Treating chronic depression with disciplined personal involvement: Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

BOOK REVIEW

Review of the book entitled Treating chronic depression with disciplined personal involvement: Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

Jorge Alberto Salton

Psychiatrist. MSc., Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Professor, Faculdade de Medicina, Universidade de Passo Fundo, RS, Brazil

^{Correspondence}

James P. McCullough Jr.

Richmond, Springer, 2006

James P. McCullough Jr., professor at the Department of Psychology at Virginia Commonwealth University, Richmond, VA, has been treating and researching chronic depression and dysthymia for approximately 30 years.^1,2 Since the 1980's, he has been developing a specific psychotherapy technique for such cases: the Cognitive Behavioral Analysis System of Psychotherapy (CBASP).^3–5

To create the CBASP, McCullough used contributions by Rogers, Piaget, Kiesler, Freire, Gendlin Prouty and Kent Bailey. The latter two authors were pointed by McCullough as pioneers in proposing the therapist's personal involvement with the patient.

McCullough recurs to Piaget's concept of preoperative thinking to describe chronically depressed patients. Similar to a child in the preoperational stage, chronically depressed patients reason in a prelogical and precausal manner. They reveal a reasoning that is not operative, not efficacious to cope with practical issues of their lives. They go from premise to conclusion in a single movement, with no stops to evaluate the reality of the situation.

Like a preoperative child, chronically depressed patients are focused on themselves and have low ability of empathy. Such egocentrism is responsible, according to McCullough, for the feeling of interpersonal loneliness that is often experienced by therapists.

Preoperative children and chronically depressed patients overuse the monologue. They sound like those recorded voices that dictate instructions by the telephone, always providing the same message, regardless of the user's reaction.

McCullough sees a relationship between his work with chronically depressed patients and that proposed by Paulo Freire to teach adults in poor populations to read and write. Therapists/professors need to find an adequate form of communicating with their patients/students. Communication does not take place if they believe that their patients/students.

Similar to Freire's method, CBASP aims at making patients perceive their responsibility for their status: if I am responsible for something, I am able to change it. Therapists have to help patients recognize the consequences of their reasoning and teach them how to behave in their interpersonal relationships. They are neither passive nor victims. Patients provide the tone of relationships, they build them.

Patients, taken by hopelessness and despair, will not create an affectionate and cooperative environment in their therapy. On the contrary, they will be lost in thought and unmotivated and may also manifest hostility. They will see the meeting with the therapist with negative eyes, even if reality is showing them the opposite. They will say: "You have been trained to show yourself as someone who likes patients;" "You may be accepting me now, but you will reject me like everyone does." A good relationship with the therapist will help patients confront the thesis that their bonds have always been and will always be weak.

Some of the CBASP techniques, which have already been explained in McCullough's previous book,⁶ are resumed:

b) Exercise of interpersonal discrimination: help patients not to attach themselves to generalizations as to their relationships and observe each particular relationship;

c) Interpersonal abilities: train abilities to have good relationships.

CBASP deals with the cognitive and behavioral areas and, considering such aspect, is a cognitive–behavioral psychotherapy. It also works with interpersonal relationships and, for that, is an interpersonal psychotherapy. However, it is different from both of them as therapists develop an intentional disciplined personal involvement with the patient. Such involvement distinguishes CBASP from psychodynamic psychotherapy. In the technique originated from classical Freudian psychoanalysis, therapist/patient personal involvement is not encouraged to avoid damaging the objective of interpreting transference.

CBASP proposes that therapists play a non–neutral role in their relationship with chronically depressed patients. It also believes that, for many of those patients, an authentic human encounter with their therapist can be the first of its kind in their lives.

In this book, McCullough emphasizes the importance of the therapist's disciplined personal involvement with chronically depressed patients and defends it as being ethical. He also understands that such attitude was victim of a taboo maintained by practitioners of other psychotherapeutic techniques.

In September 2005, the American Psychiatric Association updated its guide for the treatment of depression and included CBASP among efficacious psychotherapies.⁷

References

1. McCullough JP. Cognitive–behavioral analysis system of psychotherapy: An interactional treatment approach for dysthymic disorder. Psychiatry. 1984;47(3):234–50.

2. McCullough JP, Kasnetz MD, Braith JA, Carr KF, Cones JH, Fielo J, et al. A longitudinal study of an untreated sample of predominantly late onset characterological dysthymia. J Nerv Ment Dis. 1988;176(11):658–67.

3. McCullough JP. Psychotherapy for dysthymia. A naturalistic study of ten patients. J Nerv Ment Dis. 1991;179(12):734–40.

4. McCullough JP Jr. Treatment for chronic depression using Cognitive Behavioral Analysis System of Psychotherapy (CBASP). J Clin Psychol. 2003;59(8):833–46.

5. Klein DN, Santiago NJ, Vivian D, Blalock JA, Kocsis JH, Markowitz JC, et al. Cognitive–behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol. 2004;72(4):681–8.

6. McCullough JP. Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy. New York: Guilford; 2003.

7. Fochtmann LJ, Gelenberg AJ. Guideline watch: practice guideline for the treatment of patients with major depressive disorder. 2nd ed. Disponível em: www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.

Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007