Health : Marriage Therapy : High Divorce Rates Lead Father of Cognitive Therapy to Write a Pop Book for Troubled Couples
Dr. Aaron T. Beck’s idea was simple: Change the way people think and you can change their lives.
Challenge a few unrealistic beliefs, alter some habitual thought patterns, and people will stop being depressed; they will lose their anxieties, kick their drug habits and give up alcohol.
Beck called the method “cognitive therapy.” Despite considerable resistance from his fellow psychoanalysts over much of the past 30 years, the technique has proved quite successful--so much so that it is now one of the treatments of choice for a number of illnesses, ranging from depression to panic disorders.
Now the Philadelphia psychiatrist is offering his quick-fix therapy to those people who are not necessarily mentally disturbed or emotionally troubled but who, he believes, also desperately need help: couples whose relationships are in trouble.
At the urging of his followers, Beck has written his first pop book, “Love Is Never Enough,” a 323-page opus just released by Harper & Row and aimed not just at husbands and wives but all couples whose relationships are falling apart or at least need some retooling.
“Virtually everyone I talked to told me it was a great idea because typically people who most need help are the least likely to get it,” Beck said in a recent interview.
Established Beck Inventory
Marriage counseling may seem an odd place for an eminent Ivy League professor of psychiatry to focus his attention. After all, in the hierarchy of the profession, family therapy is not exactly at the top of the list. And Beck, who has already written numerous scholarly books, years ago earned a permanent place in the annals of the profession with his famed Beck Depression Inventory, a scale of symptoms used almost universally to diagnose depression.
Yet with somewhere between 40% and 50% of all marriages ending in divorce and with countless others in distress, Beck long ago became convinced that there was a real need for different counseling techniques.
What’s more, the courtly, good-humored professor claims to have more than just professional knowledge of committed relationships. A father of four and grandfather of seven, he has been married 38 years to the same woman, Superior Court Judge Phyllis Beck, whom he describes as “the Rose Bird of Pennsylvania, but who managed to herself get reelected, despite her liberal views.”
Beck got involved in the business of marriages quite naturally, he said, when he was working with depressed patients, many of whom also had marriages that were in trouble.
Even if they weren’t depressed, Beck found, people in rocky relationships shared many of the same “thinking defects” as those who were clinically depressed. While he credits one of his former students at the University of Pennsylvania, Norman Epstein, with first making that observation, Beck came up with the whole notion of defective thinking.
The idea came to him in the late 1950s shortly after he graduated from medical school at Yale and completed his training at the Philadelphia Psycholanalytic Institute.
At the time, he was trying to prove Freud’s theory of depression--that it was hostility against a loved one turned inward. If Freud were right, Beck had reasoned, it would be possible to find evidence of hostility in the dreams of depressed patients. But that is not what Beck uncovered. Instead, he saw recurring patterns of distorted thinking: People who were depressed did not dream of hatred or revenge; they dreamed of defeat, deprivation, loss. They did not seek failure; they twisted reality to the point where they could not recognize success, even when it came their way.
One Step Further
Beck then began to wonder: Was it possible to change those thinking patterns? If they were changed, would the patient no longer be depressed?
The answer in both cases was yes.
Cognitive therapy, the method that Beck devised for changing thinking patterns, is almost as easy to use as it is to understand, according to its practitoners, although many spend upwards of a year in training to perfect the technique.
The idea is to help troubled individuals recognize that their minds are riddled with negative messages, explained Christine A. Padesky, one of Beck’s proteges, who is an assistant clinical professor of psychiatry at UC Irvine and director of the Center of Cognitive Therapy in Newport Beach, one of dozens of such centers now in operation.
With the help of hefty doses of reality testing and some painstaking self-discipline and role playing, inappropriate and destructive thoughts can be identified and replaced with more objective--and positive--forms of thinking. And instead of months and years of introspection and analysis, the whole process can usually be completed in 8 to 12 sessions.
Training Others
In recent months, Beck has been traveling around the country explaining his method of marriage counseling in day-long cognitive therapy clinics to thousands of psychiatrists, psychologists and other mental-health professionals.
One of the peculiarities of relationships (and it is true whether the couple is married or not and whether they are heterosexual or homosexual), is that the individuals involved act perfectly normal and rational outside the relationship and “positively crazy within it,” Beck told a group of therapists in Los Angeles recently.
