PendulumThe Postpartum EffectThe Secret Strength of DepressionThe Van Gogh BluesThe Van Gogh BluesThe Weariness of the SelfThe Years of Silence are PastThirteen Reasons WhyThis Close to HappyTo Walk on EggshellsTreatment for Chronic DepressionUndercurrentsUnderstanding DepressionUnderstanding DepressionUndoing DepressionUnhappy TeenagersUnholy GhostUnstuckViniyoga Therapy for DepressionWhat Goes UpWhat the Birds SeeWhat Works for Bipolar KidsWhen a Parent is DepressedWhen Nothing Matters AnymoreWhen Someone You Love Is DepressedWhen Words Are Not EnoughWhen Your Body Gets the BluesWhere the Roots Reach for WaterWhy Are You So Sad?Why People Die by SuicideWill's ChoiceWriting Through the DarknessYou Are Not AloneZelda

Related Topics
Treatment for Chronic DepressionReview - Treatment for Chronic Depression
Cognitive Behavioral Analysis System of Psychotherapy
by James P. McCullough
Guilford Press, 2000
Review by Jennifer Radden, D. Phil.
Nov 2nd 2000 (Volume 4, Issue 44)

As its title suggests, this book has a single, limited focus: a psychotherapeutic approach designed for one patient group (chronically depressed outpatients) which applies cognitive behavioral techniques to the specific end of changing these patients’ attitudes and behavior and teaching them problem solving and relational skills. Chronic depression is identified, the technique is described, and an evaluation of the technique’s success is included. This narrow focus is one of the book’s strengths. It provides a careful, close discussion, and a how-to for a therapist engaging in this work. For such a therapist, it would be a useful practical guide.

The book has other strengths. First, it gives a thorough and comprehensible account of the research about and profile of the chronically depressed patient, who suffers one or some variant on: dysthymic disorder, double depression (multiple episodes of depression), recurring major depression lasting two years or more without full recovery between episodes, or chronic major depression. Studies cited suggest these patients are high on neuroticism, defined here as poor emotional control, have poor social coping skills, and apprehendthemeselves the victim of outside forces such as fate, or socio-policitical factors. The characteristic of the chronic depressive which is the key to treatment, according to this author, is that he or she is stuck in the immature mode of what Piaget called ‘pre-operational’ thinking. Typically, such pre-operational thinking is found in young children. It is characterised by an inability to reason from cause to effect, for example, and an imperviousness to “logical reasoning and the reality-based views “ of others. The author’s thesis is that this patient group also lacks the ability to engage in these higher level cognitive functions and needs to be trained to engage in such functions.

Another strength of the book rests in its attention to outcomes and effectiveness. This is a characteristic we have come to expect of work in cognitive behavioural therapy, but it is no less deserving of praise for that reason. That said, despite elaborate efforts to evaluate effectiveness, the actual outcome measures are not as satisfactory as one might hope. The author establishes the outcomes by examining changes in such categories as “symptom intensity,” “coping style,” “psychosocial functioning” and “interpersonal functioning.” The enormous challenges involved in evaluating therapeutic success in any terms, behavioral or otherwise, can never be overestimated, of course. But the ‘softness’ of indices such as “coping style” and “interpersonal functioning,” and the narrow interpretation of these measures employed, is bothersome. Interpreted broadly, the behavior making up a response like “interpersonal functioning” opens itself to interpretation, subjective bias and other impediments to accurate measurement; on the other hand, interpreted in narrowly behavioral terms, “interpersonal functioning” becomes a parody of the multi-faceted, rich category that expression seems to connote.

Those interested to know how the author’s particular CBASP (Cognitive Behavioural Analysis System of Psychotherapy) differs from other forms of cognitive therapy such as Beck’s Cognitive Therapy or Klerman’s Interpersonal Psychotherapy will find some contrasts laid out in Chapter 12. Most of these are alleged to stem from the idiosyncratic pathology of the chronically depressed adult - although these other therapies, while not designed solely for the chronically depressed patient, can and have been applied to that patient population. But the author also contrasts the different aetiological theories underlying each model: CBASP is said to presuppose that depression arises from “faulty coping.. which results in perceptual disengagement of the patient from his/her environment,” while Cognitive Therapy focuses on “cognitive distortion of reality” and IPT “describes aetiology and psychopathology in both medical-disease and psychosocial (interpersonal problems) terms.” This chapter is somewhat helpful in placing the author’s particular innovations. But as these passages indicate, it offers a superficial and inadequate differentiation. (Cognitive distortion of reality might equally be said to result in perceptual disengagement, and both CBASP and CT can equally be described as employing medical-disease and psychosocial terms, for example)

With too many, and sometimes confusingly arranged categories, headings and sub-headings, this book lacks narrative flow and is difficult to read. The ‘discussion’ is often little more than a series of check lists - as if the chapters had been pasted together from the author’s slides. Slide presentations, when successful, are tied together by the narrative connections provided by the presenter’s voice over: but this unifying voice over is lamentably absent here.

To the philosopher, the frequent verbatim reports of and discussions about therapeutic exchanges which pepper this book manifest a troubling kind of misplaced concreteness, akin to that noted in the book’s efforts to evaluate outcomes and to the above mentioned problems of organization and narrative flow. The quicksilver of interpersonal exchange is not satisfactorily captured in this kind of writing, and the stiffness, artificiality and triteness of these verbatim passages and discussion of them makes reading them a frustrating exercise. Overall then, the book may prove a practical guide to therapists, but little more.

Jennifer Radden received her graduate training at Oxford University and is Professor of Philosophy at the University of Massachusetts, Boston Campus. She has a long-standing interest in issues concerning mental disorder and is currently President of the Association for the Advancement of Philosophy and Psychiatry. Her published work includes Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality (MIT 1996) and she has edited The Nature of Melancholy: From Aristotle to Kristeva (Oxford University Press).


Welcome to Metapsychology. We feature over 8200 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716