Aaron T. Beck and I met in 1978 when I was his therapist. At least that’s my favorite way to tell the story.
I was a graduate student at UCLA. Beck had mailed our depression research team a manual describing a therapy being developing at the University of Pennsylvania called “Cognitive Therapy.” This manual was later published as Cognitive Therapy of Depression (Beck, Rush, Shaw and Emery, 1979).
On a visit to California, he stopped by our department to give us – eight students and our professor – a brief presentation and get reactions to his therapy. He showed a video of himself working with a client. My automatic thought was, “Here’s this man who’s invented a brilliant form of therapy, but he’s not very good at doing it.” Like many therapists viewing cognitive therapy the first time, I didn’t think his session looked very sophisticated. When he asked for a volunteer to role play his therapist, I raised my hand thinking I could conduct an interview nearly as good as his video.
Beck was good-humored after our role play and peppered me with questions about our use of cognitive therapy (CT) in our university clinic. He invited me to lunch to learn how I was using CT with depressed children. Apparently I was one of the first to do so.
That began a mentoring relationship that became a lifelong close friendship. As I reflect on these past 35 years, several of his characteristics stand out as inspirations for me as a therapist, consultant and teacher.
Beck is powered by curiosity. He has become one of the most influential psychiatrists in history because his curiosity leads him from question to question. He examines each question with observational and empirical depth. I am continually impressed by Beck’s ability to detect patterns in human experience that are simple and yet define the core of understanding.
Curiosity infuses his therapy. When he meets clients he shows great interest in their families, work, hobbies and weekly activities as well as their beliefs and emotions. I’ve learned to foster therapist curiosity in my workshops and consultation relationships because curiosity is one of the best markers of a good cognitive therapist.
Five years after we met, Beck and I were teaching a workshop in Texas and he told me the next day he was going to show the video he had shown at UCLA. He asked me to offer commentary to the audience about how it illustrated the principles of CT. I did not sleep well that night. How would I find something useful to say about a video I recalled was such a poor CT demonstration? The next day, I prepared to make polite comments as he showed the DVD.
As I watched, I was stunned. I couldn’t believe how much he had learned in five years! This video now seemed one of the best demonstrations of CT I had seen. He demonstrated genuine interest in the woman he was interviewing. She and her husband enjoyed bowling and he had a plain spoken conversation about her bowling league. Beck built on her interest in bowling to collaboratively create several experiments to test out her depressive beliefs. With experience, I could see the elegance in his simple interventions.
This is one of many times I learned that good psychotherapy happens when we meet clients where they are, use genuine curiosity to flesh out details of their experience (emotions, beliefs, behaviors and physical reactions) and find the next small step to build skills to help them feel and stay better.
One evening he and I gave a presentation to some psychiatrists. A woman nearing the end of treatment in a CT inpatient program following a suicide attempt agreed to be interviewed on stage. The next morning, I picked Beck up at his hotel and asked what he wanted to do before his flight home. He asked me to drive him to the hospital.
I was surprised he had booked a small room to meet with the woman we had interviewed on stage. He talked to her with interest about her future plans. As they talked, he took out the small spiral notebook he always carries and wrote a few notes. This was not unusual; during conversations he frequently jots down ideas to retrieve later. However, at the end of the conversation, he tore the page from his notebook and handed it to the woman. “This is my home phone number. Please call me a week or so after your discharge and let me know how things are going for you.”
By now, Beck was quite famous. I was surprised he had given his home telephone number and asked him why he did this. He replied, “She said she lives alone. People often face difficulties after discharge and I wanted her to know she is not alone. Having someone to call and talk to can make all the difference.” I’ve never forgotten this private experience that highlights Beck’s consistent caring and willingness to be genuinely available to patients.
He is also a true scientist — empirically minded instead of clinging to his own model at all costs. In our early teaching days he was frequently attacked because CT seemed radical to many. For example, some therapists had a hard time believing that working primarily in the “here and now” could change long-standing fears and interpersonal problems. Beck respectfully acknowledged these disagreements as “empirical questions” that could be resolved through investigative studies. Over the years, most of his ideas have been strongly supported by research in cognitive psychology and neuroscience.
Beck taught me to be scientific with clients using collaborative empiricism as the cornerstone of practice. This means knowing the empirical literature and using empirically supported therapies to test out client beliefs and behaviors. It also means collaborating with the person in front of us and staying curious if his or her experiences fit or don’t fit our empirical models.
Now in his 90s, Beck’s ongoing research pursues new knowledge about schizophrenia, depression and suicide. He still experiences a thrill when his team makes discoveries that can help people. When we last had lunch in Philadelphia, I smiled at his ongoing enthusiasm, still powered by genuine caring, and his unflagging curiosity. Beck has changed the world. I am one of many who benefited tremendously from his curiosity, kindness and courage to seek and follow the data.
References available from author