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Cognitive Therapy of Personality Disorders, Second Edition
Reviewed by PEDRO RUIZ
Am J Psychiatry 2007;164:1124-1125. doi:10.1176/appi.ajp.164.7.1124
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by Aaron T. Beck, Arthur Freeman, Denise D. Davis, and Associates. New York, Guilford Press, 2003, 412 pp., $49.00, $25.00 (paper).

About 14 years have passed since the first edition of this book was published. During this period, the use of cognitive therapy for the treatment of personality disorders has continued to expand extensively; thus, the authors felt that it was time to update their book based on the new knowledge, expertise, and skills learned since the first edition was introduced to the field.

This decision led to the enlistment of a cadre of top experts from the field of cognitive therapy, not only from The Center of Cognitive Therapy of the University of Pennsylvania, but also from therapists who were trained in this center and were practicing across the United States as well as in England. I should emphasize that this group of professionals constitutes the best that the field can offer vis-à-vis cognitive therapy for personality disorders. Contrary to most edited books, all of these experts made their contributions as authors of the book. In total, there were three main authors, Aaron T. Beck, M.D., Arthur Freeman, Ed.D., and Denise D. Davis, Ph.D., and 10 contributing authors. Finally, one of the authors reviewed the entire manuscript in order to ensure continuity in style, language, and content. This approach helped to avoid disparate or redundant discussions as well as to offer uniformity and consistency in the presentation of the topics addressed. I should also emphasize that this approach made reading the book more easy and agreeable.

The volume is comprised of two sections: one focusing on the history, theory, and the research efforts concerning personality disorders and the other focusing on the clinical applications of cognitive therapy for all DSM-IV types of personality disorders.

The first section includes five chapters. The first chapter covers the basic understanding of the cognitive behavioral approaches with respect to key issues such as referral of patients who suffer from personality disorders, how to make an appropriate diagnosis of these patients, and how to best treat them. Central to this theme is the concept of “schema,” which is extensively discussed in the chapter. Additionally, this chapter reviews the most relevant research efforts dedicated to the understanding of “personality.” The second chapter addresses the formation of the personality process and how personality operates as an adaptive function in the life of a person. All basic adaptation strategies are extensively discussed. The third chapter examines the concerns related to the assessment of personality disorders as well as the cognitive measures of personality pathology. The fourth chapter discusses the general principles of cognitive therapy with personality disorders; additionally, it presents an overview of specific cognitive and behavioral approaches directed to the modification of “schemas.” The fifth chapter explores the cognitive approach to the therapeutic relationship in the treatment of personality disorders; additionally, it offers a unique perspective vis-à-vis the conceptualization of transference and countertransference based on the cognitive therapy model.

Section II of the book is dedicated to the cognitive behavioral applications to all DSM-IV personality disorders. This section embraces eleven chapters. Each of these chapters follows the same organizational format: clinical manifestations, historical perspectives, relevant research and empirical data, differential diagnosis, conceptualization of the disorder based on the cognitive model, and treatment approaches in accordance to cognitive therapy. These chapters focus on the cognitive treatment of paranoid, schizoid and schizotypal, antisocial, borderline, histrionic, narcissistic, dependent, avoidant, obsessive-compulsive, and passive-aggressive or negativistic personality disorders. Each of these chapters presents a very relevant clinical overview of the given personality disorder addressed. This compendium of significant clinical information offers an excellent understanding of how to intervene in each of these disorders from a cognitive perspective. Finally, the last chapter of the book summarizes a series of key clinical issues related to cognitive treatment and also delineates the future perspectives in the use of cognitive therapy vis-à-vis personality disorders. I should also note that the set of references is very rich and well selected with respect to the topics discussed in this book.

In summary, I immensely enjoyed reviewing this book. It offers the best overview that I have ever read about the historical, theoretical, and clinical applications of cognitive therapy in the treatment of personality disorders. I not only learned extensively by reading this book, but I am planning to use the knowledge I acquired in my clinical practice as well. Additionally, I will use this acquired knowledge in my ingoing educational activities with medical students, psychiatric residents, psychology interns, and other health and mental health trainees. I think that all psychiatric and mental health practitioners should not only read this book, but also keep it handy in their daily practices.

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