Treating Chronic Depression with Disciplined Personal Involvement Co
For more than a century, the psychotherapist role has been dominated by Freud’s neutrality rule: don’t become personally involved with patients! McCullough challenges this widely accepted dictum in a new treatment approach for the chronically depressed pa
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James P. McCullough, Jr.
Treating Chronic Depression with Disciplined Personal Involvement Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
James P. McCullough, Jr. Department of Psychology Virginia Commonwealth University Richmond, VA 23284-2018 USA [email protected]
Library of Congress Control Number: 2005938502 ISBN-10: 0-387-31065-7 ISBN-13: 978-0387-31065-7
e-ISBN 0-387-31066-5
Printed on acid-free paper. C 2006 James P. McCullough, Jr. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the author (James P. McCullough, Jr.), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
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(TB/MUY)
To Mike, John, and Kristin— . . . through the years, our three children have personally enriched my life.
Foreword
Chronic depression has only been recognized as a significant clinical problem within the past 10-15 years. It has been neglected in large part because clinicians and researchers tend to focus on acute depressive episodes at the expense of more chronic, low-grade symptoms, and because it has frequently been misdiagnosed (and often dismissed) as a personality disorder. However, chronic depression is a significant clinical and public health problem. In the recent National Comorbidity Survey Replication, the lifetime prevalence of dysthymic disorder, just one of the several forms that chronic depression can take, was 3.4% in a nationally representative community sample (Kessler et al., 2005). Approximately 30–40% of depressions seen in clinical settings are chronic, and chronic depression is associated with significant impairment in functioning, high health care expenditures, and untold personal suffering (Klein & Santiago, 2003). Importantly, chronic depressions differ from more classical, episodic major depression in a number of ways. Chronic depressions are more likely to emerge from a background of childhood adversity and abuse, are associated with higher rates of mood disorders in first-degree relatives, and are coupled with greater personality dysfunction and psychiatric comorbidity (Klein & Santiago, 2003). Perhaps most importantly, chronic depression is less likely to respond to antidepressant medications and traditional antidepressant psychotherapies than non-chronic major depression (Stewart et al., 1989; Thase et al., 1994). In the mid-1970s, Jim McCullough was one of a small group of clinical researchers who recognized the importance of chronic depression and the unmet needs of those suffering
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