Tag: Rational Emotive Behavior Therapy

Albert Ellis

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In my post “The Gloria Sessions” I wrote about a three-part video series titled “Three Approaches to Psychotherapy”  in which a brave young single mother named Gloria had brief therapy sessions with three of the twentieth century’s giants of psychotherapy. The three therapists were Dr. Carl Rogers (client centered therapy), Dr. Fritz Perls (gestalt therapy), and Dr. Albert Ellis (rational therapy). Little did I know  when I saw the series in grad school that I would actually meet two of these luminaries. I’ve already described my encounter with Carl Rogers. I’ll conclude this post with an account of my brief exchange with Albert Ellis.

Ellis is best known as the creator of Rational Emotive Behavior Therapy (REBT), and is widely considered one of the most influential psychotherapists since Freud. I first came across his work as a teenager, when I read his 1958 book Sex Without Guilt, which made the case that guilt about responsible sexual behavior is irrational. This was my first introduction to rational thinking, which made a lot of sense to me. However, parts of the book were (in retrospect) just his claptrap notions, like his theory of homosexuality – which was still considered a mental illness back then. He corrected his errors in later editions of the book.

Ellis was a foundational pioneer of what is now known as cognitive behavioral therapy (CBT), and I consider his A New Guide to Rational Living to be his single most important book. (He wrote or co-authored more than eighty books and many academic papers.) When I watched him in “Three Approaches to Psychotherapy,” I didn’t like his therapeutic style. He was the opposite of sensitive, gentle, avuncular Carl Rogers; he was a fast-talking, abrasive New Yorker, who seemed impatient in his dealings with Gloria. But I couldn’t argue with his logic, and Gloria seemed to get something from the session.

Although behavioral therapies weren’t popular in my humanistic Masters program, I started learning and practicing rational thinking in the eighties, and began teaching it in my clinical practice. Being a rational thinker has spared me a lot of unnecessary pain, and I’ve been known to say that if I had a Gospel to preach as a therapist, it was the Gospel of Rational Thinking. REBT focuses on the rational analysis of irrational and self-defeating beliefs and behaviors. Ellis continued to write and lecture and do therapy until shortly before his death in 2007, at the age of 93. He has been charitably described as having a “provocative personality.” I was in the audience for several of his presentations at Evolution of Psychotherapy conferences over the years, and witnessed his provocative style first-hand.

For one thing, his presentations were laced with profanity, and his response to any objections about his language was usually  along the lines of “F _ _ _ you!” If you didn’t like the words he chose, that was your problem. He was still the abrasive stereotypical New Yorker I’d first seen on videotape in grad school; but I’d come to appreciate his personality and his delivery, as well as his contributions to psychotherapy. He made the point in his public speaking that it’s what you say that  matters, not so much how you say it. In his own way he echoed Fritz Perls’ idea, “I am not in this world to live up to your expectations and you are not in this world to live up to mine.”

At an Evolution of Psychotherapy conference I happened to find myself on the same elevator as Dr. Ellis and his small entourage. Seizing on the opportunity, I asked him, “Dr. Ellis, didn’t you write a book titled Sex Without Guilt?” “Yes I did. Did you read it?”  “Yes I did.” “Did it help you?” “I’ve read several of your books and I think I’m a better man for it.” Dr. Ellis grinned at me and said, “I’ll bet you’re a sexier  man for having read Sex Without Guilt, too!”

I don’t know about that, but I do know that Ellis’ influence made me a better therapist. He enhanced my ability to reach some clients, helping them to understand that they didn’t need to feel guilty about being a sexual person, with sexual feelings and needs.

The Gloria sessions

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I’ve written posts about my education as a psychotherapist in the humanistic psychology program at the University of West Georgia, and my exposure to a variety of therapeutic modalities. These included Rogerian (client-centered), gestalt, and cognitive behavioral therapy. I remember watching a videotaped film titled “Three Approaches to Psychotherapy” that I’ve always thought of as “the Gloria sessions.” For many years this film was only available for viewing by professional therapists, faculty, and students of psychotherapy; but now all three sessions can be viewed on YouTube.

In 1965 a courageous young woman named Gloria – a divorced single mother – agreed to be videotaped in brief therapy sessions with three of the most influential American psychotherapists of the twentieth century: Dr. Carl Rogers (client-centered therapy), Dr. Fritz Perls (gestalt therapy), and Dr. Albert Ellis (cognitive behavioral therapy). Watching the sessions again, I was reminded of Gloria’s courage and candor. The production quality isn’t always good and following the Perls  session takes concentration, due both to poor sound quality and Perls’ thick German accent. But if you want to see three masters of psychotherapy at work, this film is a treasure trove. Their approaches to working with Gloria are very different.

In each segment, the therapist briefly describes his approach to therapy, then works with Gloria, then comments on the session. In the first segment Carl Rogers says that if the therapist can establish certain conditions in relating to the client, “therapeutic movement” will predictably occur. The first condition is genuineness, and the second is congruence – meaning that your non-verbal communication is congruent with your verbalizations. The third condition is transparency , meaning that the therapist hides nothing and can be easily “seen through.” Rogers states that if these three conditions exist, and the therapist can be in tune with the client’s “inner world” (how she experiences herself in the world) insights and growth will follow.

