At a recent case conference, Dr. Aaron Beck met with a patient suffering from depression while graduate students watched the session via live video feed in another room. The patient expressed strong dissatisfaction with his job and career direction (even though he held an objectively desirable position). At the same time, the patient was depressed, and did not presently have enough initiative or belief in himself to alter his trajectory.
During the session, after hearing about the patient’s typical week and what was bothering him most, Dr. Beck began to focus on alleviating the most pressing current problem - depression. He asked, “if your job isn’t giving you satisfaction, what else could give you satisfaction?” Dr. Beck drew a pie chart on a piece of paper and asked the patient to tell him what proportion of his life was invested in his job. The patient answered “two-thirds.”
After more questioning however, the patient said that his family was actually much more important than his job, that in terms of what he valued, his family was 80% of the circle, and 20% was his job. Nevertheless, he felt that he would not make use of his talents if he focused on just his family. He wanted a satisfying career.
Dr. Beck then asked if the individual’s talent and ability to pursue a satisfying career were more likely to flourish if he felt happy, and created the right climate to nourish his potential. The patient agreed. They then came up with the following goals: 1) Create the right climate to realize potential. 2) Work on depression, which is suppressing talent. 3) Continue to maximize the satisfaction the patient obtains from being with his family.
They outlined several concrete steps to begin working towards these goals, and Dr. Beck talked about the Give/Get balance — that what you’re putting out in terms of obligation, worrying, etc. and what you’re getting back in terms of satisfaction, happiness, etc., have to be in balance, otherwise depression can ensue.
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This is an excellent example of narrowing down the clients view of his situation and finding an issue to address that in turn will lead to a desired result. Often is seems like there are many problems and the patient doesn’t know where to begin, Dr. Beck is skilled in assisting the client to sift through the issues and gain knowledge and acceptance of a starting point.
[...] More than just the everyday blues, clinical depression affects about 17.6 million Americans each year. Fortunately it can be treated by either medication or cognitive therapy. There is actually evidence suggesting that antidepressants as well as brain exercise can provoke neurogenesis. However, it’s still unclear yet whether such neurogenesis can actually prevent dementia or simply delay it. [...]
Great post. I believe that the core cognitive therapy practices can be applied by every person to improve our happiness and productivity, without needing to have a “mental health” problem.
has there been any research on the impact of cognitive therapy on well-functioning individuals? maybe on health or job-related outcomes?
Alvaro, thanks for your comments. There actually has been research on CBT for unemployment. Here’s a blog post we did a little while ago on the topic: Unemployed? CBT Can Help.
Hello: I actually saw that study, so let me clarify: what about healthy and well-employed individuals?
As an executive who has worked in a variety of companies, I have seen a number of people (more often than one would think) who have successful careers for a long time yet are prone to depressions and anxiety that could be helped through CT-like techniques. Informally I do use them often with people I mentor: how to pay more attention to the positive instead of focusing on the negative, how to focus on the big picture vs. some distracting details, how to make decisions based on meaningful personal criteria rather than some external impositions…it is interesting to me to see that (at least based on my understanding) some important skills can be developed by every single person and that CT is focused on disease, not productivity.
Clinical Depression has a biological counterpart in the brain neuronal chemistry which can be changed with CBT. With modern antidepressants relief comes earlier – that is to be expected, but in the long run the overall well being of the individual is better with CBT or CBT+antidepressants. For mild Depressions CBT alone would be adequate. For severe Depression drugs initially and after partial recovery CBT added to drug treatment would be beneficial. For moderate Depression CBT+ or – drugs depending on the expertise of the therapist in CBT.
Another problem is that when patients talk about their problems they sometimes hide part of their concerns – especially with regard to sexual orientation. In such cases abreaction with the aid of drugs could be utilised before pinpointing aspects to be worked on.
Major losses (grief), job satisfaction, material wealth, sexual satisfaction are the four major sources of sadness.
CBT when done in a Gestalt perspective is bound to be an even more powerful tool. This perspective should be there even at history collection stage – seeing a familymember or two, during the enquiry stage (use of different methods to collect knowledge about her/his psyche) and at the CBT administration stage and follow up. Men are not machines that can be brought in and brakes and suspension fixed in a few sessions and sent away. They are complex and a complex, involved, multi-faceted treatment modality will be more approapriate to many that suffer emotional problems. True there are a handful few who repair themselves once the brakes are done. They learn how to repair next time something goes wrong. Teach a man to fish….
Alvaro, we certainly have seen healthy individuals improve their lives through the use of Cognitive Therapy, though we’re not aware of studies that have investigated this area.