Albert Ellis Revisited

Albert Ellis was one of the most influential psychotherapists of all time, revolutionizingthe field through his writings, teachings, research, and supervision for more than halfa century. He was a pioneer whose ideas, known as Rational Emotive Behavior Therapy(REBT), formed the basis of what has now become known as Cognitive BehaviorTherapy (CBT), the most widely accepted psychotherapeutic approach in the world.This book contains some of Ellis’ most influential writings on a variety of subjects,including human sexuality, personality disorders, and religion, with introductions by some of today’s contemporary experts in the psychotherapy field. The 20 articlesincluded capture Ellis’ wit, humor, and breadth of knowledge and will be a valuableresource for any mental health professional for understanding the key ingredientsneeded to help others solve problems and live life fully.

Jon Carlson, PsyD, EdD, ABPP, is Distinguished Professor in the Division of Psychologyand Counseling at Governors State University and a psychologist at the Wellness Clinicin Lake Geneva, Wisconsin. Dr. Carlson has authored 60 books and 175 articles, andproduced over 300 professional videos.

William Knaus, EdD, is a former professor and one of the original directors ofpostgraduate training at the institute that Albert Ellis founded. He has authored or co-authored 20 books, 75 articles, and over 100 Psychology Today self-help blogs. Heoriginated the research-supported Rational Emotive Education Program for childrenand adolescents. Dr. Knaus is best known for his seminal work on procrastination andits solutions.

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Albert Ellis Revisited

Edited byJon Carlson and William Knaus

First published 2014by Routledge711 Third Avenue, New York, NY 10017

and by Routledge27 Church Road, Hove, East Sussex BN3 2FA

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2014 Taylor & Francis

The right of the editors to be identified as the authors of the editorialmaterial, and of the authors for their individual chapters, has beenasserted in accordance with sections 77 and 78 of the Copyright, Designsand Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproducedor utilised in any form or by any electronic, mechanical, or other means,now known or hereafter invented, including photocopying andrecording, or in any information storage or retrieval system, withoutpermission in writing from the publishers.

Trademark notice: Product or corporate names may be trademarks orregistered trademarks, and are used only for identification andexplanation without intent to infringe.

Library of Congress Cataloging in Publication DataAlbert Ellis revisited/[edited by] Jon Carlson and William Knaus.

pages cmIncludes bibliographical references and index.1. Ellis, Albert, 1913–2007. 2. Clinical psychologists—United States—Biography. 3. Rational emotive behavior therapy—United States—History. 4. Cognitive therapy—United States—History 5.Psychotherapy—United States—History. I. Carlson, Jon, editor ofcompilation. II. Knaus, William J., editor of compilation.RC438.6.E45A43 2013616.89′14092—dc23[B]2013015720

ISBN: 978-0-415-87544-8 (hbk)ISBN: 978-0-415-87545-5 (pbk)ISBN: 978-1-315-88408-0 (ebk)

Typeset in Minionby Florence Production Ltd, Stoodleigh, Devon, UK

This volume was supported by the Albert Ellis Tribute Book Series Committee, which is devoted to promoting Albert Ellis’ work on Rational Emotive Behavior Therapy through books.

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Contents

List of Contributors xAcknowledgments xivIntroduction to Albert Ellis xviii

PART I

Theoretical Foundations 1

1 Rational Psychotherapy 3JANET L. WOLFE AND WILLIAM KNAUS

2 Rational Emotive Therapy 19H. JON GEIS

3 Psychotherapy and the Value of a Human Being 38LEON POMEROY

4 RET Abolishes Most of the Human Ego 62SAM KLARREICH

5 Expanding the ABCs of Rational Emotive Therapy 73WILL ROSS

6 Group Rational Emotive and Cognitive Behavioral Therapy 86WILLIAM KNAUS

7 The Biological Basis of Human Irrationality 103ROBERT E. ALBERTI

8 Why Rational Emotive Therapy to Rational Emotive Behavior Therapy? 124STEVEN C. HAYES

PART II

Applications 135

9 Psychoneurosis and Anxiety Problems 137EDWARD GARCIA AND WILLIAM KNAUS

10 The Role of Irrational Beliefs in Perfectionism 158WILLIAM KNAUS AND VINCENT E. PARR

11 A Twenty-Three-Year-Old Girl, Guilty About Not Following Her Parents’ Rules 174RUSSELL GRIEGER

12 Flora: A Case of Severe Depression and Treatment with Rational Emotive Behavior Therapy 222NOSHEEN K. RAHMAN

13 Using Rational Emotive Behavior Therapy Techniques to Cope With Disability 239NANCY HABERSTROH

14 Denial 253JOSEPH GERSTEIN

PART III

Special Issues 267

15 Can Rational Emotive Behavior Therapy (REBT) Be Effectively Used With People Who Have Devout Beliefs in God and Religion? 269ARNOLD A. LAZARUS

16 Will the Real Sensuous Person Please Stand Up? 280JOEL BLOCK

17 Should Some People Be Labeled Mentally Ill? 291IRWIN F. ALTROWS

18 How Rational Emotive Behavior Therapy Belongs in the Constructivist Camp 310RICHARD L. WESSLER

viii Contents

19 An Answer to Some Objections to Rational Emotive Psychotherapy 329MICHAEL EDELSTEIN

20 The Future of Cognitive Behavior and Rational Emotive Behavior Therapy 338ELLIOT D. COHEN

Index 357

Contents ix

Contributors

Robert E. Alberti, PhD, is a psychologist, marriage and family therapist, Fellow of theAmerican Psychological Association, Clinical Member of the American Associationfor Marriage and Family Therapy, and former university professor and dean. Author/co-author of several books, and editor–publisher of more than one hundred—including five by Albert Ellis—his work has received international recognition as the“gold standard” for psychological self-help.

Irwin F. Altrows, PhD, CPsych, is a psychologist in private practice in Kingston, Ontario,Canada, and an Adjunct Assistant Professor in the Departments of Psychiatry andPsychology at Queen’s University. He attained the designations of Associate Fellowand Teaching Faculty with the Albert Ellis Institute. He finds REBT invaluable inassessing and treating children, correctional inmates, and people with mental andphysical disorders.

Joel Block, PhD, completed a postdoctoral fellowship with Dr. Albert Ellis and iscurrently a senior psychologist at the North Shore-LIJ Health System and on theclinical faculty (Psychiatry) of the Einstein College of Medicine. Dr. Block is adiplomate of the American Board of Professional Psychology and the author of over20 books on relationships and sexuality.

Jon Carlson, PsyD, EdD, ABPP, is Distinguished Professor in the Division of Psychologyand Counseling at Governors State University and a psychologist at the WellnessClinic in Lake Geneva, Wisconsin. Dr. Carlson has authored 60 books and 175articles and produced over 300 professional videos.

Elliot D. Cohen, PhD, is Professor and Chair of the Department of Humanities at IndianRiver State College and Adjunct Professor of Clinical Ethics at Florida State UniversityCollege of Medicine. A principal founder of the philosophical counseling movementin the United States, he is the inventor of logic-based therapy (LBT), a form ofrational emotive behavior therapy. His latest book is The Dutiful Worrier: How toStop Compulsive Worry without Feeling Guilty (New Harbinger).

Michael Edelstein is a clinical psychologist with an in-person and telephone therapypractice. He has appeared on over 300 radio shows, lectures regularly, and trainsprofessionals. He was awarded “Author of the Year” for his book, Three MinuteTherapy, by a professional organization (www.nacbt.org). He was past president of

the Association of Behavior and Cognitive Therapists and trained volunteers at theNational Save-A-Life League and at Community Sex Information, both in New YorkCity. He’s the professional advisor for San Francisco SMART Recovery, an addictionself-help group. You can find more information at: www.ThreeMinuteTherapy.com.

Edward Garcia, MA, is a former co-director of Training at the Institute for AdvancedStudy in Rational Emotive Therapy and co-author of Building Emotional Muscle andHomer the Homely Hound Dog. He has private practices in Manhattan and Atlanta,Georgia, and is an Adjunct Professor.

H. Jon Geis, PhD, was the original director of postgraduate training at the Institute forAdvanced Study in Rational Emotive Psychotherapy. He is a member of the ScientificSociety of Suma Sxi and has a private practice. He has taught at New York University,Columbia, and Yeshiva University and is the author of Effectively Leading a Groupin the Present Moment.

Joseph Gerstein, MD, is retired from Harvard Medical School. He was the FoundingPresident of SMART Recovery. He conducted over 2,000 group counseling sessionswith people with drug and alcohol abuse and dependencies.

Russell Grieger, PhD, is a licensed clinical psychologist in private practice, treating hispatients with REBT as taught by Albert Ellis. He also consults with organizations ofall shapes and sizes and teaches part time at the University of Virginia, integratingREBT principles into a good many of these activities. Russ lives in Charlottesville,Virginia, with his wife and two children.

Nancy Haberstroh, MBA, PhD, was Director of Psychological Services, MonsonDevelopmental Center but has now retired. She spent 38 years implementing rationalemotive education with developmentally disabled and intellectually handicappedindividuals, and carried out assessment center management evaluations as well asmarketing research.

Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology atthe University of Nevada. An author of 32 books and over 460 scientific articles, hiscareer has focused on an analysis of the nature of human language and cognitionand the application of this to the understanding and alleviation of human suffering.Dr. Hayes has been President of several scientific societies, and his work has beenrecognized by several awards, including the Lifetime Achievement Award from theAssociation for Behavioral and Cognitive Therapy.

Sam Klarreich, PhD, President of The Berkeley Centre for Effectiveness and The Centrefor Rational Emotive Therapy (Toronto), has a distinguished career that spans morethan 30 years as a psychologist, author, advisor, and senior-level consultant. Previouspositions include chief psychologist at a major Toronto hospital, director of anemployee assistance program at a multinational oil company, vice-president for anational career consulting firm, and managing director of a national humanresources/management consulting firm. He has written numerous professionalpapers, had timely articles in major newspapers and business magazines on a varietyof health-related topics, and has eight books to his credit.

Contributors xi

William Knaus, EdD, is a former professor and one of the original directors ofpostgraduate training at the institute that Albert Ellis founded. He has authored orco-authored 20 books, 75 articles, and more than 100 Psychology Today self-helpblogs. He originated the research-supported rational emotive education program for children and adolescents. Dr. Knaus is best known for his seminal work onprocrastination and its solutions.

Arnold A. Lazarus, PhD, ABPP, is Distinguished Professor Emeritus of Psychology,Rutgers University, and Executive Director, The Lazarus Institute, Skillman, NewJersey.

Vincent E. Parr, PhD, is a licensed Clinical Psychologist in private practice in Tampa,Florida, at the Institute for Advanced Study RTMZ (Rational Theory Mindfulnessand Zen). He has a postdoctorate from the Institute for Advanced Study in RationalPsychotherapy and holds a teaching faculty certificate from the Albert Ellis Institute,both in New York City. He has practiced REBT for more than 40 years and Zen formore than 23 years. You can contact him at ReasonandZen.com.

Leon Pomeroy, PhD, is Adjunct Professor at George Mason University and has a privatepractice in Woodbridge, Virginia USA. He is a Fellow of the Albert Ellis Institute.He was Senior Staff Psychologist and Chief of Behavioral Medicine at the OutpatientClinic, VA Medical Center, Brooklyn, New York (retired) and is retired from privatepractice on Manhattan’s Upper East Side. He is the author of The New AxiologicalPsychology.

Nosheen K. Rahman has been a Professor and Director of the Centre for ClinicalPsychology at the University of the Punjab in Lahore, Pakistan. She completed herMasters in Psychology from Government College, Lahore, and a PhD in EducationalPsychology from Fordham University, New York City. Her interest in rationalemotive therapy (RET), as REBT was known then, brought her to New York Cityin 1973. She completed her Fellowship in RET at the Albert Ellis Institute in NewYork City. She trained in both individual and group psychotherapy under thepersonal supervision of Dr. Albert Ellis. On her return to Pakistan, she introducedREBT into the regular curriculum of clinical psychology at the postgraduate level.In her 26 years of academic teaching and clinical practice in Lahore, she has foundREBT to be the most sought-after modality for emotional health in Pakistan.Furthermore, she has supervised a great deal of research into the application of REBTin the Pakistani population for PhD, MPhil, and postgraduate diplomas in clinicalpsychology.

Will Ross is Webmaster of REBTnetwork.org and author and publisher of online REBTself-help materials. He is a self-help hotline counselor and trainer.

Richard L. Wessler, PhD, is Emeritus Professor of Psychology and former Director ofTraining at the Albert Ellis Institute, co-developer of Cognitive Appraisal Therapy,and co-author of Succeeding with Difficult Clients and two books on Rational EmotiveTherapy, plus numerous articles.

xii Contributors

Janet L. Wolfe received her PhD in Clinical Psychology from New York University,where she is Adjunct Professor in the Department of Applied Psychology. She servedfor over 35 years as Director of the Albert Ellis Institute in New York City, andcurrently has a private consulting and therapy practice in New York City. Dr. Wolfeis co-editor of The Resource Book for Practitioners and author of What to Do WhenHe Has a Headache: Renewing Desire and Intimacy in Your Relationship, which hasbeen published in six countries. She has written more than 100 chapters and articlesin professional books and journals. She has conducted hundreds of workshops incognitive behavior therapy applications to anxiety and stress management,communications training, addictions, and couple and family counseling throughoutthe US, Europe, South America, and Asia, and has helped spawn numerous programsin schools, clinics, and agencies based on REBT/CBT principles.

Contributors xiii

Acknowledgments

We wish to thank the Provost’s Office at Governors State University (GSU) for providingstate-of-the art digital scanning equipment for use in reproducing the originalmanuscripts in a digital format. We also wish to thank the Division of Psychology andCounseling at GSU for help in preparing the manuscripts for republication and forobtaining permission for their use. Specifically, we want to acknowledge Dr. ShannonDermer, Raquel Rios-Aguirre, Mona Douglas, Nanette Nelson, Lindsey Raske, RobertRauworth, Nicole Roy, Shalon McCray, and Fatima Almaru.

We wish to thank Julia Frank-McNeil of the American Psychological Association forher assistance in securing permission to utilize so many of Dr. Ellis’ original papers.We also wish to thank Debbie Joffe Ellis for her permission to use Dr. Ellis’ photo onthe front cover the book.

Finally, we wish to thank our Routledge editor, Dr. George Zimmar, for his ongoingsupport and encouragement in making this important project a reality.

The editors would like to thank those concerned for the articles reproduced in thefollowing chapters.

Chapter 1

Ellis (1958). Rational psychotherapy. Journal of Psychology, 59 (1), 35–49. Reprintedwith permission of Taylor & Francis Group.

Chapter 2

Ellis (1985). Rational emotive psychotherapy. In I. Kutash & A. Wolf (Eds.), Theoryand techniques in the practice of modern therapies (pp. 277–297). San Francisco, CA:Jossey-Bass. Copyright © 1985 by Irwin Kutash. A good faith effort has been made toobtain permission to reprint this article, but the publisher was unable to locate or contactthe copyright holder.

Chapter 3

Ellis (1972). Psychotherapy and the value of a human being. In J. W. Davis (Ed.), Valueand valuation: Axiological studies in honor of Robert S. Hartman. Knoxville, TN: Universityof Tennessee Press. Reprinted with permission of University of Tennessee Press.

Chapter 4

Ellis (1976). RET abolishes most of the human ego. Psychotherapy: Theory, Research,and Practice, 13 (4), 343–348. Copyright © 1976 by the American Psychological Associa-tion. Reproduced with permission. No further reproduction or distribution is permittedwithout written permission from the American Psychological Association.

Chapter 5

Ellis (1985). Expanding the ABCs of rational emotive therapy. In M. J. Mahoney & A. Freeman (Eds.), Cognition and psychotherapy (pp. 313–323). New York: Plenum Press. Copyright © 1985 by Springer Science + Business Media B.V. Reprinted withpermission.

Chapter 6

Ellis (1985). Group rational emotive and cognitive behavioral therapy. InternationalJournal of Group Psychotherapy, 42 (1), 63–80. Copyright © 1985 by Guilford Publica-tions, Inc. Reprinted with permission.

Chapter 7

Ellis (1976). The biological basis of human irrationality. Journal of Individual Psychology,32 (1), 145–168. Copyright © 1976 by the University of Texas Press. All rights reserved.Reprinted with permission.

Chapter 8

Ellis (1999). Why rational emotive therapy to rational emotive behavior therapy? Psycho-therapy: Theory, Research, and Practice, 36 (2), 154–159. Copyright © 1999 by theDivision of Psychotherapy (29), American Psychological Association. Reproduced withpermission. No further reproduction or distribution is permitted without writtenpermission from the American Psychological Association.

Chapter 9

Ellis (1982). Psychoneurosis and anxiety problems. In R. Greiger & I. Z. Greiger (Eds.),Cognition and emotional disturbance (pp. 17–45). New York: Human Science Press.Copyright © 1982 by Springer Science + Business Media B.V. Reprinted with permis-sion.

Chapter 10

Ellis (2002). The role of irrational beliefs in perfectionism. In G. I. Flett & P. Hewitt(Eds.), Perfectionism: Theory, research, and treatment (pp. 217–229). Washington, DC:American Psychological Association. Copyright © 2002 by the American Psychological

Acknowledgments xv

Association. Reproduced with permission. No further reproduction or distribution ispermitted without written permission from the American Psychological Association.

Chapter 11

Ellis (1971). A twenty-three-year-old girl guilty about not following her parents’ rules.In A. Ellis, Growth through reason. Palo Alto, CA: Science & Behavior Books. Reprintedwith permission of Science & Behavior Books.

Chapter 12

Ellis (1988). Flora: A case of severe depression and treatment with rational emotivebehavior therapy. In R. P. Halgen & S. K. Whitbourne (Eds.), A casebook in abnormalpsychology (pp. 166–180). New York: Oxford University Press. Copyright © 1988 OxfordUniversity Press, USA. Reprinted with permission.

Chapter 13

Ellis (1997). Using rational emotive behavior therapy techniques to cope with disability.Professional Psychology: Research and Practice, 28 (1), 17–22. Copyright © 1997 by theAmerican Psychological Association. Reproduced with permission. No further repro-duction or distribution is permitted without written permission from the AmericanPsychological Association.

Chapter 14

Ellis (1992). Denial. In A. Ellis & E. Velten (Eds.), When AA doesn’t work for you: Rationalsteps to quitting alcohol. Fort Lee, NJ: Barracade Books. Reprinted with permission.

Chapter 15

Ellis (2000). Can rational emotive behavior therapy (REBT) be effectively used withpeople who have devout beliefs in God and religion? Professional Psychology: Researchand Practice, 31 (1), 29–33. Copyright © 1997 by the American Psychological Associa-tion. Reproduced with permission. No further reproduction or distribution is permittedwithout written permission from the American Psychological Association.

Chapter 16

Ellis (1972). Will the real sensuous person please stand up? In A. Ellis, The sensuousperson: Critique and corrections. New York: Lyle Stuart. Reprinted with permission.

Chapter 17

Ellis (1967). Should some people be labeled as mentally ill? Journal of ConsultingPsychology, 31 (5), 435–444. Copyright © 1967 by the American Psychological Associa-

xvi Acknowledgments

tion. Reproduced with permission. No further reproduction or distribution is permittedwithout written permission from the American Psychological Association.

Chapter 18

Ellis (1998). How rational emotive behavior belongs in the constructivist camp. In M. Hoyt (Ed.), The handbook of constructive therapies (pp. 83–89). San Francisco, CA:Jossey-Bass. Copyright © 1998 by John Wiley & Sons, Inc. Reprinted with permission.

Chapter 19

Ellis (1965). An answer to some objections to rational emotive psychotherapy. Psycho-therapy: Theory, Research, and Practice, 2 (3), 108–111. Copyright © 1965 by the Divisionof Psychotherapy (29), American Psychological Association. Reproduced with permis-sion. No further reproduction or distribution is permitted without written permissionfrom the American Psychological Association.

Chapter 20

Ellis (1997). The future of cognitive behavioral and rational emotive therapy. In S. Palmer & V. Varma (Eds.), The future of counseling and psychotherapy (pp. 1–14).London: Sage Publications. Copyright © 1997 by Sage Publications. Reprinted withpermission.

Acknowledgments xvii

Introduction to Albert Ellis

Psychologist and rational emotive behavioral therapist Dr. Albert Ellis brilliantly helpedshape the psychotherapeutic landscape for both his contemporaries and for futuregenerations of psychotherapists. Working tirelessly for over 60 years, often for 15–18hours a day, he directly helped thousands of clients achieve positive mental health andimprove the quality of their lives. He indirectly helped millions by his psychology self-help and professional books, and by the network of counselors and psychotherapiststhat he helped train. Since Albert Ellis introduced rational therapy in 1956, ongoingresearch demonstrates the efficacy of his seminal and advanced ideas.

Al Ellis was the quintessential example of a bright and busy man who loved his work.Few, if any, can claim to have seen the number of individual clients that Al Ellis sawover his career. From Monday through Friday, he worked from 9:00 a.m. to 11:00 p.m.His client sessions were one-half hour long. He often had two group therapy sessionseach evening, with as many as 15 clients in each of his groups benefitting from hiseducative form of therapy. Saturday was a short day for seeing clients. He worked from9:00 a.m. to noon. Then he worked for the rest of the weekend writing. He relishedgiving workshops and lectures and doing his Friday Night Workshops, where hedemonstrated REBT by doing REBT with volunteers from his audience. In between histherapeutic work and his professional and public presentations, Al authored or co-authored over 85 books and more than 550 articles and chapters for books of readings.

Al Ellis was both a pioneer and revolutionary in the area of psychotherapy. His books on sex and sexuality occurred at a time when sex was a sordid topic. His rationaltherapy was a flashpoint that ignited the cognitive revolution in psychotherapy. Thisconsummate innovator evolved rational therapy into rational emotive therapy, andfinally into rational emotive behavioral therapy. At each phase in the evolution of hiscognitive, emotive, behavioral system, Ellis extended and enriched REBT.

Celebrating the Work of a Great Man

It is with great pleasure that we present a book of readings that highlights psychologistAlbert Ellis’ enormous contributions to the field of psychotherapy. Albert Ellis Revisitedis an Albert Ellis Tribute Series book dedicated to the celebration and expansion ofAlbert Ellis’ work. The book contains chapters and articles that Al wrote in differentphases of his career.

