Table Of ContentCOGNITIVE
BEHAVIOURAL
THERAPY
IN MENTAL HEALTH CARE
Alec Grant - Jem Mills - Ronan Mulhern - Nigel Short
Forewords by Christine Padesky and Robert Leahy
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Cognitive Behavioural
Therapy in Mental
Health Care
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Praise for the Book
‘At last a text book about cognitive approaches to mental health that can be
understood without the use of a dictionary or a scientific calculator. This book
manages to bring to life both the theory of technique and the reality of practice.
It is a must have book for anyone working in mental health.’
Ron Coleman, author, trainer and consultant based in Fife, Scotland
‘This is a wonderful text – fresh, contemporary and practical, as well as subtly
subversive! It manages to convey the essence of cognitive therapy in a clear,
easy-to-read manner, while drawing the reader to re-consider some of the more
questionable assumptions of mainstream approaches. In addition, it contains a
number of innovative and important chapters – for instance, on assertive out-
reach, dual diagnosis, establishing cognitive behavioural work cultures, and cri-
tiquing evidence-based mental health. Somehow the authors manage both to
embrace and overturn the established order – a remarkable achievement.’
James Bennett-Levy, Oxford Cognitive Therapy Centre
‘Cognitive behaviour therapy is the ideal therapy for the modern NHS: it has a
strong evidence base, it is focused and short term, and its collaborative, nor-
malising approach is in keeping with the move to involve service users as much
as possible with their treatment. Yet most textbooks on the subject pay little
attention to the health service setting in which it is practised. This book is unique
in presenting cognitive behaviour therapy in an accessible, contextualised way
for mental health p ractitioners working in the NHS today. The chapters on spe-
cific areas are tailored to the needs of health service professionals, addressing
disorders such as psychosis, borderline personality disorder, and dual diagno-
sis, as well as anxiety and depression. There are also valuable contributions on
working in assertive outreach teams and forensic services. It is relatively easy
to go on a basic training course, but much harder to find regular supervision and
time to practise newly learned skills. There are chapters devoted to managing
this “resistance” from managers, colleagues and organisations, with tips on how
to establish cognitive behavioural work cultures. The authors have a great deal
of experience of practising and teaching CBT and this richness is revealed in
the many case examples throughout the text. This book will be particularly use-
ful for community psychiatric nurses and other mental health workers who want
to employ cognitive behavioural ideas in their everyday practice.’
Stirling Moorey, Head of Psychotherapy South London and Maudsley Trust
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Cognitive Behavioural
Therapy in Mental
Health Care
Alec Grant
Jem Mills
Ronan Mulhern
and
Nigel Short
SAGE Publications
London ● Thousand Oaks ● New Delhi
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Chapter 1 © Alec Grant, Jem Mills, Ronan Chapter 8 © Dave Jones and Ronan Mulhern 2004
Mulhern and Nigel Short 2004 Chapter 9 © Ian Dyer and Ronan Mulhern 2004
Chapter 2 © Alec Grant, Jem Mills, Ronan Chapter 10 © Paul Rogers and Joe Curran 2004
Mulhern and Nigel Short 2004 Chapter 11 © Jem Mills, Alec Grant, Ronan
Chapter 3 © Ronan Mulhern, Nigel Short, Mulhern and Nigel Short 2004
Alec Grant and Jem Mills 2004 Chapter 12 © Neil Kitchiner and Nigel Short 2004
Chapter 4 © Jem Mills, Alec Grant, Ronan Chapter 13 © Ronan Mulhern, Nigel Short, Alec
Mulhern and Nigel Short 2004 Grant and Jem Mills 2004
Chapter 5 © Alec Grant, Jem Mills, Ronan Chapter 14 © Nigel Short, Alec Grant, Jem Mills
Mulhern and Nigel Short 2004 and Ronan Mulhern 2004
Chapter 6 © Jem Mills, Ronan Mulhern, Nigel Chapter 15 © Alec Grant, Jem Mills, Ronan
Short and Alec Grant 2004 Mulhern and Nigel Short 2004
Chapter 7 © Jem Mills, Ronan Mulhern, Alec Chapter 16 © Alec Grant, Jem Mills, Ronan
Grant and Nigel Short 2004 Mulhern and Nigel Short 2004
First published 2004
Apart from any fair dealing for the purposes of research or
private study, or criticism or review, as permitted under the
Copyright, Designs and Patents Act, 1988, this publication may
be reproduced, stored or transmitted in any form, or by any means,
only with the prior permission in writing of the publishers, or in
the case of reprographic reproduction, in accordance with the
terms of licences issued by the Copyright Licensing Agency.
