Beck's Cognitive Therapy

Distinctive Features 2nd Edition

Frank Wills

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000430202
• Edition: 2
• Topic: Psicologia
• Subtopic: Psicologia clinica

Beck's Cognitive Therapy explores the key contributions made by Aaron T. Beck to the development of cognitive behaviour therapy.

The book describes the development of the unique model of therapy developed by Professor Aaron. T. Beck and his daughter, Dr. Judith. S. Beck. The first part on theory explains how the Becks understand psychological problems. The second part on practice describes the main methods and skills that have evolved in cognitive therapy.

Updated throughout to include recent developments, this revised edition of Beck's Cognitive Therapy will be ideal for both newcomers and experienced practitioners.

Part I

Theory

1
Aaron. T. Beck

His life and the development of the principles of cognitive therapy

Aaron Beck was born to a family of Russian Jewish origin in Providence, Rhode Island in July 1921. He supported the Boston Red Sox baseball team and has joked that it was their disastrous runs of form in the 1950s and 1960s that first made him think of studying depression¹. He suffered serious illness as a young child but overcame these difficulties and became an energetic and determined person. His vigour is still evident and almost 100 years after his birth, he is still writing and giving interviews. He married Phyllis in 1950 and had three children, the second of whom, Judith. S. Beck, went on to become his major collaborator and will figure prominently in this book. After medical training, he gravitated towards neurology but in 1950 became, initially reluctantly, involved in psychiatry. Following the orthodox route of those days, he completed training in psychoanalysis but, whilst admiring that model, later moved away from it.

It now seems that it was the authoritarian behaviour of his local psychoanalytic establishment more than the therapeutic method itself that pushed Beck away (Rosner, 2018). He did not like the way psychiatrists dismissed their patients’ capacity for ‘common sense’ and he seems to have longed to evolve a more democratic way of treating patients. The Beck family has a tradition of sympathy for the liberal politics of the Democratic Party, which from 1960 onwards supported the development of community mental health in the United States. This support came full circle in 2013 when Beck was given a Kennedy Forum award² to mark 50 years since the first community mental health act, describing him as “one of the most influential individuals within community mental health” (Penn Med News, 28 October, 2013).

From his earliest days, Beck showed curiosity and favoured empiricism. During his research on the concepts underlying psychoanalytic therapy, he slowly began to develop a cognitive basis for understanding psychopathology. After an intense period of research and experimentation focused on depression in the early 1960s, Beck published a landmark study, Depression: Clinical, Experimental and Theoretical Aspects, in 1967. The impact of this book led to trials of treatment based on cognitive principles at Beck’s Mood Clinic at the University of Pennsylvania. The trials produced notably good results and when Beck and his colleagues in 1979 published a book, Cognitive Therapy of Depression, based on their treatment protocol, this publication had a major, worldwide impact on the fields of psychological therapy and psychiatry (Weishaar, 1993). Beck’s work was by this time attracting international recognition and he proved himself very effective in inspiring others, in and beyond the United States – and perhaps especially in the UK. As he extended his approach from depression to some of the anxiety disorders (Beck & Emery, 1985), others extended it to areas such as obsessive compulsive disorder (Clark, D.A., 2019), posttraumatic stress disorder (Ehlers & Clark, 2000), schizophrenia (Kingdon et al., 1994), and many other psychiatric problems (Salkovskis, Ed., 1996c). Beck (1991) addressed a question posed 15 years earlier, “Can a fledgling psychotherapy challenge the giants of the field?” (Beck, 1976, p. 333). By 1991 he could answer in the affirmative. Beck has always claimed an even greater goal than establishing a specific model of therapy, namely to influence permanently the wider practice of psychological therapy and to push it towards more effective methods. Whilst this book aims to describe the development of Beck’s cognitive therapy model, it will in its second half also explore this wider goal.

In 1994, Beck began to pull back from everyday work at the University of Philadelphia. He and his daughter, Judith, who had by this time trained as a cognitive therapist and was beginning to write herself, co-founded the Beck Institute for Cognitive Therapy (later Cognitive-Behaviour Therapy³). Beck has continued to research and write widely and productively and to promote cognitive therapy internationally. Judith published an influential text, Cognitive Therapy: Basics and Beyond, in 1995 – with revised editions in 2011 and 2021. As he has negotiated his eighties and nineties, Beck has remained incredibly productive, with the pace of his work only dropping off somewhat. He now has over 600 publications and continues to give seminars and interviews for the Institute’s website, often available via YouTube. So, as ever with Beck, there is a good deal of necessary updating from the 2009 first edition of this book.