Each chapter starts with a commentary by a friend or colleague who reflects on therelevance of Al’s thinking and how it applies to the world we know today. We dividedthis book into three parts and three eras. The parts are REBT theory, practices, andspecial issues. The eras are marked by the name changes Al made to his system: (1)1956–1963: rational therapy; (2) 1964–1993: rational emotive therapy; and (3) 1994 tothe present: rational emotive behavioral therapy (REBT).

Lest we be remiss, we also need to look at Ellis, the person.Albert Ellis, a fragile child, grew into a shy adolescent who feared rejection by women.

At the age of 19, a motivated Ellis gave himself behavioral assignments where hecombatted this fear by doing what he feared. For example, he forced himself to havecasual conversations with women at the Bronx Botanical Gardens. From studyingphilosophy, Ellis taught himself how to examine his anxiety thinking and to change itto accepting that it was not the end of the world if a woman rejected him. He kept self-improving until he felt comfortable talking with women.

By using an early version of behavioral exposure therapy, a young Ellis taught himself to rid himself of his own irrational demons. He taught himself to dispute anddefuse his irrational thinking about rejection. Later, when he actively practiced rationaltherapy, Ellis gave his clients homework assignments where they actively worked at self-improvement between their therapy sessions. He kept notes on these assignments. Hechecked on client progress at the beginning of each new session.

In a world where image management often prevails over truth and reality, Ellis tooka different path. His autobiography testifies to his openness. His confessions are worthnoting. Ellis was quite candid about his public sexual behavior and many of his humanfoibles and faults.

For some who knew him well, Al showed a softer side to his personality. Hecommunicated as you might expect when talking to a friend. He was practically alwayssupportive.

Ellis was flawed, honest, and capable. He leaves us with a legacy of how a flawedperson can make enormous contributions. As time passes, his contributions will remain,and his flaws will fade.

Comments on Commentators

The commentators represent a unique group. Janet Wolfe, who was with Al for 37 yearsand who served as Executive Director for the Institute that Al founded, launches thiswork by commenting on Al’s seminal article on rational therapy. Jon Geis, WilliamKnaus, Ed Garcia, and Rick Wessler represent all of the former directors of postgraduateREBT training from Al’s institute. This is the first time this special group has cometogether to share their views on REBT in a book.

Original fellows, associate fellows, and primary certificate holders in REBT, who werepresent when rational emotive therapy was gaining momentum, contribute their uniqueperspectives on the REBT therapy system. They are joined by more recent members ofthe REBT family of therapists and contributors. Arnold Lazarus, founder of multimodaltherapy, Steven Hayes, founder of acceptance and commitment therapy, and ElliotCohen, founder of the philosophical counseling movement in the US, helped celebrate

Introduction xix

Al’s more than 60 years of professional contributions by bringing an outside perspectiveto Albert Ellis Revisited.

As we expected, the commentaries were mainly favorable to Al’s thinking, but notperfectly so. That’s good. Few enjoyed a challenge more than Al Ellis. He was famousfor his analyses. Were he alive today, we’re confident that he’d relish commenting onthe comments.

Present Directions and Future Prospects for REBT

Albert Ellis’ magnificent work lives on. Look closely. You will see a rational mosaicwoven through cognitive, emotive, and behavioral forms of therapy that have grownfrom Al’s pioneering efforts. His bedrock REBT system inspired the evolution ofnumerous complementary and evidence-based practices, such as cognitive therapy,CBT, acceptance and commitment therapy, and dialectical behavioral therapy.

While he lived, this consummate innovator was quick to point out how new cognitiveand behavioral systems are like branches springing from the roots and trunk of thesystem he founded. He happily accepted them as part of the CBT family of therapies.He was also quick to differentiate between REBT and CBT.

Al was clear on the distinctiveness of REBT. He believed that much human miserystemmed from clients’ irrational demands that the self, others, and the world conformto prejudgments about how things ought to, or must, be. He asserted that, by usingactive and persuasive methods, and by adopting and using his three dimensions ofacceptance (unconditional acceptance of self, others, and life), much human sufferingcould be alleviated. His system was a positive, preventive system, intervention method,and philosophy for living life rationally and enjoyably.

Although times change, entitlement demands for ease and comfort, success, control,and approval continue. Paralleling this continuing trend, the prevalence for anxiety anddepression is rising alarmingly.

As long as people think irrationally, Al’s theory and practice apply. So does hisassertion for how to make profound and positive personal changes: If you want to getbetter you have to do better. That means working your duff off using REBT.

In 2007, Albert Ellis died, in his 93rd year, and he died as he lived: rationally acceptingwhat he could not control. Throughout his career as a psychologist and psychotherapist,Al showed an unwavering clarity of thought. He continued his work until the last monthof his life. To the amazement of his physicians, he left this world with a rationalacceptance of his mortality.

In various ways, contemporary therapists continue to apply the rational emotivebehavioral approach that Al pioneered. We are confident that his work will continuethrough future therapists who draw from the intellectual gifts that he left to the fieldof psychotherapy. Al’s thoughts live on. They continue to have great relevance today.We predict that many talented therapists, researchers, and lay people will continue toevolve the REBT system for the betterment of humanity.

William Knaus and Jon Carlson

xx Introduction

Part I

Theoretical Foundations

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1 Rational Psychotherapy

INTRODUCTION

Janet L. Wolfe and William Knaus

Both because of his interests in philosophy and his early experiences as a “self-changer,”Albert Ellis found his neo-analytic training too limiting. He was set to try a differentway. He experimented with an educationally oriented, philosophically based, practicalcognitive psychotherapy that he called rational therapy (RT).

Rational Psychotherapy (Ellis, 1958) was the first of hundreds of articles Ellis publishedon his new system of psychotherapy. In this 14-page work, he set the foundation forwhat would later become REBT. He sounded the trumpet for the cognitive revolutionin psychotherapy. But this was not his first publication on this new rational system.

You can find the genesis of Ellis’ brand of cognitive, emotive, behavioral therapy in the first of many psychology self-help books that he wrote. Pick any page in How toLive with a Neurotic (Ellis, 1957), and we are confident you’ll find a rational gem. Forexample, Albert Ellis described the human tendency to magnify and catastrophize. Inreference to neurotic-thinking individuals, Ellis commented, “what they believe to betrue, they usually make true; what they think is changeless, becomes so. But if humansbelieve they can change, they inevitably put this belief into action” (1957, pp. 17 & 18).

In this seminal article, Ellis identified distinctive features of rational therapy. Heargued that, regardless of their causes, when clients stick to harmful belief systems, theyoverburden themselves with irrational demands about how they, others, and the worldought to be. He postulated that, once free of burdensome irrational demands, clientswould suffer no more than the normal human emotional stresses that come about fromlosses, disappointments, and barriers that interfered with their healthy human strivings.They would be free to act productively and enjoy their lives.

Albert Ellis viewed dysfunctional irrational beliefs as coming from different sources,such as social indoctrination. He listed 12 irrational ideas that he asserted were at theroot of much human misery. He asserted that it would take effortful practice to dislodgethem.

The role of the rational therapist was to identify clients’ harmful irrational beliefsand to forcefully show them how to uproot and replace them with functional beliefsystems. The rational therapist would figuratively “pound away” at the “nonsense” untilthe client developed realistic ways to construe or to reconstruct reality.

Ellis focused on how people think their way into feeling disturbed. He advocated forempirically testing his system, and identified two hypotheses. He later added psycho-logical homework assignments and his now famous ABC model to the system. Heshared a vision for how future mental health practitioners would practice RT.

Ellis Challenged Establishment Thinking

In the system he initially called Rational Therapy, Ellis threw down the gauntlet. Hechallenged the therapeutic establishment, which, at the time, was largely monopolizedby psychoanalysis and neo-analytic practitioners.

Threaten someone’s system, and they are likely to react. Some analytic adherentsattempted to marginalize Ellis and RT. However, Albert Ellis was trained in psycho-analysis and had undergone his own analysis. It could not realistically be said that hedid not understand the system he challenged. Ellis had a honed and sharp intellect andquickly showed he could persuasively advance his positions. He enjoyed the debate. Hewas formidable.

Ellis’ sharp wit and pen are obvious in the article. He showed how he would arguehis points for years to come. He used case examples. He applied his scientific trainingas a psychologist in formulating his views. He applied logic and reason to an issue. Thiscombined approach may have been sufficient to give RT traction. However, the fieldwas ripe for a paradigm shift.

Albert Ellis developed RT when Freudian, neo-Freudian, behaviorist, and Rogeriansystems were dominant. However, this was a time when the prevailing winds in psycho-therapy were changing. A few analysts expressed concern with therapeutic outcomes(Knight, 1941; Oberndorf, 1942). Psychoanalysts saw relatively few people relative tothe resources devoted to this pursuit, and the results were unimpressive (Low, 1950).The behaviorists were increasingly viewed as too mechanical. Research on Rogeriantherapy suggested that the non-directive approach was better suited for reasonably well-adjusted college students than for people with serious emotional disturbances.

As rumblings of discontent with the existing systems spread across the therapeuticworld, Ellis and his colleagues founded the not-for-profit Institute for Rational EmotiveTherapy, which provided programs for the community and postgraduate training formental health professionals. Ellis and his growing number of adherents presented RTwidely, both to professional and public audiences. This system opened the opportunityfor practically anyone to have access to a relatively quick and efficient psychotherapy.Knight’s (op. cit.) criteria for change could be more readily achieved through RT: (1)disappearance of presenting symptoms, (2) real improvement in mental functioning,and (3) improved reality adjustment.

The 1949 Boulder Conference resulted in a scientist practitioner model for clinicalpsychology that later led to research-guided practice and to today’s evidence-basedpractices. The Boulder Conference established the requirement that, for a psychotherapysystem to earn acceptability, it had to (1) show utility, (2) present testable hypotheses,and (3) show potential for achieving evidence-based status. RT met that test. At thesame time, the research/practitioner model challenged the monopolistic psychoanalyticand neopsychoanalytic system. Analytic proponents typically argued that only membersof this group were qualified to evaluate analytic outcome. This “insider club” approach

4 Janet L. Wolfe and William Knaus

to outcome research left many scientific practitioners rolling their eyes. The argumentdidn’t fly.

As Albert Ellis worked to advance RT, new psychotherapy systems simultaneouslyemerged. With his hoary beard and earthy style, Gestalt therapist guru Fritz Perls wasa 1960s favorite. Eric Berne came on the scene with Games People Play. Joseph Wolpepropelled behavioral therapy into dominance. The 1960s was the time of the humanpotential movement. Ellis, dedicated to humanism, was in the middle of it all. Whenthe dust settled, Ellis stood tall. In an often-quoted meta-analysis by Mary Smith andGene Glass (1977), Ellis’ brand of therapy was the second most effective on the list of10 therapy methods.

Albert Ellis was a man on a mission. He was a prolific writer. He authored or co-authored over 85 books and over 550 articles and chapters for books of readings. Helectured, conducted workshops, and actively trained therapists in his methods. He sawmore psychotherapy clients than any other therapist, living or dead. It is unlikely thatmany, if any, personally did more than Albert Ellis to advance a psychotherapy system.

What came of Albert Ellis’ tireless efforts? There are more than 4,000 AmericanPsychological Association database listed articles, chapters in books of readings, anddissertations where the words rational and therapy appear. More than 1,000 studiessupport his main premise that certain kinds of negative thinking were associated withemotional disturbance. Research into his two-stage theory of emotions (emotionaleffects from rational beliefs differ from emotional effects from irrational beliefs) issupported. Ellis’ system showed efficacy across a broad range of psychologicaldisturbances. He is directly or indirectly responsible for the training of thousands ofpsychotherapists in his approach.

It is fair to say that Ellis was the grandfather of cognitive behavior therapy, and thathis original formulation has strongly influenced therapy research and practice. Ellis saw his work extended through over 24,000 articles, chapters, and dissertations listedunder cognitive behavior therapy in the American Psychological Association database.Although some articles are critical of Ellis’ rationally oriented methods, the majoritysupport his original formulations, and a significant majority of psychologists todayidentify themselves as cognitive behavior therapists or rational emotive behaviortherapists.

How Does RT Apply Today?

When we think of rational therapy, we don’t think about how to move from ahistorically relevant to a contemporarily relevant context for RT. REBT is the evolvedextension of Ellis’ original formulation, and this is the system that is practiced today.Thus, revisiting Albert Ellis in this area is like a walk down memory lane, while hisinfluence still clearly illuminates the therapeutic path. The issue is how to expand theframework that Albert Ellis, along with his colleagues, pioneered and advanced.

Research in the basic REBT continues to be a subject of favorable outcome studies.Among the myriad of possible present and future applications of the REBT system, wesee two major educational opportunities to apply REBT principles and practices toprevent disturbance and dysfunction, at school and over the Internet.

Rational Psychotherapy 5

Prevention continues as a primary aim of REBT, and the school setting is a naturalplace for children to start to learn and apply rational principles.

A top priority is the effective execution of positive school mental health programsto provide instruction to children and youth on the application of rational life skillsthey can use in different ways, in different contexts, for decades to come. REBT andthe school-oriented rational emotive education curriculum show efficacy (Esposito, 2009;Gonzalez et al., 2004). Knaus has donated a rational emotive education program, andany interested readers can download the program, at no cost, at www.rebtnetwork.org/library/Rational_Emotive_Education.pdf.

The Internet is a platform for efficiently disseminating rational concepts for purposesof both preventing psychological disabilities, and directly helping alleviate stress formillions who suffer from afflictions from their own thinking. Albert Ellis’ rational modelgives self-helpers an organized way to identify and clarify what happens when theypersistently think themselves into anxieties, depression, and other untoward mentalstates. In this model, A stands for an activating event, such as a job rejection. B standsfor the beliefs about the event. Some beliefs will be sensible, and others irrational orharmful. C stands for the emotional and behavioral extensions of the beliefs. D is achange phase of disputing or challenging harmful beliefs. This is the cognitiverestructuring phase of the process. E refers to new effects from the rational thinkingobtained through D.

The use of hyperlinks from concepts to exercises to monitoring progress hasunparalleled potential. We predict this medium will favor systems, such as REBT, as alight along the therapeutic path.

References

Berne, E. (1964). Games people play: The basic handbook of transactional analysis. New York:Ballantine Books.

Ellis, A. (1957). How to live with a neurotic. New York: Crown.Esposito, M. A. (2009). REBT with children and adolescents: A meta-analytic review of efficacy

studies. Dissertation Abstracts International: Section B: The Sciences and Engineering, 3195.Gonzalez, J. E., Nelson, J. R., Gutkin, T. B., Saunders, A., Galloway, A., & Shwery, C. S. (2004).

Rational emotive therapy with children and adolescents. Journal of Emotional and BehavioralDisorders, 12(4), 222–235.

Knight, R. P. (1941). Evaluation of the results of psychoanalytic treatment. American Journal ofPsychiatry, 98, 434–446.

Low, A. (1950). Mental health through will-training. Boston, MA: Christopher Publishing.Oberndorf, C. P. (1942). Consideration of the results of psychoanalytic therapy. American Journal

of Psychiatry, 99, 374–381.Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American

Psychologist, 32(9), 752–760.

6 Janet L. Wolfe and William Knaus

RATIONAL PSYCHOTHERAPY

Albert Ellis

The central theme of this paper is that psychotherapists can help their clients to livethe most self-fulfilling, creative, and emotionally satisfying lives by teaching these clientsto organize and discipline their thinking. Does this mean that all human emotion andcreativity can or should be controlled by reason and intellect? Not exactly.

The human being may be said to possess four basic processes—perception, move-ment, thinking, and emotion—all of which are integrally interrelated. Thus, thinking,aside from consisting of bioelectric changes in the brain cells, and in addition to comprising remembering, learning, problem-solving, and similar psychologicalprocesses, also is, and to some extent has to be, sensory, motor, and emotional behavior(Cobb, 1950; Ellis, 1956). Instead, then, of saying, “Jones thinks about this puzzle,” weshould more accurately say, “Jones perceives–moves–feels–THINKS about this puzzle.”Because, however Jones’ activity in relation to the puzzle may be largely focused uponsolving it, and only incidentally on seeing, manipulating, and emoting about it, we mayperhaps justifiably emphasize only his thinking.

Emotion, like thinking and the sensori-motor processes, we may define as anexceptionally complex state of human reaction, which is integrally related to all theother perception and response processes. It is not one thing, but a combination andholistic integration of several, seemingly diverse, yet actually closely related, phenomena(Cobb, 1950).

Normally, emotion arises from direct stimulation of the cells in the hypothalamusand autonomic nervous system (e.g., by electrical or chemical stimulation) or fromindirect excitation via sensori-motor, cognitive, and other conative processes. It maytheoretically be controlled, therefore, in four major ways. If one is highly excitable andwishes to calm down, one may (a) take electroshock or drug treatments; (b) use soothingbaths or relaxation techniques; (c) seek someone one loves and quiet down for his sake;or (d) reason oneself into a state of calmness by showing oneself how silly it is for oneto remain excited.

Although biophysical, sensori-motor, and emotive techniques are all legitimatemethods of controlling emotional disturbances, they will not be considered in thispaper, and only the rational technique will be emphasized. Rational psychotherapy isbased on the assumption that thought and emotion are not two entirely differentprocesses, but that they significantly overlap in many respects and that thereforedisordered emotions can often (though not always) be ameliorated by changing one’sthinking.

A large part of what we call emotion, in other words, is nothing more or less thana certain kind—a biased, prejudiced, or strongly evaluative kind—of thinking. Whatwe usually label as thinking is a relatively calm and dispassionate appraisal (or organizedperception) of a given situation, an objective comparison of many of the elements inthis situation, and a coming to some conclusion as a result of this comparing ordiscriminating process (Ellis 1956). Thus, a thinking person may observe a piece ofbread, see that one part of it is mouldy, remember that eating this kind of mould

previously made him ill, and therefore cut off the mouldy part and eat the non-mouldysection of the bread.

An emoting individual, on the other hand, will tend to observe the same piece ofbread, and remember so violently or prejudicedly his previous experience with themouldy part, that he will quickly throw away the whole piece of bread and thereforego hungry. Because the thinking person is relatively calm, he uses the maximuminformation available to him—namely, that mouldy bread is bad but non-mouldy breadis good. Because the emotional person is relatively excited, he may use only part of theavailable information—namely, that mouldy bread is bad.

It is hypothesized, then, that thinking and emoting are closely interrelated and attimes differ mainly in that thinking is a more tranquil, less somatically involved (or, at least, perceived), and less activity-directed mode of discrimination than is emotion.It is also hypothesized that among adult humans raised in a social culture thinking andemoting are so closely interrelated that they usually accompany each other, act in acircular cause-and-effect relationship, and in certain (though hardly all) respects areessentially the same thing, so that one’s thinking becomes one’s emotion and emotingbecomes one’s thought. It is finally hypothesized that since man is a uniquely sign-,symbol-, and language-creating animal, both thinking, and emoting tend to take theform of self-talk or internalized sentences; and that, for all practical purposes, thesentences that human beings keep telling themselves are or become their thoughts andemotions.

This is not to say that emotion can under no circumstances exist without thought.It probably can; but it then tends to exist momentarily, and not to be sustained. Anindividual, for instance, steps on your toe, and you spontaneously, immediately becomeangry. Or you hear a piece of music and you instantly begin to feel warm and excited.Or you learn that a close friend has died and you quickly begin to feel sad. Under thesecircumstances, you may feel emotional without doing any concomitant thinking.Perhaps, however, you do, with split-second rapidity, start thinking “This person whostepped on my toe is a blackguard!” or “This music is wonderful!” or “Oh, how awfulit is that my friend died!”

In any event, assuming that you don’t, at the very beginning, have any conscious orunconscious thought accompanying your emotion, it appears to be difficult to sustainan emotional outburst without bolstering it by repeated ideas. For unless you keeptelling yourself something on the order of “This person who stepped on my toe is ablackguard!” or “How could he do a horrible thing like that to me!” the pain of havingyour toe stepped on will soon die, and your immediate reaction will die with the pain.Of course, you can keep getting your toe stepped on, and the continuing pain maysustain your anger. But assuming that your physical sensation stops, your emotionalfeeling, in order to last, normally has to be bolstered by some kind of thinking.

We say “normally,” because it is theoretically possible for your emotional circuits,once they have been made to reverberate by some physical or psychological stimulus,to keep reverberating under their own power. It is also theoretically possible for drugsor electrical impulses to keep acting directly on your hypothalamus and autonomicnervous system and thereby to keep you emotionally aroused. Usually, however, thesetypes of continued direct stimulation of the emotion-producing centers do not seemto be important and are limited largely to pathological conditions.

8 Albert Ellis

It would appear, then, that positive human emotions, such as feelings of love orelation, are often associated with or result from thoughts, or internalized sentences,stated in some form or variation of the phrase “This is good!” and that negative humanemotions, such as feelings of anger or depression, are frequently associated with orresult from thoughts or sentences which are stated in some form or variation of thephrase “This is bad!” Without an adult human being’s employing, on some consciousor unconscious level, such thoughts and sentences, much of his emoting would simplynot exist.

If the hypothesis that sustained human emotion often results from or is directlyassociated with human thinking and self-verbalization is true, then important corollariesabout the origin and perpetuation of states of emotional disturbance, or neurosis, maybe drawn. For neurosis would appear to be disordered, over- or under-intensified,uncontrollable emotion; and this would seem to be the result of (and, in a sense, thevery same thing as) illogical, unrealistic, irrational, inflexible, and childish thinking.

That neurotic or emotionally disturbed behavior is illogical and irrational wouldseem to be almost definitional. For if we define it otherwise, and label as neurotic allincompetent and ineffectual behavior, we will be including actions of truly stupid andincompetent individuals—for example, those who are mentally deficient or braininjured. The concept of neurosis only becomes meaningful, therefore, when we assumethat the disturbed individual is not deficient or impaired but that he is theoreticallycapable of behaving in a more mature, more controlled, more flexible manner than heactually behaves. If, however, a neurotic is essentially an individual who acts significantlybelow his own potential level of behaving, or who defeats his own ends though he istheoretically capable of achieving them, it would appear that he behaves in an illogical,irrational, unrealistic way. Neurosis, in other words, consists of stupid behavior by anon-stupid person.

Assuming that emotionally disturbed individuals act in irrational, illogical ways, thequestions which are therapeutically relevant are: (a) How do they originally get to beillogical? (b) How do they keep perpetuating their irrational thinking? (c) How canthey be helped to be less illogical, less neurotic?

