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Cognitive Therapy
Theoretical Modality Paper
By Matt Littlefield
HSC – 510 Theories of Counseling
National Louis University – Lisle

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Abstract
While learning about the different kinds of theoretical orientations to psychotherapy, I was both
inspired and anxious about choosing only one that best fits my persona. After a great deal of
reflection and deliberation, I have chosen to focus on Cognitive therapy [CT]. Even though CT
utilizes some behavioral techniques, and can also be referred to as Cognitive Behavioral Therapy
[CBT], for simplicity’s sake, I will refer only to CT throughout this paper. It best fits my
personality in part due to the importance placed on the quality of the client-therapist relationship.
CT also fits the way I look at people in need of help. I do not see people as whatever their
possible technical diagnosis might be; I see them as suffering from symptoms largely due to
erroneous beliefs about themselves and cognitive misinterpretations regarding their life
experiences. This paper explores various sources, in order to present the historical background
and founder, view of human nature in relation to the client-therapist relationship, main
interventions utilized, and specific reasons why I chose the CT modality. I will also portray my
own personal theory of counseling by taking the liberty of employing what I view as the best
techniques from other modalities.

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Cognitive Therapy
“I think, therefore I am” is perhaps the most famous quote about cognition in the history
of the world (Descartes, 1637). In a preview of his recent book titled The Gap: The Science of
What Separates Us From Other Animals, Thomas Suddendorf states that he has repeatedly
“found two major features that set us apart: our open-ended ability to imagine and reflect on
different situations, and our deep-seated drive to link our scenario-building minds together”
(Suddendorf, 2014). He went on to assert that development of these two qualities have turned
“memory into mental time travel, social cognition into theory of mind, problem solving into
abstract reasoning, social traditions into cumulative culture, and empathy into morality”
(Suddendorf, 2014).
Cognitive therapy [CT] best fits my persona because it addresses thinking and how it
affects feeling and doing. CT allows the client to become empowered by taking an active role in
achieving insight into why one thinks in a certain way. The client is not considered sick or ill,
but rather as suffering from dysfunctional thinking by way of making flawed interpretations of
events. Just like when you hear the same song repeated over-and-over, self-defeating, negative,
and inaccurate thoughts can play on-an-on in one’s mind. If one repeats something harmful over
a long period of time, even if it is absolutely not based in fact, one can start to believe it as fact.
The main objective of this paper is to detail what makes CT unique among the many
modalities. I will also describe why I have chosen to focus on this model primarily, although I
do plan to use effective tools from other theories whenever appropriate. CT has proven to be
effective and popular among therapists within the counseling community. According to Corey
(2015), CT has become “one of the most influential and empirically validated approaches to
psychotherapy” (p. 289).

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Historical background and founder
Dr. Aaron T. Beck founded CT during the 1960’s. According to Weishaar (2002), Beck
is “a lot like cognitive therapy – active, direct, pragmatic, creative, and optimistic about change”
(p. 1). Corey (2015) adds that Beck has a “vision for the cognitive therapy community that is
global, inclusive, collaborative, empowering, and benevolent” (p. 289). As stated on the Beck
Institute for Cognitive Behavior Therapy website, it has been “studied and demonstrated to be
effective in treating a wide variety of disorders. More than 1,000 studies have demonstrated its
efficacy for psychiatric disorders, psychological problems, and medical problems with a
psychiatric component” (Beck Institute for Cognitive Behavior Therapy, 2015).
Dr. Beck has made an indelible mark on the field of psychotherapy. Weishaar (2002)
described a young man, who had a remarkable childhood. He was the youngest of three sons,
although another son and their only daughter passed away before he was born. These tragedies
may have led his mother to become more anxious, depressed, and over-protective. Her fears
were exacerbated by a childhood accident that nearly killed the little 7-year-old Aaron (p. 2).
Hollon (2010) described that “a broken bone in his arm became infected and he developed
septicemia, an infection of the blood that was nearly always fatal at that time” (p. 66). Weishaar
(2002) picked-up the story from there: “He was told that he would be briefly separated from his
mother to have x-rays taken and instead was taken to surgery, where the surgeon began cutting
before the anesthesia had taken effect” (p. 2).
Because he missed so much time recovering, he was held back in school. However, that
did not deter him from not only catching-up, but from excelling past his peers. “He believes this
experience taught him the value of persistence and how to turn a disadvantage into an
advantage” (Weishaar, 2002, p. 3) He went on to graduate magna cum laude from Brown

