Group therapy

“Why do they hate us?”

This question, usually asked with a note of anguish, often arises when America is attacked or criticized for its actions, or even just for being America.

Many who try to answer the question cite poverty, inequality, religion, or some historical grievance. Aaron Beck, University Professor Emeritus of Psychiatry and director of the Psychopathology Research Unit in the Psychiatry Department, has a different answer: They see us through a distorted cognitive filter.

The father of cognitive therapy, who launched a revolution in the treatment of depression and anxiety in the 1960s, has now turned his sights to conflict and violence between individuals, groups and even entire nations. His most recent book, “Prisoners of Hate,” applies cognitive principles to issues of domestic abuse, bigotry, inter-ethnic strife and international disputes.

All this comes at a time when Beck’s insights have moved solidly into the psychiatric mainstream, earning him honors for his lifetime of research, instruction and writing (see “Awards & Honors”). After 50 years at Penn, he shows no signs of slowing down.

Q. When did it dawn on you that the traditional psychoanalytic model of treatment wasn’t quite working?
I was trained as a psychoanalyst, and I decided to conduct research that could validate some of the psychoanalytic hypotheses, and one of the most common disorders then and now was depression.

The major hypothesis at the time was that people who got depressed had a lot of anger and hostility, sometimes toward someone they loved. And they would repress this hostility and turn it against themselves. We did a study comparing the dreams of depressed patients with the dreams of non-depressed patients. We expected to find more hostility in the dreams of the depressed patients, but as it turned out, they actually showed less hostility. At the same time, we also observed that these patients perceived themselves in very negative ways in their dreams.

So in therapy, then, which is another type of experiment, I found that by focusing on the role of these negative aspects of thinking about themselves, their experiences and their relationships, and subjecting them to reason and reflection, that people were able to change their negative view, and when the negative view changed, then they got better.

So it looked like this was a far more effective working model than the old psychoanalytic model. It took about two years to get all of this worked out, but once the shift occurred, I was able to use this same model on all kinds of problems, ending up most recently in problems of violence.

Q. How does this cognitive model explain violence?
What you’re saying is, Is there a preliminary set of circumstances which precede this cycle of violence?

We’re all predisposed to protect ourselves in some way against external threats. This is known as the flight-fight reaction. Alongside this, we have a predisposition to deal with facts that we feel are wrongs and people we feel have wronged us, and in some way get even with them.

Ordinarily, we can use reason [to counter our] specific impulses to get revenge or to attack something that we feel is a real threat to us. However, when the threat is perceived as very strong, then we are likely to overreact to it.

In a group situation, when another group is perceived in a negative way, the forces of reason are put to one side and one identifies with the group values, and that’s how we get into group prejudice and group violence, because reason no longer plays any role at all in our behavior. The only thing that counts is the glory of the group and the survival and preservation of the group.

Q. How do you subject an entire society or group to cognitive therapy?
That’s not an easy thing, so we have to deal with something specific, places in the world where it can be done. One of the places I’m working is Northern Ireland. In that particular country, the violence has pretty much subsided, but the animosity is still there. The emotions and the pictures of the adversary as enemy are still there and can get stirred up, and the country is divided.

My cohorts in Northern Ireland are meeting with the top ministers in the government and a number of legislators, because many of these people would like to have some degree of settlement of the issues but they still perceive the opponents in a very negative way. They’re meeting with the clergy, with community activists not connected with the clergy who would like to have some harmony and not be under threat, but they have distrust for the activists on the other side. And then they are also doing work with mediators.

They’re going to be working in schools, trying to get them integrated, the sports teams, various other social organizations, working at a grass-roots level to try to overcome the antagonism and distrust. And how do you do that but by trying to show them how they have this distorted view of the other side?

Q. What about terrorists? How do we apply all this to, say, al-Qaeda?
The psychology of al-Qaeda is the same kind of psychology of any subordinate group that is in warfare against what they consider the dominant force. They tend to see the dominant force as the enemy, and once they see the dominant force as the enemy, then they have to do whatever they can to undermine the enemy, to redress the wrongs and remove the threat. That’s the simplified version.

Q. Is there any kind of psychological intervention that could defuse this situation?
I don’t think that a psychological intervention itself is going to defuse it, but let’s say some third power wants to mediate. It has to understand the psychology of both the terrorist and also the superpower, in this case America.

Now, in this case, we considered Iraq headed by a homicidal maniac, we consider the head of al-Qaeda this crazy [person], and so on. These people are actually perfectly rational and in their own way, they are trying to achieve their own particular ends. It may be self-defeating, and we certainly hate what they’re doing, but it doesn’t mean they’re irrational and stupid.

In the case of many countries, terrorism has been successful. Many years ago in Kenya, there was a group known as the Mau Mau. And the Mau Mau were terrible. They were setting off bombs and killing farmers and their wives and children. In that particular case, terrorism succeeded. In what was Palestine and eventually became Israel, there were a series of terrorist gangs, the Stern Gang and so on.

Q. There are those who would say that this is dangerous, because as the old cliché goes, “To understand everything is to forgive everything.” What would you say to these people?
I would say I never forgive violence. I am strongly opposed to violence. I am very much in favor of peace, and that’s one of the reasons I wrote the book. But in order to achieve peace, we need to understand what the problems and difficulties are, just as in order to understand a person’s depression or anxiety and so on, we have to understand what are the forces, what are the distortions, what are the cognitive misinterpretations that are involved in what’s producing the neurosis. If you understand that, then you can take the first step towards correcting it.

Aaron Beck