The educational component

One of the strengths of the cognitive behavioural approach (e.g., Beck et al., 1979) is that the therapist presents the client with a rationale for therapy and also presents relevant educational information, or bibliotherapy, about the problems being experienced. The booklet, Coping with Depression, was designed by Beck and his colleagues to provide information to depressed clients about the experiences they may be having, in addition to introducing the main characteristics of the cognitive approach. The booklet is handed out during the first or second session to be read for homework. The client's response to the booklet has been shown to be a good predictor of whether or not the cognitive approach is likely to be effective with that particular client (Fennell & Teasdale, 1987), such that a client who clearly disagrees or does not relate to the description of the model in any way is unlikely to do well in cognitive therapy. In such a case, the therapist might be advised to discuss alternative forms of treatment with the client to see whether one of these might be more suitable.

One of the frequent experiences that therapists share is that clients may have little or no information about the problems that they are experiencing and, indeed, may even have mistaken beliefs. For example, the person may believe that he or she is the only person to have had this experience, that depression will never go away, or that depression is cured by pulling one's socks up. A crucial aspect of the early stages of cognitive therapy is therefore to explore the person's own model of depression and to provide facts and information with, when appropriate, additional reading material relevant to the person's problems. This additional information can range from specific handouts to workbooks such as that of Greenberger and Padesky (1995), which presents useful information and includes relevant exercises. A meta-analysis of the use of CBT bibliotherapy showed a clear benefit for this approach even in the absence of other intervention (Cuijpers, 1997).

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