Beck (1999) theorized that negative core beliefs about the self fall into two broad categories: those associated with helplessness and those associated with unlovability. A third category, associated with worthlessness (Figure 3.2), has also been described (J. S. Beck, 2005). When clients are depressed, their negative core beliefs may primarily fall into one of these categories, or they may have core beliefs in two or all three categories. Some have just one belief within a category; others have multiple beliefs within one category.

Sometimes it’s clear in which category a given negative core belief belongs, especially when clients actually use words such as “I am helpless” or “I am unlovable.” At other times, it’s not as clear. For example, depressed clients may say, “I’m not good enough.” You need to find out the meaning of cognitions like these to determine whether clients believe they are not good enough because they haven’t achieved enough (helpless category), or if they believe they’re not good enough for others to love them (unlovable category). Likewise, when clients say, “I’m worthless,” they may mean that they don’t achieve highly enough (helpless category) or that they won’t be able to gain or maintain love and intimacy with others because of something within themselves (unlovable category). The cognition “I’m worthless” falls in the worthlessness category when clients are concerned with their immorality or toxicity, not their effectiveness or lovability.