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by Albert Ellis and Debbie Joffe Ellis
American Psychological Association, 2011
Review by Roy Sugarman PhD on Sep 27th 2011
Ellis is of course gone now, having died in 2007 after a career that had him rated as the second most influential psychologist in history, second to Carl Rodgers and ahead of Freud. Written with his wife, and directed it seems at students, the book begins with a long history which perhaps sets about establishing himself for those who do not know him, as the father of the first Rational Therapy, the first of the cognitive movement which would later emerge as Cognitive Behavior Therapy under Beck and later luminaries.
Always a controversial figure, he broke with psychoanalysis in 1953 and moved on to finally establish the Albert Ellis Institute, and forever change the face of psychotherapy, dying at 97 years old.
REBT has taught from the beginning that when people want to be happy, the develop the desire to perform well in what is important to them, and relate to others well, and finally do what it takes to achieve what is important to them. Whether trying to achieve or avoid some event in their lives, they can inadvertently direct their wishes and wants into an escalating and unhealthy desperation for such things as if they were absolute necessities for a good life. Poor achievement reflects on them as bad people, good performance is seen as emotional evidence of being a good person.
In this way, beyond the personal, a just world hypothesis emerges which sees good and bad events as evidence of good and bad peoples as a whole, not the reality that bad things can happen to good people. Ellis relates that his philosophy on psychology began long before the 50's, when as a sickly child his parents failed to visit him in hospital as much as other less preoccupied parents did for their own children. He learned young that irrational beliefs could lead to self-disruption on the path to achieving, self-defeating behaviors leading to emotional disruptions such as anxiety and mood disorders. A failure to accept life and self unconditionally and not as evidence of some deep personal flaw, could lead to the most unhealthy of emotions such as guilt etc.
Within this seemingly alarming propensity to construct such self-defeating emotions, Ellis was quick to reveal that the opposite was therefore also possible, namely that people could, by unconditional positive regard, construct positive affirmations of life and causality, and thus avoid the trap of seeing failure as indicative of some deep inherent and immutable flaw. Despite the biological determinism of Freud and others, Ellis held that people had considerable options to choose how they wished to see themselves and be with the world, defining themselves despite the limitations or circumstance.
Given the human capacity to be 'meta' in terms of advanced language systems that allowed for thinking about thinking (about thinking about thinking), this ability to abstract themselves from their content of thought, to the processes around that thought, allowed for cognitive effort resulting in choice. When people think, they also feel and then act on those feelings. When they feel, they can also think and act; this means we can change our circumstances by acting and feeling and thinking interactions that are by choice and thus influence ourselves and our outcomes by reflecting on these things and changing them to more healthy and rational means.
Hence the rational is not alone and not sufficient to eventuate change: the emotions are necessarily part of the equation, and of course so is behavioral alteration.
What then separates out REBT from the other CBT's is its strong adherence to philosophical underpinnings: unconditional self-, other- and life- acceptance are the three underpinning philosophical foundations of REBT, linked to the emotional, cognitive and behavioral methods described in the book. Another issue is that the core irrational beliefs that influence mental health include the idea of having things that MUST happen to influence life outcomes. Although this is part of other therapies, Ellis demands that in REBT the emphasis is much stronger on the absolute necessity to address core mythologies that will profoundly influence later mental health.
Following on his discussion of the history, which I strongly feel is more about establishing himself in his typical, powerful way as the doyen of the rational-cognitive flow of history, he enters the still-student focused chapter on theory. The basic enterprise solution of REBT it to make life better for as many people as possible by alleviating the suffering that emerges from their own adherence to core belief systems that are self-defeating, and to undergo a process which supports self and other acceptance in accepting life's vicissitudes.
In common with many other philosophies of change, insight is not seen as sufficient to cause altered behavior, so work and practice of the methods involved is essential to a healthier outcome. It is not what happens that carves out our emotions and actions, but how we come to feel about them, based on what we tell ourselves about what has happened. Beliefs, feelings and behaviors are added to life events, compounding them in terms of how the outcomes are played. Thoughts feelings and behaviors are interconnected and interrelated, not separate events.
Since we are capable of both rational and irrational thoughts, rational here is based on empirical reality, keeping things in perspective, preference as to the way things should be, rather than a demand they have to be that way, non-damning of self and others, and subject to a high threshold for frustration and healthy emotional responses. Irrational thinking, as in the stinking thinking of CBT, is prone to exaggerate and catastrophize, demands things should be a certain way in keeping with some personal mythology, judges and damns self and others, has a low frustration tolerance and creates rather than responds with debilitating emotions.