Unfortunately most of the good thinking that has been done in regard to therapyduring the past 60 years, especially by Sigmund Freud and his chief followers (Ellis,1924–1950; Fenichel, 1945; Freud, 1938), has concerned itself with the first of thesequestions rather than the second and the third. The assumption has often been madethat if psychotherapists discover and effectively communicate to their clients the mainreasons why these clients originally became disturbed, they will thereby also discoverhow their neuroses are being perpetuated and how they can be helped to overcomethem. This is a dubious assumption.

Knowing exactly how an individual originally learned to behave illogically by nomeans necessarily informs us precisely how he maintains his illogical behavior, norwhat he should do to change it. This is particularly true because people are often, perhapsusually, afflicted with secondary as well as primary neuroses, and the two maysignificantly differ. Thus, an individual may originally become disturbed because hediscovers that he has strong death wishes against his father and (quite illogically) thinkshe should be blamed and punished for having these wishes. Consequently, he may

Rational Psychotherapy 9

develop some neurotic symptom, such as a phobia against dogs because, let us say,dogs remind him of his father, who is an ardent hunter.

Later on, this individual may grow to love or be indifferent to his father; or his fathermay die and be no more of a problem to him. His fear of dogs, however, may remain:not because, as some theorists would insist, they still remind him of his old death wishesagainst his father, but because he now hates himself so violently for having the originalneurotic symptom—for behaving, to his mind, so stupidly and illogically in relation todogs—that every time he thinks of dogs his self-hatred and fear of failure so severelyupset him that he cannot reason clearly and cannot combat his illogical fear.

In terms of self-verbalization, this neurotic individual is first saying to himself: “I hate my father—and this is awful!” But he ends up by saying: “I have an irrationalfear of dogs—and this is awful!” Even though both sets of self-verbalizations areneuroticizing, and his secondary neurosis may be as bad as or worse than his primaryone, the two can hardly be said to be the same. Consequently, exploring and explainingto this individual—or helping him gain insight into—the origins of his primary neurosiswill not necessarily help him to understand and overcome his perpetuating or secondaryneurotic reactions.

If the hypotheses so far stated have some validity, the psychotherapist’s main goalsshould be those of demonstrating to clients that their self-verbalizations have been andstill are the prime source of their emotional disturbances. Clients must be shown thattheir internalized sentences are illogical and unrealistic at certain critical points andthat they now have the ability to control their emotions by telling themselves morerational and less self-defeating sentences.

More precisely: the effective therapist should continually keep unmasking his client’spast and, especially, his present illogical thinking or self-defeating verbalizations by (a)bringing them to his attention or consciousness; (b) showing the client how they arecausing and maintaining his disturbance and unhappiness; (c) demonstrating exactlywhat the illogical links in his internalized sentences are; and (d) teaching him how torethink and re-verbalize these (and other similar) sentences in a more logical, self-helping way. Moreover, before the end of the therapeutic relationship, the therapistshould not only deal concretely with the client’s specific illogical thinking, but shoulddemonstrate to this client what, in general, are the main irrational ideas that humanbeings are prone to follow and what more rational philosophies of living may usuallybe substituted for them. Otherwise, the client who is released from one specific set ofillogical notions may well wind up by falling victim to another set.

It is hypothesized, in other words, that human beings are the kind of animals who,when raised in any society similar to our own, tend to fall victim to several majorfallacious ideas; to keep reindoctrinating themselves over and over again with theseideas in an unthinking, autosuggestive manner; and consequently to keep actualizingthem in overt behavior. Most of these irrational ideas are, as the Freudians have veryadequately pointed out, instilled by the individual’s parents during his childhood, andare tenaciously clung to because of his attachment to these parents and because theideas were ingrained, or imprinted, or conditioned before later and more rational modesof thinking were given a chance to gain a foothold. Most of them, however, as theFreudians have not always been careful to note, are also instilled by the individual’sgeneral culture, and particularly by the media of mass communication in this culture.

10 Albert Ellis

What are some of the major illogical ideas or philosophies which, when originallyheld and later perpetuated by men and women in our civilization, inevitably lead toself-defeat and neurosis? Limitations of space preclude our examining all these majorideas, including their more significant corollaries; therefore, only a few of them will be listed. The illogicality of some of these ideas will also, for the present, have to betaken somewhat on faith, since there again is no space to outline the many reasons whythey are irrational. Anyway, here, where angels fear to tread, goes the psychologicaltheoretician!

1. The idea that it is a dire necessity for an adult to be loved or approved by everyonefor everything he does—instead of his concentrating on his own self-respect, onwinning approval for necessary purposes (such as job advancement), and on lovingrather than being loved.

2. The idea that certain acts are wrong, or wicked, or villainous, and that people whoperform such acts should be severely punished—instead of the idea that certainacts are inappropriate or antisocial, and that people who perform such acts areinvariably stupid, ignorant, or emotionally disturbed.

3. The idea that it is terrible, horrible, and catastrophic when things are not the wayone would like them to be—instead of the idea that it is too bad when things arenot the way one would like them to be, and one should certainly try to change orcontrol conditions so that they become more satisfactory, but that if changing orcontrolling uncomfortable situations is impossible, one had better become resignedto their existence and stop telling oneself how awful they are.

4. The idea that much human unhappiness is externally caused and is forced on oneby outside people and events—instead of the idea that virtually all humanunhappiness is caused or sustained by the view one takes of things rather than thethings themselves.

5. The idea that if something is or may be dangerous or fearsome one should beterribly concerned about it—instead of the idea that if something is or may bedangerous or fearsome one should frankly face it and try to render it non-dangerousand, when that is impossible, think of other things and stop telling oneself what aterrible situation one is in may be in.

6. The idea that it is easier to avoid than to face life difficulties and self-responsibilities—instead of the idea that the so-called easy way is invariably the much harder wayin the long run and that the only way to solve difficult problems is to face themsquarely.

7. The idea that one needs something other or stronger or greater than oneself onwhich to rely—instead of the idea that it is usually far better to stand on one’s ownfeet and gain faith in oneself and one’s ability to meet difficult circumstances ofliving.

8. The idea that one should be thoroughly competent, adequate, intelligent, andachieving in all possible respects—instead of the idea that one should do ratherthan always try to do well and that one should accept oneself as a quite imperfectcreature, who has general human limitations and specific fallibilities.

Rational Psychotherapy 11

9. The idea that because something once strongly affected one’s life, it shouldindefinitely affect it—instead of the idea that one should learn from one’s pastexperiences but not be overly-attached to or prejudiced by them.

10. The idea that it is vitally important to our existence what other people do, andthat we should make great efforts to change them in the direction we would likethem to be—instead of the idea that other people’s deficiencies are largely theirproblems and that putting pressure on them to change is usually least likely to helpthem do so.

11. The idea that human happiness can be achieved by inertia and inaction—insteadof the idea that humans tend to be happiest when they are actively and vitallyabsorbed in creative pursuits, or when they are devoting themselves to people orprojects outside themselves.

12. The idea that one has virtually no control over one’s emotions and that one cannothelp feeling certain things—instead of the idea that one has enormous control overone’s emotions if one chooses to work at controlling them and to practice sayingthe right kinds of sentences to oneself.

It is the central theme of this paper that it is the foregoing kinds of illogical ideas,and many corollaries which we have no space to delineate, which are the basic causesof most emotional disturbances or neuroses. For once one believes the kind of non-sense included in these notions, one will inevitably tend to become inhibited, hostile,defensive, guilty, anxious, ineffective, inert, uncontrolled, or unhappy. If, on the otherhand, one could become thoroughly released from all these fundamental kinds ofillogical thinking, it would be exceptionally difficult for one to become too emotionallyupset, or at least to sustain one’s disturbance for very long.

Does this mean that all the other so-called basic causes of neurosis, such as the Oedipuscomplex or severe maternal rejection in childhood, are invalid, and that the Freudianand other psychodynamic thinkers of the last 60 years have been barking up the wrongtree? Not at all. It only means, if the main hypotheses of this paper are correct, thatthese psychodynamic thinkers have been emphasizing secondary causes or results ofemotional disturbances rather than truly prime causes.

Let us take, for example, an individual who acquires, when he is young, a full-blownOedipus complex: that is to say, he lusts after his mother, hates his father, is guiltyabout his sex desires for his mother, and is afraid that his father is going to castratehim. This person, when he is a child, will presumably be disturbed. But, if he is raisedso that he acquires none of the basic illogical ideas we have been discussing, it will bevirtually impossible for him to remain disturbed.

For, as an adult, this individual will not be too concerned if his parents or others donot approve all his actions, since he will be more interested in his own self-respect thanin their approval. He will not believe that his lust for his mother is wicked or villainous,but will accept it as a normal part of being a limited human whose sex desires mayeasily be indiscriminate. He will realize that the actual danger of his father castratinghim is exceptionally slight. He will not feel that because he was once afraid of his Oedipalfeelings he should forever remain so. If he still feels it would be improper for him tohave sex relations with his mother, instead of castigating himself for even thinking ofhaving such relations he will merely resolve not to carry his desires into practice and

12 Albert Ellis

will stick determinedly to his resolve. If, by any chance, he weakens and actually hasincestuous relations, he will again refuse to castigate himself mercilessly for being weakbut will keep showing himself how self-defeating his behavior is and will actively workand practice at changing it.

Under these circumstances, if this individual has a truly logical and rational approachto life in general, and to the problem of Oedipal feelings, in particular, how can hepossibly remain disturbed about his Oedipal attachment?

Take, by way of further illustration, the case of an individual who, as a child, iscontinually criticized by his parents, who consequently feels himself loathesome andinadequate, who refuses to take chances at failing at difficult tasks, who avoids suchtasks, and who therefore comes to hate himself more. Such a person will be, of course,seriously neurotic. But how would it be possible for him to sustain his neurosis if hebegan to think in a truly logical manner about himself and his behavior?

For, if this individual does use a consistent rational approach to his own behavior,he will stop caring particularly what others think of him and will start primarily caringwhat he thinks of himself. Consequently, he will stop avoiding difficult tasks and, insteadof punishing himself for being incompetent when he makes a mistake, will say to himselfsomething like: “Now this is not the right way to do things; let me stop and figure outa better way.” Or: “There’s no doubt that I made a mistake this time; now let me seehow I can benefit from making it.”

This individual, furthermore, will if he is thinking straight, not blame his defeats onexternal events, but will realize, that he himself is causing them by his illogical orimpractical behavior. He will not believe that it is easier to avoid facing difficult things,but will realize that the so-called easy way is always, actually, the harder and moreidiotic one. He will not think that he needs something greater or stronger than himselfto help him, but will independently buckle down to difficult tasks himself. He will notfeel that because he once defeated himself by avoiding doing things the hard way thathe must always do so.

How, with this kind of logical thinking, could an originally disturbed person possiblymaintain and continually revivify his neurosis? He just couldn’t. Similarly, the spoiledbrat, the worry-wart, the ego-maniac, the autistic stay-at-home—all of these disturbedindividuals would have the devil of a time indefinitely prolonging their neuroses if theydid not continue to believe utter nonsense: namely, the kinds of basic irrationalpostulates previously listed.

Neurosis, then, usually seems to originate in and be perpetuated by some funda-mentally unsound, irrational ideas. The individual comes to believe in some unrealistic,impossible, often perfectionistic goals—especially the goals that he should always be approved by everyone, should do everything perfectly well, and should never befrustrated in any of his desires—and then, in spite of considerable contradictoryevidence, refuses to give up his original illogical beliefs.

Some of the neurotic’s philosophies, such as the idea that he should be loved andapproved by everyone, are not entirely inappropriate to his childhood state; but all ofthem are quite inappropriate to average adulthood. Most of his irrational ideas arespecifically taught him by his parents and his culture; and most of them also seem tobe held by the great majority of adults in our society—who theoretically should havebeen but actually never were weaned from them as they chronologically matured.

Rational Psychotherapy 13

It must consequently be admitted that the neurotic individual we are considering isoften statistically normal; or that ours is a generally neuroticizing culture, in whichmost people are more or less emotionally disturbed because they are raised to believe,and then to internalize and to keep reinfecting themselves with, arrant nonsense whichmust inevitably lead them to become ineffective, self-defeating, and unhappy. Nonethe-less: it is not absolutely necessary that human beings believe the irrational notions which,in point of fact, most of them seem to believe today; and the task of psychotherapy isto get them to disbelieve their illogical ideas, to change their self-sabotaging attitudes.

This, precisely, is the task which the rational psychotherapist sets himself. Like other therapists, he frequently resorts to the usual techniques of therapy which thepresent author has outlined elsewhere (Ellis, 1955a, 1955b), including the techniquesof relationship, expressive–emotive, supportive, and insight–interpretive therapy. Buthe views these techniques, as they are commonly employed, as kinds of preliminarystrategies whose main functions are to gain rapport with the client, to let him expresshimself fully, to show him that he is a worthwhile human being who has the ability tochange, and to demonstrate how he originally became disturbed.

The rational therapist, in other words, believes that most of the usual therapeutictechniques wittingly or unwittingly show the client that he is illogical and how heoriginally became so. They often fail to show him, however, how he is presentlymaintaining his illogical thinking, and precisely what he must do to change it by buildinggeneral rational philosophies of living and by applying these to practical problems ofeveryday life. Where most therapists directly or indirectly show the client that he isbehaving illogically, the rational therapist goes beyond this point to make a forthright,unequivocal attack on the client’s general and specific irrational ideas and to try toinduce him to adopt more rational ones in their place.

Rational psychotherapy makes a concerted attack on the disturbed individual’sirrational positions in two main ways: (a) the therapist serves as a frank counter-propagandist who directly contradicts and denies the self-defeating propaganda andsuperstitions which the client has originally learned and which he is now self-propagandistically perpetuating. (b) The therapist encourages, persuades, cajoles, andat times commands the client to partake of some kind of activity which itself will actas a forceful counter-propagandist agency against the nonsense he believes. Both thesemain therapeutic activities are consciously performed with one main goal in mind:namely, that of finally getting the client to internalize a rational philosophy of livingjust as he originally learned and internalized the illogical propaganda and superstitionsof his parents and his culture.

The rational therapist, then, assumes that the client somehow imbibed illogical ideasor irrational modes of thinking and that, without so doing, he could hardly be asdisturbed as he is. It is the therapist’s function not merely to show the client that hehas these ideas or thinking processes but to persuade him to change and substitute forthem more rational ideas and thought processes. If, because the client is exceptionallydisturbed when he first comes to therapy, he must first be approached in a rathercautious, supportive, permissive, and warm manner, and must sometimes be allowedto ventilate his feeling in free association, abreaction, role playing, and other expressivetechniques, that may be all to the good. But the therapist does not delude himself thatthese relationship-building and expressive–emotive techniques in most instances really

14 Albert Ellis

get to the core of the client’s illogical thinking and induce him to think in a morerational manner.

Occasionally, this is true: since the client may come to see, through relationship andemotive–expressive methods, that he is acting illogically, and he may therefore resolveto change and actually do so. More often than not, however, his illogical thinking willbe so ingrained from constant self-repetitions, and will be so inculcated in motorpathways (or habit patterns) by the time he comes for therapy, that simply showinghim, even by direct interpretation, that he is illogical will not greatly help. He will oftensay to the therapist: “All right, now I understand that I have castration fears and thatthey are illogical. But I still feel afraid of my father.”

The therapist, therefore, must keep pounding away, time and again, at the illogicalideas which underlie the client’s fears. He must show the client that he is afraid, really,not of his father, but of being blamed, of being disapproved, of being unloved, of beingimperfect, of being a failure. And such fears are thoroughly irrational because (a) beingdisapproved is not half so terrible as one thinks it is; because (b) no one can bethoroughly blameless or perfect; because (c) people who worry about being blamed ordisapproved essentially are putting themselves at the mercy of the opinion of others,over whom they have no real control; because (d) being blamed or disapproved hasnothing essentially to do with one’s own opinion of oneself; etc.

If the therapist, moreover, merely tackles the individual’s castration fears, and showshow ridiculous they are, what is to prevent this individual’s showing up, a year or twolater, with some other illogical fear—such as the fear that he is sexually impotent? Butif the therapist tackles the client’s basic irrational thinking, which underlies all kinds offear he may have, it is going to be most difficult for this client to turn up with a newneurotic symptom some months or years hence. For once an individual truly surrendersideas of perfectionism, of the horror of failing at something, of the dire need to beapproved by others, of the notion that the world owes him a living, and so on, whatelse is there for him to be fearful of or disturbed about?

To give some idea of precisely how the rational therapist works, a case summary willnow be presented. A client came in one day and said he was depressed but did notknow why. A little questioning showed that he had been putting off the inventory-keeping he was required to do as part of his job as an apprentice glass-staining artist.The therapist immediately began showing him that his depression was related to hisresenting having to keep inventory and that this resentment was illogical for severalreasons:

(a) The client very much wanted to learn the art of glass-staining and could only learnit by having the kind of job he had. His sole logical choice, therefore, was betweengraciously accepting this job, in spite of the inventory-keeping, or giving up tryingto be a glass-stainer. By resenting the clerical work and avoiding it, he was choosingneither of these two logical alternatives, and was only getting himself into difficulty.

(b) By blaming the inventory-keeping, and his boss for making him perform it, theclient was being irrational since, assuming that the boss was wrong about makinghim do this clerical work, the boss would have to be wrong out of some combinationof stupidity, ignorance, or emotional disturbance; and it is silly and pointlessblaming people for being stupid, ignorant, or disturbed. Besides, maybe the boss

Rational Psychotherapy 15

was quite right, from his own standpoint, about making the client keep theinventory.

(c) Whether the boss was right or wrong, resenting him for his stand was hardly goingto make him change it; and the resentment felt by the client was hardly going todo him, the client, any good or make him feel better. The saner attitude for himto take, then, was that it was too bad that inventory-keeping was part of his job,but that’s the way it was, and there was no point in resenting the way things werewhen they could not, for the moment, be changed.

(d) Assuming that the inventory-keeping was irksome, there was no sense in makingit still more annoying by the client’s continually telling himself how awful it was.Nor was there any point in shirking this clerical work, since he eventually wouldhave to do it anyway and he might as well get this unpleasant task out of the wayquickly. Even more important: by shirking a task that he knew that, eventually, hejust had to do, he would lose respect for himself, and his loss of self-respect wouldbe far worse than the slight, rather childish satisfaction he might receive from tryingto sabotage his boss’s desires.

While showing this client how illogical was his thinking and consequent behavior,the therapist specifically made him aware that he must be telling himself sentences likethese: “My boss makes me do inventory-keeping. I do not like to do this . . . There isno reason why I have to do it . . . He is therefore a blackguard for making me do it . . . So I’ll fool him and avoid doing it . . . And then I’ll be happier.” But these sentenceswere so palpably foolish that the client could not really believe them, and began tofinish them off with sentences like: “I’m not really fooling my boss, because he seeswhat I’m doing . . . So I’m not solving my problem this way . . . So I really should stop this nonsense and get the inventory-keeping done . . . But I’ll be damned if I doit for him! . . . However, if I don’t do it, I’ll be fired . . . But I still don’t want to do itfor him! . . . I guess I’ve got to, though . . . Oh, why must I always be persecuted likethis? . . . And why must I keep getting myself into such a mess? . . . I guess I’m just nogood . . . And people are against me . . . Oh, what’s the use?”

Whereupon, employing these illogical kinds of sentences, the client was becomingdepressed, avoiding doing the inventory-keeping, and then becoming more resentfuland depressed. Instead, the therapist pointed out, he could tell himself quite differentsentences, on this order: “Keeping inventory is a bore . . . But it is presently an essentialpart of my job . . . And I also may learn something useful by it . . . Therefore, I hadbetter go about this task as best I may and thereby get what I want out of this job.”

The therapist also emphasized that whenever the client found himself intensely angry,guilt, or depressed, there was little doubt that he was then thinking illogically, and thathe should immediately question himself as to what was the irrational element in histhinking, and set about replacing it with a more logical element or chain of sentences.

The therapist then used the client’s current dilemma—that of avoiding inventory-keeping—as an illustration of his general neurosis, which in his case largely took theform of severe alcoholic tendencies. He was shown that his alcoholic trends, too, werea resultant of his trying to do things the easy way, and of poor thinking preluding hisavoidance of self-responsibilities. He was impressed with the fact that, as long as hekept thinking illogically about relatively small things, such as the inventory-keeping,

16 Albert Ellis

he would also tend to think equally illogically about more important aspects, such asthe alcoholism.

Several previous incidents of illogical thinking leading to emotional upheaval in theclient’s life were then reviewed, and some general principles of irrational thoughtdiscussed. Thus, the general principle of blamelessness was raised and the client wasshown precisely why it is illogical to blame anyone for anything. The general principleof inevitability was brought up and he was shown that when a frustrating or unpleasantevent is inevitable, it is only logical to accept it uncomplainingly instead of dwellingon its unpleasant aspects. The general principle of self-respect was discussed, with thetherapist demonstrating that liking oneself is far more important than resentfully tryingto harm others.

In this matter, by attempting to show or teach the client some of the general rulesof logical living, the therapist tried to go beyond his immediate problem and to helpprovide him with a generalized mode of thinking or problem solving that would enablehim to deal effectively with almost any future similar situation that might arise.

The rational therapist, then is a frank propagandist who believes whole-heartedly ina most rigorous application of the rules of logic, of straight thinking, and of scientificmethod to everyday life, and who ruthlessly uncovers every vestige of irrational thinkingin the client’s experience and energetically urges him into more rational channels. Inso doing, the rational therapist does not ignore or eradicate the client’s emotions; onthe contrary, he considers them most seriously, and helps change them, when they aredisordered and self-defeating, through the same means by which they commonly arisein the first place—that is, by thinking and acting. Through exerting consistent interpre-tive and philosophic pressure on the client to change his thinking or his self-verbalizations and to change his experiences or his actions, the rational therapist givesa specific impetus to the client’s movement toward mental health without which it isnot impossible, but quite unlikely, that he will move very far.

Can therapy be effectively done, then, with all clients mainly through logical analysisand reconstruction? Alas, no. For one thing, many clients are not bright enough tofollow a rigorously rational analysis. For another thing, some individuals are soemotionally aberrated by the time they come for help that they are, at least temporarily,in no position to comprehend and follow logical procedures. Still other clients are tooold and inflexible; too young and impressionable; too philosophically prejudiced againstlogic and reason; too organically or biophysically deficient; or too something else toaccept, at least at the start of therapy, rational analysis.

