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THERE’S MORE TO THE SURFACE THAN MEETS THE EYE
After psychology had become established as a distinct field of study in its own right, around the turn of the 20th century, two main schools of thought emerged: behaviorism, originating from Ivan Pavlov’s experiments –and which was enthusiastically championed in the USA – dominated the field of experimental psychology; and the psychoanalytical approach of Sigmund Freud and his followers, which was the basis for the field of clinical psychology.
The two had little in common.
Behaviorists rejected the introspective, philosophical approach of earlier psychologists, and strove to put the subject on a more scientific, evidence-based footing.The psychoanalysts explored those very introspections, with theories, rather than proof, to support their case.
Cognitive revolution
By the mid-20th century, both approaches to psychology were being critically examined. But although behaviourism was being overtaken by cognitive psychology in experimental work, the clinical sphere was offering no alternative to the psychoanalytical model.
Psychotherapy had evolved into many forms, but the basic idea of psychoanalysis and exploration of the unconscious was common to all of them. Some psychologists were beginning to question the validity of this kind of therapy, and Aaron Beck was among them.
"I concluded that psychoanalysis was a faith-based therapy."
Aaron Beck
When Beck qualified as a psychiatrist in 1953, experimental psychology was focused on the study of mental processes – it was the dawn of the “cognitive revolution”.However, the practical approach of cognitive psychologists remained much the same as that of the behaviorists.If anything, they were frequently even more rigorous in establishing evidence for their theories.
Beck was no exception to this.He had trained in and practised psychoanalysis, but grew sceptical of its effectiveness as a therapy. He could find no reliable studies of the success rates of psychoanalysis – only anecdotal evidence of case reports.In his experience, only a minority of patients showed improvement under analysis, and the general consensus among therapists was that some got better, some got worse, and some stayed about the same, in almost equal numbers.
Of particular concern was the resistance of many psychoanalysts to objective scientific examination.Compared with experimental psychology, or with medicine, psychoanalysis seemed largely faith-based, with widely different results between individual practitioners.Reputation was frequently based solely on the charisma of a particular analyst. Beck concluded that “the psychoanalytic mystique was overwhelming… It was a little bit like the evangelical movement”.
Many psychoanalysts regarded criticism of their theories as a personal attack, and Beck soon discovered that any questioning of the validity of psychoanalysis was likely to be countered with personal denouncement.At one time, he was turned down for membership of the American Psychoanalytic Institute on the grounds that his “desire to conduct scientific studies signalled that he’d been improperly analysed”.
Those who found fault with the idea of analysis did so, some analysts argued, because of insufficient analysis of themselves.Beck was suspicious of both the circularity of these arguments, and the link with the therapist’s own personality.
Coupled with his personal experience as a practising psychoanalyst, this led him to examine thoroughly every aspect of therapy, looking for ways in which it could be improved.
He carried out a series of experiments designed to evaluate the basis and treatment of depression, one of the most common reasons for seeking psychotherapy,and found that far from confirming the idea that this condition could be treated by examination of unconscious emotions and drives, his results pointed to a very different interpretation.
Changing perceptions
In describing their depression, Beck’s patients often expressed negative ideas about themselves, their future, and society in general, which came to them involuntarily.These “automatic thoughts”, as Beck called them, led him to conclude that the way the patients perceived their experiences – their cognition of them – was not just a symptom of their depression, but also the key to finding an effective therapy.
This idea, which came to him in the 1960s, chimed with concurrent developments in experimental psychology, which had established the dominance of cognitive psychology by studying mental processes such as perception. When Beck applied a cognitive model to treatment, he found that helping his patients to recognize and evaluate how realistic or distorted their perceptions were was the first step in overcoming depression.
This flew in the face of conventional psychoanalysis, which sought and examined underlying drives, emotions, and repressions. Beck’s “cognitive therapy” saw this as unnecessary or even counterproductive.The patient’s perception could be taken at face value because, as he was fond of putting it, “there’s more to the surface than meets the eye”.
"By correcting erroneous beliefs, we can lower excessive reactions."
Aaron Beck
What Beck meant by this was that the immediate manifestations of depression – the negative “automatic thoughts” – provide all the information needed for therapy.If these thoughts are examined and compared with an objective, rational view of the same situation, the patient can recognize how his perception is distorted.For example, a patient who has been offered a promotion at work might express negative thoughts such as “I’ll find the new job too difficult, and fail”, a perception of the situation that leads to anxiety and unhappiness.