In the final pages of his 1967 publication on depression, Beck offered the first description of what his cognitive therapy model would look like, including the principles on which it would be based. These principles were further elaborated on in his 1976 book, Cognitive Therapy and the Emotional Disorders, and again in Beck et al. (1979) Cognitive Therapy of Depression. They were formally stated as a set of principles in Chapter 10 of Beck and Emery (1985). Judith Beck has reviewed and represented these principles in her 1995 book, and again in its 2011 and 2021 revisions. The set of principles – listed below – has therefore been a consistent feature of Beck’s cognitive therapy for over 50 years and reliably differentiates it from other comparable models (Wills, 2008a). The principles therefore offer a valid template around which this book, which aims to review the model and its development, can be structured:

1. Cognitive therapy is based on an ever-evolving conceptualisation.
2. Cognitive therapy requires a sound therapeutic relationship.
3. Cognitive therapy requires collaboration and active participation.
4. Cognitive therapy aims to be time-sensitive.
5. Cognitive therapy sessions are structured.
6. Cognitive therapy is aspirational, value-based and goal-oriented.
7. Cognitive therapy initially emphasises the present.
8. Cognitive therapy is educative, aiming to teach clients to be their own therapist, and emphasises relapse prevention.
9. Cognitive therapy uses action plans (therapy homework).
10. Cognitive therapy aims to use guided discovery and teaches clients to respond to their dysfunctional cognitions.
11. Cognitive therapy uses a variety of techniques to change thinking, mood and behaviour.

Table 1.1 charts the development of the form of these principles from 1985 onwards:

Table 1.1 The development of the principles of Beck’s cognitive therapy.

Beck, A.T. & Emery, G. (1985)	Beck, J.S. (1995)	Beck, J.S. (2011)	Beck, J.S. (2020)
1. CT is based on the cognitive model of emotional disorders	1. CT is based on an ever-evolving formulation of the patient and her problems in cognitive terms	1. CBT is based on an ever-evolving formulation of the patients’ problems and an individual conceptualisation of each patient in cognitive terms	1. CBT treatment plans are based on an ever-evolving conceptualisation
2. CT is brief and time-limited	7. CT aims to be time-limited	7. CBT aims to be time-limited	10. CBT is time-sensitive
3. A sound therapeutic relationship is a necessary condition for effective CT	2. CT requires a sound therapeutic alliance	2. CBT requires a sound therapeutic alliance	2. CBT requires a sound therapeutic alliance
4. Therapy is a collaborative effort between TH & CL	3. CT emphasises collaboration and active participation	3. CBT emphasises collaboration and active participation	6. CBT stresses collaboration and active participation
5. CT uses primarily the Socratic method
6. CT is structured and directive	8. CT sessions are structured	8. CBT sessions are structured	11. CBT sessions are structured
7. CT is problem-oriented	4. CT is goal-oriented and problem-focused	4. CBT is goal-oriented and problem-focused	7. CBT is aspirational, values-based, and goal-oriented
8. CT is based on an educational model	6. CT is educative, aims to teach the patient to be her own therapist, and emphasises relapse prevention	6. CBT is educative, aims to teach the patient to be her own therapist, and emphasises relapse prevention	9. CBT is educative
9. The theory and techniques of CT rely on the inductive method
10. Homework is a central feature of CT			13. CBT uses action plans (therapy homework)
	5. CT emphasises the present	5. CBT emphasises the present	8. CBT initially emphasises the present
	9. CT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs	9. CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs	12. CBT uses guided discovery and teaches clients to respond to their dysfunctional cognitions
	10. CT uses a variety of techniques to change thinking, mood, and behaviour	10. CBT uses a variety of techniques to change thinking, mood, and behaviour	14. CBT uses a variety of techniques to change thinking, mood, and behaviour
			3. CBT continually monitors client progress
			4.CBT is culturally adapted and tailors treatment to the individual
			5. CBT emphasises the positive

Part I of this book – on the theoretical underpinnings of Beck’s Cognitive Therapy – will focus on elaborating the theoretical aspects of the key elements in cognitive therapy conceptualisation (principle a, above) – elements such as cognitions linked to specific problems, problematic cognitive schemas, negative thoughts, cognitive distortions, negative attentional factors, etc. Part II on the practice elements of Beck’s model will focus on methods and the more strategic factors involved in principles b through k, above. Further aspects of Beck’s life and research are highlighted through all these points, and a new factor will also be addressed – the implementation of CBT services via the Improving Access to Psychological Therapy (IAPT)⁴ project in the book’s conclusion.

In the 2021 edition of her major text, Judith Beck has introduced some important new ideas and principles of cognitive therapy. To some extent these represent an updating of the model – and will, I think, make it more appealing to a wider group of therapists and counsellors. In particular, she has stressed the importance of using Rogerian counselling skills, including the strengths and adaptive beliefs of clients (NB: no longer ‘patients’⁵) in conceptualisations, exploring clients’ values and aspirations, and ensuring that CBT is culturally sensitive.

Norman Cotterell, an African-American therapist at the Beck Institute, has written (Cotterell & Friedman-Wheeler, 2020) that

all must work for institutional, systemic and policy change if we are ever to mitigate the harms to people of color, and we believe psychologists can play an important role in effecting change at a systemic level … interventions at multiple levels (indivi...