This person, if he is thinking straight in the present, will not blame his defeats on external events, but will realize that he himself is causing them by his inadequate or incompetent behavior. He will not believe that it is easier to avoid than to face difficult life problems, but will see that the so-called easy way is invariably the harder and more idiotic procedure. He will not think that he needs someone greater or stronger than himself on whom to rely, but will independently buckle down to hard tasks without outside help. He will not feel, because he once defeated himself by avoiding doing things the hard way, that he must always continue to act in this self-defeating manner.

How, with this kind of logical thinking, could an originally disturbed person possibly maintain and con- tinually revivify his neurosis? He just couldn't. (Ellis, l962?, pp. 91-92.)

If the person is, say, a biologist searching for an advance in treating cancer which he has not been able to find, the cause of the "defeats" is not "inadequate or incompetent behavior," to use Ellis' terms. This is not a person who "systematically misconstrues his experiences," as Beck sees it. (l977, p. 264.) Hence, no amount of "straightening out the person's thinking" by itself is the answer. Rather, the person must decide either (a) to accept such defeats if they do occur, and change the denominator (of expected cons or hopes) or the main dimension of comparison (from success-failure to courage or lack of it), or else (b) change his work subject.

By assuming that the cognitions responsible for depression always can be shown to be logically or empirically incorrect, "distorted thinking" in Beck's terms, "irrational thinking" in Ellis', they run the risk of forcing an analysis that is appropriate for some people onto others for whom it is not appropriate, and thereby not doing well both by the cognitive point of view and some clients, too.

Ellis and Beck view the role of the therapist as helping the patient learn to think in "more rational" or "less distorted" ways. In my view, sometimes the proper role for the therapist is more like that of a sports physician or trainer in those cases where the athlete desperately wishes to continue playing. The appropriate procedure then is: a) Determine the cause of the pain. b) Decide how the pain can be mitigated, and mitigate it if possible. c) If mitigating the pain requires cessation of play, then advise the patient that there is a trade-off between playing and avoiding pain. This is like the choice that a depressed person must make between continuing to work toward a valued goal where there has been little or no success so far, and only small hope of future success, as is sometimes the case with a scientist trying to persuade the world of a new theory. The therapist may offer some devices that will at least lessen the pain while playing, however, and this can be of value. It is important that the choice to play be respected and not just treated as irrational or perverse; doing the latter can worsen the person's depression.

Self-comparisons Analysis also differs in viewing sadness as an effect of negative self-comparisons plus a sense of helplessness rather than simply loss, as does Beck; and there is a great deal of difference between the implications of these two concepts. Still another difference is the systematic step-by- step procedure suggested by the Self-comparisons Analysis, as described in earlier chapters, against which may be compared the following systematic description of Beck's procedures - (actually a description of Beck's cognitive therapy for a patient suffering from anxiety rather than depression):

The formulation of the progress of this patient can now be fitted into the therapeutic model: (1) self- observations that led directly to the ideation preceding the anxiety; (2) establishing the relation between the thoughts and anxiety attack: (3) learning to regard thoughts as hypotheses rather than facts; (4) testing the hypotheses: (5) piecing together the assumptions that underlay and generated these hypotheses; (6) demonstrating that these rules composing her belief system were incorrect. (Beck, l977, p. 261.)

next: Appendix C