During the session Gloria keeps trying to get Dr. Rogers to give her advice about making a decision, and dealing with guilt feelings related to the decision. He never accedes to her request, but keeps accurately reflecting on what she’s saying, allowing her to eventually take ownership of the issue, and to trust her own judgment. (Contrary to popular belief, good therapists seldom or never give advice.) Rogers is comfortable with silences, and at one point asks, “What do you wish I’d say to you?” She gets it. In his commentary, he remarks on how her “then-and-there” orientation at the start of the session quickly becomes a “here-and-now” focus. He highlights the “I-Thou” quality of their experience, rejecting Freud’s intellectual concept of transference/counter-transference in favor of Martin Buber’s term for authentic relating. He concludes, “Gloria and I really encountered each other” and says he thinks that both of them benefitted from their brief encounter. Watching again, I can’t help but agree.

Perls puffs on a cigarette while he describes gestalt therapy, and Gloria lights up at the beginning of the session, admitting that it’s a response to anxiety. In his introduction Perls, like Rogers, endorses the I-Thou relating essential to the therapeutic relationship, and the idea that therapy should not dwell on the then-and-there, but should always focus on the here-and-now of direct experience. He states that a gestalt therapist never offers interpretations, but provides clients with experiential opportunities to discover things about themselves, often by interrupting the client’s verbalizations and calling attention to automatic behaviors that the client is usually unaware of. Early in the session Perls labels some of Gloria’s behaviors as “phony” – which has a specific meaning in gestalt therapy. She’s initially bewildered and angry, feeling judged. She’s very defensive, but Perls doesn’t back off, and Gloria appears to catch on to what he’s saying by the end of the session. He was never judging her; he was giving her an experiential lesson in her automatic, typical defenses. It’s known in gestalt therapy as “being on the hot seat.” It was Perls who wrote what became known as the Gestalt Prayer, which starts with: “I am not in this world to live up to your expectations and you are not in this world to live up to mine.”

In his introduction, Albert Ellis expounds upon the notion that – contrary to Freudian psychodynamic theory – the past isn’t the primary determinant of present-day distress or dysfunction. The past may have a role in its formation, but it’s present behaviors that maintain the problem – specifically, the irrational things we tell ourselves about our experiences and their consequences. As I’d remembered, Ellis came across like the  stereotypical pushy, fast-talking New Yorker, but his words were precise and logical. In his short session with Gloria he manages to convey the principles of rational thinking, by applying them to Gloria’s anxieties about dating and seeking a life partner. She appears to grasp the notion that she makes undesirable situations worse by catastrophizing. “Don’t beat yourself over the head or convince yourself you’re a no-goodnik, just because you didn’t get the outcome you wanted.” He explained how he gives his clients behavioral homework assignments to complete between sessions, and suggests that Gloria should set up opportunities to take some small risks, instead of holding back in social situations. Its a behavioral technique called exposure, and Ellis was one of its early proponents.

When I first saw “Three Approaches to Psychotherapy,” I remember that there was a brief interview with Gloria after the sessions; but I wasn’t able to find it online. As I recall, Gloria said that she liked Carl Rogers the best, and learned some valuable things from Albert Ellis; but her session with Fritz Perls was the one she most benefitted from. If you don’t understand the basics of gestalt therapy, what Perls says and does in the session won’t make much sense. It shook Gloria up; but that’s what good gestalt therapists do, and Perls was one of the best. I highly recommend the Gloria sessions to social science students, psychotherapists in training or practice, and people who want to know more about psychotherapy.

Little did I know when I first watched the film that I’d actually meet Rogers and Ellis. I’ve already written about my brief meeting with Carl Rogers. In a later post I’ll describe my encounter with Albert Ellis.

Rational thinking

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My therapeutic orientation was existential and I was trained in a humanistic psychology program, but as I told both clients and colleagues, if I had a Gospel to preach in my clinical practice it was the Gospel of Rational Thinking. It’s a learnable skill and I wish it was a standard part of the public school curriculum; but the corporate state wants the public education system to turn out conditioned consumers, not independent thinkers. Independent thinkers are as hard to herd as cats. I’ve practiced and taught rational thinking for decades. Being able to spot my irrational thoughts before acting on  them has kept me from making innumerable mistakes and spared me a lot of unnecessary pain over the years. (I actually met Dr. Albert Ellis, creator of Rational Emotive Behavior Therapy, at a professional conference. I’ll tell you more about him in a later post.) Rational thinking is an important component of cognitive and cognitive behavioral therapies, whether irrational thoughts are labeled as thinking errors or as irrational self-talk. The wisdom of rational thinking correlates to the teachings of buddhism and to the Serenity Prayer. It’s a learning program that teaches people how to think rationally, without telling you what to think. It’s the opposite of  – and the antidote to – indoctrination.

