Robert L. Leahy

Despite the efforts of therapists and patients, many patients in cognitive-behavioral therapy--or any therapy--do not improve. This unique book is designed to help the clinician better understand and work with patients who seem unable or unwilling to make needed changes. Integrating ideas from a range of psychotherapeutic approaches, the book presents a multidimensional model of resistance. It enumerates the specific impediments to change that may arise in the cognitive therapy context and brings each one to life with realistic clinical illustrations. Clinicians learn practical strategies and interventions to deal with a number of types of resistance, from reluctance to comply with basic cognitive procedures to risk-aversion and self-handicapping. Also addressed are countertransference issues, including workable ways that clinicians can modify their own responses to patients to overcome impasses in treatment.

Today, under pressure from managed care companies as well as from patients who are demanding briefer and more focused treatments, therapists are creatively combining cognitive and psychodynamic approaches and obtaining unprecedented therapeutic results. In this volume, Robert Leahy describes Aaron Beck's seminal model of depression, anxiety, anger, and relationship conflict and shows how each of these problems is handled by the cognitive therapist in the context of an interactive therapeutic relationship. Leahy demonstrates how uncovering resistance to change and using the therapeutic relationship enhances recovery and promotes rapid change. With concrete examples he shows how to implement all of the basic cognitive techniques, including: —activity scheduling —graded task assignments —exposure hierarchies —response prevention —challenging underlying schemas —thought monitoring Drawing from cognitive and dynamic orientations and taking into account the complexity of countertransference and resistance, this book is for today's clinicians who, rather than being wedded to a specific approach, are committed to a quick and successful therapeutic outcome. A Jason Aronson Book