Book Review: Personality Disorders: Cognitive Therapy of Personality Disorders

Cognitive Therapy of Personality Disorders. Second Edition. Aaron T Beck, Arthur Freeman, Denise D Davis, and Associates. New York: Guilford Press; 2004. 412 p. US$46.00. Reviewer rating: Fair This is a disappointing volume, even though it presents valuable concepts for understanding the cognitive component of personality disorder, as well as many useful interventions. The first edition, published in 1990, was a seminal contribution that offered a new perspective on the treatment of personality disorder, a topic previously dominated almost entirely by therapies based on psychoanalytic theory. In it, Beck and colleagues offered an innovative perspective that had a major impact. The limitation of the first edition was its modest evidential support for both overall approach and specific treatment strategies. Indeed, the authors noted that this was embarrassing in a mode of treatment that advocates empiricism. The widely anticipated second edition was expected to correct this deficiency by offering a theory that was more coherent and solidly grounded in empirical findings and evidence-based interventions. Alas, this volume fails to deliver. This edition has 16 chapters. The first 5 offer an overview of cognitive therapy for personality disorder, present the rudiments of a theory of personality disorder, discuss issues of assessment, outline general principles and specialized techniques, and explore the important issue of the therapeutic relationship. They are followed by 10 chapters, each describing the psychopathology and cognitive therapy of a specific disorder. All the DSM-IV personality disorders are considered, except for schizotypal and passive-aggressive personality disorder. The last chapter offers a brief synthesis and comments on prospects. Chapter 2 purports to describe a theory of personality disorder. The first edition offered a sketchy framework comprising a somewhat loosely arranged set of constructs and ideas. Although many of these ideas were useful, and probably essential, components of any theory, they were not systematically articulated. The corresponding chapter in this second edition offers little that is new. It combines the first edition's Chapters 2 and 3 and offers almost identical layout and subheadings-as if the field of personality disorder had remained unchanged for the last 15 years. In fact, ideas about the disorder's nature, origins, and classification have changed markedly and continue to do so. Many of these developments are barely referenced, let alone incorporated into the model or into intervention strategies. This is part of a more general problem: the book is written with scant attention to the context of scholarship in related fields. Particularly problematic is its neglect of current work on normal personality, especially research on cognitive approaches to personality. This research provides a body of knowledge about personality processes that could have greatly enriched the reviewed volume's framework and contributed to a more solid conceptual model. As with the first edition, much of this volume is organized in terms of DSM-IV diagnoses. …

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