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From Psychoanalysis to Cognitive Therapy

Aaron T. Beck , M.D.


November 2001

My first research interests were to empirically validate psychoanalytic theory. When my


experimental studies did not bear out the retroflected hostility model of psychoanalysis, I tried
to reconcile the discrepant finding.
I latched onto a simple minded formulation: Dreams represent patients images of
themselves and their experiences. A patient would see himself in a dream as defective,
diseased, or deserted because this was his prevailing self-image at this particular time.
This dream image was continuous (not discontinuous as Freudian theory would
stipulate) with the patients conscious view of himself that he reported in my psychotherapy
with him.
Thus I reformulated patients neurosis in terms of a cognitive model.
a) Depression was an expression of the patients negative view of himself, his future,
and his experience (the negative cognitive triad).
b) Anxiety represented a fear of an unpleasant future event.
c) Phobias were a specific fear of a bad occurrence in a particular situation or set of
circumstances (for example, speaking in public.)
d) Obsessive- Compulsive Disorder encapsulated a fear of some bad event which would
happen unless the patient would take preventive action.
My formulation of the cognitive model actually coincided with my reexamination of
psychoanalytic theory of the 1950s.
The cognitive model and the therapy derived for it offered a simpler more parsimonious
way of organizing and understanding the clinical data. In addition, they were testable, and
teachable.
Contrast this with the theory and therapy of Psychoanalysis. The motivational model
which seemed to be at the center of psychoanalytic theory required a complex infrastructure to
explain the phenomena of psychiatric disorders as well as normal behavior.
Why did people get depressed? Obviously they would not consciously wish to be
depressed no would they consciously utilize certain mechanisms to make themselves
depressed.

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According to the motivational model, therefore, some unconscious, processes would need to
be invoked. Freud latched onto the notion of unconscious hostility. This actually fit the bill but
only if you interposed certain defense mechanisms between the unconscious hostility and the
conscious experience of depression.
According to the theory, this hostility was often towards a loved one- even one who had
died. The hostility that was stirred up was unacceptable: presto it was turned against the self.
This notion of retrofelcted hostility does account for suicidal wishes, self-criticalness, an
violation of the norms of social and personal behavior, including withdrawal, anhedonia, and
self-punishment and the biological needs such as appetite, sex, and sleeping.
However, the cognitive model could account for these phenomena in a simpler way,
involved identification of conscious processes, and could be tested by the patient in therapy.
The more I examined psychoanalysis, the more it struck me as a closed system.
Thus, the wish fulfillment notion of dreams would explain that if a parent dreams of the
death of a child it is because the parents wished it. Cognitive theory would propose that it
represents a fear of the child dying.
The virtue of being able to explain everything was also a trap. Since psychoanalytic
theory could be accommodated to explain almost any phenomenon, it could not be falsified. It
was possible to tweak the model in order to come up with a different explanation if one
formulation did not test out. There was such a richness of diversity of potential explanations
that something could be extracted to explain unexpected findings.
Psychoanalysis also struck me as a closed system in so far as it did not pay much
attention to the external world. The Oedipus complex, for example, as representative of the
notion of psychic determinism, determined the individuals responses to his/her parents and
consequently, to other figures later in life.
The notion of hostility was also a basic psychic form of energy that would build up over
time and then would find expression interpersonally as criticism or attack and on a social level
as violence or war.
Psychoanalysis also was a closed system and so far as therapy was considered, if a patient did
not accept an interpretation, it was due to the patients resistance. This in turn was explained
by the doctrine of repression. An interpretation that is on the mark would stir up unconscious
forces and thus force the patient to repress the unconscious impulses and oppose acceptance
of such interpretations.
Similarly, if a patient could not remember a particular event such as the primal scene,
some childhood recollection would be reconstructed as a screen memory.

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When I reviewed the entire metapsychology, structural, and energetic models of
psychoanalysis, I felt that it was overly elaborate and overly abstract and had little evidence to
support it.
Another disconcerting feature was that when I presented the same material to
supervising analysts, they drew on the same body of theory but came up with totally different
explanations of the material that I presented. This was one more example of the overly
comprehensive nature of the theory from which numerous diverse explanations could be
drawn to explain in the same phenomenon.

Originally published in Cognitive Therapy Today Volume 6, Issue 3. November 2001.