Book reviews -- Cognitive Behavioral Strategies in Crisis Intervention edited by Frank M. Dattilio and Arthur Freeman

Cognitive Behavioral Strategies in Crisis Intervention. Edited by Frank M. Dattilio and Arthur Freeman. New York: Guilford Press, 1994. 412 pp. $37.95.

The editors take an inclusive approach to crisis intervention by including psychological crises as well as circumstantial crises. They view crisis as an event or perception that upsets an individual's homeostasis. The instability that results may be behavioral or emotional, and the focus of intervention is on improving individual coping or problem-solving abilities. Dattilio and Freeman explain how cognitive therapy is a natural approach for crisis intervention in that it focuses on automatic though and schemata (structures that guide and organize processing information and understanding of life experiences), interpersonal relating style, and coping behavior. Cognitive therapy is structured and directive and thus lends itself well to short-term time-limited problem solving.

The first seven chapters focus on persons with the following diagnostic conditions: borderline personality, panic disorder, suicide and depression, schizophrenia, substance abuse, and eating disorders. The various authors suggest interventions and techniques for dealing with difficult cases. For example, paradoxical intervention with persons who have panic disorder is explained. The subtypes of motivation for suicide (hopeless, psychotic, rational, and histrionic and impulsive) are described.

Case material is used throughout the book to illustrate how cognitive intervention can be applied. Warning signals for possible substance abuse are explained to help therapists understand and confront clients early in the crisis. A two-track approach to treating eating disorders is presented: (1) gaining control of the eating behavior and (2) dealing with the psychological context of the disorder. Stress-inoculation training for sexual-assault survivors is discussed, and thorough discussion of appropriate professional responses to child sexual abuse is presented, including signs, reporting, collaboration, investigation, and effective practice with victims. Factors contributing to crises with older persons are discussed, including depression, bereavement, drug abuse, cognitive impairment, chronic illness, and changes in family roles.

In the second part of the book, special topics (group approaches, natural disasters, couples problems, families in crisis, partner violence, medical patients, aggressive patients, ethical and legal issues, and medication management and medical crisis) are covered. The chapter discussion of cognitive-behavioral approaches to family therapy is particularly interesting. Guidelines for managing partner violence and a discussion of therapist-safety issues when intervening in partner violence are provided. Treatment strategies for dealing with aggressive clients are presented. Legal issues regarding clients who present a danger to others and protection issues when working with HIV/AIDS patients, suicide, child abuse, and civil commitments are examined. The last chapter discusses issues regarding the combination of cognitive therapy and pharmacotherapy.

The editors bring together a lot of useful information in one volume. They integrate cognitive theory in crisis situations or with persons in crisis with suggestions for intervention and practical information on ethical and legal issues resulting from crisis intervention work.

Despite these strengths, the volume has several limitations. The editors cite research that indicates that effective cognitive therapy generally requires 12 to 20 sessions. Most crisis intervention, however, must take place in a much shorter period. Effective crisis intervention often requires therapeutic skills that can be initiated in a single session. The type of intervention suggested in this book generally requires an ongoing client-worker relationship. Redundancy is also a problem, given the fact that each chapter author explains cognitive therapy. In addition, few of the authors discuss which clients or under what circumstances cognitive therapy is not appropriate--information that would be extremely useful to novice workers. Finally, the text does not always link smoothly from one chapter to the next. Given these caveats, the book nevertheless provides useful reference material and might be used as a supplement to assessment, interviewing skills, theory, and intervention materials.

Copyright Family Service America Nov 1995
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