In Therapy

A user's guide to psychotherapy

Seven Questions for Judith Beck

A cognitive therapist discusses her approach to therapy.

imageInternationally renowned cognitive therapist Judith Beck shares her thoughts on the Seven Questions. Considering she wrote the book on Cognitive Therapy, sharing thoughts is a pretty big deal.

Judith S. Beck (Ph.D. University of Pennsylvania, 1983) is Director of the Beck Institute for Cognitive Therapy and Research, past president of the Academy of Cognitive Therapy and Clinical Associate Professor at the University of Pennsylvania. She is also the daughter of Aaron T. Beck, M.D., the influential founder of Cognitive Therapy, and a fellow PT blogger.

(If I had an eighth question, I'd ask if she ever gets tired of being mentioned as "the daughter of..." She has a noteworthy track record of her own without the mention of her famous father. Some kids who follow their prominent parent's footsteps bristle when lineage is mentioned - names like Dylan and Bush come to mind. But here I go, thinking about psychodynamics. If she ever did have a problem with it, I'm sure it was resolved through thought stopping or systematic desensitization long ago.)

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imageIf you are a cognitive therapist, chances are you've read Judith Beck's Cognitive Therapy: Basics and Beyond. If you've been a client in cognitive therapy your therapist probably read it. The bestselling text is a graduate school standard that has been translated into over 20 languages. Through the miracle of Youtube, you can see her cognitive therapy in action here. Recently, Dr. Beck has applied her considerable CT knowledge to the world of diet and weight loss. Her New York Times bestselling The Beck Diet Solution was recently joined by The Complete Beck Diet for Life in a popular new approach to wellness. The cognitive component to weight loss is a crucial element, apparently. According to Beck:

...dieters needed a complete program for weight loss, that incorporates a psychological approach (e.g., what to do when you're feeling discouraged, disappointed, or deprived), dieting skills, an enjoyable eating plan, and techniques for keeping motivated for life. Most people think that just following a diet will be enough. I had previously thought that just learning essential skills was enough. But now it's apparent-you need both.

This quote comes straight from her blog right here on PT named Thinking Thin. I actually invited her to participate before I knew we were blolleagues. Welcome, Dr. Beck! PT is proud to count you as a member.

Dr. Beck generously donated her time to the Seven Questions project. CBT is often misrepresented as an aloof, technical business transaction, but Dr. Beck's responses show that warmth and empathy are central elements of any therapy. She even chides therapists for not being personable and collaborative enough in session (Q3). Enjoy this response from a highly respected therapist and author who happens to have a famous last name.

Seven Questions for Judith Beck:

1. How would you respond to a new client who asks: "What should I talk about?"

Clients don't usually ask me that question, because as a cognitive therapist, I spend a little time early in the first session describing cognitive therapy and how treatment usually proceeds. (Then I make sure the process of therapy makes sense to them and feels right.) I say something such as: "Toward the beginning of every session, I'm going to ask you what problem or problems you want my help in solving. I'll also ask you whether there's anything else that's important to you that you want to discuss. That's what we call ‘setting the agenda.' How does that sound to you?"

2. What do clients find most difficult about the therapeutic process?

It varies from client to client, but generally changing their core beliefs, their most fundamental (negative and unhelpful) ideas about themselves, others, and/or their worlds can be difficult, if they've held these beliefs for a long time. But cognitive therapy offers very effective techniques to make the process easier.

3. What mistakes do therapists make that hinder the therapeutic process?

There are so many! But here are a few:
1. They don't let their normal warm and caring personalities come through.
2. They aren't collaborative with patients. They don't act as a team and make joint decisions about what to talk about and how to tackle a problem. Either they don't focus on problem-solving and helping clients change their unhelpful thinking or behavior, or they do so, but not in a collaborative way.
3. They don't ask for feedback from their patients, either during sessions when they notice clients have become upset ("What was just going through your mind?") or at the end of sessions ("What did you think of the session? Was there anything that bothered you or anything you thought I got wrong? Is there anything you'd like to do differently next session?"). They don't make sure that clients understand and agree with what they're saying.
4. They don't help clients figure out what will be helpful to do between sessions to solve problems and feel better.

4. In your opinion, what is the ultimate goal of therapy?

To reduce suffering as soon as possible, to help clients reach their goals, to facilitate a remission of clients' disorders, and to teach clients skills (particularly in changing their thinking and behavior) to prevent relapse.

5. What is the toughest part of being a therapist?

The toughest part of being a cognitive therapist is learning the specific conceptualization (the key ideas and behaviors on which to focus) and treatment for the various psychiatric and psychological disorders from which clients suffer. The treatment for depression, for example, varies in important ways from the treatment of anxiety disorders, or eating disorders, or substance abuse, or personality disorders. Many therapists use the same approach, regardless of diagnosis. No wonder clients don't necessarily feel better at the end of the session, are ill-equipped to deal with problems they encounter between sessions, and/or stay in treatment for long periods of time without significant improvement.

6. What is the most enjoyable or rewarding part of being a therapist?

Seeing clients improve quickly and stay better.

7. What is one pearl of wisdom you would offer clients about therapy?

All psychotherapy is not the same! One particular form, cognitive therapy (also known as cognitive behavioral therapy) has several hundred research studies demonstrating its efficacy for the range of psychiatric disorders, psychological problems, and many medical conditions with psychological components No other psychotherapy has been validated by so much research. If I had a medical problem, such as trouble breathing, I would go to my doctor and ask for the treatment that research has shown to be the most effective. The same should hold true for emotional problems.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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