Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.