We all engage in self-talk, our constant mental monologue, judging and labeling and making choices throughout our waking hours. Some self-talk is innocuous, but other self-talk carries a lot of weight and guides our subsequent behavior. Some of it is rational, but some is irrational – for all of us, even psychologists. In my experience most people can’t always tell the difference between their rational and irrational thoughts, and sometimes suffer painful or destructive consequences from their irrational thinking. Rational self-talk helps us to feel the way we want to feel and accomplish what we want to accomplish. Irrational self-talk leads to avoidable negative emotional states (anxiety, depression, anger) and undermines our ability to function at our best.

Many irrational thoughts are characterized by the words “always” and “never,” “should/shouldn’t” and “must.” Some examples: “I should always make a good impression on people.” “Things never go my way.” “I’ll never succeed in life.” “I shouldn’t ever let down my guard around people. They always take advantage of you.” “Life should be fair.” “I must get this promotion!” When people think irrationally, they set themselves up for disappointment, or worse, when things don’t go as they’d hoped.

At times we all wish the world was fair. But it isn’t, and thinking that it “should be” doesn’t help anyone. You might not always succeed at things you really want to succeed at, but that doesn’t make you a “failure” or a “loser.” If we tell ourselves that we’ll “never” get over a loss, we’re programming ourselves to suffer endlessly. If we expect to “always” perform optimally in interpersonal situations, we’re not allowing for the fact that we’re all flawed human beings. To err is human, and to expect perfection, or to always succeed at everything we do, is to court disappointment. Great expectations can lead to great disappointment, and moderate expectations to moderate disappointment. But if you engage in an enterprise because you feel it’s the right thing to do, with no specific expectations pinned to the outcome, you can’t be disappointed.

Here are some categories of typical irrational thoughts: Catastrophizing is imagining that worst-case scenarios are likely outcomes. Minimization is wearing blinders that don’t let you see your own strengths, or the positive potentials in a situation. Grandiosity is feeling superior, having an exaggerated sense of self-importance or ability. Personalization is when someone thinks “It’s all about me.” Thinking you’re the center of the universe. Magical thinking is characterized by acting ritualistically, as if a ritual behavior will bring about a desired outcome. Leaps in logic have to do with jumping to conclusions not based on evidence. Mindreading means attributing motives for a person’s behavior without evidence. “I know why he did that!” All-or-nothing thinking is the inability to see any shades of gray between poles of black and white. Paranoia is characterized by unjustified suspiciousness and feelings of persecution.

I’ll be writing more about mindfulness over time but, suffice it to say for now, one kind of mindfulness is paying close attention to your self-talk and where it takes you, emotionally and behaviorally. With practice, you can learn to immediately distinguish your irrational thoughts from your rational thoughts. In cognitive therapy, when you identify an irrational thought, you learn to frame a challenge to that thought. An example: “I may have lost out on that promotion, but that doesn’t mean I’m a loser.”

I used to teach clients a method called a “4-Step Check” to help them learn to spot and counter their irrational thoughts. After an upsetting event, you analyze it in writing. (1) Event. Describe what happened. (2) How I felt. This might include multiple emotions. (3) What I did.  What would a videocam have recorded? (4) What was/were my irrational thought(s). With enough practice writing 4-Step Checks, spotting irrational thoughts eventually becomes automatic, and you don’t have to do them on paper anymore.

Here’s an example of a 4-Step Check by Charles, an alcoholic in early recovery: (1) Jim, my new AA sponsor, promised to pick me up at 7:30 sharp for an 8:00 meeting across town that he knew was important for me. When he hadn’t shown up by 7:45, I hailed a cab. (2) I felt desperate and alone in the world. I got angrier every minute Jim was late. (3) I kept looking at my watch, sometimes several times a minute.  I paced back and forth on the sidewalk, cursing. I kicked a dog. (4) I should never have asked Jim to be my sponsor. He’s doesn’t really care what happens to me. He’s a selfish, unreliable bastard! You just can’t rely on anyone. I should just go to a bar instead of paying for a taxi to get to the meeting.

As it turned out, Jim showed up late to the meeting and afterwards apologized sincerely, explaining why his tardiness had been unavoidable. So Jim did his 4-Step and was able to spot his irrational thoughts and how they were related to his emotions of the moment. You may have noticed that Charles’ initial irrational thoughts were specifically related to Jim’s failure to show up when he said he would. But then he starts to generalize, telling himself that people aren’t reliable and that working on recovery is useless – a rationalization for relapse. This is an example of how an irrational thought can lead to a progressively irrational train of thoughts, going from specific to generalized irrational thinking. None of these thoughts can help Charles to feel the way he’d like to feel or to help him achieve his goals.

Any irrational self-talk statement can be challenged by asking, “How do I know that to be true? What is my proof?” In my decades as a therapist I urged many clients to “become a student of your own thinking.” Every day holds new opportunities to learn about yourself, if you pay attention. In time you start to see the patterns of your own irrational self-talk, and you internalize the 4-Step Check. Spotting irrational thoughts becomes a learned reflex and voila!, you’re a rational thinker. In my next post I’ll get into “trains of thought” that take people to places they don’t need to go.