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University, before matriculating to medical school at Yale. While he had some interest in
psychiatry, he chose to specialize in neurology. He was skeptical of the psychoanalytic
approach, but quite by chance due to a shortage of psychiatrists, he was forced to take a six
month rotation in the field. That experience served as a springboard, launching him into a career
as a psychoanalytic therapist. In making this leap, he decided to undergo therapy himself, as part
of his attempt to better understand the foundational principles of the approach (Weishaar, 2002,
p. 3).
He was hired as a psychiatry professor at the University of Pennsylvania Medical School
in 1954. He was given a grant in 1959, which allowed him to perform research on the value of
dreams. Since he still had suspicions about the premise that depressed people intended to focus
their anger upon themselves, this opportunity afforded him the chance to test his alternate theory.
The evidence he found became the foundation of CT. “The dreams were not motivated by a
need to suffer, but rather were a reflection of a person’s thinking. The model of depression was
thus reformulated, no longer based on motivation but on how a person processes information in a
negatively biased way” (Weishaar, 2002, p. 4). Corey (2015) described how Beck’s new theory
was received at the time. “As a result of this decision, Beck endured isolation and rejection from
many in the psychiatric community for many years” (p. 288).
However, he made a real breakthrough in 1977, which changed everything. The study of
41 depressed patients proved, for the first time, that CT was more effective than taking
medication:
“Cognitive therapy resulted in significantly greater improvement that did
pharmacotherapy on both a self-administered measure of depression (Beck
Depression Inventory) and clinical ratings (Hamilton Rating Scale for Depression

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and Raskin Scale). Moreover, 78.9% of the patients in cognitive therapy showed
marked improvement or complete remission of symptoms as compared to 22.7%
of the pharmacotherapy patients” (Rush, Beck, Kovacs, & Hollon, 1977, p. 17)
View of Human Nature
As Beck continued his dream research, he was surprised to discover that depressed
patients had what he called automatic thoughts. “These thoughts (cognitions) tended to arise
quickly and automatically, as though by reflex; they were not subject to volition or conscious
control and seemed perfectly plausible to the individual” (Beck, 1991, p. 369). Beck contends
that cognitive distortions are “systematic errors in reasoning that lead to faulty assumptions and
misconceptions. By encouraging clients to gather and weigh the evidence in support of their
beliefs, therapists help clients bring about enduring changes in their mood and their behavior”
(Corey, 2015, p. 303).
Corey (2015) presented seven specific cognitive distortions, which are principles of
Beck’s approach. He identified arbitrary inferences, which “refer to making conclusions
without supporting or relevant evidence,” selective abstraction, which “consists of forming
conclusions based on an isolated detail of an event,” overgeneralization, which is the “process of
holding extreme beliefs on the basis of a single incident and applying them inappropriately to
dissimilar events or settings,” magnification and minimization, which consists of “perceiving a
case of situation in a greater or lesser light than it truly deserves,” personalization, which is a
“tendency for individuals to relate external events to themselves, even when there is no basis for
making this connection,” labeling and mislabeling, which involves “ portraying one’s identity on
the basis of imperfections and mistakes made in the past and allowing them to define one’s true
identity,” dichotomous thinking, which consists of “categorizing experiences in either-or

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extremes” (pp. 303-304). Once these faulty assumptions have been identified, explored, and
changed, then the client has a real chance of experiencing long-term improvement.
These cognitive distortions fall under the broader phenomenological scope of the basic
core beliefs of an individual. “A key aspect of the therapeutic process involves restructuring
distorted beliefs (or schema), which has a pivotal impact on changing dysfunctional behaviors”
(Corey, 2015, p. 310). CT operates on the premise that once clients understand that their faulty
thinking patterns are the root cause of why they feel and act the way they do, they can become
empowered to dispute and replace those inaccurate beliefs. The real underlying power in this
discovery is that the client has the ability to change these thoughts, in order to produce a
healthier outlook and more constructive behaviors.
There is a real self-help underpinning to this theory, which helps clients view themselves
in a more proactive and positive way. In my opinion, it is not by accident that Dr. Martin
Seligman, widely considered to be the founder of the Positive Psychology movement, also
served as a professor at the University of Pennsylvania in 1970. In fact, Dr. Seligman stated that
“Aaron T. Beck and Albert J. Stunkard were teachers and sources of stimulation. I learned a
great deal about psychopathology that year; it was then that I actually began to write this book
(Helplessness)” (Seligman, 1975, p. xiii).
Client-Therapist Relationship
One of the most attractive features of the CT approach is the importance it places on the
quality of the client-therapist relationship. I firmly believe that a collaborative relationship is
essential in helping any client make progress toward his/her goals. Collaborative empiricism is
defined by Corey (2015) as a process by which:

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“The therapist attempts to collaborate with clients in testing the validity of their
cognitions. CT places more emphasis on helping clients identify their
misconceptions for themselves. Although CT often begins by recognizing the
client’s frame of reference, the therapist continues to ask for evidence for a belief
system” (p. 305).
In their commentary on the importance of the relationship in the effectiveness of
psychotherapy, Norcross & Lambert (2014) concluded:
“Even when ‘delivered’ via distance or on a computer app, psychotherapy is an
irreducibly human encounter. Some will judge that relationship a precondition of
change and others a process of change, but all agree that it is a relational
enterprise. How we create and cultivate that powerful human relationship, can be
informed by research” (p. 402)
Main Interventions
CT employs many behavioral techniques, which is why it is often referred to as CBT.
According to Corey (2015), some of the techniques utilized are “activity scheduling, behavioral
experiments, skills training, role playing, behavioral rehearsal, and exposure therapy” (p. 308).
CT practitioners also use Socratic questioning to encourage clients come to their own insightful
answers. Bibliotherapy is another technique which helps clients take action towards better
understanding why they think a certain way. It goes along with the self-help and
psychoeducational approach that helps empower clients towards more self-discovery.
Homework is another specific technique, which can be tailored to different clients for many
different reasons.

