Story of Psychology - Morton Hunt [389]
That being so, he reasoned, it should be possible “to correct his distortions through the application of logic and rules of evidence and to adjust his information processing to reality.” Perhaps not just this patient but most patients could be healed by such therapy. As Beck has said, quoting the humanistic psychologist Abraham Maslow, “The neurotic is not only emotionally sick—he is cognitively wrong.”83
This concept is the basis of the cognitive therapy of depression that Beck developed and wrote about in journal articles in 1963 and 1964, and in a 1967 book, Depression: Clinical, Experimental, and Theoretical Aspects. Later, through years of weekly conferences and case discussions with colleagues in the department of psychiatry, he extended the use of cognitive therapy to other neurotic conditions, and still later adapted it to the treatment of problems in couples’ relationships.
For some years Beck’s ideas were ignored and he was considered something of a pariah in the profession. But by the 1970s, as cognitivism pervaded psychology and, to some extent, psychiatry, his ideas were absorbed into the major theories of personality and behavior. A growing number of clinicians began relying on his methods, especially with depressed patients, and over the years some of them have modified or added to Beck’s formulations and worked out their own versions. Beck, not a self-promoting person, is still not widely known among the psychologically attuned laity, but within psychology and psychiatry he is generally acknowledged as the creator of cognitive therapy. In his version and others it is now one of the leading treatments used in the United States. About a third of all psychotherapists are primarily cognitive or cognitive-behavioral; many others use cognitive-behavior therapy part of the time.84
Cognitive therapy did not spring full-grown from Beck’s brain. He himself says that it owes something to the cognitive revolution in psychology and to the behavior therapy movement, which, to the extent that its therapy requires the patient to think about the mental steps needed to achieve change, is partly cognitive. Beck did not know of Ellis’s RET when he first conceived of cognitive therapy, but he has said that Ellis’s work played a major part in the development of cognitive-behavior therapies.85
Although Beck’s system has some resemblances to Ellis’s, Beck has been more decorous, gentle, and supportive than Ellis in his personal style. Beck also differs from Ellis in that he offers a more detailed cognitive theory of the neurotic disorders. In discussing depression, for instance, he has identified and labeled three causative factors:
—“the cognitive triad”: the depressive’s distorted view of himself or herself, his world, and his future (“I’m no good,” “My life is disappointing,” “Things will never improve”);
—“silent assumptions”: unexpressed beliefs that negatively affect the individual’s emotional and cognitive responses (“If someone’s angry, it’s probably my fault,” “If I am not loved by everyone, I’m unworthy”);
—“logical errors”: overgeneralization (taking one instance to represent a pattern), selective attention (focusing on some details and ignoring others), arbitrary inference (drawing conclusions unwarranted by logic or the available evidence), and others.86
He has made similar analyses of the cognitive distortions responsible for a number of other neurotic and even psychotic disorders.
Beck’s cognitive therapy involves much more than merely pointing out to the patient his or her cognitive distortions. A crucial part in getting the patient to recognize the distortions is the therapist-patient relationship; Beck makes much of the need for the therapist to be warm, empathetic, and sincere. He has employed a variety of cognitive and behavioral techniques, among them role playing, assertion training, and behavior rehearsal.* He has also used “cognitive rehearsal.” He would ask a depressed patient who cannot carry out even an old,