Verified by 
Teaching cognitive-behavioral therapy has led me to introduce a few tweaks that I would like to share. The basic idea behind CBT is that beliefs cause behavior and changing the belief will change the behavior, whether the change is the result of Beck’s collaborative empiricism or Ellis’s disputation, or either founder’s experimentation. The theory has some serious flaws—mainly, beliefs don’t cause behavior—but it works (because changing beliefs changes defining stimuli and potentiates deferred consequences).
Ellis introduced the idea of thinking about behavior as ABC, where A usually stands for “activating event,” B stands for “belief,” and C stands for consequences. The import is that problematic consequences are caused by the way the person thinks about the activating event, not by the activating event itself, which is another way of saying that personality is important. I’ve posted here on treating A’s (avoiding difficult situations, for example), treating C’s (drugs, for example), and treating B’s (the tendency to respond in a particular way), arguing that only the last is psychotherapy.
1. In life, it goes ABC, but in therapy it goes CAB. First, the therapist or client notices an unusual C—an emotion, a fantasy, a story, or a physical reaction. Then they track down the occasioning moment and its defining characteristic, the A. Then, they explore what B produced the C.
2. CBT, like self psychology with its organizing principles, tends to think of core beliefs as I-statements: “I am worthless,” “I am unlovable,” “If I show myself, I’ll be disappointed.” In fact, these kinds of problematic beliefs tend to be You-statements. “You are worthless,” we say to ourselves, not “I am worthless.” Awareness of this fact allows the therapist and client to evaluate the actual problematic statement; it also invites them to consider that there are two characters operating in the moment, the speaker and person spoken about. Each of these internal characters provides activating events for the other; each may hold separate beliefs about how the world works.
3. The most useful problematic beliefs to explore and change are not sentences; they are pictures, patterns, and movies. Each person who thinks “You are worthless” has a different self-image associated with the statement, an image that contains a lot more information than the word. The image might be a dead bird, a flooded outhouse, a bad driver, or a rejected lover. I use memories of early childhood as movies that depict the person’s experience of different kinds of situations. Even mainstream CBT has moved from “beliefs” to “schemas,” recognizing the greater complexity and personal meaning of maps and patterns and diagrams.
4. You’re not discussing the right B unless you yourself would do the C if you were using that map or schema, or held that particular belief. Why did the client hack into his girlfriend’s email account? It’s tempting to settle for the explanation that he believed she was cheating on him. But if you believed your partner was cheating on you, you wouldn’t yourself behave illicitly, so there must be other beliefs, or more to the schema. For example, he believes he has to hide his vulnerability and fears from her, or he operates with a schema where cheating is a foregone conclusion and the best you can do is catch the culprit.
5. The most useful ABC’s occur in therapy, not in life, because when they occur in therapy, both parties can assess what the A was and what the C was, since both were there when they happened. This grounds the exploration and the challenge of B’s in a shared experience. And it makes CBT yet another experiential therapy and not just a didactic one.
I realize that these tweaks make CBT look more like psychoanalysis’s intersubjectivity, like behaviorism’s functional-analytic psychotherapy, and like systems theory’s attempts to get families to enact problematic patterns in the therapist’s office where the therapist can do something about them. But then I think all psychotherapy (versus treating A’s and C’s) depends on clients messing up the therapy like they mess up their other relationships.
