Cognitive Therapy for Challenging Problems: What to Do When the Basics Don't Work

Judith S. Beck; Foreword by Aaron T. Beck

Format: Paperback, 324 pages
ISBN: 9781609189907
Price: $32.00

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This groundbreaking book addresses what to do when a patient is not making progress. Provided is practical, step-by-step guidance on conceptualizing and solving frequently encountered problems, whether in developing and maintaining the therapeutic alliance or in accomplishing specific therapeutic tasks. While the framework presented is applicable to a range of challenging clinical situations, particular attention is given to modifying the longstanding distorted beliefs and dysfunctional behavioral strategies of people with personality disorders. Helpful appendices include a reproducible assessment tool, the Personality Belief Questionnaire.

See also Dr. Beck's Cognitive Behavior Therapy, Second Edition: Basics and Beyond, the leading text for students and practicing therapists who want to learn the fundamentals of CBT.


“Judith Beck's first book, Cognitive Behavior Therapy, Second Edition: Basics and Beyond, was a godsend to me in my first post when I had little access to CBT supervision....I was keen to read the sequel...'What to Do When the Basics Don't Work,' and I was not disappointed. The book is structured in a similar form to its predecessor, with chapters devoted to each of the essentials of cognitive therapy; formulation, the therapeutic relationship, structuring sessions, identifying cognitions etc....Points are illustrated with case examples and transcripts of sessions, which provide very useful models of exactly how to address tricky issues such as people who keep talking and become controlling whenever a therapist becomes directive....Given the proliferation of cognitive therapy courses, the relative lack of experienced supervisors, and the complexity of cases seen, more and more therapists are likely to feel the need for advice on what to do when the basics don't work. Fortunately, this timely arrival goes a long way to filling that gap.”

Behavioural and Cognitive Psychotherapy

“An essential educational opportunity for therapists working with varied and challenging adult client populations. It is an empirically supported guide for the helping professional to regain or maintain client-therapist working momentum and for invigorating the therapeutic frame....This book would be a great desk reference for the helping professional or an added reading opportunity for a graduate practice class. The case examples offer the reader pertinent comparatives for real-world dilemmas. Moreover, they clarify the information regarding exigent clients' coping styles, core beliefs, and interfering behaviors....The strength of this text lies in its expanded technical suggestions, born from an empirical model, and put forth by an experienced practitioner....This easy-to-read book is a pragmatic tool for any experienced helping professional or graduate student eager for assistance in working with challenging client populations.”

Research on Social Work Practice

“An outstanding teaching text which I recommend to all my trainees....The chapter on dysfunctional reactions to patients is particularly good, and to be recommended to all therapists....This book will be much appreciated by therapists working with patients with challenging problems, and is an excellent companion to Cognitive Therapy: Basics and Beyond.”

Cognitive Behavioral Therapy Book Reviews

“This is a highly practical guide for using cognitive therapy with patients who present challenging problems to clinicians with diverse levels of experience. An excellent hands-on text for graduate-level courses and for novice therapists, it can also fruitfully guide mature practitioners who wish to expand their realm of expertise. Enriched with numerous illuminating case materials, the book will enlighten even the most experienced mental health worker.”

—Theodore Millon, PhD, DSc, Institute for Advanced Studies in Personology and Psychopathology

“Clinicians have been reporting for some time now that they are seeing increasingly difficult cases in their consulting rooms. Axis I and Axis II comorbidities have become the rule rather than the exception. By systematically addressing these challenges in this clearly written and eminently readable volume, Judith Beck takes cognitive therapy to a new level. This book will be equally useful to students and to experienced therapists.”

—Glen O. Gabbard, MD, Department of Psychiatry, Baylor College of Medicine

“This excellent book focuses on the art of cognitive therapy. When therapy does not seem to be going well, most clinicians can think of another therapist who they think would fare better. This book teaches you how to become that therapist. Drawing on her vast experience with therapists and clients, Dr. Beck beautifully outlines how to identify and overcome many of the difficulties that can arise in cognitive therapy. As a consequence, therapists will be heartened and more patients will experience the benefits they hope for. Highly recommended reading for novice to highly experienced cognitive therapists.”

—David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, United Kingdom

Table of Contents

Foreword, Aaron T. Beck

1. Identifying Problems in Treatment

2. Conceptualizing Patients Who Present Challenges

3. When a Personality Disorder Challenges Treatment

4. Developing and Using the Therapeutic Alliance

5. Therapeutic Relationship Problems: Case Examples

6. When Therapists Have Dysfunctional Reactions to Patients

7. Challenges in Setting Goals

8. Challenges in Structuring the Session

9. Challenges in Solving Problems and in Homework

10. Challenges in Identifying Cognitions

11. Challenges in Modifying Thoughts and Images

12. Challenges in Modifying Assumptions

13. Challenges in Modifying Core Beliefs

Appendix A: Resources, Training, and Supervision in Cognitive Therapy

Appendix B: Personality Belief Questionnaire

About the Author

Judith S. Beck, PhD, is President of the Beck Institute for Cognitive Behavior Therapy (, which provides state-of-the-art training in CBT and offers online courses on a variety of CBT topics, including Essentials of CBT: The Beck Approach. She is also Clinical Associate Professor of Psychology in Psychiatry at the University of Pennsylvania School of Medicine. She has written nearly 100 articles and chapters as well as several books for professionals and consumers; has made hundreds of presentations, nationally and internationally, on topics related to CBT; and is the codeveloper of the Beck Youth Inventories and the Personality Belief Questionnaire. Dr. Beck is a founding fellow and past president of the Academy of Cognitive Therapy.

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