A more rational way of looking at the promotion would be to see it as a reward, or even a challenge.It is not the situation that is causing the depression, but the patient’s perception of it.Cognitive therapy could help him to recognize how biased it is, and find a more realistic or broader way of thinking about the situation.
A distorting mirror creates a view of the world that can seems terrifying and ugly.Similarly, depression tends to cast a negative perspective on life, making sufferers feel more helpless.
Empirical evidence. Beck’s cognitive therapy worked for a large number of his patients.What is more, he was able to demonstrate that it worked, as he applied scientific methods to ensure that he had empirical evidence for his findings.
He designed special assessments for his patients, so that he could monitor their progress closely.The results showed that cognitive therapy was making his patients feel better, and feel better more quickly, than was the case under traditional psychoanalysis.Beck’s insistence on providing evidence for any claims he made for his therapy opened it up to objective scrutiny.Above all, he was most anxious to avoid acquiring the guru-like status of many successful psychoanalysts, and was at great pains to demonstrate that it was the therapy that was successful, and not the therapist.
Beck was not the only, or even the first, psychologist to find traditional psychoanalysis unsatisfactory, but his use of a cognitive model was innovatory. He had been influenced in his reaction against psychoanalysis by the work of Albert Ellis, who had developed Rational Emotive Behaviour Therapy (REBT) in the mid-1950s, and he was no doubt aware of the work of behaviourists elsewhere in the world, including the South Africans Joseph Wolpe and Arnold A. Lazarus.
Although different in approach, their therapies shared with Beck’s a thoroughly scientific methodology and a rejection of the importance of unconscious causes of mental and emotional disorders.
"Don’t trust me, test me."
Aaron Beck
Once the success of cognitive therapy had been established, it was used increasingly for treating depression, and later Beck found that it could also be helpful for other conditions, such as personality disorders and even schizophrenia.Always open to new ideas – as long as it could be shown that they were effective – Beck also incorporated elements of behaviour therapy into his treatments, as did many other psychotherapists in the 1980s.This has resulted in the varied forms of cognitive behavioural therapy that are used by psychologists today.
Beck’s pioneering work marked a turning point for psychotherapy, and his influence is considerable.As well as bringing a cognitive approach into clinical psychology, Beck subjected it to scientific scrutiny, exposing the weaknesses of psychoanalysis.In the process, he introduced several methods for assessing the nature and severity of depression that are still used:the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, the Beck Scale for Suicidal Ideation (BSS), and the Beck Anxiety Inventory (BAI).
How people assess the same situation varies with temperament.Beck’s cognitive therapy can help patients question their perceptions, leading to a more positive outlook.
MORE TO KNOW…
APPROACH
Cognitive therapy
BEFORE
1890s Sigmund Freud proposes an analytic approach to psychotherapy.
1940s and 1950s Fritz Perls, with Laura Perls and Paul Goodman, develops Gestalt therapy – a cognitive approach to psychotherapy.
1955 Albert Ellis introduces Rational Emotive Behaviour Therapy (REBT), breaking with the tradition of analysis.
AFTER
1975 Martin Seligman defines “learned helplessness” in Helplessness: On Depression, Development, and Death.
1980s A blend of Beck’s ideas and the behaviour therapies of Joseph Wolpe give rise to new cognitive behavioural therapies.
AARON BECK
Born in Providence, Rhode Island, Aaron Temkin Beck was the son of Russian-Jewish immigrants.Athletic and outgoing as a young child, he became far more studious and introspective after suffering a serious illness at the age of eight.
He also acquired a fear of all things medical and, determined to overcome this, decided to train as a doctor, graduating from Yale in 1946.
Beck then worked at Rhode Island Hospital, before qualifying as a psychiatrist in 1953.Disillusioned with the psychoanalytical approach to clinical psychology, he instigated cognitive therapy and later established the Beck Institute for Cognitive Therapy and Research in Philadelphia, now run by his daughter, Dr Judith Beck.
Key works
1972 Depression: Causes and Treatment
1975 Cognitive Therapy and the Emotional Disorders
1980 Depression: Clinical, Experimental, and Theoretical
1999 Prisoners of Hate: The Cognitive Basis of Anger, Hostility, and Violence