In consequence, the therapist who only employs logical reconstruction in histherapeutic armamentarium is not likely to get too far with many of those who seekhis help. It is vitally important, therefore, that any therapist who has a basically rationalapproach to the problem of helping his clients overcome their neuroses also be quiteeclectic in his use of supplementary, less direct, and somewhat less rational techniques.

Admitting, then, that rational psychotherapy is not effective with all types of clients,and that it is most helpful when used in conjunction with, or subsequent to, otherwidely employed therapeutic techniques, I would like to conclude with two challenginghypotheses: (a) that psychotherapy which includes a high dosage of rational analysisand reconstruction, as briefly outlined in this paper, will prove to be more effectivewith more types of clients than any of the non-rational or semi-rational therapies now

Rational Psychotherapy 17

being widely employed; and (b) that a considerable amount of—or, at least, proportionof—rational psychotherapy will prove to be virtually the only type of treatment thathelps to undermine the basic neuroses (as distinguished from the superficial neuroticsymptoms) of many clients, and particularly of many with whom other types of therapyhave already been shown to be ineffective.

References

Cobb, S. (1950). Emotions and clinical medicine. New York: Norton.Ellis, A. (1924–1950). Collected papers. London: Hogarth Press.Ellis, A. (1955a). New approaches to psychotherapy techniques. Journal of Clinical Psychology

Monograph Supplement, 11(3), 207–260.Ellis, A. (1955b). Psychotherapy techniques for use with psychotics. American Journal of

Psychotherapy, 9, 452–476.Ellis, A. (1956). An operational reformulation of some of the basic principles of psychoanalysis.

Psychoanalytic Review, 13, 163–180.Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: Norton.Freud, S. (1938). Basic writings. New York: Modern Library.

18 Albert Ellis

2 Rational Emotive Therapy

INTRODUCTION

H. Jon Geis

In 1949, a young Albert Ellis published 10 articles on subjects ranging from the pseudo-science of telepathy (Ellis, 1949a), to love relations among college women (Ellis, 1949b),to assortative mating (Ellis & Beechley, 1949). With his demonstrated range of scientificinterests and ambition, an observer might predict that Ellis was heading toward adistinguished academic career. However, he took a different turn. He extended thissame disciplined work ethic that was so evident in 1949 into a double-time effort todevelop and promote rational emotive therapy. Following the turn toward developingthe rational emotive psychotherapy system, Ellis gives his mid-career views on rationalemotive therapy.

In my view, Albert Ellis made noteworthy progress between the time of his originalpublished articles on rational therapy (Ellis, 1957, 1958) and his 1986 presentation onrational emotive therapy. Albert Ellis comprehensively covered significant theoreticalground in relatively few pages. A more recent statement of his clinical theory followed21 years later (Ellis, Abrams, & Abrams, 2008), but the grounding for this work wasalready evident.

Shortly after Al introduced rational therapy, I was among the first who supportedhis work. To help put his enormous contributions into historical and practical context,the editors of this book asked that I share my recollections of Albert Ellis during thispioneering period and theoretical concepts and techniques that I personally founduseful that work today. I’m happy to do this.

Ellis: The Beginning

In introducing Executive Leadership: A Rational Approach, Ellis started by musing, “Whatthe hell am I doing writing a book for executives?” (Ellis, 1972, p. 7). Although famousfor his use of salty language, Al Ellis rarely swore unless he wanted to introduce a point.

Ellis commonly used down-to-earth terms such as “shithood” (low personal worth)and phrases such as “sitting on the fence with the fence post up your ass” (indecision,unwillingness to act), metaphors, and other persuasive language. Another of my favoritesis his shorthand definition of neurosis: “Stupid behavior by a person who isn’t stupid.”

When he first introduced rational therapy, many professionals who held differentviews attempted to marginalize him, often for silly reasons, such as “He writes so muchabout sex.” More commonly, his critics went after him for his radical departure fromorthodox psychotherapy theory and practice. This knee-jerk reaction reflected a limitedunderstanding of Ellis’ work and overlooked his excellent credentials as a scientist andhis concern for creating an empirical foundation for professional psychotherapeuticpractice.

I first ran across Al Ellis in 1958, when I was a graduate student at Teachers CollegeColumbia University, and my then wife and I had started a humanist club. We invitedhim to speak with our group, and were pleased when he agreed. As I discovered, Alhad a heavy private-practice schedule and spent one-and-a-half days on his weekendswriting. Despite his busy schedule, he was normally generous, making himself availablefor public speaking (which sometimes included spirited technical debates).

It is no mystery that Al published voluminously. He was a bulldog on efficiency andnon-perfectionist about his written work. He made no special effort to create beautifulprose. He had a simple formula. His method often was to list the points he wanted tomake. He then went on to write the next article or book.

Al was sometimes criticized for rewriting the same material. I often heard that “all”of his works are “just” repeats of the same basic ideas. There is a partial truth. Whenhe wrote about rational emotive therapy, he wrote about rational emotive therapy. Thesecritics miss the far greater point of his enormous innovative contributions exhibitedthrough applying rational methods to different issues, and his expansion of thetherapeutic techniques and concepts that he used.

I was early impressed with Al’s thinking and found his approach to be a refreshingdeparture from the stranglehold practitioners of psychoanalytic and neo-analytic theoryhad on the field of psychotherapy. Among other things, it was energizing for those ofus would-be clinicians to run across someone who right off the top, in an earthyvernacular, simply “tells it like it is.”

In contrast to the long-standing passive and non-directive theories and methods ofthe time, Al’s active–directive approach garnered significant attention. When at the1968 American Personnel and Guidance Association symposium in Detroit, Al and Iheld forth on the approach. The large auditorium overflowed with people lookingforward to hearing about his innovative way of working in psychotherapy andcounseling. In support of Al’s tendency to take initiative in therapy, I offered thisobservation: “Should the lifeguard wait for the drowning swimmer to give him a definitesignal?”

After several years observing Al in a variety of public settings, I stopped my therapywith a “Sullivanian” psychotherapist. I remember the Sullivanian sucking on his pipe,hardly speaking, and offering no advice. I then switched and saw Al for six or sevenindividual sessions (a half-hour long), followed by a month or two of once-weeklygroup sessions. After that I consulted him another six or seven times for supervisoryhelp with rehabilitation clients I saw at the time.

Initially, I worked with Al at his West 56th Street New York City apartment. I observed that he had an elaborate personal filing system. Clearly, he was exception-ally well organized. Around 1959, Al invited me to take a major role in helping toestablish rational psychotherapy as a legitimate participant in the psychological helping

20 H. Jon Geis

professions. I agreed immediately to become what he called the “Director of Training”at the newly formed Institute and to undertake a weekly supervisory schedule ofinvolvement.

Al bought the five-story building at 45 East 65th Street, which then became TheInstitute for Rational Living. He took up residence on the top floor. The Institutebuilding had a large meeting hall, which early on became the venue for Friday eveningweekly public workshop demonstrations of rational psychotherapy. I conducted manyof these workshops between 1965 and 1971. I also began once-weekly four-houreducation and supervision for professionals wishing to learn more about the theoryand practice of rational therapy. I continued in this role until January 1971, when Idevoted my full time to my private practice.

In the 13 years I directly worked with Al—and also in the cordial dinner we hadtogether in Las Vegas a couple of years before his death in 2007—I found him easygoing,calm, tolerant, non-defensive, and generally unemotional. I saw this style as his typicaldemeanor. However, he could, and often would be, a showman when presenting beforehis colleagues and before the public.

A Radically Different Approach to Therapy

I found the following concepts and techniques useful in my psychotherapy practice:

Here and Now Focus

Al took a right turn away from psychoanalytic techniques, such as the use of extensivehistory taking, free association, and peeling the proverbial onion by an elaborate focuson early origins of the problem that often led nowhere relevant. Al preferred to workdirectly with the patient’s presenting problem from the first session forward to reduceneurotic thinking and to work on making changes in problem areas. While spendingonly a few minutes here and there on the early origins of the problem, Al “attacked”the client’s problems without attacking the client. In a short time, both Ellis and theclient normally collaborated on how to meet the challenges the client faced. Eachsubsequent session normally focused on what was going on “these days,” and what wasbeing done to change the self-defeating thinking and behaving that brought the clientto therapy in the first place.

Therapy is Hard Work

It was and is critically important for the client to work actively to change for the better.When clients labeled themselves as bad or good, worthy or unworthy, they tended toput themselves into labeled categories as though they were objects. Ellis encouragedclients to think of the self as a process and areas for personal change as projects. Atfirst, a client might construe this as an unusual perspective, but it was one that openeda broader range of opportunities for psychological improvement. In his famoushomework assignments, Ellis encouraged clients to engage in problem-related activitiesoutside of therapy. The assignments might be behavioral, such as risk-taking. Theymight be conceptual, such as questioning or disputing self-defeating irrationalities that

Rational Emotive Therapy 21

clogged thinking. They might be emotive, such as learning to live with tension for adefined period. This self-help work gave clients greater control over their own progress.

The Concept of Enlightened Self-Interest

Boldly and without apology, Ellis asserted that self-interest was a key human motivation.This was not a new idea. Buddha had taken a similar position 2,500 years earlier. Al’sforthright statements of it in the world of psychological practice thrust it to the forefront.To those who “argued in the negative” that it was nothing more than an appeal to“selfishness,” Al added the concept of enlightened to self-interest, meaning, of course,that it was important for individuals to understand that, in many life situations, theyhad to do things that seemed unpleasant on the face of it, but often, in the long run,directly addressing such matters were to the individual’s benefit. Self-directedresponsible actions extended from enlightened self-interest.

The ABCDE Model

Ellis early emphasized clear thinking and the application of the scientific method toidentify and then question irrational belief systems. A core process was to dispute or“challenge” one’s irrational ideas, to get rid of or to reduce self-defeating irrationalitiesthat clogged the client’s mental processes. In Reason and Emotion in Psychotherapy, AlEllis (1962) described 11 thought-clogging irrational beliefs. For example, an irrationalbelief was that one should be thoroughly competent, intelligent, and achieving in allpossible respects. Ellis’ rational antidote was to work to accept a realistic philosophyof stretching to do better, while accepting oneself with human limitations andfallibilities. This rational antidote was the end product of rational self-questioning. The11 irrational ideas (12 irrational ideas on some lists) illustrated some of the basicdistortions in human thinking that caused emotional difficulties. He later boiled the11 beliefs down to three core irrational needs for love and approval, for comfort, andfor achievement and success.

Need vs. Want

This was a core part of Al’s clinical theory. He saw demandingness at the core of mosthuman misery. Need means absolutely, irrevocably necessary, no “ifs, ands or buts.”Want and its variations mean “what would be nice, preferable.” Clients over-concernedwith perfection tended to engage in neurotic striving or might procrastinate. Trueperfection is, of course, rarely if ever actually possible, and if then only for a briefmoment in time. Yet human beings wear themselves out striving for it, often agonizingand resultantly falling into depression or related dysfunctional states. Clients workingon their preferential thinking “project” quickly learned progress took a dedicated effort.

Personal Worth

Perfectionism and fear of failure often coexisted, and this double punch hit theemotional gut hard. Ellis’ clients faced a challenge of separating their performance from

22 H. Jon Geis

their “selves.” Since humans first became able to think about themselves as an objectof their own perceptions, they realized that among the things they valued or devaluedwere themselves. From personal, social, and biological causes, self-downing and self-blaming moved like a virus through humanity. He saw that undermining self-blamingand self-damning led to relief from distress from fictions. He directly addressed thishuman tendency to rate oneself as being of low worth or value.

Low Frustration Tolerance

This was a concept Ellis used frequently in his therapy practice. He ably showed thatfeeling frustrated did not inevitably have to lead to anger and other forms of distress,and further, that one could learn to tolerate “not getting what one wants.” Sometimes,Al would show the patient that his “catastrophizing” about not getting the relativelyminor thing that he felt unable to get was simply not getting his “taffy.” He repeatedlyshowed the benefits of taking up the task that might be avoided because of anticipatedfrustration or fear of some danger. The alternative would understandably lead toprocrastination, or putting things off until another time. Al viewed procrastination asa chronic and needless problem for most human beings, and it was an area he ordinarilytackled in his psychotherapy work, as did his colleague Bill Knaus, who wrote five bookson defeating procrastination.

Anger as Irrational

It has always seemed to me that anger is the organism’s adaptive defense to protect andeven “avenge” itself. Al Ellis found himself focusing on a different form of self-defeatinganger, such as in road rage where perfectionist thinking extended into damning andcondemning the other driver for imperfect driving habits. Al emphasized the importanceof reflecting rationally on this demanding “irrationally.” A final thought: Mild emotionmay be energizing. Too strong emotion is disorganizing (except when “running awayfrom a hungry bear”) and potentially self-defeating.

Acceptance of Reality

Developing emotional tolerance by accepting reality for what it is may be counted amongthe most important ongoing constructs in Al’s work. It is also among the morechallenging to attain. Al’s interest in this area relates to his early understanding of theStoic philosophers Lucretius and Epictetus. Being appropriately “emotional” involvesacceptance, which is taking things for what they are, and not what they should be, andapplying this reasoning to oneself, others, and happenstance. Later in his career, heemphasized unconditional acceptance of self, others, and life as a guiding philosophyfor enlightened living. Few will perfectly attain these levels, but then, human perfectionis currently not possible.

Rational Emotive Therapy 23

References

Ellis, A. (1949a). Re-analysis of an alleged telepathic dream. Psychiatric Quarterly, 23, 116–126.Ellis. A. (1949b). A study of the love emotions of American college girls. International Journal of

Sexology, 3, 15–21.Ellis, A. (1957). Rational psychotherapy and individual psychology. Journal of Individual

Psychology, 13, 38–44.Ellis, A. (1958). Rational therapy. Journal of General Psychology, 59, 35–49.Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart.Ellis, A. (1972). Executive leadership: A rational approach. Secaucus, NJ: Citadel.Ellis. A. (1986). Rational emotive therapy. In I. L. Kutash & A. Wolf (Eds.), Psychotherapist’s

casebook: Theory and techniques in the practice of modern therapies (pp. 277–297). San Francisco,CA: Jossey-Bass.

Ellis, A., Abrams, M., & Abrams, L. (2008). Personality theories: Critical perspectives. New York:Sage.

Ellis, A., & Beechley, R. M. (1949). Assortative mating in the parents of child guidance clinicpatients. American Sociological Review, 14, 678–679.

24 H. Jon Geis

RATIONAL EMOTIVE THERAPY

Albert Ellis

I created rational emotive therapy (RET) in 1955, after being trained as an analyst and using classical psychoanalysis and analytically created therapy for several years andfinding both these methods ineffective. I vainly tried to “reform” psychoanalysis andmake it scientific (Ellis, 1949a, 1949b, 1950, 1956b) but was notably unsuccessful inmy revisionism. Nor was I able to scientifically accept or effectively use the other mostrespected therapies of the early 1950s, such as those of Erich Fromm (1947), KarenHorney (1939), Carl Rogers (1951), Otto Rank (1945), and Harry Stack Sullivan (1953).Only Alfred Adler (1927, 1929) seemed to make really good sense; but his methodologywas not active–directive or deeply philosophical enough for me, and he almost entirelyignored the findings and the techniques of the behavior therapists (Eysenck, 1953;Jones, 1924a, 1924b; Salter, 1949; Skinner, 1953; Watson and Rayner, 1920).

Believing that two main aspects of psychotherapy—the philosophical and thebehavioral—were being sadly neglected, I began experimenting with these methods in1953 and incorporated them into RET. Then, because I believed in a no-shilly-shally,evocative, confronting approach (particularly after I had spent several years beingallergic to the passivity of psychoanalysis!) from the start I made RET highly emotive;and I added to its emotive elements in the 1960s by adapting some of the mainexperimental and encounter techniques to its cognitive behavioral approach (Ellis,1969b). While many present-day schools of psychotherapy are distinctly eclectic in usinga variety of techniques, RET is a pioneering form of psychological treatment which istruly comprehensive (or, to use Arnold Lazarus’s term, multimodal) and which uses,with virtually all clients, several kinds of therapeutic methods.

Even RET theory is variegated and eclectic, since it has several main postulates thatare not easily subsumed under a few major propositions. Thus, its hypotheses includethe following (Ellis, 1962, 1971, 1973b, 1979a, 1979c, 1980, 1984a, 1984b; Ellis andHarper, 1975; Ellis and Whiteley, 1979):

Emotion, thought, and behavior rarely, if ever, are pure or unalloyed: each includesimportant elements of the others, and all three continually interact with and causeaspects of one another.

What we call emotional disturbances (especially neurotic feelings such as severeanxiety, depression, self-deprecation, and rage) are caused or contributed to by acomplex of biological and environmental factors, and most seriously disturbedindividuals have strong innate (biological) tendencies to over- or underreact toenvironmental influences and to exaggerate and/or minimize the significance of manyevents (especially the traumatic events) of their lives.

Humans are easily affected by the people and the things around them (the systemin which they develop and live), but they intentionally also easily affect the people andthings (the system) around them. To be affected, however, does not necessarily meanto be disturbed. Unfavorable conditions such as cruel parents, poverty, and bigotedteaching affect virtually everyone, but they hardly result in serious disturbance of allthose affected. Affectability does not equal disturbability. Each individual’s innatevulnerability to the system’s influences also contributes to his or her disturbances—

and often contributes more than environmental factors do. Because of their innatetendencies to react (and to overreact) to their surrounding system, people significantlydecide or choose to disturb themselves—or to not disturb themselves—about theinfluences of the system in which they live.

Once people disturb themselves about the events or the other people in their lives,they almost always have the ability—if they choose to work at using it—of undisturbingthemselves and of re-creating minimal (though not zero) disturbance in the presentand future. Human irrationality and self-defeatism, however, are to some extentsynonymous with the human condition. Consequently, virtually no humans are (or arelikely to be) consistently and totally rational or undisturbed.

People disturb themselves emotionally, intellectually, and behaviorally. Thus, theyoften think, emote, and act in a manner that defeats their own best interests and thoseof the social group in which they choose to live. There is no one way in which they dothis. But they can best understand and change their disturbed feelings and actions byclearly and specifically recognizing the most important cognitions by which they usuallymake themselves neurotic.

These disturbing cognitions consist largely of irrational Beliefs (iBs) or basic self-defeating philosophies which people, consciously or unconsciously, adopt or create andthen strongly hold and which significantly motivate them to feel and act self-sabotagingly. The ABC theory of RET hypothesizes that people go to the stimuli, orActivating Events (A), in the system in which they reside with goals, purposes, ordesires—especially the goals of continuing to survive and of living in a reasonably happyor unfrustrated manner. When they encounter (or think they encounter) undesirablethings—especially failure and/or disapproval—they tend to tell themselves at point B(their Belief System) both rational Beliefs (rBs) and irrational Beliefs (iBs), and theselead to self-helping or self-defeating Consequences, or Concomitants (Cs).

When unfortunate or undesirable Activating Events (As) occur and when peoplehave rational Beliefs (rBs) about these As, their rBs tend to take the form of preferenceor wish statements—for example, “I don’t like this failure and I wish it had not occurred,but I can stand it and still lead a reasonably happy life.” If they stay with these rBs, orpreference statements, these people will have appropriate feelings or consequences (forexample, disappointment and frustration) that help them to take self-helping actions(for example, working to succeed next time).

When unfortunate or undesirable Activating Events (As) occur, people often alsocreate irrational Beliefs (iBs) about these As, and these iBs tend to take the form ofabsolutistic “musts” and command statements—for example, “This failure must notoccur, and because it did occur as it absolutely should not, I can’t stand it; it’s awful;and I am a rotten person for not preventing it!” If people add these iBs to their rBs,they will have inappropriate feelings, or Consequences (Cs)—for example, severe anxietyand depression that will encourage them to take self-defeating actions (such aswithdrawal or desperate attempts to succeed next time).

When people feel disturbed and act self-defeatingly (at C), they have the ability tolook at their As, rBs, and iBs and to Dispute (D) their iBs until they surrender themand change them back to rBs—thereby changing their inappropriate feelings and self-defeating behaviors (at point C). They can best understand (observe and figure out)their iBs cognitively, through empirical observation and rational analysis. Even when

26 Albert Ellis

iBs are unconscious, they are rarely deeply hidden and can usually be observed,discovered, and logically figured out (if one uses RET theory) quickly and without toomuch trouble.

When people’s iBs are logically and empirically discovered (and sometimes even whenthey are not clearly discovered), they can be counteracted and dissolved in a variety ofcognitive, emotive, and behavioral ways. They can most effectively be eradicated orminimized by using several rather than only one of these thinking, affective, and action-oriented methods.

Briefly stated, this is the RET theory of emotional disturbance and its alleviation. Letme now show how I used RET theory and practice in treating a twenty-seven-year-oldwoman afflicted with severe social and work anxiety. When I first saw this woman,whom I shall call Jane, she was (as all the members of her therapy group agreed)unusually attractive. Hardly a day passed when some man (or some lesbian) did nottry to pick her up at her office, on the subway, on the street, or in the stores where sheshopped. In spite of all this attention, she was extremely shy with men, especially theones she found most desirable, and reported that her mind went absolutely blank whenshe was about to talk to one. She was so self-conscious that she could hardly facestorekeepers and often had her mother do her shopping. When men persisted in tryingto date her—which they often did—she would first avoid them because of her shyness.Then she would desperately latch onto one who was most persistent and just wouldn’ttake no for an answer. When he proved (as he always did) to be an unsuitable mate,she would stay with him much longer than she wanted to, being deathly afraid to returnto the mating “rat race.”

Jane, who had quite a good sense of humor in spite of her conversational ineptness,referred to herself as a “basket case” in her vocational as well as her social life. She hadbeen trained as a high school teacher but could not bear facing a classroom of kids andtherefore had taken a Civil Service job as an administrative assistant—a job she easilygot by scoring high on an examination. She would have liked to get any number ofbetter jobs for which she was qualified, but she was terrified of job interviews andtherefore never applied. She hated herself for sticking at her present low-level position,but this self-hatred only made her more convinced that she was incapable of adequateinterpersonal relations.

