Aaron Beck || Humanizing Psychiatry

of mine. I used to live in the building next door to him in Philadelphia and we'd have tuna sandwiches together in Sundays at his place and have all sorts of discussions, including discussions about humanistic psychology and how to treat patients as humans. First. He was always so encouraging on my work, and I enjoyed our discussions about his life and work immensely. I will miss his amazing bow tie, our fist bumps together, and his sharp mind, which lastened

all the way until the end. In my last in person meeting with him, just before the pandemic hit, I handed him a microphone and asked if he would talk about what research he was most excited about these days, and whether he could give any advice to young psychologists. That recording is what you will hear today on the podcast. Remarkably,

Tim worked all the way up until his death. To many he is most known for his work in cognitive behavioral therapy, which is a time sensitive, structured present oriented psychotherapy that has been scientifically tested and found to be effective in more than two thousand studies for the treatment of many different health and mental health conditions. When implemented correctly, CBT can help individuals get better and stay better. Not many people know this, though, but Tim's work was much

more than the seminal work he did pioneering CBT. Tim was recently working on a new form of psychotherapy with his colleagues Ellen and Verso and Paul Grant, called Recovery oriented cognive therapy, which deeply humanizes psychiatric patients. Guided by Tim's cognive model, Recovery oriented cognitive therapy is an evidence based practice that provides concrete, actionable steps to promote recovery

and resiliency. Originally developed to empower individuals given a diagnosis of schizophrenia, Recovery oriented cognitive therapy applies broadly to individuals experiencing extensive behavioral, social, and physical health challenges. It is a highly collaborative, person centered and strength based approach as it focuses on developing and strengthening positive beliefs of purpose, hope, efficacy, empowerment,

and belonging. The approach is specifically formulated and effective for individuals who have a history of feeling disconnected and distrustful of service providers, who are not help seeking, or who experience challenges that impede action towards aspirations. The reach of recovery oriented cognitive therapy extends to mental health professionals across all disciplines, families and loved ones, and peers with lived experience. One other thing I'd like to mention before before we

get today's episode is the Beck Institute. In nineteen ninety four, Tim and his daughter, doctor Judith S. Beck, founded Beck Institute as a five h one c three nonprofit with the mission of improving lives worldwide through excellence and innovation

in cognitive behavioral therapy, training, practice, and research. In twenty nineteen, Beck Institute opened the Beck Institute Center for Recovery Oriented Cognitive Therapy to train professionals and staff who work with individuals given a diagnosis of a serious mental health condition, such as schizophrenia. Beck Institute honors the legacy of doctor Aaron Beck by providing training and resources in both CBT

and CTR to people around the world. In the nonprofits twenty seven year history, over twenty eight thousand health and mental health professionals have received training in CBT or CTR through a variety of programs. You can help honor doctor Aaron Beck's legacy by making a gift to the Aaron T. Beck Fund at Beck Institute. This enables the organization to continue doctor beckcas leadst work with the Center for CTR at Beck Institute, develop programs, fun scholarships for trainees, and

everything in between. The Beck Institute website can be found at Beckinstitute dot org. Okay, now, without further ado, I bring you our guest today, doctor Aaron T. Beck. I have a mic and yeah, we're just do you want so? Do you want to take this? It's right here, and just put as close to your mouth as possible, Okay, okay, and just say hello, Hello, Hello, Yeah, I think this would be good. Hello, No, this is great. Okay. So Tim Beck, it's so great to be here with you today.

Such a legend in the field of psychology and one of my personal heroes. I just wanted to talk to you a little bit about some of the work you're up to. I've been working with two psychologists. One of them is Paul Grat, and we've been working together the last twenty years. He formed one of three groups that I was supervising, so his group was eventually in SUPERI

mental illness. And then there was a second group, which I had to do with the application of cognitive therapy to the community, and then the third has to do with the prevention of suicide. And there has been a transformation in the department so that well, I'm still supervising the other two, Paul Grants having depart of the department with his group and gone to the Beck Institute. Despite that, I'm still supervising the three teams, but the team that

