Practical CBT: Using transdiagnostic case formulations and therapies based on problem-maintaining circles

Gary Bakker

The next generation of evidence-based CBT practice is here.


In 2008, clinical psychologist Gary Bakker first introduced Problem-Maintaining Circle Theory to the teaching and clinical application of cognitive behaviour therapy. PMC Theory bridges the gap between psychotherapy process research, and the demands of practical real-world therapy. The result is a new non-medicalising conception of clinical psychological problems. PMC Theory allows the development of reliable CBT-based assessment, case formulation, and therapy selection. This ensures more effective practical interventions that are easily understandable, and complementary to the allied fields of medicine, psychiatry, and counselling. The theory is conceptually consistent, clinically-focused, and uses the huge evidence base available in the CBT literature.

Since the first release of his ground-breaking clinician manual Practical CBT, Gary’s work has been in constant demand. This new 342-page edition further develops the theoretical basis of the PMC model by describing a grand unified theory . It also extends the recommended assessment questions, taxonomy of PMCs, and homework activities to inlude:

• depression
• anxiety
• anger
• health anxiety
• eating disorders
• relationship problems
• chronic pain
• obsessive–compulsive disorder
• substance abuse/dependence
• sexual problems.

This is the ultimate ‘how-to’ manual for CBT therapists, drawing on 40 years of clinical practice and research. Learn how best to communicate the CBT approach to clients and get them to do their homework effectively. Select and apply evidence-based CBT therapies. The manual includes 72 Homework sheets, including verbatim scripts to help ensure clients get the best out of therapy and a downloadable PDF booklet of 33 client handouts.

This manual is intended for therapists who have obtained their basic grounding in the theory, origins, and principles of CBT but now need to bridge the gap to real-life, real-time application to a real person with a real problem sitting in front of them. Experienced therapists will also find help with new strategies and homework tasks, as these are presented in the form of verbatim scripts which can be adapted and varied as clinical judgement affords. As well, they will find a conception of clinical psychological problems based on the notion of PMCs as a simple model of CBT which can aid in the choice of assessment questions and strategies, the development of effective case formulation, and the selection of appropriate interventions and treatments.

About the Author

Gary Bakker is a clinical psychologist with 40 years of experience (over 20,000 consultations!) working with children, adolescents, adults, couples, and families in clinics, hospitals, community centres, and for 30 years in private practice. He trained in CBT when it was newly emerging as the evidence-based therapy of choice, receiving the Fiona Allen Prize during his masters program. Gary has since given innumerable seminars and workshops on themes in CBT, all the while honing its presentation, clarity, and acceptability for his clients, resulting in the verbatim suggested scripts that comprise much of this book. He has bridged the gap between attention to the psychotherapy process and outcome research, and the demands of practical real-world therapy. The result is a whole new non-medicalising conception of clinical psychological problems, called PMC Theory.

Table of Contents

Section 1— Introduction and Theoretical Basis

Chapter 1 How To Use This Manual

Chapter 2 Why CBT?

Chapter 3 A Full CBT Model

Chapter 4 The PMC Approach to CBT

Section 2 — Assessment, PMC Taxonomy, and Treatment Selection

Chapter 5 The Initial Assessment

Chapter 6 A Sample PMC Taxonomy

Chapter 7 Assessment-To-Treatment Decision Pathways

Section 3 – Homeworks

Section 4 – Scripts