Before my seeing her, Jane had had one year of Rogerian therapy with a collegecounselor when she was nineteen. She felt that it had helped her feel a little better buthad not made inroads against her shyness. She had had two years of psychoanalyticallyoriented therapy by the time she was twenty-three but felt that it had only made hervery dependent on her analyst and more than ever afraid to face the world on her own.She was disillusioned with therapy and was prepared to give up all hope of ever changingwhen her twin sister, who had very similar problems and who had had a year of RET,which resulted in considerable improvement, virtually insisted that she come to theInstitute for Rational Emotive Therapy in New York and even volunteered to pay forher first two months of treatment. Still reluctant to go into therapy again but notassertive enough to resist her sister’s entreaties, Jane agreed to give RET a chance.

As is typical in my practice of RET, I used a number of cognitive, emotive, andbehavioral methods with Jane, the most important of which I shall now describe.

Rational Emotive Therapy 27

Cognitive Methods of RET

The main cognitive techniques of RET that I used with Jane were the following.

Teaching the ABCs of RET. Because of her previous therapy, Jane held the commonpsychoanalytic belief that people become disturbed because of the traumatic events oftheir childhood. I used the first few sessions to disabuse her of this notion and to showher that we all strongly tend to bring ourselves—and especially our innate and uniqueproclivities to desire and to demand—to our parents and teachers in early life and theyimpart to us preferences and standards that we adopt and thereafter, as Pogo has aptlystated, we have met the enemy and it is us! Consequently, we take many of ourpreferences and standards from our early caretakers (and from TV!), but we addabsolutistic musts to them and make those preferences into dire “needs” (Ellis, 1962;Ellis and Becker, 1982; Ellis and Harper, 1975). Moreover, I showed Jane that no matterhow and where she originally acquired her irrational shoulds, oughts, and musts, shestill had them today, and she had better acknowledge their power to upset her andwork at understanding and surrendering them.

Although Jane at first resisted taking responsibility for her iBs because she found itmore acceptable to blame her “dominating” mother for “making” her irrational andshy, she soon changed her tune when I showed her that her younger sister, who waseven more dominated by her mother (because she was the “baby” of the family), hadalways refused to give in to this domination and turned out to be unusually outgoingand assertive—as, indeed, the mother herself was. Jane and her twin sister, in contrast,seemed to take after their shy and unassertive father, who was divorced from theirmother when they were five years old and who thereafter had little to do with any ofhis three daughters. When, after our third session, Jane decided that she really hadlargely created her own iBs (for example, “I must never be disapproved by people Ifind significant”) and that these Beliefs (and not her dominating mother) had madeher pathologically shy, she “bought” much of the RET theory and started to look activelyfor her self-defeating philosophies.

Detecting Irrational Beliefs. In rational emotive therapy, D stands for Disputing iBs(Phadke, 1980). But D can be subdivided into three main processes: Detecting iBs,Discriminating them from rBs, and Debating them. I first showed Jane how to detecther iBs—and particularly how to look for her absolutistic shoulds, oughts, and musts.She soon came up with some basic irrational Beliefs: (1) “I must speak well to peopleI find attractive.” (2) “I must be interesting and clever.” (3) “I must speak easily andspontaneously without too much effort.” (4) “When I don’t speak well and impresspeople as I should, I’m a stupid, inadequate person!”

These iBs, Jane was able to see, were the main and most direct contributors to, or“causes” of, her gut feelings of anxiety. But—as is commonly the case, and as RETalways investigates—she also had some iBs about her anxiety. Whenever she experienced(or thought she might experience) anxiety, she almost immediately thought, first, “Imust not be anxious! It’s terrible if I am!” and then “I especially must not show othershow anxious I am. If I do, they will surely reject me—and that would be awful!” TheseiBs about her nervousness led Jane to take her primary symptom (anxiety) and turn it

28 Albert Ellis

into a deadly secondary symptom (anxiety about anxiety); and once she developed thissecondary anxiety, she was so upset by it that her original nervousness escalated. Shethen went on to a tertiary feeling of panic and hopelessness, motivated by her tertiaryiB: “Now that I’m so panicked and can’t get myself out of feeling this way, I’ll neverbe able to overcome my anxiety. I can’t stand this intense panic—and I can’t change!”

Discriminating Irrational from Rational Beliefs. I showed Jane that she had not only iBs(musts) but a number of rBs (preferences) and that the latter were legitimate and self-helping. For example, on the secondary and tertiary level, some of her rBs were “I don’tlike being anxious and showing it to others, but I can accept these feelings and workat getting rid of them” and “If people do reject me for showing them how anxious Iam, that will be most unfortunate, but I can stand it.” With the help of RET, Jane wasable to see that these rational Beliefs (preferences) were quite different from herirrational Beliefs (unrealistic demands) and that she had the option of choosing toconvince herself of the former rather than of the latter.

Debating Irrational Beliefs. I asked, and taught Jane how to ask herself, several logicaland empirical questions to Debate and Dispute (at point D) her secondary and tertiaryiBs. For example: (1) “Even though my panic (and panic about my panic) is so intenseand handicapping, where is the evidence that I can’t stand it and that I can’t overcomeit?” (2) “Granted that my anxiety will turn some people off, will everyone boycott mefor displaying it? And if some people do despise me for showing panic, will that reallybe terrible, and do I truly need their approval?”

As she Disputed these secondary and tertiary iBs that led to her anxiety about heranxiety, Jane also went back, under my guidance, to her primary iBs and actively andpersistently began to Debate them in this vein: (1) “Why must I speak well to peopleI find attractive?” (2) “Where is it written that I have to be interesting and clever?” (3) “Do I really have to speak easily and spontaneously, without too much effort?” (4)“When I don’t speak well and impress people, how does that make me a stupid,inadequate person?” She answered these Disputes as follows:

There is no reason I must speak well to people I find attractive, but it would bedesirable if I do so; so I shall make an effort—but not kill myself—to do so.

It is written only in my head that I have to be interesting and clever, but it wouldbe nice if I were! (3) I can speak uneasily and unspontaneously and still get by withmost people with whom I converse. (4) When I speak poorly and fail to impresspeople, that only makes me a person who spoke unimpressively this time—not atotally stupid or inadequate person.

As she did the Disputing and questioned her own irrational Beliefs, Jane began tofeel much better and to be more willing to speak up with people she favored.

Coping Self-Statements. I used another of RET’s favorite methods with Jane—havingher figure out, write down, and repeat to herself several times a day helpful copingstatements (rational Beliefs) that she would eventually internalize (Ellis, 1962, 1973a;

Rational Emotive Therapy 29

Ellis and Becker, 1982; Lazarus, 1966; Meichenbaum, 1977). Some of those she foundmost helpful were the following: “I can speak up to others, even when I feeluncomfortable doing so.” “I would like to speak well, but I never have to.” “No onedies of social anxiety!” “I’m an intelligent person.” “When people I favor reject me, itoften means more about them and their tastes than about me.” “Even when I actstupidly and impress people badly, I can still learn a lot and enjoy myself with them.”

Referentiating. A RET technique adopted from general semantics is referentiating(Danysh, 1974; Korzybski, 1933). Using this method with Jane, I helped her to writedown and regularly review the advantages of making herself uncomfortable andovercoming her low frustration tolerance when she forced herself to act unsuitably.Normally, she referented to herself only the disadvantages (for example, her feelings ofawkwardness) when she spoke up with desirable people. She now listed several benefitsof doing so, especially these: (1) She would get practice in speaking and thereby becomemore fluent (2) She would learn what it was best to say—and not to say—to others.(3) She would meet a larger sample of people from whom to choose friends or lovers.(4) She would see that many people were as shy and as conversationally backward asshe was. (5) She could accept the challenge of doing badly and of then not puttingherself down. (6) She would find her life more interesting. (7) Her anxiety would bemore intense but less prolonged. As she continued to do this kind of referenting, Janefound that she was able to carry out her homework assignments of encountering otherswith much more ease than she had ever had in doing similar things before.

Teaching RET to Others. I used to warn my clients, when I practiced psychoanalysis,not to analyze their friends and relatives, because they almost always did so badly andthereby harmed themselves and their “clients.” However, I now do the opposite andstrongly encourage many of them to teach RET to their associates and to try to talkthese others out of their irrational Beliefs, for as Bard (1980) has experimentally shown,teaching RET to others frequently helps the teachers learn its Disputing and othermethods themselves. Jane particularly used RET with her mother, her younger sister,and her close women friends, and she reported that actively working with them to seeand surrender some of their irrationalities significantly helped her to observe andeffectively debate several of her own.

Psychoeducational Methods. RET has always promoted the use of books and audiotapesin teaching its principles to clients and members of the public. For example, RETencourages clients to record their own therapy sessions and to listen to them severaltimes to remember better and to zero in more effectively on the points made by boththe therapist and the client during a session. Jane found recordings of her own sessionsextremely valuable teaching tools and regularly listened to each one a few times betweensessions.

Problem Solving. RET sees people as having two kinds of problems: (1) practicalproblems, such as Jane’s not having an interesting job or her winding up with unsuitablemale partners, and (2) emotional problems, or problems about having practical

30 Albert Ellis

problems. With Jane, as we do in RET generally, I started with the emotional problemsand showed her how to minimize or eliminate them. Then I worked with Jane on herpractical problems. For example, I went over her job-seeking problems with her, showedher how she could write a good résumé, and discussed the difficulties of how to getinterviews, how to handle these interviews, and how to turn down some jobs and waitfor the better ones she was actually seeking. We also discussed the practical issues ofhow she could look for a suitable male partner and how she could eliminate the poorprospects and do better with the good ones.

Use of Humor. According to RET theory, the irrational Beliefs (iBs) that people adoptand create with which to upset themselves emotionally usually arise from their givingdue meaning or consideration to their desires and preferences (which is rational) andthen going far beyond this to give exaggerated significance to these wishes. They takethings much too seriously. As one of its main techniques to combat this kind ofexaggerated, or “awfulizing,” thinking, RET employs a good deal of humor. It reducesclients’ ideas to absurdity, shows them how contradictory and ridiculous these viewsare, and gets them to sing (and preferably internalize) some rational, humorous songsthat they can use to overcome their overserious cognitions.

Since Jane had a good sense of humor, I used many humorous sallies with her, andsome of them proved quite effective. She particularly found benefit in singing to herselfsome of my rational, humorous songs when she had fits of anxiety or depression. Twothat she found especially useful were these:

Perfect Rationality(to the tune Funiculi, Funicula by Luigi Denza)

Some think the world must have a right direction And so do I! And so do I!Some think that with the slightest imperfection They can’t get by—and so do I!For I, I have to prove I’m superhuman, And better far than people are!To show I have miraculous acumen—And always rate among the Great!Perfect, perfect rationalityIs, of course, the only thing for me!How can I ever think of beingIf I must live fallibly?Rationality must be a perfect thing for me!

I’m Depressed, Depressed!(to the tune The Band Played On, by Charles B. Ward)

When anything slightly goes wrong with the world, I’m depressed, depressed!When any mild hassle before me is hurled, I feel most distressed!When life isn’t fated to be consecratedI can’t tolerate it at all!When anything slightly goes wrong with the world, I just bawl, bawl, bawl!

(Lyrics by Albert Ellis, Copyright 1977 by the Institute for Rational Emotive Therapy.)

Rational Emotive Therapy 31

Emotive Methods of RET

As I have emphasized for many years (and as many writers on psychotherapy havenonetheless chosen to ignore), RET is almost always a multimodal school of psycho-logical therapy and rarely treats a client without using several emotive and behavioral,as well as cognitive, methods (Bard, 1980; Ellis, 1962, 1969a, 1969b, 1973b; Ellis andBecker, 1982; Ellis and Harper, 1975; Grieger & Boyd, 1980; Walen, DiGiuseppe, &Wessler, 1980; Wessler & Wessler, 1980). Some of the main emotive–evocative methodsthat I used with Jane were the following.

Rational Emotive Imagery. Using rational emotive imagery (Maultsby, 1975; Maultsbyand Ellis, 1974), I showed Jane how to imagine some of the worst things she couldthink of, such as meeting a man she found very attractive, having him speak to her,and then being struck dumb and unable to talk intelligibly. Imagining this, she wouldfeel exceptionally depressed and self-hating. She then would work on making herselfonly feel appropriately disappointed and sorry rather than inappropriately depressedand self-downing. She would practice this kind of rational emotive imagery severaltimes each day for thirty or more days in a row until the image of this kind of socialfailure (or actual in vivo failure) quickly and automatically brought on the appropriatefeelings of disappointment and regret—not anxiety and feelings of inadequacy.

Shame-Attacking Exercises. Jane derived a good deal of benefit from the shame-attackingexercises I created in the 1960s that have since been used by RET and several otherforms of therapy (Ellis, 1969b; Ellis and Abrahms, 1978; Ellis and Becker, 1982; Ellisand Grieger, 1977). She first picked several silly things—such as yelling aloud the stopsin the New York subway and singing at the top of her voice on the street—and forcedherself to do them while working to make herself feel unashamed. When she couldsucceed at this, she then spoke to a number of strange (and attractive) men on buses,in elevators, in the supermarket, and in other public places, tried to get intoconversations with them, and asked whether they would like to call her for lunch or adate. She was terrified to do this at first, but after she had done it about twenty times,she lost almost all her anxiety and shame and was able to meet several suitable men inthis manner and to begin dating one steadily.

Roleplaying. I roleplayed several job-interview and social-encounter situations with Jane.I discussed with her what she was telling herself to make herself anxious and shy inthese situations and what she could tell herself instead, and I brought out some negativefeelings of which she was not fully aware and helped her change them. I also critiquedher skills in these situations and got her to reconsider and revamp them. Even better,when the members of one of my therapy groups, which she attended for six months,did roleplaying routines with her, they were able to get her to bring out moreapprehensive feelings and to give her some excellent suggestions on how to deal withthese feelings and how to improve her social skills. I often find it valuable for shy andinhibited people like Jane to join one of my RET therapy groups for a while, becausethey have more social learning opportunities in the group than they usually have inone-to-one therapy. In group she also learned to talk other members out of theirirrational Beliefs—which helped her to dispute her own irrational Beliefs (Ellis, 1982).

32 Albert Ellis

Group Socializing. In one of my groups, Jane also learned to relate better to several ofthe other members, to call on them for help in between therapy sessions, and to trysocializing activities with some of them that she might not have done by herself.

Forceful Self-Statements. RET theorizes that people disturb themselves not only by ideas,thoughts, attitudes, and philosophies but also by holding onto their “musturbating”beliefs strongly, forcefully, and vehemently. It therefore encourages clients like Jane todeindoctrinate themselves forcefully and vividly with dramatic impact (Dryden, 1984;Ellis, 1979a, 1979b, 1984a, 1984b, 1985a, 1985b). Jane was shown how to devise rationalself-statements and to powerfully repeat them to herself (and to others) many timesuntil she solidly began to feel them and to be convinced of their truth. Thus, she oftenvigorously told herself, “It’s a pain in the ass to get rejected socially or in a job interview,but it’s not awful!” “I want very much to find a suitable mate, but I don’t have to!” “Ifpeople see how anxious I am, they will hardly run away screaming. And if they do,tough shit!” “I can talk to attractive men, no matter how uncomfortable I feel!”

Forceful Self-Dialogue. Another RET emotive technique Jane used was to have a forcefulrational dialogue with herself and record it (Ellis and Becker, 1982). She would startwith an irrational Belief—such as that she must speak easily and spontaneously, withouteffort—and then rationally, but with real vigor, argue against this belief, so that herrational voice finally won out over her irrational one and her feelings changedappropriately. She would listen to these tapes herself or let friends or therapy groupMembers listen to them and check with them to see whether her rational argumentswere good and to see how powerfully she put them across to her irrational self.

Sometimes, doing role reversal, I or a member of her group would play Jane’sirrational self. She would play her rational self and try to argue us vigorously out ofour dysfunctional thinking.

Unconditional Self-Acceptance. I always unconditionally accepted Jane, as this is anintegral part of RET, no matter how badly she behaved inside and outside therapy.Even when she came late to sessions or got behind in paying her bill to the institute, Ifirmly showed her that her behavior was bad but that I never considered her a badperson. Going further, I taught her how to fully accept herself under all conditions andto rate only her acts and traits and never her totality, her being, or her self (Ellis, 1962,1972, 1973b, 1976; Ellis and Becker, 1982; Ellis and Harper, 1975; Hauck, 1973; Miller,1983). Of all the things she learned in RET, unconditional self-acceptance, she thought,was the most useful.

Behavioral Methods of RET

As with virtually all my clients, I used several behavioral methods of RET with Jane—particularly the following.

Activity Homework. From the start of her therapy, Jane was given activity homeworkassignments: to talk to men she found attractive, to go on job interviews, to make somepublic talks, and to tell her lovers she no longer wanted to see them once she was fairly

Rational Emotive Therapy 33

sure they were not for her (Ellis, 1962, 1979c, 1984a, 1984b). She did many of theseassignments even though she felt uncomfortable doing them—and thereby learned theRET maxim “There’s little gain without pain.” Whenever she did them, she soon gotover her discomfort and even started enjoying some of them—such as talking to andflirting with suitable males. By doing these assignments, she also clearly observed howanxious and ashamed she was at first, and she was able to zero in on the irrationalBeliefs behind her anxiety.

Reinforcements and Penalties. Jane was shown how to reinforce herself—usually withreading or going to a concert—after she did her homework and to refrain from thiskind of reinforcement if she did not do it. She found reinforcements especially usefulfor helping her do rational emotive therapy, because she would do it for several daysin a row and then slack off and forget about it if she had no reinforcer.

RET uses penalties as well as reinforcers for clients who do not do their homework(Ellis and Abrahms, 1978; Ellis and Becker, 1982; Ellis and Grieger, 1977; Ellis andWhiteley, 1979). When Jane did not carry out her assignments, she chose to burn atwenty-dollar bill, and that quickly worked to help her do them.

Skill Training. Jane was given, in individual sessions, in group therapy, and in severalworkshops for the public that are regularly held at the New York Institute for RationalEmotive Therapy, instruction in assertion training, in social encountering, in writinga résumé, and in communication skills. Skill training helped her in various areas—suchas communicating better with her mother—that she never directly brought up as seriouspsychological problems. And partly because of it, she said, toward the close of hersessions, “I am very happy that I started RET for my social anxiety and other emotionaldifficulties. But the great bonus of these sessions has been my being able to actualizeand better enjoy myself in several ways that I never even realized therapy could benefitme. But I am delighted to say that it really has!”

Summary and Conclusion

Rational emotive therapy (RET) is a comprehensive system of psychotherapy that showspeople that although they are born with strong biological tendencies to think, emote,and act in self-defeating ways, and although their environment usually influences themto adopt unrealistic and illogical views that may considerably add to their disturbances,they still have considerable freedom both to disturb themselves and to undisturb andactualize themselves. It helps them discover exactly how they consciously andunconsciously accept and invent rational Beliefs (rBs) to help themselves and irrationalBeliefs (iBs) with which to emotionally upset themselves; and it teaches them a numberof cognitive, emotive, and behavioral methods by which, with considerable work andpractice, they can bring about profound philosophical changes that will enable themto lead significantly less disturbed and happier lives.

I saw Jane for nine months, first once a week for individual sessions of RET and thenmainly in group therapy. By the time therapy ended, she was able to talk easily to themen she found attractive; she was preparing to take a teaching job, which she hadalways previously avoided; she had no trouble confronting salespeople when she

34 Albert Ellis

shopped; she was able to change her unsuitable male partners after she had gone withthem for only a few weeks or months; and she was in a public-speaking group,Toastmasters, and did so well there that she was made an assistant.

I no longer see Jane for therapy, but she frequently attends my Friday night workshopson problems of daily living and often participates actively in them, asking questions ofand giving rational suggestions to the volunteers with whom I have public demon-stration sessions of RET. She also stays for the coffee sessions we arrange for theworkshop participants and easily socializes with people at these sessions. She is mostgrateful for her RET experience and refers a number of her friends and associates tome and our other therapists at the Institute for Rational Emotive Therapy.

Jane’s case is not entirely typical of clients suffering from social anxiety, because sheworked harder at RET than many other clients do, and her improvement was thereforefaster and more profound than it sometimes is in similar cases of overwhelming anxiety.But her progress does show that some of the most severely anxious people can helpthemselves considerably in a relatively short time if they accept and persistently usesome of the main RET formulations and techniques.

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3 Psychotherapy and the Value of a Human Being

INTRODUCTION

Leon Pomeroy

Any joint consideration of values and self-acceptance comes about because humanbeings are habitual self-evaluators, born of the selective pressures of biosocial, psycho-social, and cultural evolution. There is no way clinicians can escape dealing with thehabit of clients engaging in self-valuation.

It is human nature to make choices, and we cannot escape valuing and vaulting onething over another. We also make choices over the way we evaluate ourselves, but thiscan be an automatic choice, and understanding how we go about this self-valuation isat the heart of “the value of a human being” addressed by Albert Ellis.

Before I begin, I’d like to share a personal perspective on this paper. I regard thetask of drafting these introductory remarks to Ellis’ paper as a labor of love. It challengesme, as I’m invited to comment on two of the most important concepts in all ofpsychology: namely, the concept of value and the concept of self-esteem. Making mattersmore challenging is the fact that values and self-esteem are interrelated in a fashionthat cries out for a historical approach to them. I hope to show how Ellis’ views of self-esteem stand in opposition to those of most other theoretical clinicians, and why hecorrectly avoids the concept self-esteem, while advancing the concept self-acceptance.

The Questions You Ask Light the Paths You Take

During the course of psychotherapy, sooner or later a person’s self-evaluation surfacesas a basic issue. In Psychotherapy and the value of a human being, Albert Ellis advanceshis view on self-acceptance by focusing on this question: How can a person maintaina consistent self-acceptance and self-respect across conditions where performances andothers’ judgments vary? This question was the foundation question behind the evolutionof Ellis’ concept of unconditional self-acceptance: One can legitimately judge behaviorand act to change while at the same time accept the “self” as too complex to compressinto a “worth” or “worthless” dichotomy.

In this seminal REBT article, Ellis differentiates rational emotive therapy from other positions on the evaluation of the self. He explores a range of therapeutic viewsand shows how his self-acceptance philosophy significantly differs, for example, from

self-esteem theorist Nathaniel Branden’s views. Ellis shows how self-esteem beliefs evokecontingency worth disturbances that drive many into therapy. In Ellis’ view, self-esteemmay be the cause rather than the solution for self-worth forms of human disturbance.It’s a self-rating system, and Ellis rejects any global self-rating.

