The Mind in Therapy: Cognitive Science for Practice

KATHERINE D. ARBUTHNOTT, DENNIS W. ARBUTHNOTT and VALERIE A. THOMPSON The Mind in Therapy: Cognitive Science for Practice Mahwah, NJ: Lawrence Erlbaum, 2006, 432 pages (ISBN 0-8058-5675-7, US$49.95 Paperback) Reviewed by DAVIDJ. A. DOZOIS

Cognitive science has undoubtedly contributed importantly to our understanding of adaptive and maladaptive human functioning and will increasingly continue to do so. Basic cognitive science offers a tremendous wealth of knowledge about various processes and mechanisms that are fundamental to a client's functioning, a therapist's efficacy, and the client-therapist interaction. Among other forms of psychological interventions, cognitive therapy has explicitly adopted constructs and adapted methodologies from cognitive science and has evolved conceptually and clinically as a result of this empirical work (cf. Clark & Fairburn, 1997). As McFaIl and Townsend (1998) cogently argued, however, most clinical psychologists focus on idiographic solutions to a client's problems and pay less attention to the nomothetic solutions that pertain to a broader range of issues: "It is as if the two worlds of psychology not only moved in independent orbits, but also occupied different corners of the universe. Many clinical psychologists seem unaware of and unaffected by developments and discoveries in the nomothetic world, even when these potentially could help them understand, assess, treat, predict, and prevent psychopathology and other suffering" (p. 325). Clinical science and practice, they contend, would benefit from greater integration with cognitive science.

In The Mind in Therapy: Cognitive Science for Practice, Arbuthnott, Arbuthnott, and Thompson attempt to bridge this gap by grounding psychotherapy in basic cognitive science. They do not intend to do so in the way that empirically based treatment does (i.e., by demonstrating what works for which particular psychiatric difficulties or by examining what are the effective ingredients of therapy) ; rather, their text applies the conceptual underpinnings of cognitive science, and its empirical findings, to particular practical issues. This book is thus timely, innovative, and interesting.

In 16 chapters, the authors review different areas of cognitive research and emphasize findings relevant to the theoretical and applied aspects of psychotherapy. An overarching objective of the book is to better inform practitioners about some of the key cognitive variables that impact clients, therapists, and the therapy process. Each chapter begins with general definitions of key terms and explains how various cognitive constructs, and the research literature surrounding them, are important to psychotherapy. Many chapters also include case illustrations to translate these concepts into application.

