I was having a ‘digital clearout’ of my laptop and came across old papers that I had written for my doctorate.
Some are no use to man or beast, as many years have passed since they were written and are now outdated. However, I have copied and pasted a part of a paper I had written on Cognitive Behavioural Therapy, as I think it might help to explain some useful workings of the model.
In Beck’s (1979) cognitive model, at its simplest level, thoughts, mood and behaviour are related. In an assessment session with a 19-year-old woman who was discussing her relationship with a prospective boyfriend, I used this opportunity to educate her into the basics of the model.
I asked her to imagine that the young man she was attracted to asked her on a date. In this scenario, he was sitting opposite her but often would appear distracted and glance over her shoulder.
I asked my client, what would you think? She replied that she thought he would be looking at another woman. Using standard cognitive behavioural techniques, it emerged that she thought the ‘other woman’ was more attractive. When prompted, she said this made her feel angry and jealous and may result in her leaving her date.
When I gave her the same scenario and told her that he was looking over her shoulder to check if a taxi he had booked had arrived to take her somewhere special for dinner, her mood changed.
Very quickly, this young woman grasped the idea that her ‘negative automatic thoughts’ (he’s looking at another woman) influences how she ‘feels’ (jealous and angry) and this affects her behaviour (in that she may have missed out on a nice evening) – even though the situation had not changed, her beliefs about the situation had.
‘Beliefs represent the individual’s understanding of themselves, their world, and others’ (Beck, 1967). For example, in my own practice when working with a young man who was referred for agoraphobia, it was not being outside per se that was the problem, but rather the client’s difficulties where being manifested from his beliefs about being outside.
Underlying his fear of going outside was the negative automatic thought of ‘what if something happens to my wife and kids?’ which as Beck (1995:14) stated these thoughts are not the result of deliberation or reasoning but occur without the client necessarily being aware of them.
Using standard techniques we were able to identify this and other similar thoughts and the client became aware of the concomitant emotion of fear and how it stopped him from going out without either his wife or children.
Working collaboratively we then modified the belief when discussing the likelihood that something would happen to his family… has something happened to them before? Using a combination of modification of his dysfunctional beliefs and behavioural experiments, the client is now able to go outside without either being accompanied by his wife or children.
The outside place has not changed but the client’s beliefs about going out alone have. It is not a situation in and of itself that determines what people feel but rather the way in which they construe a situation (Beck 1964).
Alexander, F. (1956). Psychoanalysis and psychotherapy: Developments in theory, techniques, and training. New York: Norton.
Alford, B.A. & Beck, A.T. (1997). The integrative power of cognitive therapy. New York: Guilford Press.
Beck, A.T. (1964). Thinking and depression: II. Theory and therapy. Archives of general psychiatry, 10, 561-571.
Beck, A.T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
Beck, A.T. (1979). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.
Beck, A.T., Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: Guilford Press.
Beck, J. (1995). Cognitive Therapy: Basics and Beyond. New York: The Guilford Press.
Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Routledge.
Division of Counselling Psychology. British Psychological Society.
Gerhardt, S. (2004). Why Love Matters. Hove, East Sussex: Brunner-Routledge.
LeDoux, J. (2002). The Synaptic Self: How our brains become who we are. London: Macmillan.
Luborskdy, L., Crits-Chrisoph, R., Alexander, L., Margolis, M. and Cohen, M. (1983). Two helping alliance methods of predicting outcomes of psychotherapy. Journal of Nervous and Mental Disease. 171, 480-491.
O’Brien, M. and Houston, G. (2000). Integrative Therapy A Practitioner’s Guide. London: Sage Publications.
Safran, J.D. and Muran, J.C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64(3), 447-458.
Safran, J.D. and Muran, J.C. (2000). Resolving therapeutic alliance ruptures: diversity and integration. Psychotherapy in Practice, 56(2), 233-243.
Safran, J. and Segal, Z. (1996). Interpersonal Process in Cognitive Therapy. New Jersey, U.S.A.: Aronson Inc.
Young, J.E., Klosko, J.S. and Weishaar, M.E. (2003). Schema Therapy A Practitioner’s Guide. New York: The Guilford Press.