Self and Valuation

Ellis seeded the profession of psychology with a cornerstone of preventive psychology.Apart from offering a more practical approach to the counseling of clients with problemsin living, Ellis’ theory of self-acceptance, as the “royal road” to unlocking humanpotential, holds important implications for all the social sciences.

How we go about valuing ourselves, for better or worse, is the ultimate psychologicalresource, made all the more important in the rapidly changing world of the twenty-first century, where knowledge doubles every 10 years. At the heart of Ellis’ view,building identity and consciousness inside our skins, and illuminating the world outsideour skins, links self-valuation to world-valuation. Given minimal instinctual templatesfor values, we invent most of them. This frees us to change values that lead todysfunctional results, and adopt values that promote self-efficacy, health, and happinessand allow us to flourish.

Ellis’ Views on Self-Acceptance

In his theory of optimal self-valuation and “the value of a human being,” Ellis viewsself-acceptance as the only realistic and practical way of addressing the nature andconsequences of self-valuation. He approaches the subject from the perspective ofclinical pragmatism, which dictates that it is far more realistic to help clients achieveself-acceptance, along the lines of unconditional positive regard, than self-esteem, alongthe lines of achieving certain behavioral outcomes. What if these outcomes cease to beavailable? If you are a prize-fighter and esteem yourself for that, what happens whenyou lose a match, or when you grow old?

Ellis acknowledges how the concept of “unconditional positive regard” was coinedby Carl Rogers, but that it is weakened with culturally imposed surplus meaning thatconfuses more than clarifies. This happens because we tend to value a person as “good”because he has done something “good,” or “bad” because he has done something “bad.”

Ellis concedes that Carl Rogers “appears to believe one can accept oneself irrespectiveof one’s achievements; merely because he is he, he is alive, and he exists,” which is theultimate expression of non-contingent worth. This philosophy is devoid of any tendencyto define oneself in terms of one’s performances or achievements. In taking thisapproach Ellis parts company with Nathaniel Branden and others who subscribe to thenotion that a good deed makes a good person, and a bad deed makes a bad person.

The Classic Ellis–Branden Debate Revisited and Updated

An examination of the debate between Nathaniel Branden and Albert Ellis, on self-esteemand self-acceptance, provides a path to understanding Albert Ellis’ self-acceptance views and why self-acceptance formed a philosophical cornerstone to his REBT methods.

Psychotherapy and the Value of a Human Being 39

The concept of self-esteem had been long ignored by clinicians until NathanielBranden and Albert Ellis took a strong theoretical interest in the subject in the 1960sand 1970s. The essence of Ellis’ approach, as distinguished from that of other psy -chologists, lies in his interpretation of optimal styles of self-valuation aroundunconditional self-acceptance and the re-direction of valuation away from self and toone’s performances, traits, and achievements only.

Both Branden and Ellis thoughtfully distinguish between self-acceptance and self-esteem. Ellis argues that self-esteem, as used by Branden and others, implies self-valuation based on intelligent, rational, correct, competent behavior as “the consequenceof a mind fully committed to reason . . . as the consequence of un-breached rationality,”which Branden views as the “only valid criterion of . . . authentic self-esteem.” Ellis alsoquotes Branden as asserting that self-acceptance implies unconditional acceptance ofself, no matter what one’s performances or achievements amount to. A more completereading of Branden’s theory reveals that his concept of self-esteem relegates self-acceptance to but one pillar of self-esteem. It turns out this pillar of self-esteem is astatement of non-contingent self-worth, but his other pillars of self-esteem are instancesof contingent self-worth. It is here that Branden appears to contradict himself.

To his credit, Nathaniel Branden writes, in his most recent Six Pillars of Self-Esteem(1994), that he experiences himself as “a teacher of values” and that he writes “as ateacher to myself.” However, he fails to explore the meaning of values and valuationsto the depth that Ellis does. Thus, we face in Branden’s theory of self-esteem both anapparent contradiction and a neglect of any meaningful consideration of values so basicto unpacking of the meaning of self-esteem. If Al Ellis were alive today, he would bequick to set Branden’s self-esteem theory aside as polemic contributing to the very stateof mind that he, Ellis, helped “ego distressed” clients work to vanquish.

Branden has written about self-esteem in a manner that wins for him recognition asone of the pioneers of self-esteem theory. He acknowledges that it was the familytherapist, Virginia Satir, who may have been among the first to call attention to theconcept of self-esteem, but, unlike he and Ellis, she had no theoretical interest in thesubject. Branden acknowledges how Rogers, unlike himself, avoided the concept of self-esteem in favor of the concept of unconditional positive regard. Ellis acknowledges howhe, unlike Branden and more like Rogers, avoided the concept of self-esteem in favorof the concept of self-acceptance.

Both Ellis and Branden believe the concepts of self-esteem and self-acceptance arerelated but not identical. For Ellis, the difference makes a difference. It was during the1970s that a general awareness of these concepts began to take hold in the culture ofclinical psychology. Branden observes that, at the time, there was no “general theoryof self-esteem; nor, even an agreed-on definition of the term.” He rightly concludesthat even today there is no widely shared definition of self-valuation we call “self-esteem.” It should be of no surprise that Ellis breaks away from, and thoroughly rejects,self-esteem in favor of self-acceptance.

All clinicians, including Ellis and Branden, agree that we cannot ignore theconsequences of self-valuation giving rise to self-esteem or “the value of a humanbeing.” Branden’s best thinking on the subject of self-esteem defines it as possessingthe components of self-efficacy and self-respect, conferring upon the individual thepersonal conviction as to one’s own value, the value of oneself, one’s personhood, and

40 Leon Pomeroy

one’s being. For Branden, self-valuation has a way of attaching “emotional rewards”to achievements and performances that contribute to the construction of identity andself-esteem.

Ellis’ view of optimal self-valuation attaches emotional rewards to achievements andperformances, without reference to self, without any attachments to self, which heinsists his clients see as separate from performances and achievements, even as oneassumes personal responsibility for one’s performances and achievements.

When all is said and done, Branden sees self-esteem as contingent on confidence inone’s ability to think and cope with the challenges of life and in one’s right to happiness.He is opposed to the view that self-esteem “is a gift” of any sort and believes it mustbe earned. Ellis knows that unconditional self-acceptance is not gift: It must be earned,as it goes counter to cultural conditioning. Nevertheless, he sees unconditional self-acceptance as the ultimate psychological resource in the modern world.

Both Ellis and Branden agree self-valuation is a basic psychological resource. Theydiffer on the target of valuation, with Branden pointing to the self, and Ellis pointingto the properties of self that aren’t the self.

Ellis rejects Branden’s self-efficacy definition of self-esteem as committing what hecalls the contingent-worth fallacy. Ellis also rejects Branden’s self-worth definition ofself-esteem for the same reason. It is more nuanced, but not without the contradictionpreviously noted.

Ellis makes self-acceptance the core of his theory of optimal self-valuation concerning“the value of a human being.” He rejects Branden’s self-esteem theory as “impractical”and “misguided.” Ellis asserts that, for practical reasons and reasons of human fallibility,a bad act is not a bad person, nor is a good act a good person. He does so in the contextof insisting on the existential discipline of separating one’s core self from peripheralproperties, behaviors, performances, and achievements.

Both Ellis and Branden agree that evolution and culture have shaped deep-seatedhabits of self-valuation based on good deeds. There can be no escaping this historicalcontext. While Branden focuses on the deeds that “grow” self-esteem, Ellis splits selffrom deeds and acknowledges the infinite value of self as compared with the finite valueof deeds. He then argues for the redirection of valuation away from self and in thedirection of deeds, in the manner of a deliberate and conscious dissociation of behaviorfrom the self, which cannot gain or lose value, as distinguished from one’s behavior,which can gain or lose value independent of the self.

Ellisonian existential theory amounts to an identity-correction of the most profoundsort. It kills ego. It unlocks one’s potential to achieve the good things in life for oneselfand others. In Ellis, we have the supreme formulation of a non-contingent theory ofself-worth as our most important psychological resource.

The following are the elements of Ellis’ theory of optimal self-valuation and “thevalue of a human being”:

• the axiological redirection of self-valuation with the assumption of personalresponsibility for one’s behavior;

• the dissociation of self and behavior, with one assuming responsibility for one’sbehavior;

• the total rejection of overt and subtle expressions of contingent-worth thinking;

Psychotherapy and the Value of a Human Being 41

• unconditional self-acceptance based on the infinite value of the person because heis he, he is alive, and he exists as a part of a wider scheme of things.

In summary, Ellis’ axiom of unconditional self-acceptance rests on a premise ofinfinite value supported by axiological science. It is the belief that one has infinite worthbecause he is he, she is alive, and she exists as part of the larger world around her; thathe cannot be valued, cannot gain value, cannot lose value, and that only his behavior,performance, and achievements can be valued and can lose value. This perspectiveeliminates ego in all considerations of being and becoming.

Ellis, Hartman, and Valuation

Today, it remains surprising that the study of values, so essential to clarifying themystery around self-esteem versus self-acceptance, has taken a back seat. UnlikeBranden, Ellis sought to clarify the meaning of values, in the context of self-valuations,by drawing upon the contributions of philosopher Robert Hartman.

In the words of Ellis: “any intelligent clinician could benefit from Robert Hartman’svalue theory.” This theory is the basis of today’s axiological science and its foremostapplication, axiological psychology.

Ellis acknowledges how he successfully used Robert Hartman’s earlier existentialarguments with clients for many years. He acknowledges the “strong pragmatic appeal”of Hartman’s value theory. At the time he wrote this paper, Ellis rightly noted thatHartman’s theory lacked supporting empirical evidence and elegance. As to “elegance,”Ellis failed to note Hartman’s rigorous, operational definition of the meaning of “good”in our lives, and his carefully derived mathematical model of habitual evaluativephenomena. As to empirical support, Ellis would discover 33 years later, in the pagesof my book, the empirical support for Hartman’s theory of value that was lacking atthe time he wrote this paper. In fact, this empirical evidence transforms Hartman’stheory of value into a science of value, which stands as an empirical cornerstone ofEllis’ concept of unconditional self-acceptance as the “royal road” to unlocking humanpotential (Pomeroy, 2005).

Are Ellis’ Self-Acceptance Views Viable Today?

Ellis’ analysis of self-valuation is as fresh and relevant today as it was when he firstaddressed this issue with his clients circa 1955. This 1972 article provided a consolidationof his thinking that was a platform for much of his therapeutic work. His self-acceptancephilosophy is a cornerstone of the REBT system. It is as viable a construct today as in1972, perhaps more so. The REBT approach, in its various forms, continues to be usedto help distressed clients rid themselves of the contingent-worth burden, and thatpractice will continue.

We still struggle with socially developed concepts of worth and the value of a person.The matter of how clients think about themselves, think about others, and think aboutevents will go on for the foreseeable future.

Clinicians generally agree the loss of the sense of the adequate, competent self triggersproblems in living commensurate with the degree of self-disparagement. They write

42 Leon Pomeroy

about this observation. We needn’t concern ourselves with the many and variedconsequences of diminished self-esteem here. They are generally recognized for whatthey are: disturbances in the core of self-evaluation. Thus, developing a realistic, self-acceptant outlook continues as the sine qua non of psychotherapy outcomes.

Values are inevitable, even in the world of facts. Values may be the building blocksof beliefs involved in the construction of identity, the management of self-acceptance,and what passes for self-esteem in common parlance. Clients will continue to confrontcore, cognitive valuation processes on the path to develop functional values systemsfor self-guidance.

There is no way we can expect to overcome the universal habit of self-valuation, noris this desirable. It’s how we go about this valuation that influences how we shape ourlives. However, we may shape or redirect our self-views to optimize pro-self, pro-social,as distinguished from anti-self, anti-social behavior. In pursuit of this optimization,Ellis presents a non-contingent-worth theory of self-valuation to advance this purpose.

Self-acceptance is neither an entitlement nor a gift. For Ellis, self-acceptance mustbe earned. The concept of working to attain such a psychological benefit, asset, orresource cannot be denied.

Practicing clinicians, and scientist–clinicians, cannot successfully practice theirprofession without good theory. The consideration of the relative merits of self-esteemversus self-acceptance approaches begs the theoretical question of the meaning of valuesand the “value of a human being.” The study of values and the “value of a humanbeing” have been neglected in the history of psychology and the history of self-esteem,because of the complexities associated with the empirical, especially in the area of self-esteem. This has changed with our emerging axiological science and axiologicalpsychology. It’s always easier to survey college sophomores on their sexual preferencesthan to do the hard work in this area.

Ellis’ thoughts concerning the possibility of a value science clarifying the value of ahuman being are catching up with us and hold the promise of nurturing highly self-acceptant people, who accept responsibility for their choices and actions, and achievehigher levels of positive mental health than self-loathing individuals who externalizeblame. Researchers can now operationally define these and other value-based hypotheses,test them, and help advance a true science of values so as to avoid Maslow’s historicconcern that the concept of values might be obsolete, while embracing the view thatcontingent-worth views of self-esteem are obsolete.

References

Branden, N. (1994). Six pillars of self-esteem. New York: Bantam Books.Hartman, R. S. (1967). The structure of value. Carbondale, IL: Southern Illinois University Press.Hartman, R. S. (1994). Freedom to live: The Robert Hartman story. Edited by Arthur R. Ellis.

Amsterdam and New York: Rodopi Press.Pomeroy, L. (1991). Psychology and value theory. In R. B. Edwards and J. W. Davis (Eds.), Forms

of value and valuation. New York: University Press of America.Pomeroy, L. (2005). The new science of axiological psychology. Amsterdam and New York: Rodopi

Press.

Psychotherapy and the Value of a Human Being 43

PSYCHOTHERAPY AND THE VALUE OF AHUMAN BEING

Albert Ellis

Almost all modern authorities in psychotherapy believe that the individual’s estimationof his own value, or worth, is exceptionally important and that if he seriously denigrateshimself or has a poor self-image, he will impair his normal functioning and makehimself miserable in many significant ways. Consequently, one of the main functionsof psychotherapy, it is usually held, is to enhance the individual’s self-respect (or “ego-strength,” “self-confidence,” “self-esteem,” “feelings of personal worth,” or “sense ofidentity”) so that he may thereby solve the problem of self-evaluation (See references:Adler, 1927, 1931; Ellis, 1962; Ellis and Harper, 1967; Ellis, Wolfe, & Moseley, 1966;Kelly, 1955; Lecky, 1945; Rogers, 1951).

When an individual does not value himself very highly, innumerable problems result.He frequently will focus so intensely on what a rotten person he is that he will distracthimself from problem-solving and will become increasingly inefficient. He may falselyconclude that a rotter such as he can do virtually nothing right, and he may stop tryingto succeed at the things he wants to accomplish. He may look at his proven advantageswith a jaundiced eye and tend to conclude that he is a “phony” and that people justhaven’t as yet seen through him. Or he may become so intent on “proving” his valuethat he will be inclined to grovel for others’ favors and approval and will conforminglygive up his own desires for what he thinks (rightly or wrongly) they want him to do(Ellis, 1967; Hoffer, 1955: Lecky, 1945; Nietzsche, 1965). He may tend to annihilatehimself, either literally or figuratively, as he desperately tries to achieve or to please(Becker, 1964; Hess, 1966; Watzlawick et al., 1967). He may favor noncommitmentand avoidance, and become essentially “nonalive” (May, 1967). He may sabotage manyor most of his potentialities for creative living (Gardner, 1964). He may become obsessedwith comparing himself to others and their achievements and tend to be status-seekingrather than joy-exploring (Farson, 1966; Harris, 1963). He may frequently be anxious,panicked, terrified (Branden, 1964; Coopersmith, 1968; Ellis, 1962; Rosenberg, 1962).He may tend to be a short-range hedonist and to lack self-discipline (Hoffer, 1955).Often he may become defensive and thus act in a “superior,” grandiose way (Adler,1964; Anderson, 1962, 1964; Low, 1967). He may compensatingly assume an unusuallyrough or “masculine” manner (Adler, 1931; Maslow, 1966). He may become quite hostiletoward others (Anderson, 1964; Low, 1967). He may become exceptionally depressed(Anderson, 1964). He may withdraw from reality and retreat into fantasy (Coopersmith,1968; Rosenberg, 1962). He may become exceptionally guilty (Ellis, 1967; Geis, 1965).He may present a great false front to the world (Rosenberg, 1962). He may sabotage anumber of special talents which he possesses (Coopersmith, 1968). He may easilybecome conscious of his lack of self-approval, may berate himself for having little orno confidence in himself, and may thereby reduce his self-image even more than hehas done previously (Ellis, 1962; Ellis and Harper, 1967). He may become afflicted withnumerous psychosomatic reactions, which then encourage him to defame himself stillmore (Coopersmith, 1968; Rosenberg, 1962).

This list is hardly exhaustive since almost the entire psychotherapeutic literature ofthe last fifty years is more or less concerned with the harm an individual may do himselfand how badly he may maim or destroy his relations with others when he condemnshimself, makes himself feel guilty or ashamed about his acts or inactions, and otherwiselowers his self-image. This same literature illustrates the corollary proposition almostendlessly; namely, that when a human being somehow manages to accept, respect, andapprove of himself, in most instances his behavior changes remarkably for the better:his efficiency considerably improves, his anxiety, guilt, depression, and rage lessen, andhe becomes much less emotionally disturbed.

An obvious question therefore presents itself: If the individual’s perception of hisown value, or worth, so importantly affects his thoughts, emotions, and actions, howis it possible to help him consistently to appraise himself so that, no matter what kindof performances he achieves and no matter how popular or unpopular he is in hisrelations with others, he almost invariably accepts or respects himself? Oddly enough,modern psychotherapy has not often posed this question—at least not in the form juststated. Instead, it has fairly consistently asked another, and actually almost antithetical,question: Since the individual’s self-acceptance seems to depend on (1) his succeedingor achieving reasonably well in his society and on (2) his having good relations withothers, how can he be helped to accomplish these two goals and thereby to achieve self-esteem?

Self-acceptance and self-esteem may seem, at first blush, to be very similar; butactually, when they are clearly defined, they are quite different. Self-esteem—as it isfairly consistently used by Branden (1964), Rand (1961, 1964), and other devotees ofAyn Rand’s objectivist philosophy—means that the individual values himself becausehe has behaved intelligently, correctly, or competently. When taken to its logicalextremes, it “is the consequence, expression and reward of a mind fully committed toreason” (Branden, 1965; italics mine); and “an unbreached rationality—that is, anunbreached determination to use one’s mind to the fullest extent of one’s ability, anda refusal ever to evade one’s knowledge or act against it—is the only valid criterion ofvirtue and the only possible basis of authentic self-esteem” (Branden, 1967; italics mine).

Self-acceptance, on the other hand, means that the individual fully and uncondition-ally accepts himself whether or not he behaves intelligently, correctly, or competentlyand whether or not other people approve, respect, or love him (Bone, 1968; Ellis, 1962;Ellis et al., 1966; Rogers, 1961). Whereas, therefore, only well-behaving (not to mentionperfectly behaving) individuals can merit and feel self-esteem, virtually all humans arecapable of feeling self-acceptance. And since the number of consistently well-behavingindividuals in this world appears usually to be exceptionally small and the number ofexceptionally fallible and often ill-behaving persons appears to be legion, the consistentachievement of self-esteem by most of us would seem to be remote while the steadyfeeling of self-acceptance would seem to be quite attainable.

Those psychotherapists, therefore, who think and practice in terms of their clients’achieving a high measure of self-esteem or of highly conditional, positive self-regardare clearly misguided. What they had better more realistically aim for would be to helpthese clients attain self-acceptance or unconditional positive regard. But even the veryterm unconditional positive regard, which was originally coined by Carl Rogers (1951,1961), tends to have misleading overtones, since, in our culture, we usually regard

Psychotherapy and the Value of a Human Being 45

someone positively because of a good thing that he has done, for some beauty orstrength of character he possesses, or for some talent or particular achievement. Rogers,however, really seems to mean that the individual can be accepted, and can accepthimself, without reference to regard or achievement; or that, as I have noted elsewhere,he can accept himself just because he is he, because he is alive, because he exists (Ellis,1962, 1968, 1971; Ellis et al., 1966; Ellis and Gullo, 1971).

It is mainly philosophers, and existentialist philosophers in particular, who havehonestly and determinedly tackled the problem of human value and who have tried todetermine what the individual can do to see himself as a worthwhile being even whenhe is not behaving in a notably competent, successful, or supposedly deserving way.Among these philosophers, Robert S. Hartman has led all the rest. No one has givenmore time and thought to the general problem of value than he; and no one, to myknowledge, has come up with a better explication of intrinsic value, or a human being’sworth to himself, than has Hartman.

According to Hartman’s theory “value is the degree in which a thing fulfills itsconcept. There are three kinds of concept—abstract, construct, and singular. Corre-spondingly, there are three kinds of value: (1) systemic value, as the fulfillment of theconstruct, (2) extrinsic value, as the fulfillment of the abstract, and (3) intrinsic value,as the fulfillment of the singular concept. The difference between these three conceptsis that a construct is finite, the abstract is denumerably infinite, and the singular is non-denumerably infinite” (Hartman, 1959, p. 18).

By sticking to these highly original and well-delineated concepts of value, Hartmanis able to concentrate upon the exceptionally important idea of intrinsic value and, byits use, to prove, as well as I have ever seen anyone prove, that the human individualis fully and unconditionally acceptable in his own right, as a unique and singular person;that he always has value to himself, as long as he is alive; and that his intrinsic worth,or self-image, need not depend in any way on his extrinsic value, or worth to others.Hartman gives several reasons why an individual may invariably accept himself, orconsider himself good or valuable in spite of his talents and achievements or lackthereof. These reasons include:

1. A thing is good if it fulfills the definition of its concept. A “good man,” therefore,is a person who fulfills the definition of a man—that is, one who is alive, who hasarms, legs, eyes, a mouth, a voice, etc. In this sense a Martian might well not be agood man; but virtually every alive Earthian would be (Hartman, 1967a, p. 103).

2. “It is infinitely more valuable, in the strictly defined sense of infinity, to be a morallygood person than to be a good member of society, say a good conductor, baker,or professor. To be sincere, honest, or authentic in whatever one does is infinitelymore important that what one does” (Hartman, 1967a, p. 115). As long, therefore,as a man is sincere, honest, and authentic—as long as he is truly himself—he hasgreat intrinsic value, no matter what his fellowmen may think of him.

