Abstract
Brian Sheldon’s Cognitive-Behavioural Therapy: Research and Practice in Health and Social Care (2nd ed.) offers a fairly comprehensive review of the position occupied by cognitive–behavioral therapy (CBT) within the canon of treatment methodologies in the field of behavioral health practice. Beginning with the history and development of CBT, Sheldon moves on to review the theoretical underpinnings, psychological assumptions, and brain science supporting CBT, including an analysis of unique features that set the model apart from other psychosocial therapies. The volume includes a review of the evidence basis for CBT and offers a discussion of assessment procedures and interventive techniques in common use within the model, illustrated by brief case vignettes as appropriate. Treatment of the procedural side of CBT within the book tends to emphasize behavioral techniques more than the cognitive. Throughout the book, Sheldon’s elegant and literate writing style is peppered with wryly humorous and idiosyncratic asides that keep the reader in a state of amused mild suspense, wondering where he or she is going to go next.
While all the content areas noted above might be expected in a book by this title, this volume also includes a considerable amount of material that may seem unexpected or occasionally even out of place. Examples may be found in Chapter 2, entitled “Research on the Effectiveness of Cognitive-Behavioural Therapy.” Although the chapter does a good job of reviewing the evidence basis for CBT, it also describes the early roots of CBT as a form of treatment for unipolar depression and subsequently moves on into a review of the epidemiology, etiology, diagnostic indicators, and alternative forms of treatment for this disorder, leaving the reader perhaps wondering what happened to CBT itself along the way. Bipolar disorder, anxiety disorders, and eating disorders are similarly reviewed in a manner reminiscent of an agency-based in-service training on psychopathology, with particular emphasis on the Diagnostic and Statistical Manual of Mental Disorders (DSM) categories of disorder for which CBT is most commonly recognized as the treatment of choice. Similarly, there is a surprisingly lengthy discussion in Chapter 6 (“Assessment, Monitoring, and Evaluation”) on research methodologies used for outcomes assessment, with particular emphasis on single system designs. Sheldon’s treatment of these topics sets a tone that continues throughout the remainder of the book: that it is mainly about the phenomenon of CBT, or its position and status within the behavioral health field, rather than an in-depth explication of its techniques and procedural nuances, from a more clinical perspective. Thus, for readers wanting to know a lot about CBT from a broad perspective within the social sciences, this volume could be ideal. However, those wanting a how-to book offering particular emphasis on technique and procedural explication might prefer to keep looking.
Sheldon’s scholarship and breadth of familiarity with the massive body of literature on CBT is skillful and generally well integrated into the author’s material throughout the text. He is himself an unusually credentialed practitioner and academic, qualified in psychiatric nursing and psychology as well as social work. While rare and exemplary, these qualifications may occasionally lead the author into temptation to express opinions supported more by professional reputation than by evidence. An example can be seen in the following passage: I have some reservations about the current fashion for dividing up the problems of childhood with quasi-medical syndromes (see DSM-IV-TR) and prefer (on good evidence) to see them as mainly clue to maladaptive learning experiences; failures of adequate parenting; poor education; and adverse group influence. Although taxonomies are an essential first step in understanding, giving something a name on the basis of its surface features and then implying that this is the cause does little to advance our clinical understanding. Not that there aren’t real syndromes (e.g. autism; Asperger’s syndrome) (see Sheldon & McDonald 2009: 314), nor that there are not background biological predispositions, but rather that most children with behavioural problems are where they are as a result of environmental conditions (p. 67).
Sheldon’s Cognitive-Behavioural Therapy: Research and practice in health and social care (2nd ed.) is a valuable book and a significant accomplishment but is probably not for everyone. It seems likely to this reviewer that the work would not be helpful for the majority of master’s degree candidates in social work who might find many of the author’s allusions beyond their scope (and possibly intellectually intimidating). Seasoned clinicians would probably find the tone and assumed level of a priori familiarity with the topic closer to their comfort level, but possibly of reduced interest, owing to a relative lack of emphasis on the nitty-gritty clinical and technique-based side of CBT (particularly the cognitive array of techniques). On the whole, the work resembles a journal literature review article on CBT, addressing a broad scope of CBT’s history, attributes, and aspects but expanded to book length. For those looking for a volume of this nature, this work could be a great time saver as a condensed source for reference material. For instance, for research scholars who are also deeply involved in practice, this volume could be a marvel and is enthusiastically recommended.