Social Work Now, Issue 39, pages 21-28.
Cognitive therapy tends to focus on how the client’s thoughts distort reality and lead to anxiety and depression. But what if reality contains stresses that might cause anyone anxiety or depression? Sharon Berlin (2002) in her book, Clinical Social Work Practice: A Cognitive-Integrative Perspective, emphasised the need to integrate into cognitive-behavioural assessment and treatment traditional social work person-in-environment concerns about the real challenges of the environment of the client. The point is fundamental: the very notion that an individual’s cognition is ‘distorted’ or ‘irrational’ depends on a prior assessment of the real environment and whether the individual is reacting normally to it, so cognitive assessment makes no sense without bringing in the individual’s relationship to the environment.