Cognitive-behavioral theories of counseling: Traditional and non-traditional approaches

Cognitive-behavioral theories of counseling: Traditional and non-traditional approaches

Gravitz, Melvin A

Sapp, M. (2004). Cognitive-behavioral theories of counseling: Traditional and non-traditional approaches. Springfield, IL: Charles C. Thomas. Reviewed by V. K. Kumar, Ph.D., Dept of Psychology, West Chester University of Pennsylvania, West Chester, PA.

Dedicated to his students, Marty Sapp’s textbook is written with not only students in mind, but also clinicians. The book is well organized with an appropriate title. Except for the first two chapters, all other chapters follow essentially the same outline: chapter overview; historical or biographical details; descriptions and explanations of key concepts and theoretical formulations; the therapeutic processes with subheadings of therapeutic goals; role of the therapist; therapeutic relationship; critique (of the approach in terms of 7 criteria: comprehensiveness, precision and testability, parsimony, empirical validity, heuristic value, applied value, and multicultural applications and limitations); summary; glossary of key terms; and review questions. All chapters include helpful information on relevant psychotherapy related websites, telephones, and even addresses for obtaining information on training programs, associations, and any major journals.

Chapter 1 starts the reader off with a provocative question “How do we know that psychotherapy is effective?” (p. 3). Following an encouraging response that “When psychotherapy groups are compared to control groups, psychotherapy has an overall d effect size [emphasis in original] of .70” (p. 3), Sapp takes up the issue of whether the effects are specific to psychotherapy or are merely placebo effects. Reviewing the work of Kirsch (1990), and Kirsch and Lynn (1999), who argue for strong placebo effects in psychotherapy, Sapp argues that although placebo effects are important, not all of the effectiveness of psychotherapy can be accounted for by such effects. For example, he noted: “there are fairly conclusive data that certain forms of hypnosis are correlated with changes in brain functions that are independent of placebo effects (Woody & Bowers, 1998)” (p. 8). Obviously, if placebo effects can fully account for the variance in the effectiveness of psychotherapy, then this and other books on psychotherapy will simply be irrelevant.

Chapter 1 provides an introduction to meta-analysis, the meaning of effect sizes, and three tables listing various traditional and non-traditional therapies of cognitive- behavioral orientations, corresponding effect sizes, number of studies used in the meta-analyses, 95% confidence intervals constructed on the effect sizes, and information on power. These tables are informative and interesting as well, For example, per Table 1-3 (p. 15), hypnosis practitioners will be pleased to note that hypnotherapy is associated with a large effect size of 1.82 (.95 C I=.8025 = d = 1.0163), higher than that found for covert-behavioral techniques (1.52), modeling ( 1.43), and cognitive-behavior therapy (1.13). Such information can be very helpful to both clinicians and clients, given the current emphasis on evidence-based psychotherapy.

Highlights of Chapter 1 are the sections “Major Cultural Groups within the United-States” and “Racial Prejudice within the Brain.” These sections certainly call for cultural sensitivity when diagnosing and treating clients from a different culture. It was helpful to see a section, although usually rather brief, on “Multicultural Applications and Limitations” in each of the chapters that discuss various psychotherapies. In including these brief sections on multicultural applications, perhaps Sapp’s intention may have been to simply raise consciousness against manualized delivery of psychotherapy services to people of different cultures and to emphasize the need for more research. A more extensive treatment of multicultural applications would indeed require a major undertaking worthy of a separate textbook.

Chapter 2 discusses the seven criteria listed previously for evaluating a psychotherapeutic modality. Chapter 2, somewhat unusual for a psychotherapy textbook, includes a brief explanation of research method concepts: dependent and independent variables; control, intervening, and suppressor variables; and internal validity. However, in discussing the regression equation, it might have been better to denote the criterion or predicted variable as y (not y’). Thus, using the expression y = a + bx+ e (not y ‘= a +bx +e as stated on p. 20) and using y’ = a + bx, where y’ = predicted score, would have been more consistent with common usage in statistics textbooks (see e.g., Sheskin, 2004).

While I was pleased to see an explanation of effect sizes and results of the metaanalyses in the first two chapters, the reasons for including explanations of concepts related to research methods, reliability, and regression are not very clear, since these concepts are hardly used in later sections of the book when discussing the various psychotherapies.

A helpful section to be included in Chapter 1 would have been on the three Levels of Psychotherapy, which Sapp refers to throughout the textbook, For example, I encountered “Level III” for the first time on page 32, and the concepts of Level I and Π are not introduced until much later (pages 50 and 49, respectively). Nevertheless, their meaning does become clear as one reads through the textbook.

Chapters 3 through 12 cover the traditional therapies which “developed from academic psychology or were embraced by academic psychology,” (p. 11) and non-traditional forms of cognitive behavior therapies which neither developed from academic psychology, nor were embraced by it. The traditional forms of cognitive therapy included are the behavioral, social learning, and multimodal, along with the approaches of Ellis, Beck, Meichenbaum, and Kelly. The non-traditional forms of cognitive therapy included are those developed by Alfred Adler, Eric Beme, and William Classer, Some biographical details of various founders are interesting and informative. Chapter 13, entitled “Summary” provides a brief outline of what is contained in each chapter.

Sapp provides a highly readable account of a variety of cognitive-behavior psychotherapies in these 10 separate chapters. Additionally, throughout the textbook an effort was made to point out commonalities and differences among these different approaches. The reader will find a clear exposition of different theoretical viewpoints as well as counseling techniques generated by them with illustrations. Given that there is currently a great deal of interest in cognitive-behavior therapy approaches to hypnosis (see e.g., Zarren & Eimer, 2002), hypnosis practitioners will find the textbook generally helpful. In particular, the content included in chapters 1 and 4 will interest hypnosis practitioners.

The discussion of Kirsch and Lynn’s (1998) automaticity theory in Chapter 1 is highly relevant for individuals interested in hypnosis. As indicated earlier, the comparative effect sizes data on various psychotherapies, including hypnotherapy are very helpful. Of special interest to hypnosis practitioners is Chapter 4 on Behavior Therapy, which includes a discussion of some of the current research on hypnosis and sections on Eye Movement Desensitization and Reprocessing (EMDR), Eye-Movement Technique, and protocols for relaxation, guided imagery, and cognitive-behavioral hypnosis.

Overall, it is a timely book given the influence and prominence of cognitive-behavioral approaches in current practice. The systematic approach taken in writing these chapters, with an emphasis on both theoretical and application perspectives, makes the textbook very appealing for use, especially at the graduate level, For practicing clinicians, the textbook should serve as a good reference book that is definitely worth the desk space.


Sheskin, D. J. (2004). Handbook of parametric and nonparametric statistical procedures (3rd. ed.). Boca Raton: CRC.

Zarren, J. L, & Eimer, B. N. (2002). Brief cognitive hypnosis: Facilitating the change of dysfunctional behavior. New York: Springer.

Copyright American Society of Clinical Hypnosis Apr 2006

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