Is Cognitive Case Formulation Science or Science Fiction?

Since the seminal publication of Cognitive Therapy and the Emotional Disorders (A. T. Beck, 1976), cognitive therapy has emerged as one of the most popular and widely taught therapeutic modalities of the last 20 years (Rush & Beck, 2000), because, in part, of its consistency with the scientistpractitioner model. Although the scientist-practitioner model has been controversial (Albee, 1970; Barlow, 1981; Barlow, Hayes, & Nelson, 1984; Garfield, 1998; Rice, 1997; Strupp, 1976), it has probably been the dominant model within clinical psychology since the American Psychological Association’s (APA) landmark Boulder conference (Raimy, 1950). A primary reason for the widespread acceptance of cognitive therapy is its concordance with the scientistpractitioner model. For example, in the area of depression several scholarly reviews (Clark & Beck, 1999; Coyne & Gotlib, 1983; Haaga, Dyck, & Ernst, 1991; Kwon & Oei, 1994; Teasdale, 1983; Whisman, 1993) suggest consistent support for important aspects of the cognitive theory of depression. In addition, numerous therapy outcome studies suggest that for a significant proportion of individuals, cognitive therapy for depression leads to a clinically significant relief of depressive symptoms (see Clark & Beck; DeRubeis & Crits-Christoph, 1998; Dobson, 1989; Robinson, Berman, & Neimeyer, 1990). Similar scholarly reviews suggest support for important aspects of the cognitive theory of anxiety disorders (e.g., Rapee, 1991) and support for cognitive therapy as an efficacious and effective intervention for anxiety disorders (Barlow, Gorman, Shear, & Woods, 2000; see also DeRubeis & Crits-Christoph). Finally, there is also some support for cognitive theory of personality disorders (see Cottraux & Blackburn, 2001). Although it is premature to judge the efficacy or effectiveness of cognitive therapy for personality disorders, preliminary evidence suggests that patients with comorbid Axis I and II disorders respond to cognitive therapy, albeit less favorably than those with Axis I disorders alone (e.g., Kuyken, Kurzer, DeRubeis, Beck, & Brown, 2001;Mennin & Heimberg, 2000). AQ1