In Chapter 1, the authors make the case that cognitive processes are essential to all forms of psychotherapy in that they provide the pathways for treatment change or set up constraints to psychotherapeutic intervention. In the second chapter, Arbuthnott and her co-authors contextualize the processes and methods of psychotherapy within the framework of problem-solving. They review the literature on what facilitates effective problem-solving and how to overcome deficits and impasses. Chapter 3 provides a good review of memory retrieval and priming. The issue of how past memories are activated is described, vis-�-vis an associated network, and recommendations are made for how therapists might elicit and reframe a client's autobiographical memories in the most effective manner possible. The literature pertaining to autobiographical memory, the "lifeblood of psychotherapy" (p. 55) is further elaborated upon in Chapters 4 and 5. Common errors in autobiographical memory (e.g., overconfidence, schematic knowledge errors) are also described and the implications for therapists highlighted. In Chapter 6, prospective memory is discussed in the context of between-session extratherapy tasks. The authors state that therapists often assume that the failure to complete homework is due to motivational issues when this problem may, instead, be related to prospective memory lapses. Although this is an interesting proposition, it does beg the question of whether particular homework assignments may not be important enough to clients if they need additional cues to trigger memory for task completion. The literature on attentional processes, category judgment, decision-making and reasoning, counterfactual thinking and meta-cognition are then addressed in a series of very interesting, thought-provoking and well-written chapters (Chapters 7-12). The dynamic relationship between cognition and emotion is also described as it pertains to attention, memory, judgment, and emotion regulation (Chapter 13). The benefits and limitations of cognitive and behavioural inhibition are outlined in Chapter 14. Basic cognitive processes are then applied to the understanding of some of the major principles and tenets of psychodynamic therapy (Chapter 15). Although intriguing, the inclusion of this chapter stood out as a bit curious in my opinion. The theme of the book is how cognitive science is relevant to the process of psychotherapy regardless of one's theoretical orientation. Why the authors chose to demonstrate specifically how cognitive science maps on to extant psychodynamic principles is not clear. They argue that "cognitive theory has been of special benefit to psychodynamic theory" (p. 327), the meaning of which is vague (i.e., the authors could be stating either that psychodynamic therapy has benefited most from cognitive science or that this approach has the most to gain by incorporating cognitive science within its theory and practice and establishing a more sophisticated empirical base). If the authors are referring to the latter, they are likely correct; psychodynamic theory would indeed benefit from the refraining of constructs proposed by Arbuthnott et al. in that it would help to separate what is congruent with basic cognitive functioning and what it not. However, the focus on this modality of treatment to the relative exclusion of others is not entirely consistent with the broad approach of the book. Moreover, the vast knowledge base of clinical cognitive science (which has been applied to cognitive therapy and continues to influence its development) is underdeveloped in this text. It would also have been nice to have read some discussion about the use of cognitive methodologies in the assessment of treatment outcome (e.g., Segal, 1997). The final chapter summarizes the literature and attempts to address the question, "So how are therapists to proceed?" Recommendations are provided for how to apply the findings from cognitive science to various stages in therapy (initial session, diagnosis, treatment planning, intervention, and termination). The authors appropriately qualify this chapter, stating that the suggestions they provide are necessarily speculative given that so little integrative work has been conducted in this area. Nonetheless, the recommendations are solidly placed within the framework of basic cognitive processes and are worth considering.

The goal of the book - to increase clinicians' understanding of the cognitive processes and mechanisms involved in therapy and to encourage practitioners to integrate this knowledge within the treatments that they provide - is certainly achieved. A selling feature of this book is that it does start to bridge the gap between cognitive science and clinical practice. Being a scientist-practitioner involves not only paying attention to what works in therapy (i.e., the treatment outcome literature) but also having a firm conceptual and empirical grasp of the mechanisms involved in assessment and treatment. This book facilitates such an understanding. Practitioners who read this text will be more cognizant of the cognitive processes that influence treatment and, rather than having these processes impact therapy in automatic, unintended, and potentially harmful ways, may be more deliberate in their use of cognitive mechanisms in therapy.

[Reference]

References

Clark, D. M., & Fairburn, C. G. (Eds.). (1997). Science and practice of cognitive-behavioural therapy (pp. 119-154). New York: Oxford University Press.

McFall, R. M., & Townsend, J. T. (1998). Foundations of psychological assessment: Implications for cognitive assessment in clinical science. Psychological Assessment, 10, 316-330.

Segal, Z. V. (1997). Implications of priming for measures of change following psychological and pharmacological treatments. In H. H. Strupp, L. M. Horowitz, & M.J. Lambert (Eds.), Measuring patient changes in mood, anxiety, and personality disorders: Toward a core battery (pp. 81-99). Washington, DC: American Psychological Association.

[Author Affiliation]

Katherine D. Arbuthnott is Professor of Psychology at the University of Regina. Her research interests include inhibitory processes in attention, memory, and behavioural control and memory accuracy. Her work has recently been published in the Canadian Journal of Experimental Psychology and Memory & Cognition.

Dennis W. Arbuthnott is a therapist in private practice in Regina. He has written articles published in Thinking & Reasoning, Journal of Memory and Language, and the Canadian Journal of Experimental Psychology,

Valerie A. Thompson is Professor of Psychology at the University of Saskatchewan.

David J. A. Dozois is Associate Professor in the Department of Psychology at the University of Western Ontario. His research focuses on cognitive vulnerability to depression. He also maintains a small private practice.