A 60-Year Evolution of Cognitive Theory and Therapy

As I look back over the past 65 years, my professional life has been filled with what I can best describe as a continual series of adventures. For the most part, the challenges that I’ve confronted were of my own making: Like Theseus in the labyrinth, whenever I seemed to find a solution to a problem, I was confronted with another problem. My initial difficult confrontation occurred when I was a fellow at the Austin Riggs Center in Stockbridge, Massachusetts. I was assigned to work with a young man with a pervasive delusion of being followed by government agents. To my surprise, even though the therapy was for the most part supportive, the delusion disappeared. In 1952, I subsequently published this case history as the first reported successful psychotherapy of an individual with schizophrenia (Beck, 1952). This case report is of particular interest since 50 years elapsed before I returned to the psychotherapy of schizophrenia: a form of mental illness that is considered, then and now, to be relatively impervious to psychotherapy. In 1956, fresh from having passed my boards in psychiatry, I initiated my first major undertaking: validating the various propositions of psychoanalysis. Having undergone a personal analysis and completed the other requirements for admission to the Philadelphia Psychoanalytic Institute, I was totally committed to the theory and therapy of psychoanalysis, but I felt that for psychoanalysis to be accepted by the larger scientific community, it would require a solid base of evidence. On the basis of that conclusion, I decided to test out the central psychoanalytic proposition that depression was caused by inverted hostility. That is, if the patient experienced unacceptable anger toward a close person but repressed this unacceptable anger, it would come out in the form of self-criticism, negative expectancy, suicidal wishes, and depressed mood. I teamed up with Marvin Hurvich, a psychology graduate student at the University of Pennsylvania. I prepared a scoring manual for hostility in dreams, and Marvin blindly scored a sample of dreams from patients with depression as well as a control group of patients who were not depressed. To our surprise, the patients with depression showed less hostility in their dreams than did the nondepressed individuals. This negative finding posed a dilemma for us: It would seem that the absence of manifest hostility in dreams, which had been characterized by Freud as the “royal road to the unconscious,” invalidated the theory of inverted hostility. However, after examining the content of dreams for a second time, we found that the dreams of the patients with depression consistently portrayed the dreamer or the action in the dream in a negative way. Conversely, this consistent finding was not evident in the dreams of the nondepressed patients. We then reasoned that the hostility was unable to penetrate through the dreams, but it still existed at an unconscious level and assumed the form of a need to suffer. Because of this theme, we labeled these dreams as “masochistic” and found that using this negative portrayal of the dreamer as a symbol of the need for personal suffering clearly differentiated the patients with depression from those without (Beck & Hurvich, 1959). In the early 1960s, I teamed up with Jim Diggory and Sy Feshbach from the Department of Psychiatry at the University of Pennsylvania. Although our empirical articles weren’t published until years later, I conducted a number of experiments at that time based on the premise that if patients with depression had a need to suffer, they would perform better after a negative experience than after a positive experience (Loeb, Beck, & Diggory, 1971; Loeb, Beck, Diggory, & Tuthill, 1967; Loeb, Feshbach, Beck, & Wolf, 1964). For example, failure at a task or continuous negative feedback would lead to better performance than would a positive experience on a task. 804187 PPSXXX10.1177/1745691618804187BeckEvolution of Cognitive Theory and Therapy research-article2018