3. Man can think about an infinite number of items in the universe and he may thinkthat he is thinking about each of these items. He can also think that his thoughtsabout his thinking are being thought, and so on ad infinitum. Hence he is essentiallyinfinite—“a spiritual Gestalt whose cardinality is that of the continuum. Thiscardinality, however, is that of the entire space–time universe itself. The result of

46 Albert Ellis

this axiological proof of the value of man is that every individual person is as infiniteas the whole space–time universe” (Hartman, 1967a, pp. 117–118). In anyaxiological system, therefore, man’s intrinsic value is above all other values, andhe must be conceived of as being valuable or good.

4. “Being is extensionally the totality of all beings. Intensionally, it is the totality ofall consistently thinkable properties: it is that than which nothing richer inproperties can be thought. But if Being is this totality, then by the definition ofgood given by the Axiom, Being is good. For if Being is the totality of all consistentlythinkable properties, its goodness is the secondary property defined by thistotality—good is a property of the set of properties that define Being” (Hartman,1967a, p. 119).

5. If man does not accept the intrinsic value of a human being as more importantthan his extrinsic value to others, if he does not learn that “intrinsic value hasnothing to do with what a person does, but only with what he is,” he will not seethe injustices that he does to himself and others, will lose out on life and love, andwill create a world of death and desolation. Pragmatically, therefore, for his ownself-preservation and happiness, he had best fully accept the premise that he isgood because he exists (Hartman, 1960, p. 22).

6. “I have moral value in the degree that I fulfill my own definition of myself. Thisdefinition is: ‘I am I.’ Thus, in the degree that I am I, I am a morally good person.Moral goodness is the depth of man’s own being himself. That is the greatestgoodness in the world” (Hartman, 1962, p. 20).

7. “Who gives me my definition of myself? Of course, nobody can give me thedefinition of myself but myself. So, I defined man as the being that has its owndefinition of itself within itself. . . . Now, then, I know I am human if I have myown definition of myself within myself. What then is the property I have to fulfillto be a good myself? Precisely this: to be conscious of myself, to define myself—for to define myself, to be conscious of myself—that is the definition of myself.The more, therefore, I am conscious of myself, the more, and the more clearly, I definemyself—the more I am a good person.” All one has to do, then, to be good, is tobe conscious of himself (Hartman, 1962, p. 11).

8. “This is the important thing, you cannot fully be systemic or extrinsic unless youare fully intrinsic, fully yourself. In other words, the moral man will also be a betteraccountant, pilot, or surgeon. The value, dimensions are within each other. Thesystematic, the social, and the human envelop each other. The human contains thesocial, and the social the systematic. The lower value is within the higher. Thesystemic is within the extrinsic, and the extrinsic within the intrinsic. The morefully you are yourself, the better you will be at your job and in your social role,and in your thinking. Out of your intrinsic being you summon the resources tobe anything you want to be. Thus, the intrinsic, the development of your innerself, is not a luxury. It is a necessity for your own being yourself in all threedimensions” (Hartman, 1962, p. 31).

9. “Man as personality, as intrinsic value, is in a dimension which makes him not morevaluable—for the intrinsic value is not comparable—but incomparably valuable incomparison to the whole extrinsic world, the physical universe. This world is nothingcompared to the intrinsic value of one person” (Hartman, 1962, p. 95).

Psychotherapy and the Value of a Human Being 47

10. Extrinsic value of an individual depends on his fulfilling an abstract concept ofwhat a human being should be, while intrinsic value depends on his fulfilling asingular concept. His intrinsic or personal value, therefore, cannot be measured inextrinsic terms; and he is, consequently, good within his own right, as a singularperson (Hartman, 1959).

11. “A person’s arrival in the world is a cosmic event because of the unlimitedpossibilities of the human person” (Hartman, 1967b, p. 2). Consequently, if theworld has any value, the person and his existence should have as much or morevalue.

12. “Once one starts with the axiom of value, namely that value is richness of properties,then, since man is an infinity of properties, it is impossible to say that he may bebad. All thus depends on the definition of ‘good,’ and this is a definition in valuetheory which has to be accepted or else a new value theory has to be designed”(Hartman, 1967b, p. 3).

Although these arguments of Hartman may not be definitive or unchallengeable,they certainly provide much useful material which any bright and philosophicallyoriented psychotherapist may use to combat his clients’ overwhelming fears that theirtraits and abilities are far from ideal, that many people whom they encounter more orless disapprove of them, and that therefore their intrinsic value, or self-worth (whichthey importantly correlate with their extrinsic value, or worth to others), is abysmallylow. I have used Hartman’s kind of existential arguments with self-deprecating clientsfor a good many years now, and I have usually found that they work rather well. Forif a disturbed individual insists that he is worthless and hopeless, it does not take mevery long to show him that this “fact” is really an hypothesis and that although he maythink he can substantiate it with some kind of evidence, he actually cannot. Since,moreover, his stubbornly maintaining this hypothesis inevitably leads him to dismalresults, he had damned well better give it up—and he usually, at least to some degree, does.

As Hartman himself notes, however, especially when he admits that a man’s acceptinghimself as a good person “all . . . depends on the definition of ‘good’,” the basicargument in favor of the theory that man has intrinsic value and that he cannot possiblybe worthless is essentially tautological and definitional. There is really no empiricalevidence to hack (or confute) it, and it looks very much as though there never will beany. True, it has a strong pragmatic appeal; for if the opposite point is made, and it isheld that man in general or a man in particular is bad or unworthy of his own or others’respect, dire consequences will ensue. Therefore, he had bloody well better accept his“goodness” rather than his “badness,” if he is to survive long and happily.

I am hardly opposed to this pragmatic argument, as I doubt any effective psycho-therapist would be. The trouble, however, is with the inelegance of the philosophicpremise that goes with it. Granted that man’s thinking of himself as bad or worthlessis usually pernicious and that his thinking of himself as good or worthwhile is morebeneficial, I see no reason why these two hypotheses exhaust the possibilities of usefulchoices. I believe, instead, that there is a third choice that is much more philosophicallyelegant, less definitional, and more likely to conform to empirical reality. And that isthe seldom-posited assumption that value is a meaningless term when applied to man’s

48 Albert Ellis

being, that it is invalid to call him either “good” or “bad,” and that if educators andpsychotherapists can teach people to give up all “ego” concepts and to have no “self-images” whatever, they may considerably help the human dilemma and enable menand women to be much less emotionally disturbed than they now tend to be.

Must man actually be a self-evaluator? Yes and no. On the yes side he clearly seemsto be the kind of animal who is not merely reared but is also born with strong self-evaluating tendencies. For nowhere in the world, to my knowledge, does civilized mansimply accept that he is alive, go about the business of discovering how he can enjoyhimself more and discomfort himself less, and live his century or so of existence in areasonably unselfconscious, nondamning, and nondeifying manner. Instead heinvariably seems to identify and rate his self as well as his performances, to be highlyego-involved about accomplishing this and avoiding that deed, and to believe and feelstrongly that he will end up in some kind of heaven or hell if he does the “right” andeschews the “wrong” thing.

Take, for example, the extremely permissive, hedonistic-oriented people of Polynesiaand, especially, of Tahiti. The Polynesians, as Danielsson (1956, 1961) reports, are stillpleasure-seeking and careless, are outspoken in sex matters, are premaritally free, haveerotic dances, delight in sexual games, practice free love without legal weddings, andare fairly free extramaritally; and in the not-too-distant past they also practiced polygynyand wife-lending, danced in the nude, engaged in sexual intercourse in public, hadpleasure houses for young people, permitted periodic sexual liberty, and encourageddeflowering ceremonies.

At the same time, however, the Polynesians have many taboos, the violation of whichmakes them feel utterly ashamed and self-hating. To this day, for instance, they seriouslyadhere to circumcision rites when the male reaches puberty; they have separate eatingand sleeping houses; and they cling to rigid division of work between the sexes. In thepast, moreover, they have practiced sexual privileges based on birth and rank, obligatorymarriage of widows, ritual continence, the forbidding of women to concern themselveswith religious matters, and the isolation of females during periods of menstruation.Religiously and politically they have been very strict: “The Polynesian chiefs and nobleswould certainly never have been able to maintain their provocative privileges in thelong run if they had not had an effective support in religion. According to the Polynesianreligious doctrine they were descended from gods and were thus holy and unassailable.. . . The Polynesian gods required sacrifices, on many islands even human sacrifices.Nothing, therefore, was easier and more natural for a devout chief than to get rid ofall troublesome persons by sacrificing them. . . . In Tahiti the most powerful rulers werealways carried by a servant when they wanted to go anywhere, for if they touched theearth the owner would not be able to tread on it in future. . . . Certain Hawaiianpotentates were so holy that subjects had to stop working at once, throw themselvesflat on the ground and remain in that position so long as the rulers were in sight; soin order not to paralyze the food supply the rulers inspected the fields by night. MostPolynesian chiefs could not eat with their families, and on certain islands they wereactually so full of mana that they could not eat at all, but had to be fed” (Danielsson,1956, pp. 52–53).

General discipline in Polynesia, moreover, has been and still, to a considerable degree,is based on exceptionally ego-raising and ego-debasing rules: “Polynesian ethics were

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certainly far from being as charitable as the Christian, and what was permitted a chiefwas often forbidden to his subjects, but on the other hand the existing rules wereinfinitely better observed than they are with us. The cause of this strict discipline was,of course, that public opinion in the small Polynesian communities or tribes had astrength and importance which even a newly arrived schoolmistress or a curate in aremote country district can hardly imagine. Public disapproval was in Polynesia simplyintolerable, and there was as a rule no possibility of moving to another district or islandon account of the enmity between the different tribes. Good behavior was therefore aprimary necessity. . . . Although contrary views have sometimes been expressed, thePolynesians were not moral anarchists, but rather slaves of custom” (Danielsson, 1956,p. 55).

I have quoted at length here to show that even among one of the most sexuallypermissive and easy-going groups of which we have knowledge, rules and rites of“proper” conduct are the norm rather than the exception, and humans become so ego-involved in following these rules and so ashamed to break them that they literally hurtor kill themselves and easily permit themselves to be severely punished or sacrificedwhen they flout these publicly approved regulations. If there ever was a culture in whichpractically all the members did not similarly denigrate themselves and bring severeemotional or physical penalties on their own heads for engaging in “wrong” or “bad”behavior, I have never heard of it and would be delighted to learn about it.

The reason, I believe, for this practically universal tendency of man to put himselfdown, as well as to rate some of his ineffective performances negatively, is his biologicalpredisposition to be what we call self-conscious. Certainly many of the lower animals(especially the mammals and primates) seem to be somewhat aware of “themselves,”in that they “know” or “learn” that one kind of behavior (e.g., going where food islikely to be) is more “rewarding” or “reinforcing” than another kind of behavior (e. g.,randomly exploring their environment). But these lower animals act much moreinstinctively than does man, meaning that they “think” about their actions much lessthan he does; they rarely, if ever, appear to think about their thinking; and it is probablyimpossible for them to think about thinking about their thinking. In the usual senseof the word, therefore, they have no “selves,” and are not particularly aware that “they”are responsible for their own “good” or “bad” acts and that, consequently, “they” are“good” or “bad” individuals. In other words, they are only to a limited degree, if at all,what we call ego-involved in their performances.

Man, on the contrary, not only has a strong “self-awareness” or “ego,” but he alsohas an exceptionally strong, and I again think innate, tendency to tie it up with hisdeeds. Since he is a thin-skinned and highly vulnerable animal (as compared, say, tothe rhinoceros, which can be quite careless about its behavior and is not likely to sufferill effects) and since he relies so heavily on cognition rather than instinct for his survival,it is greatly to his advantage that he observe and appraise his actions to see whetherthey are satisfaction- or pain-producing and to keep modifying them in one directionor another. Unfortunately, however, just as he protectively rates his performances inrelation to his own survival and happiness, he also dysfunctionally tends to rate his self;and he thereby almost inevitably does himself in.

Let me graphically illustrate this human tendency with a typical case of rationalemotive psychotherapy, which is a system of therapy based on the hypothesis that people

50 Albert Ellis

become emotionally disturbed by foolishly rating or giving report cards to their selvesas well as to their deeds. Mr. Richard Roe comes to see me because he is terriblydepressed about his work and because he frequently becomes enraged at his wife andacts cruelly to her when she has her minor lapses of decorum. I first show him, perhapsin a session or two of psychotherapy, how and why he is making himself depressed. At point A, an action exists—he is not doing well at his work and his boss is consist-ently bringing his poor performance to his attention. At point C—the emotionalconsequence—he is becoming depressed. Quite wrongly he concludes that the action atpoint A is causing his disturbed emotional reaction, or consequence, at point C:“Because I am working inefficiently and because my boss is displeased and may fireme, I am depressed.” But if A really caused C, I quickly show him, magic or voodoowould exist: for how can an external event (his inefficiency or his boss’s disapproval)cause him to think or to feel anything?

Obviously, Roe is doing something about these outside actions to make himself sufferthe consequence of depression. Probably he is first observing these actions (noticingthat his performance is inefficient and that his boss is disapproving) and then reflectingon them (thinking about their possible effects and appraising how he would dislikethese effects). Moreover, he is appraising these possible results in a highly negative way.For if he were not noticing his poor work or if he were appraising it as a good thing(because it would enable him to get fired from a job he really did not want), he wouldhardly feel depressed. In fact, he might feel elated!

It is almost certain, therefore, that Roe is signaling, imagining, or telling himselfsomething at point B (his belief system) to produce his depressed reactions at point C.Most probably, he is first telling himself a rational belief (point rB): “I see that I amworking inefficiently and that my boss may fire me; and if he did, that would beunfortunate. I certainly wouldn’t like being fired.” This rB belief is rational because, inall probability, it would be unfortunate if he were fired. He would then (1) be withoutincome, (2) have to look for another job, (3) possibly have to put up with a displeasedwife, and (4) perhaps have to take a worse or lower-paying position; etc. There areseveral good, empirically ascertainable reasons why it would not be pleasant if he werefired. Therefore, his rB hypothesis that it would be unfortunate for him to keep workinginefficiently is a sane, verifiable proposition.

If, moreover, Roe held rigorously to his rB conclusion, he would most probably neverfeel depressed. Instead, he would feel the rational consequences (rC) of displeasure,disappointment, sorrow, regret, annoyance, or feeling of frustration. These are allnegative emotions but are far from the feeling of depression. In order to make himselffeel the irrational consequence (iC) of depression, he would almost certainly have to addto his rational belief an inappropriate, self-defeating, self-denigrating irrational belief(iB): “If I keep working inefficiently and am fired, that would be awful. I couldn’t standhis disapproving of me and firing me. Not only would that action show that my workis poor, but it would also conclusively prove that I am pretty worthless; that I can neverdo well on a job like this; and that I deserve to be poor, unloved, and otherwise punishedfor the rest of my life for being such a slob!”

Roe’s irrational belief is inappropriate for several reasons: (1) it is definitional andunverifiable. However unfortunate his working inefficiently and his being fired may be,it is only “awful,” “terrible,” or “catastrophic” because he thinks it is. Actually it is still

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only unfortunate or inconvenient. (2) It is an over generalization. Because he doesn’tlike being fired hardly means that he can’t stand it. Because his work is inefficient doesnot prove that he, a human being, is no good. Because he now works poorly is notevidence that he will always do so. (3) It is a non sequitur. If he really were a worthlessindividual who could never succeed at any job, why should he deserve to be unlovedand punished? Being thus handicapped, he might well be said to deserve an unusualdegree of love and help from the rest of us less-handicapped humans. What just personor deity would ever condemn him for having been born and reared to be deficient? (4)It almost invariably leads to dreadful and even more unfortunate results than thosewhich Roe may naturally derive from his inefficient work behavior. For if he thinks it awful to be disapproved of and cannot stand being dismissed, he will probably make himself so anxious that his job efficiency will deteriorate rather than improve,and he will stand even less chance of keeping his job. Moreover, if his boss lets him go and he concludes that, therefore, he is worthless, he will tend, on future jobs, to act as if he were unable to perform, and he will bring about his self-fulfilling prophecy—he will not do well and will be dismissed again (thereby falsely “proving” his originalhypothesis).

As a rational emotive psychotherapist, therefore, I will clearly show Roe what hisrational beliefs and irrational beliefs are; I will try to help him discriminate his sensiblerB from his foolish iB hypotheses; and I will indicate how he can keep his rB appraisalsof his performances and feel rational consequences (sorrow, regret, displeasure,increased effort to work more efficiently) and to minimize or eliminate his iB appraisalsand their irrational consequences (feelings of panic, depression, increased inefficiency,etc.).

Similarly, I will explain and help change Roe’s feelings of rage against his wife. I willshow him that when her actions, at point A, are inconsiderate, impolite, or unjust, heis probably first signaling himself the rational belief, “I don’t like her behavior; I wishshe would change it; what a nuisance!” At point rC, he is consequently experiencingthe rational consequences—that is, emotions of dissatisfaction, disappointment,frustration, and annoyance. At point iB, he has the irrational belief “Because she isacting badly, I can’t stand it. She is a horrible person. I’ll never be able to forgive herfor acting like that. She deserves to suffer eternally and to be eventually roasted in hellfor the awful way she is treating me!” He, consequently, at point iC, feels the irrationalconsequences of rage and self-pity. If I can induce Roe to retain his sensible rBhypotheses and to surrender his condemnatory iB hypotheses, he will tend to feeldispleasure but not rage, and he will probably have a better chance of helping his wifechange her unpleasing behavior.

The main point here is that the actions that occur in Roe’s (or anyone’s) life at pointA do not cause or make him feel depressed or enraged at point C. Rather, his thoughts,appraisals, and evaluations—his beliefs at point B—create these feelings. To a largedegree he has a choice at point A about what he will feel at point C regarding the actionsor agents in his life—as long as he thinks about his thinking, challenges some of his iBconceptions and conclusions, and returns to his empirically based rB hypotheses. Being,however, born and raised a human, he easily and naturally tends to make a magicaljump from rB to iB conclusions; and, much more often than not, he confuses his self,his total personality, with his performances, and he automatically evaluates and rates

52 Albert Ellis

the former along with the latter. Consequently, he very frequently ends up by damninghimself and other people (that is, denigrating his and their intrinsic value) rather thanmerely appraising the efficacy or desirability of his or their performances (his and theirextrinsic value). He thereby gets into all kinds of needless difficulties, or emotionalproblems, with himself and with others.

Again, I ask: Must man be a self-evaluator? And again I answer: Yes, to some degreehe must, since it is biologically and sociologically almost impossible for him not to doso. In terms of self-preservation, if he did not constantly evaluate his performances, hewould soon be dead: for before he can safely drive a car, climb a mountain, or cultivatea certain kind of food, he had better know how competent he is likely to be in theserespects, else he will maim or kill himself. So, to survive, he really has to assess hisdeeds and his potentials.

Self-appraisal, moreover, has distinct advantages as well as disadvantages. If you(unempirically and unscientifically) rate yourself, your being, as “good,” “great,” or“noble” when you succeed in love, work well on your job, or paint a fine canvas, youwill tend, at least for awhile, to be much happier than if you merely rate yourperformance in a similar manner. If you (unrealistically) appraise your girl friend oryour wife as being a “glorious,” “marvelous,” or “goddess-like” person when you (moreaccurately) really mean that she has some highly desirable and pleasing traits, you willalso tend to feel ecstatic about your relations with her. Man, as May (1967, 1969) hasstrongly pointed out, largely lives with demons and deities, and it is silly to think thathe does not gain much by doing so.

But is it really worth it? Does man absolutely have to rate himself as a person andevaluate others as people? My tentative answer to both these questions, after spendinga quarter of a century busily engaged as a psychotherapist, writer, teacher, and lecturer,is no. Man has an exceptionally strong, inborn, and socially acquired tendency to be aself- and an other-appraiser; but by very hardheaded thinking, along with active workand practice, he can persistently fight against and minimize this tendency; and if hedoes, he will, in all probability, be considerably healthier and happier than he usuallyis. Instead of strongly evaluating his and other people’s selves, he can pretty rigorouslystick to rating only performances; instead of damning or deifying anyone or anything,he can adhere to reality and be truly demonless and godless; and instead of invent-ing demands and needs, he can remain with desires and preferences. If he does so, I hypothesize, he will not achieve utopia (which itself is changeless, absolutistic, andunrealistic) but he most probably will achieve more spontaneity, creativity, and satis -faction than he has ever previously achieved or presently tends to attain. Some of themain reasons for my espousing man’s taking a non-evaluative attitude toward himself(while still evaluating many of his traits and performances) are as follows:

1. Both positive and negative self-evaluation are inefficient and often seriouslyinterfere with problem-solving. If one elevates or defames himself because of hisperformances, he will tend to be self-centered rather than problem-centered, andthese performances will, consequently, tend to suffer. Self-evaluation, moreover,is usually ruminative and absorbs enormous amounts of time and energy. By itone may possibly cultivate his “soul” but hardly his garden!

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2. Self-rating only works well when one has many talents and few flaws; but,statistically speaking, few are in that class. It also tends to demand universalcompetence. But, again, few can measure up to such a demand.

3. Self-appraisal almost inevitably leads to one-upmanship and one-downmanship.If one rates himself as being “good,” he will usually rate others as being “bad” or“less good.” If he rates himself as being “bad,” others will be seen as “less bad” or“good.” Thereby he practically forces himself to compete with others in “goodness”or “badness” and constantly feels envious, jealous, or superior. Persistent individual,group, and international conflicts easily stem from this kind of thinking and feeling;and love, cooperation, and other forms of fellow-feeling are minimized. To seeoneself as having a better or worse trait than another person may be unimportantor even beneficial (since one may use his knowledge of another’s superior trait tohelp achieve that trait himself). But to see oneself as being a better or worse personthan another is likely to cause trouble for both.

4. Self-evaluation enhances self-consciousness and therefore tends to shut one upwithin himself, to narrow his range of interests and enjoyments. “It should be ourendeavor,” said Bertrand Russell, “to aim at avoiding self-centered passions andat acquiring those affections and those interests which will prevent our thoughtsfrom dwelling perpetually upon ourselves. It is not the nature of most men to behappy in a prison, and the passions which shut us up in ourselves constitute oneof the worst kinds of prisons. Among such passions some of the commonest arefear, envy, the sense of sin, self-pity, and self-admiration” (Russell, 1952).

