I first met Aaron “Tim” Beck (1921-2021) at his Centre for Cognitive Therapy in Philadelphia, in 1981. I remember an elegant man with white hair, wearing a grey linen suit, white shirt, and a red dickie bow. What struck me about him was his warmth, his openness and his curiosity. I knew very little about him at that time. The “father” of cognitive behaviour therapy (CBT) whose influence worldwide on mental health services was to become legendary, was only just hitting the world of psychotherapy. As a practicing psychiatrist and psychoanalyst in the 1950 and 1960s, Beck had become uncomfortable with the model’s emphasis on uncovering the childhood roots of our difficulties rather than coping with one’s vulnerabilities in the present. He was more concerned with the way the wounds of our past were played out in our everyday responses to life. Beck was also uneasy with the power dynamics of the traditional “expert vs patient” psychotherapy relationship. He preferred a more collaborative approach, where therapist and client worked as a team, and clients were given every chance to take back control of their lives. CBT came out of Beck’s trust in people. He never minimised the reality of past trauma or current adversity but he believed that even in our darkest moments, there was things we can do to take care of ourselves. The therapist’s job was to marshal our resources – internal and external – to help us face adversity in a constructive way.
CBT helps people become aware of their thoughts and consider how helpful they are. Working together as a team, client and therapist devise small behavioural tasks to test their negative thoughts. For example, rather than buy into a person’s belief “I can’t do anything right”, they break down a task into bite-size steps that a person can manage. Nothing succeeds like success. Even the smallest success can lift a person’s mood.
The more distressed we feel, the more he focus on identifying simple actions – setting a small achievable goal – to restore some feeling of control. When our mood lifts, when our painful emotions have run their course, he would invite us to become aware of self-defeating thoughts that undermine our self-esteem and make it impossible to face our difficulties. Sometimes our deeper beliefs are the legacy of early trauma which we have carried in our bones for years, unknown to ourselves.
The “cognitive” part of CBT referred to the work that the client and therapist did together to allow the client to think about whatever they were dealing with in a more helpful and hopeful way.
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Over time CBT has given rise to the entire self-help movement in psychology we have today. And the core principles of CBT underpin every mental health promotion campaign. The model has also become accepted globally and the default approach in mental health services globally.
Beck’s last publication (written in his late 80s) was a book of how we can recover from psychosis. In his final decade, he became very focused on what CBT might have to offer people who were marginalised, homeless and addicted. He was primarily a person who was concerned to help people facing challenging, painful situations.
I ask myself, “What would he say to any of us right now who are having a tough time?”
He would slow things down and invite us to be curious and listen in to what was passing through our minds. And to ask ourselves: “Might there be another way to think about this situation?”, and “What would be a kinder way to think about myself as I faced this situation?” and “How would I speak to a friend in the same situation as I find myself now?”
And he might tell us that we only had to do one thing, one thing at a time.
Beck’s original model of cognitive therapy has evolved and deepened since its inception. It has matured into a more compassionate, mindful and accepting way of responding to human suffering, whilst never losing sight of the inner strengths of the client to cope with adversity.
Tony Bates, Adjunct Professor of Psychology UCD