Inquiries concerning reproduction outside those terms should be
sent to the publishers.
SAGE Publications Ltd
1 Oliver’s Yard
55 City Road
London EC1Y 1SP
SAGE Publications Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
B-42, Panchsheel Enclave
Post Box 4109
New Delhi 110 017
British Library Cataloguing in Publication data
A catalogue record for this book is available from
the British Library
ISBN 0 7619 4141 X
ISBN 0 7619 4142 8 (pbk)
Library of Congress Control Number: available
Typeset by C&M Digitals (P) Ltd., Chennai, India
Printed in Great Britain by The Cromwell Press Ltd, Trowbridge, Wiltshire
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TO MARY, AMY AND ANNA
Alec Grant
TO SALLY, JEVAN AND ROHAN
Jem Mills
TO BILLY, JEAN AND ABIGAIL
Ronan Mulhern
TO JONATHAN, RUTH AND GRIT
Nigel Short
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Contents
Acknowledgements ix
Foreword by Christine Padesky xi
Foreword by Robert L. Leahy xiii
Preface xv
1 An introduction to the cognitive behavioural approach
and why it is needed 1
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
2 The therapeutic alliance and case formulation 7
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
3 Key skills of assessment 23
Ronan Mulhern, Nigel Short, Alec Grant and Jem Mills
4 Cognitive behavioural interventions: understanding
techniques in the context of theory 34
Jem Mills, Alec Grant, Ronan Mulhern and Nigel Short
5 Establishing cognitive behavioural work cultures 54
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
6 Working with people who hear voices and have strange beliefs 68
Jem Mills, Ronan Mulhern, Nigel Short and Alec Grant
7 Working with people who have complex emotional and
relationship difficulties (borderlines or people?) 82
Jem Mills, Ronan Mulhern, Alec Grant and Nigel Short
8 Working with people who have a dual diagnosis 100
Dave Jones and Ronan Mulhern
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viii Contents
9 Working with people who are violent in mental health
settings and relationships 113
Ian Dyer and Ronan Mulhern
10 Working with people in forensic settings 128
Paul Rogers and Joe Curran
11 Working with people in assertive outreach 143
Jem Mills, Alec Grant, Ronan Mulhern and Nigel Short
12 Working with people who have psychological problems
because of a physical illness 161
Neil Kitchiner and Nigel Short
13 Working with people who are depressed 182
Ronan Mulhern, Nigel Short, Alec Grant and Jem Mills
14 Working with people who are anxious 202
Nigel Short, Alec Grant, Jem Mills and Ronan Mulhern
15 A critique of evidence-based mental health and its relationship
to cognitive behavioural psychotherapy 223
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
16 Organisational factors impacting cognitive behavioural practice 234
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
Epilogue 243
Bibliography 245
Index 257
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Acknowledgements
We wish to thank Joe Curran, Ian Dyer, Dave Jones, Neil Kitchiner and Paul
Rogers for their support of, and contributions to, this project. Warmest regards
go to Christine Padesky and Robert Leahy for their inspirational leadership in
the cognitive behavioural community and their great influence on our work.
We are indebted to the following people for valuable feedback on the book:
James Bennett-Levy from the Oxford Centre for Cognitive Therapy, Liam
Clarke and Gail Louw from the University of Brighton and our friends Justine
Chase-Gray, Eugenie Hobden and Jane Lever who gave us feedback on
specific chapters. Finally, we wish to thank our clients and undergraduate and
MSc Cognitive Psychotherapy students at the University of Brighton, who
have taught us so much and without whom this book would not have been
possible.
