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J Can Acad Child Adolesc Psychiatry. 2010 May; 19(2): 146.
PMCID: PMC2868563

Clinical Handbook of Psychological Disorders: A Step-By-Step Treatment Manual, Fourth Edition

Reviewed by John Charles Rogers, MD

Clinical Handbook of Psychological Disorders: A Step-By-Step Treatment Manual, Fourth Edition.
David H. Barlow, editor. , Editor.  The Guilford Press:  New York, NY,  2008. 722 pages. CDN  $75.00. 

Many clinicians and students will be familiar with the earlier editions of this work, first published in 1985, and for them this collection of expert authors, strict emphasis on evidence-based treatments, and chapter-by-chapter treatment of psychological disorders will be quickly recognizable. This edition has been refreshed and updated with references to the newest evidence-based publications, and those familiar with Barlow’s compilations will be eager for this updated version.

For those unfamiliar with previous editions, its title may be misleading. A “handbook” conjures thoughts of a paperback manual, but this is a beautiful, hard-covered textbook and a handsome addition to any clinical library. It is not meant to be a quick reference in the labcoat pocket. It is fully 733 pages, double–columned, with each chapter supported by an extensive, current and particularly pertinent bibliography.

There are sixteen chapters, and, for the most part, each of these is dedicated to the most current evidence-based psychological treatments for 13 specific disorders: Panic Disorder and Agoraphobia, Post-Traumatic Stress Disorder, Social Anxiety, Obsessive Compulsive Disorder, Major Depressive Disorder, Borderline Personality Disorder, Bipolar Disorder, Schizophrenia and other Psychotic Disorders, Alcohol Use Disorders, Drug Abuse and Dependence, Eating Disorders, Sexual Dysfunction and Couple Distress. This chapter by chapter approach to the aforementioned disorders is the scaffolding upon which the bulk of this book is based. In this sense each of these chapters is typical of the other, and each is well written, well referenced, and by and large definitive.

Each of these chapters begins with the diagnosis as described by the criteria of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV-TR). Routinely, there follow discussions of epidemiology, current research, and evidence-based treatment protocols, and in many, a theoretical model of treatment is offered. In each chapter there is at least one case study with detailed description including client-therapist dialogue over a series of sessions. Case studies are followed by discussion and conclusions. In this sense, this book is best consumed in tutorial fashion, one whole chapter at a time, and not necessarily from cover to cover. Step-by-step instruction may at times seem tedious, but it is the stepwise instruction that is the hallmark of this text and the gem upon which the teaching pivots. For the diligent, when applied to a current clinical case, this approach can become not just practical, but exciting.

Not all the chapters are based on the format described above. Indeed, the topic of depression is dealt with in three chapters, one dedicated to treatment with Cognitive Behavioural Therapy, another with Interpersonal Therapy and a third with a rather new concept — treatment by Behavioural Activation. This latter chapter, a chapter on Eating Disorders, and another chapter titled “Emotional Disorders: A Unified Approach” seem to have ignited the editor’s enthusiasm. Not only do these chapters deviate from the usual format and serve as new additions in the current text — it seems that within the boundaries of these chapters, there is a new thinking and a new comprehensive approach to psychological treatments. After all, handbooks and manuals, important tools to guide and to teach, must have a theoretical foundation, and it seems that in these chapters, the authors are moving towards a comprehensive understanding of the person that allows an explanation of their symptoms, be they panic, depression, obsessive or delusional thought, or abnormal eating.

Offered here is a foretaste of some exceptional themes: this book includes a meta-psychological theory that transcends the DSM-IV-TR with a non-categorical approach to emotional disorders (page 216), an alternative to traditional CBT — Behavioural Activation for Depression (page 328), and a marvelously sympathetic way of understanding anxiety and depression as rooted in the threatening contingencies of past and future experience (page 333). As well, there is a theoretical understanding of the thoughts, actions, and feelings of a person with an eating disorder so that the various types are connected — Bulimia nervosa is understood as the “the nothing or all ” inverse of Anorexia nervosa (page 580). Also exquisite is the authors’ exploration of the natural human phenomena of self-consciousness and the universal need for a feeling of self-worth (page 566).

Clinical Handbook of Psychological Disorders then is two books. On the one hand, it is what readers have come to expect — a well-written, painstaking, step-by-step guide to the psychological treatment of psychiatric disorders and with exceptional value in being current, expert, evidence-based, and most of all superbly thorough. But the authors offer that their work is not definitive, and they have also allowed for the possibility of a “second text” scattered throughout and embedded in the first. It is this second text that is a subtle injunction to practitioners. The client is a whole person and not just a sum of his disorders, and there is an imperative to understand more completely the person and the person’s relationship with the world. It is this personal understanding upon which future clinical practice will hinge.

This is a text that should be in every clinical library so as to be referenced based on the clinician’s needs. For the student of psychological treatments, and the bibliophile, a personal copy would provide exceeding value in its study and stimulate ardour based on its thoroughness and beauty.

Articles from Journal of the Canadian Academy of Child and Adolescent Psychiatry are provided here courtesy of Canadian Academy of Child and Adolescent Psychiatry