Ellis then expands on 12 aspects of irrational beliefs, which he says emanate from various sources such as parenting culture, or the mass media for instance. These include believing it is a dire necessity to be loved or approved of by others, rather than oneself, certain acts are wrong or villainous and entirely damning of the perpetrator, telling ourselves that a bad situation is catastrophically untenable, unpleasant times must never exist in life, that one has to be terrified of dangerous or unpleasant things rather than just wary, roadblocks in life should never happen, and should be totally avoidable, and of course Ellis' favorite dislike of religion, the need to have a greater force than oneself in charge of life's trajectory, and the need to believe that one is totally awesome in every way as opposed to having talents in only some aspects of life, that a past defining event should continue to do so lifelong, the need to change others who should not act the way they do, inertia and inaction as a wait and see philosophy to a passive life, and finally that you have virtually no control over your emotions and you cannot help feeling certain things. This last one is of course controversial as one really doesn't have much control over the autonomic nervous system and its branches, but of course Ellis' point is that our response to the conscious awareness of them, our 'feelings' is of course up to us to modify in terms of impact and direction that they may impart.
The ABCDE philosophy of REBT is then the clarification of the connection between an Activating event and its Consequences, by identifying the Beliefs involved, replacing these by Disputing the irrational and leading to the emergence of Effective new philosophies in turn are themselves feedback loops to a better response to activating events in future.
The work and practice are thus multimodal, involving testing what works best and for whom, such as cognitive techniques such as the ABCDE, possible secondary symptoms, cost to benefit ratio assessments, distraction methods (not as avoidance methods), modeling, writing audio or video therapies, talking about REBT with others, problem solving, and philosophical discussion. Emotive-Evocative techniques include RE Imagery, shame-attacking exercises, the use of strong coping statements, disputing tapes, humor etc., and the Behavioral Techniques such as in-vivo desensitization, reinforcements and penalties, skill training, relapse prevention, singing rational humorous songs (on of Ellis' favorite things) done loudly and with gusto. Affirming his humanist principles, Ellis moves on the therapy process, primary change mechanisms.
Human responses to misery thus involve choice, we make them, so we can un-make them. Changing absolutistic thinking is thus a primary change mechanism, and if we absolutely have to do something, there is something fundamentally wrong with us if we don't. Horney called this the 'tyranny of the shoulds'; Ellis refers to this as 'masturbation'.
Disputing rigid thinking is also one of these techniques, after one has tidied up the premise-conclusion mess of the 'masturbation'. The role of the client and therapist is then discussed in the long term, as well as specific approaches to various known conditions such as depression, covering the next 70 pages of this chapter which dominates the book.
The need to test the underlying wants and needs principles, the shoulds and musts, is illuminated further on in the book, as the Albert Ellis Institute was not very involved in formal assessment of its own approach, and most of it being part of CBT, Ellis is content to retrofit his work with that of the extensive evidence that CBT and the underlying tenets of REBT that populate it are sound.
The future then for REBT is thus hand in hand with CBT, something which Ellis addresses again as he did in the start of the book. He strongly wishes, not wants, the elegant methods of REBT which have been neglected by CBT to emerge more strongly, as people acknowledge that REBT is the original format for CBT and contains more than its offspring does. As Ellis has died, and his AEI continues to exist and train therapists, rather than accredit them, this is probably not likely. Ellis, had he lived, and followed his own philosophy, would agree this does not have to happen, nor must it happen, and he would I hope be unconditionally accepting of the space that CBT now occupies in the evidence based world of modern psychology. Modern students however would know only a little bit of this, as problem based learning takes hold in some countries, but reading this little book would do a thorough job in keeping Ellis's huge contribution to modern cognitive and behavioral therapies alive. Without Ellis, the darker age of psychoanalytic philosophy might still dominate, and the contributions of Family Therapy, Motivational Interviewing, Client-Centered Therapy and other useful therapies such as Interpersonal Therapy might not be as commonly used.
Ellis' larger than life atheism, sex therapies, public appearances and politics did as much as his contributions to bring him to the forefront of the world's advances in the 20th century schools of psychology, and establish his notoriety as a great character who founded the Sexual Revolution of the 60's, but this book may help him live longer in our minds, and certainly introduce the 21st Century generations to his work, his life, and his personality.
© 2011 Roy Sugarman
Roy Sugarman PhD, Level7 Psychology, www.roysugarman.com