Story of Psychology - Morton Hunt [390]
Beck also assigned “homework.” The patient, between sessions, had to monitor his or her thoughts and behavior, make deliberate efforts to alter them, and carry out specific tasks. This not only overcame the patient’s inertia and lack of motivation but also yielded actual accomplishments that tended to correct the patient’s incorrect belief that he or she was unable to achieve anything. Toward the same ends, Beck also often asked the patient to write a weekly report of his or her activities and tell the degree to which each was gratifying.
The crucial work of the therapy, however, was examining, in the office sessions, the patient’s ideas and correcting his or her cognitive distortions. Beck’s manner of doing so was very different from Ellis’s. One severely depressed woman told Beck, “My family doesn’t appreciate me,” “Nobody appreciates me, they take me for granted,” and “I am worthless.” Her evidence was that her adolescent children no longer wanted to do things with her. Here is how Beck led her to test the reality of her view of her children’s feelings:
PATIENT: My son doesn’t like to go to the theater or to the movies with me anymore.
THERAPIST: How do you know he doesn’t want to go with you?
P: Teenagers don’t actually like to do things with their parents.
T: Have you actually asked him to go out with you?
P: No. As a matter of fact, he did ask me a few times if I wanted him to take me…but I didn’t think he really wanted to go.
T: How about testing it out by asking him to give you a straight answer?
P: I guess so.
T: The important thing is not whether or not he goes with you, but whether you are deciding for him what he thinks instead of letting him tell you.
P: I guess you are right but he does seem to be inconsiderate. For example, he is always late for dinner.
T: How often has that happened?
P: Oh, once or twice…I guess that’s really not all that often.
T: Is his coming home late for dinner due to his being inconsiderate?
P: Well, come to think of it, he did say that he had been working late those two nights. Also, he has been considerate in a lot of other ways.87
The patient later found out that her son was, in fact, willing to go to the movies with her.
As this example illustrates, the crucial aspect of Beck’s style of cognitive therapy is Socratic questioning to get the patient to produce information contradicting his or her assumptions or conclusions, thereby correcting these cognitive distortions. The technique is even more apparent in this excerpt from a therapy session with a twenty-five-year-old woman who wanted to commit suicide because her husband was unfaithful and she regarded her life as “finished”:
T: Why do you want to end your life?
P: Without Raymond I am nothing…I can’t be happy without Raymond. But I can’t save our marriage.
T: What has your marriage been like?
P: It has been miserable from the very beginning. Raymond has always been unfaithful. I have hardly seen him for the past five years.
T: You say that you can’t be happy without Raymond. Have you found yourself happy when you are with Raymond?
P: No, we fight all the time and I feel worse.
T: Then why do you feel that Raymond is essential for your living?
P: I guess it’s because without Raymond I am nothing.
T: Before you met Raymond, did you feel you were “nothing”?
P: No, I felt I was somebody.
T: If you were somebody before you knew Raymond, why do you need him to be somebody now?
P: (puzzled) Hmmm…
T: Have any men shown an interest in you since you have been married?
P: A lot of men have made passes at me but I ignore them.
T: Do you think there are other men as good as Raymond around?
P: I guess there are men who are better than Raymond because Raymond doesn’t love me.
T: Is there any chance of your getting back together with him?