Book excerpt: Cognitive behavioural therapists face numerous instances during each session and throughout the course of treatment in which they must make a clinical decision. These ""decision points"" include instances in which any number of clinical issues could be addressed, a specific intervention is not achieving its desired effect, the patient does not understand or accept the rationale for the technique, or a crisis has emerged that requires a shift in focus. This book describes strategic decision making, a flexible yet evidenced-based approach to working through decision points in order to move treatment forward in cognitive behavioural therapy. It dispels the myth that there is a single ""right"" therapeutic intervention that must be delivered in any one instance; in fact, many courses of action can facilitate change provided they are implemented strategically. Strategic decisions: follow logically from the case conceptualization are arrived upon collaboratively between the therapist and patient allow the patient to leave the session with something new are seen through in their entirety before their effectiveness is evaluated This compelling, accessible book will benefit all cognitive behavioural therapists, especially those who have mastered basic concepts and are refining their skills in applying them to complex cases.