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Beck became first known for his work on depression, which was inspired by his own life
experiences. Weishaar (2002) reported that he became depressed after a bout with hepatitis, as
well as after losing his campus office following the loss of grant funding. While working from
home, he published two books on depression (p. 5). In 1961, Beck created the Beck Depression
Inventory, which is still widely used as a self-report tool in order to determine the presence of
depression; in 1974, he developed both the Hopelessness Scale and the Suicide Intent Scale; in
1978, he created the Dysfunctional Attitudes Scale; in 1980, he developed a way to evaluate the
effectiveness of cognitive therapists with his Cognitive Therapy Scale; and finally, he developed
the Scale for Suicidal Ideation in 1997, which helps to predict risk and assesses for the potential
of suicide (Hollon, 2010, p. 71).
He termed the pattern that leads to depression as the cognitive triad. “Depressed patients
have a negative view of themselves (seeing themselves as worthless, inadequate, unlovable,
deficient), their environment (seeing it as overwhelming, filled with obstacles and failure), and
their future (seeing it as hopeless, no effort will change the course of their lives). This negative
way of thinking guides one’s perception, interpretation, and memory of personally relevant
experiences, thereby resulting in a negatively biased construal of one’s personal world, and
ultimately, the development of depressive symptoms” (McGinn, 2000, p. 257).
Beck also had personal experience with working with troops who returned from battle
with PTSD, struggling with his own phobias (blood and injury, public speaking, suffocation,
heights, and abandonment), and began researching suicide since the early 1970’s (Weishaar,
2002). Corey (2015) also added that CT has proven to be effective in treating people with
generalized anxiety disorders, eating disorders, substance abuse problems, anger problems,
borderline and narcissistic personality disorders, schizophrenic disorders, chronic pain, other

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medical illnesses, crisis intervention, child abusers, divorce counseling, skills training, and stress
management. It has also succeeded not only with individuals, but also with couples and families
(p. 307).
Conclusion
I am most impressed with the evidence-based success of CT, the way clients are viewed,
how they are treated, and due to the common-sense techniques used to elicit change. I place a
premium on addressing the thinking construct first, in order to bring about healthier behaviors
and more positive feelings within the client. I get excited thinking about collaborating on plans
with my clients, so that they can come to believe more in their capacity to change for the better.
My plan is to use the Motivational Interviewing [MI] technique with teenagers and young adults,
but more of a Socratic dialogue with older adults.
It was still a difficult decision for me to choose only one theoretical modality to focus on,
because I see the value in parts of other psychotherapies. I was also drawn to consider Adlerian,
Existentialism, Person-Centered, Gestalt, and Reality therapy approaches due to their belief in
the power of the client-therapist relationship. I was not surprised to read that Adler was one of
the primary influences on Beck during the 1960’s. I really admire their view of clients, the
flexibility with which they can tailor specific techniques to clients, the focus on turning insight
into action, and their curiosity in birth order.
When it came down to the finish line, Gestalt therapy finished a close second for me.
The here and now, what and how, unfinished business, nonverbal cues, importance of awareness,
choice, and responsibility all made a powerful impression on me. However, I found that I really

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find it valuable to also explore the ‘why’ of issues. It may very well be that someone might
mistake me for a Gestalt therapist someday and that would be just fine with me, too.
While I appreciate the search for meaning, the awareness, freedom, and personal
responsibility, and the belief that we are constantly recreating ourselves in the Existential model,
I feel that I can employ those issues via CT. My personal experience with the Person-Centered
approach leads me to want to use this as a technique in crisis situations, especially. Reality
therapy is intriguing to me due to the WDEP framework and the value placed on choice theory.
Surprisingly, I also found that the Feminist analysis of both the gender and power roles has value
for me to consider exploring whenever appropriate.
Since I have always had an interest in positive psychology, I plan to incorporate
optimism into my therapeutic approach. I also plan to study Dialectical Behavior Therapy
[DBT], Mindfulness-Based Stress Reduction [MBSR], Mindfulness-Based Cognitive Therapy
[MBCT], and Acceptance and Commitment Therapy [ACT] further. I have found peace and
comfort through prayer, meditation, guided mediation, and yoga, so I would like to learn more
about those approaches. I am looking forward to crafting my own perspective through more
research and reflection on my values.

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