Copyright © 2007-2017 Russ Dewey
Not everybody responds well to non-directive therapy, with its insistence that the direction for change come from the client. Some people respond better to direct challenges or specific advice.
Such a person might prefer the therapy of Albert Ellis. Ellis called his technique rational-emotive behavior therapy (REBT).
Ellis was born in Pittsburgh, Pennsylvania, in 1913. He lived in New York City from the age of four and received his PhD in Clinical Psychology in 1947. He practiced clinical psychology and psychotherapy full-time in New York City from 1952 to 1968.
In a very active career, Ellis saw over 10,000 clients and published over 500 articles, often working from 9 a.m. until 11 p.m. daily. He lived in an apartment above the REBT institute in New York and never retired, dying in 2007.
Ellis claimed high success rates using principles and assumptions almost opposite to Rogerian therapy. REBT is a short-term therapy, whereas nondirective counseling can go on for many months.
Unlike Rogers, Ellis uses a directive or prescriptive approach. He did not wait for clients to arrive at their own solutions to problems. Instead, he pointed out problems immediately and insistently, refusing to let a client divert attention.
What causes "emotional dysfunctions" in Ellis's view?
Ellis believed emotional dysfunctions are related to self-talk. Self-talk was Ellis's label for the way a person described a situation to himself or herself.
Ellis thought that belief systems, as reflected in self-talk, determined a person's emotional responses to situations. He said basic psychological dysfunctions are due to irrational modes of thinking expressed in irrational statements we make to ourselves.
What Ellis called irrational could also be called unrealistic. To Ellis, an irrational thought (or statement) was one that was untrue if taken literally, such as, "I'll die if I don't pass this test."
Ellis would point out that in all likelihood, one would not die because of failing a test. However, talking to oneself like that could provoke negative emotions and distress.
Ellis would recommend a more realistic appraisal of a situation, such as, "I will be extremely disappointed if I do not pass this test." That could be accepted as a true statement. Then rational problem solving (such as planning how to do as well as possible on the test) was more likely to proceed in an atmosphere of calm.
Ellis used an "ABCDE" mnemonic or memory system to teach the basics of rational-emotive behavior therapy. Here are the five elements:
A = Activating event
B = Belief system
C = Consequences (especially emotional) of A and B
D = Disputing irrational thoughts and beliefs.
E = Emotional and Cognitive effects of revised beliefs
A is the activating event: an event that triggers stress or worry. It might be a crisis in a personal relationship, a speech to be given, chronic lack of confidence, job dissatisfaction, or sexual problems...anything that sends a person to a counselor. Like Rogers, Ellis was willing to tackle any problem.
What are the elements of the ABCDE mnemonic?
B stands for belief system: the person's way of describing the situation inwardly. Ellis found that people often create (or say to themselves) ideas that are counterproductive and not literally true, reducing clear thinking.
For example, a man whose wife is leaving him might comment, "This is the end of the world for me; I'll never find somebody who matters as much to me as Mabel." Ellis would challenge this belief directly. "Is it really the end of the world?"
"Is the planet going to explode tomorrow, if she leaves you? Have you gotten to know all the women in the world, so you know that you can't love any of them?"
C stands for consequences of irrational beliefs. Unrealistic or self-sabotaging thoughts produce bad consequences. They can be self-fulfilling prophecies.
For example, if you think "Nobody likes me," you are likely to act timid and unfriendly. That makes it difficult for people to like you.
Some people repeat negative thoughts again and again. This repetitious thinking is called rumination. It is a bit like self-programming. A person who is constantly thinking, "This is horrible!" (or some other irrational idea) may stay in a bad mood because of the constant negative self-coaching.
Replacing exaggerated thoughts and fears with a calmer, more reasonable assessment can improve a person's mood and lead to more adaptive behavior. That is what Ellis referred to as replacing irrational with rational thoughts.
In what sense was Ellis willing to be "therapeutically obnoxious"?
D stands for disputing irrational beliefs. Ellis's treatment consists of challenging (disputing) irrational beliefs as directly as possible. Transcripts of REBT sessions show Ellis in his prime was willing to be therapeutically obnoxious.
He cussed, interrupted, shouted, and otherwise drew attention to a client's irrationalities. However, that was just Ellis's style, and other cognitive behavior therapists do not usually act that way.
Irrational beliefs can be disputed calmly. The important thing is to replace negative, unrealistic thinking with a more realistic and adaptive appraisal of problem situations.
E stands for the effects of changing one's interpretation of a situation. Emotions are a response to the world as interpreted. If the world is interpreted in a logical and realistic manner, distressing emotions tend to change.
If REBT is effective, a person loses their symptoms of anxiety or distress and sees situations differently. "Seeing a situation differently" is what later cognitive behavior therapists call cognitive restructuring.