“We’ve had couples watch videotapes of other distressed couples and they see precisely what is wrong. In their own relationships, they have no idea,” he said.
What seems to be an innocent statement will provoke a fight simply because the person who hears the statement does “some automatic and quite inaccurate mind reading,” he said. A wife, for instance, will think that she knows what her spouse is thinking when in fact she hasn’t a clue, Beck said. Instead of assuming she knows what her husband is thinking, she ought to ask first. “Is this what you meant?” If it isn’t, they should both keep talking--and listening--until they do understand one another, Beck said.
“Mind reading,” he cautioned, “is not something anyone can do. We forget that.”
Over-Sensitivity Common
Couples often will take the “slightest slight and blow it up into a monumental problem,” he said. An example of this appeared on the popular TV show “thirtysomething.” A wife was angry at her husband because he hadn’t asked her enough times during a party they were hosting if she was doing all right, even though every time he did ask she said she was doing fine. One of Beck’s couples faced an almost identical set of misunderstandings. “Of course, I had to take (the example) out of my book,” he said, “because people would have thought I lifted it. They would never have believed that in real life people are just as sensitive and dramatic as are they are on TV.”
People over-dramatize their lives in many ways, Beck said. One common way is to “catastrophize” events or statements. A husband, noting that his wife is late from work might think, “She’s late. She’s always late from work and my dinner is never ready. She must have had an accident. Or, more likely, she simply doesn’t love me. Why else would she be late?” What the husband can, and should, be taught to think, Beck said, is something along these lines: “Oh, my wife is late. She must have gotten delayed at the office. Or, perhaps she hit some traffic. Whatever the case, she’ll surely be home soon.”
Yet another tendency is for couples to bury hidden messages inside innocuous statements or to ask innocuous questions loaded with past grievances. “The right way,” Beck said, “to ask your husband to help your child with home work might be, ‘Since you’re so good with math, do you suppose you could help our son with his algebra tonight?’ A less effective way would be to say, ‘Do you suppose you could possibly take time out from your incessant TV watching long enough to spend some time with your fatherless son?”
One of the most troublesome aspects of long-term relationships, Beck said, is that after repeated misunderstandings partners often “flip flop” their opinions of each other. A husband who was once “intellectual” becomes “stuffy.” A “lively” wife turns “emotional.” Simply pointing this out and asking partners to draw up lists of their spouses’ good characteristics, rather than focusing on their bad qualities, can begin to reverse the situation, Beck said.
Part of the problem in many marriages is that there are socially ingrained differences in the thinking and communication styles of men and women. Women, for instance, are in the habit of displaying many more listening skills than are men, Beck explained. While women nod and smile and say uh-hum and mm-hmmm, men typically remain silent and expressionless. “So when a wife says, ‘You’re not listening--again,’ and her husband retorts, probably for the 5,000th time, ‘I can repeat every word you just said,’ the woman nonetheless becomes angry that her husband doesn’t care what she’s saying.”
Likewise, problems occur because women are taught from the time they are little to discuss intimate problems openly while men have been cautioned repeatedly to remain silent about such matters.
“A woman’s point of view is, ‘As long as you can talk about problems, the marriage is working,’ ” Beck noted. “A man’s view is, ‘As long as you have to talk about problems, the marriage isn’t working.’ That about sums it up.”
Although most trained therapists could point out these tendencies to a couple that is having trouble, Beck says that traditional marriage counselors don’t always solve fundamental problems because they often do little more than proffer the kind of advice “a very wise friend might give.”
Beck is even critical of his own training and background. While psychoanalysts may well help individuals in a relationship discover the roots of their distorted perceptions and eventually resolve them, he said the “biggest problem is that by the time you get this worked out your marriage has fallen apart.”
So far there is little more than anecdotal evidence that the benefits of the approach are permanent.
One success story, Padesky said, comes from a Pennsylvania couple who turned up on the “Donahue Show” recently when Beck was on the air. The couple said they had driven all the way to Chicago from Philadelphia just to thank Beck publicly for having saved their marriage 20-some years ago.
Because of its low cost and the short-term nature of the treatment, cognitive therapy has become especially popular in England, the Scandanavian countries, Japan and other countries that have well-established, cost-conscious government health plans. In recent years, interest has also been growing in mainland China and so far, Beck said, five therapists have come to the U.S. to study under his supervision.
“After the Cultural Revolution in China, psychiatrists there looked around to see what was going on in the profession around the world. This is one of the things they found,” he said.
