A week of book reviews

This week I’ve decided to review some of the books that I’ve recently bought for my bookshelf (not that they stay there!). Anyone who knows me will agree that I’m a bookworm, and the two most horrible websites (at least to my bank balance) are Amazonand Fishpond!

Onto today’s book – just arrived, although not a new book, published in 2006, it’s called ‘Cognitive behavioural therapy in groups’, written by Peter J. Bieling, Randi E. McCabe and Martin M. Antony. It’s published by Guilford Press, and I got mine from Fishpond at a cost of $58.25.

The reason I’m so pleased with this book is that for ages I’ve been looking for something to help with group processes and carrying out cognitive behavioural therapy. While groupwork was a core part of my training as an occupational therapist, and I’ve followed this up with facilitation training, many people working in pain management feel somewhat overwhelmed at the thought of taking a group. What can then happen is that the group sessions become almost an educational ‘lecture’ rather than a cognitive behavioural approach – which isn’t nearly as effective. We know that ‘information’ alone doesn’t necessarily change people’s beliefs or behaviour, and that people need to actively engage with and process new material to reconceptualise the implications of, for example, the fact that hurt does not equal harm.

This quite readable book has three parts – the first part is the most applicable to pain management, and covers the ‘General principles and Practice of Cognitive-Behavioural Therapy Groups’. There are six chapters that discuss why we might use a group approach rather than work individually with people; looks at how to use the inevitable group dynamics productively; then reviews cognitive strategies, behavioural strategies and a basic structure that can be used to implement CBT within a group setting. The final chapter in this section is about some of the problems and obstacles that occur in groups and how to overcome these.

The second part is much less relevant to pain management, and deals with nine mental health diagnoses and how groups have been used in these instances. It’s a shame that chronic pain groups were not included, because group therapy has been a fundamental of most cognitive behavioural approaches to pain management.

The final section looks at comorbidity and CBT groups and finally an FAQ section. There is an extensive reference list (forty pages!), and the whole book is well-indexed.

So, let’s take a quick look at the chapters in Part 1.
Chapter 1 – CBT groups – possibilities and challenges. Several reasons have been put forward for conducting CBT approaches in a group rather than individually since the early days of CBT. Of course the main reason initially given is that it is more cost-effective than working individually with people, but there are other good reasons to consider this way of delivering CBT such as the way that people learn vicariously (ie by watching and learning from what other people say and do) and the way in whcih people can feel less isolated when they meet others with similar problems. The chapter reviews several models for analysing group process from outside the CBT framework and applies these to the specific requirements of the CBT approach. It particularly defines ‘group process’ and ‘CBT technique’, with technique referring to the learning tools and methods people use to review their thoughts, beliefs, emotions and behaviours in order to make changes, while process refers to the interpersonal interactions among and between group members and facilitators.

Chapter 2 – Group process – This chapter very clearly describes a number of the group process dynamics that occur longitudinally as group members and facilitators interact. These processes may directly influence self disclosure, a sense of optimism, reduce isolation, moving from a ‘self focus’ to a focus that includes others, direct modification of behaviours (particularly applicable in relation to reducing pain behaviours), and group cohesion and emotional processing. I particularly liked a table included in this chapter that identifies the process factor, defines the factor and summarises how to positively influence and use the process for client change. Some very good dialgoues are provided to illustrate ways to attend to group process while carrying out some of the basic CBT techniques within a group setting. I’ve learned some good things about how to structure my responses to facilitate better group participation especially around home learning review. The last part of this chapter considers the longitudinal development of group development and presents another wonderful table identifying the ‘stage’ of the group and effective therapist responses to ensure the CBT approach is maintained throughout.

Chapter 3 – Cognitive strategies within a group setting.
This chapter explains the range of cognitive therapuetic techniques such as guided discovery, collaborative empiricism and Socratic dialogue, and provides an overview of how these can be applied. Once again it uses dialogue to guide through examples of how this might work in a group – and although the examples are specific to mental health issues, they can still be applied in most cases to people with chronic pain.

Chapter 4 – Behavioural techniques in a group setting.
It’s good to look at both the advantages and disadvantages of groupwork for CBT, and this chapter reviews this very briefly. Basic behaivoural approaches such as exposure therapy, behavioural self monitoring, using the group to monitor each other’s behaviour and so on are discussed in the chapter, but I have to say I think there are more aspects of behavioural therapy that can be used than are described in this chapter, as well as more challenges than are discussed.

Chapter 5 – Structre and organisational issues. Now this is one chapter everyone should read before starting to take a group CBT programme! Four aspects vital to effective group programme management are discussed: participant selection, therapist factors, between-session structure and within-session structure. The emphasis is on learning and experience both within the group, and the chapter makes it clear that balance between all aspects of both group process and CBT technique is needed throughout. A good solid read on the ‘how to’ of administering a group-based CBT programme.

Chapter 6 – Problems. Another chapter that everyone should read – or will want to read because it has answers! I can’t think of a single group where at least one of the issues that is discussed in this chapter has not occurred. From having a dominating group member to someone who speaks on behalf of the others to ‘help’ to someone who rarely turns up or appears disinterested…hmmm sound familiar? Like some of the other chapters, it has a great table describing various member behaviours and appropriate therapeutic responses to them. The final section deals with group process that derive from aspects of the CBT model such as didactic aspects of some parts of therapy, the very structured approach that CBT sessions take, the need for some ‘outside of group’ sessions in certain circumstances, and how to deal with trainees and non-group people observing.

To summarise: while the second part of this book may not necessarily directly apply to people taking pain management group sessions using a CBT approach, the first part is, I think, essential reading for anyone wanting to really apply CBT within a group setting. The writing style is straightforward, the example dialogues very helpful, and summary tables really clear. There are heaps of references (if you’ve ever had to justify having a co-therapist to your manager, you’ll appreciate some of them in particular!), and the FAQ section answers yes, some of those really frequently asked ones! This is a book I just wish had either included chronic pain groups, or was published in two volumes so the first part was available in a stand-alone edition.

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