It was with great interest that I read Professor Lovibond's paper, not the least because of the fact that before returning to the UK in 1991 I had spent approximately 2½ years working in Australia. In his article Professor Lovibond charts the history of behaviour therapy in Australia and comments on the current academic and professional situation there. He raises issues concerning scientific rigour, clinical practice, service delivery, and professional organisation. Some of these are general issues and many readers from many places around the world will find sympathy with these. Others are relevant to the local circumstances within Australia and are less pertinent to other countries. My first reaction to the article was surprise that problems within clinical psychology were being aired at a World Congress of Behaviour Therapy and within a behaviour therapy journal. This is perhaps explained by Professor Lovibond's view that behaviour therapy is too narrow a term for what is really clinical psychology and should be so entitled. But from a UK perspective there is here a confounding between the theory and practice of behaviour therapy (I will use the term cognitive-behaviour therapy as being more reflective of current thinking) and the profession of clinical psychology. I will devote most of this short article to outlining the situation in the UK so that it can be seen why Professor Lovibond's suggestion that behaviour therapy and clinical psychology are synonymous would not be readily acceptable in the UK. Firstly, I would like to comment on the situation regarding behaviour therapy before briefly describing that of the profession of clinical psychology.

This paper is a review of studies on psychological treatments for positive psychotic symptoms, and a detailed description of two of these studies, the Manchester Symptom Project, which aimed to decrease positive symptoms by training patients in effective coping strategies, and the Liverpool Auditory Hallucination project, which aimed to provide a cognitive-behavioural treatment for individuals with persistent and distressing voices. The results from these studies indicate that enduring positive symptoms which have not responded to neuroleptic medication can be effectively treated by psychological methods.

Schizophrenia is a multifaceted disorder that can affect many aspects of the sufferer's life. Recent advances in the use of cognitive—behaviour therapy as an adjunct treatment for schizophrenia have been shown to result in significant improvements in psychotic symptoms. However, to date, much less attention has been paid to other co-morbid and emotional disorders that often co-exist with psychosis and that can be a severe burden to the sufferer. This article briefly reviews clinical trials of cognitive—behavioural treatments for schizophrenia and their outcome and then goes on to describe clinically important co-morbid or associated clinical problems: social anxiety, posttraumatic stress disorder (PTSD), depression and suicide risk. Because the psychotic symptoms usually receive priority, there has been little in the cognitive—behavioural literature on the nature and treatment of these co-morbid disorders. The nature of these problems and issues relating to their treatment are discussed.

Recent interest in the way social factors influence the course of schizophrenia has led to attempts to monitor and manipulate these factors. The work on the Expressed Emotion of the relative has been especially influential in this area. A number of studies have now been conducted in which a psychosocial intervention has been employed in an attempt to prevent relapse after discharge from hospital. These studies are reviewed with an emphasis on their methodological adequacy and on the nature of the intervention used. Recent studies have demonstrated a positive result for psychosocial interventions used in combination with neuroleptic medication. However, analysis of these studies does not allow us to conclude that we can identify the ‘active ingredients’ in these psychosocial treatment regimes. Although there is cause for optimism, further investigation is required.

Low self-esteem is a common characteristic amongst populations with schizophrenia and co-morbid substance abuse (dual diagnosis) and has been linked to increased psychopathology, substance abuse and lower social functioning. The following study built upon the promising results of Hall and Tarrier (2003) and examined the feasibility and clinical utility of a cognitive behavioural intervention for low self-esteem within a population of dual diagnosis inpatients. A small sample of dual diagnosis inpatients (N = 23) were screened during a one-month wait list period to ensure stability in presentation of low self-esteem, psychopathology and substance abuse before commencing a brief eight-session intervention for low self-esteem. Results collected post intervention showed participants displayed significant increases in levels of self-esteem and corresponding significant decreases in depressive symptoms and psychopathology associated with schizophrenia. These improvements were maintained at 3-month follow-up. Outcomes were examined in terms of identifying and implementing beneficial treatments for dual diagnosis populations within everyday psychiatric settings, a population often considered one of the most challenging to treat.

Low self-esteem is an underlying component of depression and psychological therapy may first need to address deeply entrenched negative self-evaluations in order to challenge and reduce the rigidity of core beliefs (Fennell, 1997). Hall and Tarrier (2003) developed an effective brief intervention aimed at reducing low self-esteem in patients with psychosis. Subsequent anecdotal evidence suggested that this intervention may also provide positive results in an older adult population with depression. In this case study, the intervention was implemented with a 79-year-old woman who was experiencing anxiety symptoms and depression with suicidal thoughts. Following implementation of the self-esteem intervention, significant improvements were obtained. This paper offers preliminary evidence that this novel intervention can be used successfully with older age clients and provides a positive and engaging therapy for depression.

Background. Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account.

Method. Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong–Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL).

Results. Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant.

Conclusion. Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

Low self-esteem in psychosis is common and has been found to be significantly related to a number of clinical variables and to symptom severity. This report describes the follow-up evaluation of a simple time-limited cognitive behavioural intervention aimed to improve feelings of low self-worth in the treatment of psychotic symptoms. A previous small scale pilot project found encouraging results for the efficacy of the novel intervention following its delivery and at 3-month follow-up. This report examines the benefits of the technique at 12 months following delivery of the intervention. These preliminary results suggest that the intervention may promote improved levels of self-esteem, psychotic symptomatology and social functioning over the longer term. Implications for practice and future research are discussed.

The historical origins of the case formulation approach to assessment and treatment are described and its role in clinical practice and research discussed. It is argued that treatment based on individual case formulations should not be precluded from clinical trials. The empirical evidence for the reliability and efficacy of case formulation is reviewed. The evidence that an idiosyncratic case formulation approach to treatment has any advantage over a standard protocol is equivocal; however, the studies that have been carried out are under powered and potentially suffer from a Type II error. The standard procedure for case formulation is briefly described and the argument advanced that this method of clinical assessment should be soundly based upon empirical evidence and hypothesis testing and not on speculation. Three modifications are suggested to the current practice of case formulation. These are: 1) the conceptualization of dysfunctional systems in the maintenance of clinical problems; 2) the historical background of a clinical problem should be described in terms of vulnerabilities and epidemiological evidence-base; and 3) the pivotal role of social behaviour and context should be emphasized and accommodated in a formulation. The advantages of a case formulation, in providing an understanding of the maintenance of clinical problems, in providing an integrated approach to intervention are outlined.