The Power of Small Changes

The Power of Small Changes

A Step-by-Step Approach to Treating Depression: An Interview with Judith Beck

By Judith Beck

November/December 2014

What are the defining characteristics of the cognitive therapy approach to depression?

Judith Beck: The hallmark of cognitive therapy is understanding clients’ reactions—emotional and behavioral—in terms of how they interpret situations. For example, currently I’m treating a severely depressed client I’ll call Mary, who basically sits on the couch for most of the day, feeling hopeless and sad. Even though she understands that she’d be better off if she were to become more active, she can’t overcome her profound lethargy. She continually has thoughts like This apartment is so messy. Nothing’s put away. What’s wrong with me? I should get up and do something, but it’ll just be a drop in the bucket. What’s the point? No wonder she feels so depressed and hopeless and just stays on the couch.

The repeated themes in people’s thinking and behavior always make sense once we understand the basic way they view themselves, their world, and other people. Mary, for example, sees herself as helpless and incompetent, a “complete failure,” and that pervades her moment-to-moment experience. Not only does she feel unable to get off the couch, but she also believes that she won’t be able to solve any of her problems and that nothing, including therapy, can help.

That kind of outlook is one of the biggest problems in working with depressed clients. How do you begin trying to work with someone who seems so

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