Succeeding with Difficult Clients

Applications of Cognitive Appraisal Therapy


  • Richard Wessler, Cognitive Psychotherapy Services, New York, New York, U.S.A.
  • Sheenah Hankin, Cognitive Psychotherapy Services, New York, New York, U.S.A.
  • Jonathan Stern, Cognitive Psychotherapy Services, New York, New York, U.S.A.

"I know that I am doing therapy correctly and well, so why aren't some of my clients changing?" "Why do I feel anxious when I think about my next session with that difficult client?" When psychotherapy stalls, it's time to try new ideas. The authors' experience with difficult clients -- uncooperative, hostile, uncommitted to change -- gave them a new perspective on working with therapeutic impasses. Papers describing Cognitive Appraisal Therapy have appeared in many books and journals, and now for the first time these ideas are compiled into a single volume. Heavily influenced by the psychotherapy integration movement and in a radical departure from conventional cognitive-behavior therapy, they see motivation in terms of affect and attachment rather than cognitive schemas, and resistance and setbacks as the result of emotional setpoints. Practitioners from all corners of the psychotherapy landscape will be able to integrate Cognitive Appraisal Therapy into their therapeutic approaches to help them work successfully and confidently with difficult clients as individuals, as couples and in groups.
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Clinical psychologists, counseling psychologists, social workers, psychiatrists, nurse practitioners, and mental health counselors.


Book information

  • Published: July 2001
  • ISBN: 978-0-12-744470-3


"The book is easy to read, comprehensible, and very useful in application... This book was very helpful in working with some of my own difficult clients who I found struck in their process of change and a few tips from the book allowed me to adjust my exploration questions, helping to lower resistance and causing the change."

Table of Contents

Part I: Cognitive Appraisal TheoryWhat Makes Difficult Clients Difficult.Motivation and Attachment.Basic CAT Concepts: Persontypic Affect, Justifying Cognitions, and Security-seeking Behaviors.Patterns of Personality.The Difficult Client Revisited.Part II: Cognitive Appraisal TherapyThe CAT Assessment.Interventions Based on the CAT Model.Affect-based Interventions.Additional Interventions Involving Cognition, Behavior, Adjunctive Medication, and Therapeutic Impasses.The Process of CAT (Case Studies).Part III: Applications of CATCAT with Personality-disordered Clients.Working with Borderline Personality-disordered Clients.Couple Therapy.CAT Group Therapy.Working with "Difficult" Parents.References.Author Index.Subject Index.