Treating Chronic Depression with Disciplined Personal Involvement

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 patient. He proposes disciplined personal involvement as an alternative to therapist neutrality with chronically depressed patients, describing how this approach can be used in a contingent manner to successfully modify pathological behavior. These latest guidelines expand on his pioneering work, Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy(CBASP).

In this new volume, Treating Chronic Depression with Disciplined Personal Involvement: CBASP, Dr. McCullough describes in detail what disciplined personal involvement is and how it is administered. The book was written during a current four-year national clinical trial sponsored by NIMH involving 910 chronically depressed outpatients being treated at eight sites in the U.S.

The following topics will be covered:

- Historical review of the psychotherapist neutrality role

- Rationale for disciplined personal involvement in the treatment of chronic depression

- Training veteran psychotherapists to administer disciplined personal involvement

- Numerous verbatim case examples presented to illustrate therapist disciplined personal involvement

- Appendix Section operationalizing the CBASP disciplined personal involvement techniques and discussing needed CBASP research

McCullough’s fresh perspective and psychotherapy wisdom make this text a must read for all clinical practitioners, training clinicians in university settings, and psychotherapy researchers. Treating Chronic Depression with Disciplined Personal Involvement: CBASP offers a radically new alternative to the traditional therapeutic relationship.

"McCullough's Treating Chronic Depression With Disciplined Personal Involvement is a breath of fresh air. It is edgy, innovative, gutsy, and engaging.  McCullough places his therapeutic approach in context by comparing it with other therapies, making his book both scholarly and absorbing. He presents a high-risk–high-gain approach for chronically depressed patients, an extremely difficult group with which to work. The volume contains extensive and intense patient–therapist dialogue. This dialogue provokes tension, anxiety, and self-reflection in the reader and is extremely useful for conveying a feel for this approach. Congratulations to McCullough on this remarkable work.  He has made an extremely important contribution to both the treatment of chronic depression and the larger literature on the curative power of the therapist–patient relationship."

-Laurence P. Riso, PsycCRITIQUES, Contemporary Psychotherapy - APA Review of Books, Volume 52, Issue 33

"Dr. McCullough’s incredible insights led him to develop a unique form of psychotherapy for chronic depression that has a staggering rate of success, as reported in the NEJM, 2000. World-wide application of this therapy, based upon his remarkable text, The Treatment for Chronic Depression, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), is comparable to Fleming’s discovery of Penicillin. This newest text, Treating Chronic Depression with Disciplined Personal Involvement, is a major contribution to the scientific refinement of therapy and is applicable, in my judgment, to virtually all who committed to understanding and relieving the unspeakable suffering of depression."

- Robert S. Brown, Sr., M.D., Ph.D.,Clinical Professor of Psychiatric Medicine, School of Medicine,University of Virginia, Richmond, VA, USA

"Combining a series of deftly interwoven case examples and written commentary, Dr. McCullough provides a clear indication of the major methods of CBASP in this volume. His passion for patients with chronic depression comes through clearly in these pages, as does the desire to integrate theory and research in the further development of this approach to treating this mental health problem. This volume will undoubtedly go a long distance to making CBASP better known and used in helping patients with chronic depression."

- Keith S. Dobson, Ph.D., President-elect, International Association of Cognitive Psychotherapy, Professor and Head, Department of Psychology, University of Calgary, Alberta, Canada

"Sixty years of empirical research on the therapeutic bond has shown that the patient-therapist relationship is of fundamental importance, but the theories and applications have tended to be overly general and vague. In his revolutionary new book, Professor McCullough has filled the void and the practice of psychotherapy, thankfully, will never be the same. With firm historical precedent, straightforward theory and engaging constructs, and a wealth of detailed and intriguing case histories followed by sage clinical commentary, this work is both a call to arms and a detailed training manual for a new (and better) generation of psychotherapists."

- Kent Bailey, Ph.D., Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA

"McCullough is a pioneer in the psychotherapy of chronic depression. The techniques outlined in this volume are truly innovative and thoughtful and he brings obvious passion and compassion to the therapeutic endeavor. I am touched by his wisdom and dedication and highly recommend this book."

-James H. Kocsis, M.D., Professor of Psychiatry,Weill Cornell Medical College, New York, NY, USA

"Research growing out of practice" best describes the way Dr. James P. McCullough, Jr., Professor of Psychology & Psychiatry of Virginia Commonwealth University, has conducted his 35-year university career. During the mid-1970s, Dr. McCullough began working with chronically depressed outpatients. At the time, chronic depression was considered to be a personality disorder and not thought to be responsive to medication or psychotherapy. Dr. McCullough developed his therapy model, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), while working with chronically depressed patients. He investigated the treatment efficacy of CBASP using single-case design methodology and published the first articles on CBASP in 1980 and 1984. With the publication of the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) in 1980, the American Psychiatric Association removed chronic depression from personality disorder status and redefined it (dysthymia) as a psychological disorder. Chronic depression was suddenly thrust into the mainstream of clinical treatment and research where it has remained ever since.

In addition to developing a psychotherapy method to treat the disorder, in 1980, Dr. McCullough began a series of diagnostic investigations studying chronically depressed nonpatients for extended periods of time. The aims of this research were to investigate the psychological characteristics of chronically depressed individuals over time, to determine when the disorder began, and to see if the disorder would remit spontaneously with time. He found very few remissions (13%) and of those who did, over half relapsed within two years. The majority of the nonpatients reported an onset which began during adolescence. Dr. McCullough concluded that chronic depression is in large measure a "disorder of adolescence" and indeed a lifetime problem that doesn't improve over time without adequate treatment. His diagnostic research continues up to the present time.

In the late 1980s, Dr. McCullough served as a Field Trial Site Coordinator studying dysthymia, major depression, and two minor depressions in the American Psychiatric Association's DSM-IV revision project. He has also participated as a Principal Investigator in two national, multi-site investigations involving 1316 chronically depressed outpatients. The second study utilized CBASP alone and in combination with medication and compared both groups to a medication alone group. Patients who completed the acute phase of the study and who received combination treatment obtained the highest response rates (85%) ever reported in a depression study. The results were published in a lead article in May of 2000 in The New England Journal of Medicine. Dr. McCullough is currently participating as Principal Investigator in a 4-year NIMH treatment project enrolling 910 chronically depressed outpatients at 8 sites in the U.S. CBASP is being used as an augmentation strategy for patients who do not fully remit during a three months medicine-only acute phase.

He currently remains at Virginia Commonwealth University in the Department of Psychology teaching psychotherapy to clinical psychology graduate students and training mental health professionals both in this country and abroad to administer CBASP. His books have been translated into German, Japanese, and Spanish. See www.cbasp.org link for more psychotherapy training information.