Cognitive re-structuring may have two benefits. It can open up new avenues of problem-solving, and it can reduce distressing emotions, both as a consequence of re-appraising the situations that brought a person to therapy.
How is REBT a semantic therapy?
In a 1975 revision of Ellis's 1961 classic A Guide to Rational Living, titled A New Guide to Rational Living, Ellis and Harper commented that REBT–then called Rational Emotive Therapy or RET–was a semantic therapy.
Semantics is the science of word meanings. RET concentrated on words: their utterance, their meanings, and their effects on emotions and behavior. Ellis and Harper (1975) wrote:
Uniquely...unlike lower animals, people tell themselves various sane and crazy things. Their beliefs, attitudes, opinions, and philosophies largely (though hardly exclusively) take the form of internalized sentences or self-talk.
Perhaps because of his attention to semantics, Ellis decided to rename his therapy in the 1980s. He inserted the word behavior into the title. This makes sense, because speech is a behavior, and RET (now REBT) was aimed at modifying self-talk.
It is also a cognitive therapy, because it aims to change the way people think and reason about the world. Therapies that resemble Ellis's are now called cognitive behavior therapies.
A prominent example is Beck's therapy for depression (discussed later in this chapter). Transcripts from one of Beck's sessions could be mistaken for transcripts of a skilled (and non-obnoxious) REBT counselor.
Certain irrational beliefs or attitudes are heard repeatedly from clients in therapy. Ellis and Harper listed 10 irrational ideas in A New Guide to Rational Living (1975).
Ellis and Harper (1975) labeled as Irrational Idea #1 the "idea that you must–yes, must–have love or approval from all the people you find significant."
Most people enjoy affection and approval, and it is good to have it, but sometimes it is not available. People can harm themselves by pursuing the impossible ideal of having everybody love them.
What is irrational idea #1?
Related to irrational idea #1 is the compulsion to live up to the standards of others. As Carl Rogers pointed out, people who come to therapy are often trying to live up to standards or roles imposed upon them by others. They are dominated by Musts, Shoulds, and Oughts.
A client might say, "I really must go home this weekend; Mom and Dad say I don't appreciate the help they are giving me. But I always have a miserable time..." Ellis might say, "Why must you? What would happen if you did what you wanted to do, one weekend, instead of automatically putting your own interests aside?"
If the client replied something like, "They would never forgive me," Ellis would dispute that statement, pointing out that it is not literally true. People will forgive you, particularly if you are honest about needing to do something different from what they want.
Irrational Idea #2 is "I must not fail" or, as Ellis and Harper put it, the idea that you must prove thoroughly competent, adequate, and achieving. This idea is irrational because, in truth, nobody is good at everything, and sometimes people do fail.
Does failure kill people? Generally not, unless they are engaged in foolish risky actions.
Failure is often educational. Elon Musk, for example, often comments about how a successful entrepreneur must tolerate occasional failures. If you try new things, sometimes you will fail, and you can learn a lot from failures.
Ellis noticed that clients often use the word "must." They use it in connection with their own behavior ("I must do this...") or in connection with the behavior of others ("My husband must love me at all times....") Ellis calls this musterbating and pointed out it was usually unrealistic.
Ellis reacted to a client who feels his wife must come back to him in this way:
Your statement, "I must not get rejected by my mate, and therefore I find it awful that he or she has left me," actually means, "Because I want very much to have my mate love me, he or she must."
Well, what sense does that make? Do you–really–control your mate's (or anyone else's) feelings? Do you–truly!–rate as King of Kings or the Mother of the Universe? Lots of luck! (Ellis and Harper, 1975, p.79)
Musterbating is also relevant to irrational idea #2, "I must not fail." Success is desirable, but some people paralyze themselves because they are afraid of failing. After all, if you "must not fail," and if you try there is some possibility of failing, then you must not try!
What is musterbating?
In reality, people have to accept the possibility of failure in order to try for success. The irony is that accepting the possibility of defeat raises the probability of succeeding, because it frees one to act.
What is damning?
Irrational Idea #3 is damning. Harper and Ellis describe this as the idea that when people act obnoxiously and unfairly, you should blame and damn them, and see them as bad, wicked, or rotten individuals.
Some people apply this to themselves, giving themselves up as hopeless. Others turn the blame on someone else. Either way, it is not very constructive.
For example, a man whose wife is leaving him might (if allowed) spend the entire therapy hour detailing her crimes and inadequacies, how he believes she lied and cheated, led a loose life, and on and on.
Ellis would point out that the man is indulging in damning. Like other irrational beliefs, damning expresses emotion. The man is conveying the fact that he feels angry and betrayed.
Ellis would challenge the belief that all the blame can be put on one person, when a relationship goes sour. He might redirect the man's thinking to adaptive responses, adjustments, and ways of learning from the experience.
