Dr. Beck was originally trained in psychoanalysis in the 1950s. How did he transition from psychoanalysis, the predominant methodology of that time period, to developing Cognitive Therapy?

Here’s an excerpt from a great interview Dr. Beck gave in 2004.

Interviewer: Can you reminisce about your role as a psychoanalyst?

Dr. Beck: Let me respond with a clinical illustration. A woman patient is on the couch and she spends the entire time talking about her sexual escapades.  At the end of the session I do what I think analysts are meant to do – I ask her how she feels.  “Very anxious,” she responds.  This makes good sense, I say, because you have these sexual impulses but since they are forbidden, they rise to consciousness and break through your defenses, and this causes anxiety.  And she says, “You’re right; that is brilliant.”  But she has a tentative tone in her voice.  I indicate that she seems tentative.  She replies,  “Yes, I was afraid that I was boring you.”  I seize on that.  You have been here all these months and this is the first time you have told me about your fear of boring me.  “It had never occurred to me to reveal this,” she retorts.  I ask how often she thinks like this.  “All the time.  I think it when I am with you and when I am with other people.”

I then noted that other patients also were not reporting what they thought.  It then occurred to me that there are two types of communication: internal and external.  Internal refers to the automatic thoughts people have about themselves which they do not ordinarily share.  On the other hand, thoughts usually communicated (ie. external) in psychoanalysis are of the kind that people do communicate to other people.  At this point I thought that if I was going to get at what I call automatic thoughts, I ought to sit them up [the patients] so that we could talk back and forth.  I also discovered that I was having automatic thoughts.  I had not been aware of them until I started focusing on them.  That is how I abandoned the couch.  This fitted into the cognitive model I was gradually formulating and also gave me an approach to therapy.

This Interview with Dr. Beck is a detailed, personal account in which Dr. Beck explains the history of Cognitive Therapy, including how he went about developing and refining CT, creating CT models for different disorders, and subjecting CT to rigorous clinical testing.