I'm most interested in is as Paul Grant's team. Okay, now he's been working with a severely mentally ill He and his group they have been actually developing a new treatment which they are calling a recovery oriented cognitive therapy. And the way that got started was around twoy eleven, the Commissioner of Mental Health for the City of Philadelphia said he had to give a talk at the APA and it was going to be about recovery orientation. And I said, well, I haven't worked with addicts, oh, in

the field of addiction for a long time. And he said, oh, oh, this is a different type of recovery. This is not the old fashioned recovery. But this has to do with an improvement and well being, socialization, doing things that are worthwhile in one's own had and creative and enjoyable and so on. And he said that this is where we want our metal patients to be mm and I said, well, that's a great goal, but how how do you propose to get them from running around in the unit hearing

voices or maybe smearing things around? And uh, I say, how do you get them from this highly regressive state to the state of recovery And he said, well that's your job. So I said, okay, so the other challenge, that's a challenge. So Ever, since then we've been working with mental patients and we have gradually developed a treatment which is based on the recovery being the outcome of the treatment. But of course the treatment itself involves much

more than just having an outcome. And so we had written, we had written a book and had a contract on evidence based therapy for the mentally ill. Around twenty and twelve, the book was finished, but it was not recovery oriented. It was like the old fashioned cognitive therapy. And then Paul and then one of his students who now became his associate, works on writing up a new book. And this new book has been completed and it's in the hands of the publisher right now. And this new book

describes in detail just what the therapy is like. And so this is the idea of the therapy. You first try to find out what the person's aspirations are. I love that, and you go over it and over their aspirations and how they would feel about meeting their aspirations. And when they really have their aspirations fixed in their own mind, their motivation to reach that area becomes increased. And the next thing that we do is we try

to find out what the individual sweet spot is. So every individual that we've had has something that he's really good at, something that they have done in the past, and we find that they're actually doing it in the present but it has gone on recorded. So we tell the staff between this week and next week, I want you to tell it how the patients are acting at their best, and they say, oh, they're never at their best. They're all hitting other people, they're throwing food around while

they're in the corner hose landing. So we say, okay, well, it's just keep your eye open. And then we found out that in a unit of fourteen patients they're all fourteen, had an experience at their best when they seemed to be completely normal. And so this was the key thing. And so one person would be teaching dancing to some of the other patients, another one would be drawing pictures of the other patients, another person was making a shoe

fe for them. And the interesting thing is one they are in their sweet spot, then they seem particularly normal. And actually Paul has subjects it to the word normal, so we use the word adaptive. So they are adapting totally to this. And during this period of adaptation, as apparent that these people are perfectly capable of behaving adaptively, that they have not despite their apparent craziness. Ah, they have not lost at all their ability to be quote normal,

are adaptive. So my task a few weeks ago, about three or four weeks ago, was to write a paper explaining the adaptiveness of these people and we said, and so the type of the initial title of the paper would be adaptiveness, and it's a really mentally ill most of the schizophrenic or all sorts of different things. Well, so there are only two categories of patients, those who were diagnosed with schizophrenic and they are hearing voices and the delusional. The other type that go in are in

the hospital because they are assaultive. And this is uncontrollable on the outside I see. So they're assault shive or self injurious, and so in the self injurious they're taking they swall hard objects like force and knives. And a couple of the people who we have demonstrated widely came from where they're they're actually their death. They were going back and forth for surgery to the hospital and are

now accommodated. So anyhow, getting back to the theory, I wanted to prepare a theory as to why these people get better. And then as I worked at the cases, it seems that you do try to activate their humanity. Excuse me, activate their humanity. Yeah, in a way, Well, we activate their humanity, and it turns out that they love doing things for patients, for the other patients, or for the staff that they they have a strong urge to do things for other people, and when they are

doing these things, they are totally adaptive. However, this does not last, otherwise they'd be out of the hospital within a week. The therapy consists of extending the period of adaptiveness short of day by day, and we we do a well of the work with the staff rather than with the patients per se, and the staff then gets

the patients much more into the adaptive mode. And so I then developed a theory of modes, and the idea is that the personality consists of various sexes, and you see these molds and a wide variety of cases for example, and multiple personality to sort of which I think is a real disorder. The people can operate at times being very hostile and bellisering when they're one person, and when they shift to another person, they change the name and

they are say, humble, self effacing, very passive. In working with these people, we realize that these are different aspects of the personality and this is something that we've labeled modes, and the mental patients are perfectly capable of getting into an adaptive mold. Then try to provide opportunities for them to remain in this mold. So the next step in my theorizing, Yeah, I think of what is the function of personality? And these modes seem to be very adaptive

