Dr Robert London

Cognitive Therapy Reaches a Milestone

Clinical Psychiatry News - Volume 34, Issue 11, Page 21 (November 2006)

Dr. Aaron T. Beck's recent win of the Albert and Mary Lasker Foundation's prestigious medical prize for his groundbreaking work in developing cognitive therapy has significant meaning for me on several levels.

First, I grew up hearing about the wonders of the Lasker Foundation and its commitment to medicine through my father, an ophthalmologist, and his very close friendship with Col. Luke Quinn, a health care lobbyist in Washington who worked closely with Mary Lasker in promoting research into eye disease and blindness.

Second, the award is rarely given to psychiatrists. Third, as a psychiatrist who started his career using and developing short-term therapy techniques, I have been deeply influenced by Dr. Beck's work. In fact, it was a powerful force in many of the techniques I developed, used, and taught in my own short-term psychotherapy program for 20 years at New York University Medical Center-Bellevue Hospital.

Dr. Beck is one of many great thinkers, innovators, and clinicians in psychiatry and psychology, such as Albert Ellis, Ph.D., Dr. Frederick “Fritz” Perls, and Carl Rogers, Ph.D. All of these pioneers made substantial contributions to the processes of rethinking maladaptive behaviors, ideas, and perceptions, and they added more effective skills in living more emotionally comfortable lives through talk psychotherapy.

In my work using my learning, philosophizing, and action techniques, in which a cognitive therapeutic approach is applied in varying degrees through learning, philosophizing, and action—depending on the problem to be addressed—I have been able to help people achieve therapeutic goals efficiently and thoughtfully.

All this good work has moved us away from the traditional open-ended, intellectually driven psychoanalytical theories that had such a lock on talk therapy throughout most of the 20th century.

From the time of his 1909 Clark University lectures in Worcester, Mass., Freud's influence not only dominated psychiatry and psychology but intellectualism in education, child rearing, and environmental issues in the United States. This influence slowed and at times actively rebuked many problem-solving, behaviorally oriented treatments that were developed.

As the story goes, Dr. Beck set out in the 1950s to prove psychoanalytic theory valid. As the story continues, he was not able to validate psychoanalytic theory and began to formulate a cognitive style on how people thought and processed information.

He realized that the way in which people thought had a great influence on their emotions, feelings, and behaviors.

If these distorted or negative thoughts dominated a clinical picture, they could be challenged to more appropriate thoughts. The patients, then, using their cognitive skills, were able to change thoughts, feelings, and behaviors for the better.

What Dr. Beck did was to codify and test his results over three decades, something that had never been done with the talk therapies. He stands alone, not only in terms of success, but in documentation. The psychiatrist who set out to validate analytic psychotherapy placed his own cognitive therapy in direct competition with the psychoanalytic models of the time.

In those days, and even in some present quarters, challenging the various psychoanalytic theories was and is tantamount to challenging religious doctrine. I remember analytic supervisors in my residency program insisting that psychoanalysis was more scientific than mathematics or physics. They rejected other approaches as shallow or even meaningless.

Today we all talk of Aaron Beck's cognitive therapy, which has grown and includes numerous variations, including my own. However, unfortunately, in many areas of mental health outpatient care, traditional psychoanalytically oriented therapy is still the mainstay.

It does cause one to wonder why a person might need 5–10 years to understand her problem without even solving it, when, in the cognitive therapy spectrum of treatments, it is often a matter of months for problem resolution.

To this day, many people talk about cognitive-behavioral therapy, dialectical behavior therapy, and myriad behavioral/re-thinking therapeutic techniques. Few clinicians know how to use these techniques.

Doing cognitive therapy is hard work. You need to be alert. You need to be creative. You need to know the didactic material. You need to formulate protocols for the various problems encountered and changes that each individual may bring.

As leaders in the delivery of mental health services, we psychiatrists need to make sure that cognitive behavior therapy models become a mainstay of psychiatric residency programs so that a graduating resident knows how to work efficiently in multiple cognitive models.

In future columns, I plan to explore additional concepts of the cognitive approach to psychotherapy. Let me know about your experience in using cognitive therapy, and I will try to pass this along to my readers.

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