Irrational idea #4 is awfulizing: the idea that you have to view things as awful, terrible, and horrible when things go wrong.
"I can't stand it" is a common remark heard in therapy. Ellis disputed this assertion when he heard it, or when he heard somebody say they could not "bear" something.
What is awfulizing? What common remark made Ellis react strongly?
People use these statements to express emotion; they do not mean them literally. Ellis forced his clients to confront the fact that such statements cannot be taken literally.
Awfulizing does not suggest a constructive course of action. If taken seriously, it can paralyze a person.
Repeating to yourself "I can't stand it" is like self-hypnosis. Pretty soon you can't stand it. Better to say to yourself, "This bothers the heck out of me, but I guess I can survive it."
How does Ellis feel about the attitude that you control your own destiny?
Irrational idea #5 is the idea that emotional misery comes from external pressures and that you have little ability to control or change your feelings. The rational alternative, recommended by Ellis, is control your destiny by taking responsibility for how you interpret and react to events.
Irrational Idea #6 is that if something seems dangerous or fearsome, you must preoccupy yourself with it and make yourself anxious about it. Ellis believes that when one evaluates a future event as catastrophic, one becomes anxious. Ellis's solution is to re-evaluate the situation in a more realistic manner.
What is catastrophizing?
Ellis called the preoccupation with upcoming disasters catastrophizing. For example, a student doing poorly in a course might become emotionally upset about the upcoming catastrophe of failure until the student is unable to study.
Ellis is likely to point out that an unpleasant event, if it occurs, will not be the end of the world. True, the student would prefer to do well in the course, but life will go on. Perhaps the student can learn from the experience.
Catastrophizing is oriented toward the future but has the same negative effect as awfulizing. It paralyzes rather than suggesting an adaptive course of action.
Both are forms of self-talk that create bad feelings such as anxiety. Both distract attention from more rational thought processes and actions (such as a studying) that might address the underlying cause of a problem.
Irrational Idea #7 is the notion that avoiding life's difficulties is more rewarding than undertaking new challenges. Ellis was impatient with clients who sought to avoid difficult or challenging situations.
Ellis probably would have agreed with Maslow's advice to students who wanted to self-actualize. Pick the "growth alternative" rather than the "safety alternative" when faced with a life decision. Take on challenges and use them to grow.
Irrational Idea #8 is that your past remains all-important. Because something strongly influenced your life, it has to keep determining your feelings and behavior today.
This irrational idea made the list as a reaction to psychodynamic therapies, which place overwhelming importance on events early in life. It was also a reaction to clients who insisted on dwelling on past sorrows and traumas, rather than solving problems in their present-day life. Ellis and Harper wrote:
Often, in the course of one of my typical working days, I see about twenty individual and another twenty group therapy clients; and most of them, to one degree or another, believe that they have to behave in a certain disturbed way because of previous conditioning or early influences...
...To which I normally respond:
"Rubbish! Whatever early conditioning, or pernicious influences you experienced during childhood, their effects don't linger on, today, just because of these original conditions–but because you still carry them on, because you still believe the nonsense with which you originally got indoctrinated.
Now when will you dispute your own often-repeated beliefs and therefore un-condition yourself?" And the battle of therapeutic de-indoctrination continues merrily apace, until (usually) I win or (sometimes, alas) the client flees from me... (Ellis and Harper, 1975, p.169)
What is Ellis's reaction to people who feel they are trapped by traumatic events in their past?
Irrational Idea #9 is that people and things should turn out better than they do and that you must view it as awful and horrible if you do not find good solutions to life's grim realities. "Let's face it," Ellis wrote, "Reality often stinks."
"People don't act the way we would like them to act. This doesn't seem to be the best of all possible worlds.... But you still don't have to feel desperately unhappy."
Finally there is Irrational Idea #10, which Ellis and Harper said "millions of civilized people believe in heartily." That was that you can achieve maximum human happiness by inertia and inaction or by passively and uncommittedly "enjoying yourself."
To the contrary, Ellis and Harper assert, people are most happy when involved in some activity that draws them outside of themselves. (This relates to idea #7 as well.) Ellis wrote:
...The three main forms of vital absorption comprise: (a) loving, or feeling absorbed in other people; (b) creating, or getting absorbed in things; and (c) philosophizing, or remaining absorbed in ideas. Feeling inert, passive, or inhibited normally keeps you from getting absorbed in any of these three ways–and hence from truly living.
Living essentially means doing, acting, loving, creating, thinking. You negate it by prolonged goofing, loafing, or lazing. (Ellis and Harper, 1975, p.187)
These ideas are reminiscent of Maslow and Adler. Maslow commented on how self-
Ellis, A. & Harper, R. E. (1975) A New Guide to Rational Living. New York: Wilshire.
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Copyright © 2007-2017 Russ Dewey