and the most are different sectors of the personality. So my next step was I came to the conclusion that the function of personality in general as adaptation. Oh but the function, but the people, because of their constructions of things, are in maladaptive modes. And so the therapy consists of changing from and we're doing an experiment now and which we recognize that people who are not going to believe that this is happening. Of our administrators of hospitals believe,

but the profession won't believe it. So, yeah, a precious headset and the headset as you say, eeg, And we put the headset on when there are they're worse, and then when they're solemnly in the adaptive mode, and already we see that there's a change, a different part of the brain is activated when they're in the adaptive mode. Wow, that's huge, so so very terrific. And so that's the subjects of our paper. So you can't wait to eat it. Yeah, I was appreciate your feedback. Paul had a number of

very good suggestions for the paper. I was using words like normal and so on. He says, that's too world is an expression, and a lot of people will rejectful use of their normal. I think so, so we use the word adaptive, and I like adaptive constructive, right, so when they're doing construction things, they're in the adapt from more. Yes, and so my very latest has to do with looking back at how the original therapy depicted itself and how

a new therapy the self depicting at all. So the third type of therapy, which has to do with basing exercises or distancing once so or something that's called better cognition. So I think that the therapy that we're doing with the hospital and patients is inevitable because they are not capable of the type of discussions that we're part and partial of the original therapy. So that we can call the new therapy recovery oriented therapy, or we can call

by the fact that people become better adjusted. So that's one type of therapy. The original therapy was based mostly on the individuals distortions and the negative biases about their experiences and so the original therapy which is now being practiced bioledged by the people I have trained prior to Paul Grants, so that therapy is based on negating the negative biases or correcting the now adaptive constructions of situations.

And the third type, the third approach, which I think is valuable, has to do with the breathing exercises that people do. And it seems that that by being occupied with their breathing, the people are able to distance themselves from their negative constructions of situations. So I therefore promoting

the idea of three therapies. And we don't know as yet what the application of the initial therapy was that is changing the misconceptions of people, and how afflication that's gonna be regod to the more humanistic and holistic Sarah Bath that I've been talking about love it today. And we also don't know the full application of the breathing exercisers, which has become very popular, and there has to be some validity to it. Mm hmm. So that's it. That's

all I know, you know, that's not all. That's not all you know. I just want to say something about the humanistic approach you're taking when you started your career. You were influenced by some of the humanistic psychologists, right like Abraham Masl and Karen Horney and various folks. You told me that they were the Carl Rogers. They had an impact on you, right, Well, they did, but the structure of my Sarah, they wish more and correcting the negative, right,

rather than accentuating the positive. Right. But it sounds like now you've you've really kind of come full circling. Yeah, yeah, I comfort full cycle as far as the severe and patience. But we still have to see, uh where the three approaches. Yeah have an application. Sure, you're such a treasure. And you know, I just won't if give any advice to any young psychologists that want to make an impact in the world such as you have. So I can't look back to the impact and what I did to make

that impact. But I would say that I wear from my patients, and then I would figure out what was going on within the patients and what the mechanisms were.

For example, I observed that depressed people would be very self critical after they had an event, that that I pinched it and pinched on their self esteem, and so I then would use a technique, oh, such as looking at the distortions, and then I would test the shadow laboratory and when that worked, then I would write up a solabers and when I found a publisher, then I would publish the sold as a book. So what I would propose to the buddy your psychologists is you have

to you have to see the raw material. You have to see individuals, and it could be as simple as being in a counseling center, but you have to get your raw material from your observations. Then you have to test out what the evidence is that you have discovered the truth. And then you have to demonstrate that your approach actually makes the people better. And then when you've done that, then you go on to the next problem next. Thank you so much. Okay, thank you you ready for lunch?

Now I'm going to have lunch. Let's do it. Little fist bump saying it's the end of the episode. Thank you, Do you want to eat a little bit? Yeah? Oh that's so interesting, okay, and killing me so in case we don't record anymore, let me just say thank you so much for sharing that with me and your latest work. I think it's going to be so foundational. And helps them make me able to thank you for talking with me. Oh good, Thank you. Thanks for listening to this episode

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