5. Blaming or praising the whole individual for a few of his acts is an unscientificovergeneralization. “I have called the process of converting a child mentally intosomething else, whether it be a monster or a mere nonentity, pathogenic metamor-phosis,” Jules Henry declared. “Mrs. Portman called [her son] Pete ‘a humangarbage pail’; she said to him, ‘you smell, you stink’; she kept the garbage bag andrefuse newspapers on his high chair when he was not in it; she called him Mr.Magoo, and never used his right name. Thus he was a stinking monster, a nonentity,a buffoon” (Henry, 1963). But Henry failed to point out that had Mrs. Portmancalled her son, Pete, “an angel” and said to him, “you smell heavenly,” she wouldhave equally converted him, by the process of pathogenic metamorphosis, intosomething he was not; namely, a godlike being. Peter is a human person whosometimes smells bad (or heavenly); he is not a bad-smelling (or heavenly smelling)person.

6. When human selves are lauded or condemned there is a strong implication thatpeople should be rewarded or punished for being “good” or “bad.” But, as notedabove, if there were “bad” people, they would already be so handicapped by their“rottenness” that it would be thoroughly unfair to punish them further for being“rotten.” And if there were “good” people, they would already be so favored bytheir “goodness” that it would be superfluous or unjust to reward them for it.Human justice, therefore, is very badly served by self-evaluations.

7. To rate a person high because of his good traits is often tantamount to deifyinghim; conversely, to rate him low because of his bad traits is tantamount todemonizing him. But since there seems to be no way of validating the existence ofgods and devils and since man can well live without this redundant hypothesis, it

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merely clutters human thinking and acting and probably does much more harmthan good. Concepts of god and the devil, moreover, obviously vary enormouslyfrom person to person and from group to group; they add nothing to humanknowledge; and they usually serve as obstructions to precise intrapersonal andinterpersonal communication. Although it is possible that people who behavestupidly and weakly may derive benefits from inventing supernatural beings, thereis no evidence that those who act intelligently and strongly have any need of them.

8. Bigotry and lack of respect for individuals in their own right are consequences ofself- and other-evaluation. For if you accept A because he is white, Episcopalian,and well educated and reject B because he is black, Baptist, and a high schooldropout, you are clearly not respecting B as a human—and, of course, areintolerantly disrespecting millions of people like him. Bigotry is arbitrary, unjust,and conflict-creating; it is ineffective for social living. As George Axtelle has noted,“Men are profoundly social creatures. They can realize their own ends more fullyonly as they respect one another as ends in themselves. Mutual respect is an essentialcondition of effectiveness both individually and socially. Its opposites, hatred,contempt, segregation, exploitation, frustrate the realization of values for allconcerned and hence they are profoundly destructive of all effectiveness” (Axtelle,1956). Once you damn an individual, including yourself, for having or lacking anytrait whatever, you become authoritarian or fascistic; for fascism is the very essenceof people-evaluation (Ellis, 1965a, 1965b).

9. By evaluating an individual, even if only in a complimentary way, one is oftentrying to change him or trying to control or manipulate him; and the kind ofchange envisioned may or may not be good for him. “Often,” Richard Farson notes,“the change which praise asks one to make is not necessarily beneficial to theperson being praised but will redound to the convenience, pleasure or profit ofthe praiser” (Farson, 1966). Evaluation may induce the individual to feel obligatedto his evaluator; and to the degree that he lets himself feel compelled or obligatedto change himself, he may be much less of the self that he would really like to be.Positive or negative evaluation of a person, therefore, may well encourage him tobe less of a self or of a self-directed individual than he would enjoy being.

10. Evaluation of the individual tends to bolster the Establishment and to block socialchange. For when one gives himself a report card he not only becomes accustomedto telling himself, “My deeds are wrong, and I think I’d better work at improvingthem in the future,” but also, “I am wrong, I am a ‘no-goodnik’ for performingthese poor deeds.” Since “wrong” acts are largely measured by societal standards,and since most societies are run by a limited number of “upper level” people whohave a strong, vested interest in keeping them the way they are, self-evaluationusually encourages the individual to go along with social rules, no matter howarbitrary or foolish they are, and especially to woo the approval of the powers-that-be. Conformism, which is one of the worst products of self-rating, generallymeans conformity to the time-honored and justice-dishonoring rules of the“Establishment.”

11. Self-appraisal and the measuring of others tend to sabotage empathic listening.Close and authentic relationships between two people, as Richard Farson pointsout, are often achieved through intensive listening: “This does not merely mean

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to wait for a person to finish talking, but to try to see how the world looks to thisperson and to communicate this understanding to him. This empathic, non-evaluative listening responds to the person’s feelings as well as to his words; thatis, to the total meaning of what he is trying to say. It implies no evaluation, nojudgment, no agreement (or disagreement). It simply conveys an understandingof what the person is feeling and attempting to communicate; and his feelings andideas are accepted as being valid for him, if not for the listener” (Farson, 1966).When, however, one evaluates a person (and oneself) as one listens to the otherperson, one is usually prejudicedly blocked from fully understanding him, seeinghim as he is, and uncompetitively understanding and getting close to him.

12. Person-rating tends to denigrate human wants, desires, and preferences and toreplace them with demands, compulsions, or needs. If you do not measure yourselfness, you tend to spend your days asking yourself, “Now what would I reallylike to do, in my relatively brief span of existence, to gain maximum satisfactionand minimum pain?” If you do measure your selfhood, you tend to keep asking,“What do I have to do to prove that I am a worthwhile person?” As RichardRobertiello has observed, “People are constantly negating their right to takesomething just purely because they want it, to enjoy something simply becausethey enjoy it. They can hardly ever let themselves take anything for pure pleasurewithout justifying it on the basis of having earned it or suffered enough to beentitled to it or rationalizing that, though they enjoy it, it is really an altruistic actthat they are doing for someone else’s good. . . . It seems as if the greatest crimeis to do something simply because we enjoy it and without any thought of doinggood for anyone else or of serving an absolute need in us that is essential for ourcontinued survival” (Robertiello, 1964). Such is the folly born of self-deservingness!

Placing a value on a human being tends to sabotage his free will. One has little enoughself-direction in the normal course of events!—since even his most “voluntary” activitiesare significantly influenced by his heredity and environment; and when he thinks thatone of his thoughts, feelings, or actions is really “his,” he is ignoring some of its mostimportant biosocial causes. As soon as one labels himself as “good” or “bad,” as a “genius”or as an “idiot,” he so seriously stereotypes himself that he will almost certainly biasand influence much of his subsequent behavior. For how can a “bad person” or an“idiot” determine, even to a small degree, what his future actions will be, and how canhe work hard at achieving his goals? Moreover, how can a “good person” do non-goodacts, or a “genius” turn out mediocre works along with his outstanding ones? Whatasinine, creativity-downing restrictions one almost automatically places on himselfwhen he thinks in terms of these general designations of his selfness!

To give a human an accurate global rating is probably impossible for several reasons:

(a) The traits by which he is to be rated are very likely to change from year to year,even from moment to moment. Man is not a thing or an object, but a process.How can an ever-changing process be precisely measured and rated?

(b) The characteristics by which a person is to be evaluated have no absolute scale bywhich they can be judged. Traits which are highly honored in one social group areroundly condemned in another. A murderer may be seen as a horrible criminal

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by a judge but as a marvelous soldier by a general. A man’s qualities (such as hisability to compose music) may be deemed fine in one century and mediocre in alater age.

(c) To rate a human globally, special weights would have to be given to each kind ofpositive and negative action that he performed. Thus, if a man did a friend a smallfavor and also worked very hard to save a hundred people from drowning, hislatter act would normally be given a much higher rating than his former act; andif he told a lie to his wife and also battered a child, his second deed would beconsidered much more heinous than his first. But who is to give an exact weightto his various deeds, so that it could finally be determined how globally “good” or“bad” he is? It might be convenient if there existed on earth some kind of St. Peter,who would have a record of every single one of his deeds (and, for that matter,his thoughts) and who could quickly assess him as a potential angel or as hell-bound. But what is the likelihood of such a St. Peter’s (even in the form of aninfallible computer) ever existing?

(d) What kind of mathematics could we employ to arrive at a single, total rating of a human being’s worth? Suppose an individual does a thousand good acts, andthen he fiendishly tortures someone to death. Shall we, to arrive at a generalevaluation of his being, add up all his good acts arithmetically and compare thissum to the weighted sum of his bad act? Shall we, instead, use some geometricmeans of assessing his “goodness” and “badness”? What system shall we employto “accurately” measure his “value”? Is there, really, any valid kind of mathematicalevaluation by which he can be rated?

(e) No matter how many traits of an individual are known and employed for his globalrating, since it is quite impossible for him or anyone else to discover all hischaracteristics and to use them in arriving at a single universal rating, in the finalanalysis the whole of him is being evaluated by some of his parts. But is it everreally legitimate to rate a whole individual by some (or even many) of his parts?Even one unknown, and hence unevaluated, part might significantly change and,hence, invalidate the final rating. Suppose, for example, the individual is given (byhimself or others) a 91 percent general rating (that is, is considered to have 91percent of “goodness”). If he unconsciously hated his brother most of his life andactually brought about the early demise of this brother, but if he consciously onlyremembers loving his brother and presumably helping him to live happily, he willrate himself (and anyone but an all-knowing St. Peter will rate him) considerablyhigher than if he consciously admitted his hatred for his brother and causing thisbrother needless harm. His “real” rating, therefore, will be considerably lower than91 percent; but how will this “real” rating ever be known?

(f) If an individual is given a very low global rating by himself and others—say, hewinds up with a 13 percent general report card on himself—it presumably meansthat (1) he was born a worthless individual; (2) he never possibly could becomeworthwhile, and (3) he deserves to be punished (and ultimately roasted in somekind of hell) for being hopelessly worthless. All of these are empirically unverifiablehypotheses which can hardly be proved or disproved and which tend (as statedabove) to bring about much more harm than good.

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(g) Measuring a human being is really a form of circular thinking. If a man is “good”because he has “good” traits, his “goodness,” in both instances, is based on somekind of value system that is definitional; for who, again, except some kind of deityis to say what “good” traits truly are? Once his traits are defined as being “good,”and his global “goodness” is deduced from his specific “goodnesses,” the conceptof his being globally “good” will almost inevitably prejudice one’s view of hisspecific traits—which will then seem “more good” than they really may be. Andonce his traits are defined as being “bad,” the concept of his being globally “bad”will almost inevitably prejudice one’s view of his specific traits—which will thenseem “more bad” than they really may be. If the “good” traits of a person who israted as being globally “good” are prejudicedly seen as being “more good” thanthey really are, one will keep seeing him, by prejudice, as being “good,” when hemay not actually be. Globally rating him, in other words, includes making aprophecy about his specific “good” traits and rating his specific traits as “good”includes making a prophecy about his global “goodness.” Both these prophecies,in all probability, will turn out to be “true,” whatever the facts of his specific andgeneral “goodness” actually are; for “goodness” itself can never accurately bedetermined, since the entire edifice of “goodness” is based, as I have said, onconcepts which are largely definitional.

(h) Perhaps the only sensible way of making a global rating of an individual is on thebasis of his aliveness: that is, assuming that he is intrinsically good just because heis human and alive (and that he will be non-good or non-existent when he is dead).Similarly, we can hypothesize, if we want to accept redundant and unnecessaryreligious assumptions, that an individual is good because he is human and becauseJehovah, Jesus, or some other deity in whom he believes accepts, loves, or givesgrace to all humans. This is a rather silly assumption, since we know (as well aswe know anything) that the individual who believes in this assumed deity exists,while we have no way of proving the existence (or non-existence) of the deity inwhich he believes. Nonetheless, such an assumption will work, in that it will referback to the more basic assumption that a human is globally “good” just becausehe is human and alive. The trouble with this basic concept of general human“goodness” is that it obviously puts all humans in the same boat—makes them allequally “good” and leaves no room whatever for any of them to be “bad.”Consequently, it is a global rating that is not really a rating, and it is entirelydefinitional and is rather meaningless.

(i) The concept of giving any human a general or global evaluation may be an artifactof the inaccurate way in which almost all humans think and communicate withthemselves and each other. Korzybski (1933, 1951) and some of his main followers,such as Hayakawa (1965) and Bourland (1969), have pointed out for a good manyyears that just as pencil is not the same thing as pencil, so individual, is hardly thesame as individual. Consequently, generalizing about pencils and about individualsis never entirely accurate. Bourland has especially campaigned, for the last decade,against our using any form of the verb to be when we speak about or categorizethe behavior of a person. Thus, it is one thing for us to note that “Jones has (orpossesses) some outstanding mathematical qualities” and another to say that “Jonesis an outstanding mathematician.” The former sentence is much more precise and

58 Albert Ellis

probably “truer” than the latter. The latter sentence, moreover, implies a globalrating of Jones that is hardly warranted by the facts, if these can be substantiated,of Jones’s possessing some mathematical qualities. If Korzybski and his followersare correct, as they in all probability (at least to some degree) are, then global termsand ratings of humans are easily made (indeed, it is most difficult for us not tomake them) but would better be fought against and transformed into more specificevaluations of their performances, talents, and traits. Such generalized (orovergeneralized) grades exist (since we obviously keep employing them), but itwould be much better if we minimized or eliminated them.

j. All of man’s traits are different—as apples and pears are different. Just as one cannotlegitimately add and divide apples and pears and thereby get a single, accurateglobal rating of an entire basket of fruit, so one cannot truly add and divide differenthuman traits and thereby obtain a single, meaningful global rating of a humanindividual.

What conclusions can be drawn from the foregoing observations and deductionsabout psychotherapy and human value? First, that self-reference and self-evaluation area normal and natural part of man. It seems to be much easier for him to rate his self,his being, as well as his performances, than it is for him only to assess the latter andnot the former.

When man does appraise himself globally, he almost invariably gets into trouble.When he terms himself “bad,” “inferior,” or “inadequate,” he tends to feel anxious,guilty, and depressed, to act below his potential level of efficiency, and to falsely confirmhis low estimation of himself. When he terms himself “good,” “superior,” or “adequate,”he tends to feel forever unsure of maintaining his “goodness,” to spend considerabletime and energy “proving” how worthwhile he is, but still to sabotage his relations withhimself and others.

Ideally, it would seem wise for man to train himself, through rigorous thinking aboutand working against some of his strongest inborn and environmentally bolsteredtendencies, to refuse to evaluate himself at all. He had better continue, as objectivelyas he can, to assess his traits, talents, and performances, so that he can thereby lead alonger, pain-avoiding, and satisfaction-filled life. But, for many reasons which areconsidered in detail in this chapter, he would better also accept rather than rate his so-called self and strive for the enjoyment rather than the justification of his existence.According to Freud (1963), the individual attains mental health when he follows therule “Where id was, there shall ego be.” Freud, however, did not mean by ego man’sself-evaluating but his self-directing tendencies. According to my own views (Ellis, 1962,1968, 1971; Ellis et al., 1966) and the principles of rational emotive therapy, man attainsmaximum understanding of himself and others and minimum anxiety and hostilitywhen he follows the rule “Where ego was, there shall the person be.” By ego, of course,I mean man’s self-rating and self-justifying tendencies.

For man, as an individual living with other individuals in a world with which heinteracts, is too complex to be measured, or given a report card. He may be legitimately“valued,” in the sense of accepting and abiding by the empirically determinable factsthat (1) he exists, (2) he can suffer satisfaction and pain while he exists, (3) it is usuallywithin his power to continue to exist and to experience more satisfaction than pain,

Psychotherapy and the Value of a Human Being 59

and (4) it is therefore highly probable that he “deserves” to (that is, would better) goon existing and enjoying. Or, more succinctly stated, man has value because he decidesto remain alive and to value his existence. Observations and conclusions other thanthose based on these minimal assumptions may well be foolishly egocentric and fictional,and in the final analysis human—all too human, but still essentially inhumane.

References

Adler, A. (1927). Understanding human nature. New York: Greenberg.Adler, A. (1931). What life should mean to you. Boston, MA: Little Brown.Adler, A. (1964). Social interest: A challenge to mankind. New York: Capricorn.Anderson, C. (1962). Saints, sinners and psychiatry. Portland, OR: Durham Press.Anderson, C. (June, 1964). Depression and suicide reassessed. Reprint from Journal of the

American Medical Woman’s Association.Axtelle, G. E. (1956). Effectiveness as a value concept. Journal of Educational Sociology, XXIX,

240–246.Becker, E. (1964). The revolution in psychiatry. New York: Free Press.Bone, H. (1968). Two proposed alternatives to psychoanalytic interpreting. In Emanuel F.

Hammer (Ed.), Use of interpretation in treatment (pp. 169–196). New York and London: Grune & Stratton.

Bourland, D. D. (1969, May 23). Language. Time, p. 69.Branden, N. (1964, June). Pseudo-self-esteem. Objectivist Newsletter, HI, 6, 22–23.Branden, N. (1965). Who is Ayn Rand? New York: Random House.Coopersmith, S. (1968, February). Studies in self-esteem. Scientific Monthly, CCXVIII, 2, 96–106.Danielsson, B. (1956). Love in the South Seas. New York: Reynal.Danielsson, B. (1961). Sex life in Polynesia. In A. Ellis and A. Abarbanel (Eds.), The encyclopedia

of sexual behavior (pp. 832–840). New York: Hawthorn Books.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Ellis, A. (1965a). Sex without guilt. New York: Lyle Stuart.Ellis, A. (1965b). Suppressed: Seven key essays publishers dared not print. Chicago, IL: New Classics

House.Ellis, A. (1967). Psychotherapy and moral laxity. Psychiatric Opinion, IV, 5, 18–21.Ellis, A. (1968). Is objectivism a religion? New York: Lyle Stuart.Ellis, A. (1971). Growth through reason. Palo Alto, CA: Science & Behavior Books.Ellis, A., & Gullo, J. M. (1971). Murder and assassination. New York: Lyle Stuart.Ellis, A., & Harper, R. A. (1967). A guide to rational living. Englewood Cliffs, NJ: Prentice Hall.Ellis, A., Wolfe, J. L., and Moseley, S. (1966). How to prevent your child from becoming a neurotic

adult. New York: Crown.Farson, R. A. (1966). Praise reappraised. Encounter, 1, 13–21. (Reprinted from Harvard Business

Review, 1963, Sept.–Oct.)Freud, S. (1963). Collected papers. New York: Collier Books.Geis, H. J. (1965). Guilt feelings and inferiority feelings: An experimental comparison. PhD

dissertation, Columbia University.Harris, S. J. (1963, December 12). A man’s worth is not relative. Detroit Free Press.Hartman, R. S. (1959). The measurement of value. Crotonville, NY: General Electric Company.Hartman, R. S. (1960, Autumn). Sputnik’s moral challenge. Texas Quarterly, III, 3, 9–22.Hartman, R. S. (1962). The individual in management. Chicago, IL: Nationwide Insurance

Company.Hartman, R. S. (1967a). The structure of value. Carbondale, IL: Southern Illinois University Press.

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Hartman, R. S. (1967b, June 27). Letter to Albert Ellis.Hayakawa, S. I. (1965). Language in action. New York: Harcourt Brace.Henry, J. (1963). Culture against man. New York: Random House.Hess, J. L. (1966, October 14). Michelin’s two stars lost, Paris chef shoots himself. New York

Times, 1, 3.Hoffer, E. (1955). The passionate state of mind. New York: Harper & Row.Kelly, G. (1955). The psychology of personal constructs. New York: Norton.Korzybski, A. (1933). Science and sanity. Lancaster, PA: Institute of General Semantics.Korzybski, A. (1951). The role of language in the perceptual process. In R. R. Blake & G. V.

Ramsey (Eds.), Perception (pp. 170–202). New York: Ronald Press.Lecky, P. (1945). Self-consistency. New York: Island Press.Low, A. (1967). Lectures to relatives of former patients. Boston, MA: Christopher Publishing.Maslow, A. H. (1966). The psychology of science. New York: Harper & Row.May, R. (1967). Psychology and the human dilemma. Princeton, NJ: Van Nostrand.May, R. (1969). Love and will. New York: Norton.Nietzsche, F. W. (1965). In H. J. Blackman (Ed.), Reality, man and existence: Essential works of

existentialism. New York: Bantam.Rand, A. (1961). For the new intellectual. New York: Random House.Rand, A. (1964). The virtue of selfishness. New York: Signet.Robertiello, R. (1964). Sexual fulfillment and self-affirmation. Larchmont, NY: Argonaut.Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications and theory. Boston,

MA: Houghton Mifflin.Rogers, C. (1961). On becoming a person: A distinguished therapist’s guide to personal growth and

creativity. Boston, MA: Houghton Mifflin.Rosenberg, M. (1962). The association between self-esteem and anxiety. Psychiatric Research, I,

135–152.Russell, B. (1952). The conquest of happiness. New York: Signet.Watzlawick, P., Helmick Beavin, J., Jackson, D. D. (1967). Pragmatics of human communication.

New York: W. W. Norton.

Psychotherapy and the Value of a Human Being 61

4 RET Abolishes Most of theHuman Ego

INTRODUCTION

Sam Klarreich

It is interesting that a greater number of people than ever before plonk themselves infront of their televisions, and even more in front of their computer screens, quitecontent to be entertained. Shows and websites of every variety are popular. However,some run into trouble because life is passing them by. They may be criticized by othersfor being lazy, not contributing, being addicted to their screens. These people mayremain chronic, passive bystanders and view a world that they are part of, yet not aparticipant in. No wonder severe boredom, self-deprecation, and eventual dissatisfactionwith life set in.

Mid-life crisis and the misery that often accompanies it remain very prominent andoccur at every phase of our life cycle, not just “mid-life”, largely because of a lack offulfillment, in spite of the opportunities that abound. People become preoccupied withwhat they have failed to achieve in life, are consumed with the wrong direction theircareer has taken, are overwhelmed with the questionable choices they have made anddespondent over the choices they have not made because they were fearful at the time,are anxious about what the future holds, and feel helpless to steer in a direction thatwill bring them happiness. A chronic malaise settles in, as we become more discouragedwith what we’ve become and more panic ridden with the fact that we are driftingaimlessly on the road of life.

At an alarming rate, waistlines across the planet are increasing, and the incidence ofobesity is reaching epidemic proportions. Instead of a life-enriching shift in how weeat, how active we are, and what contribution we are making, we resort to quick-fixdiets that may temporarily take the weight off. After the pounds have dropped, wereturn to old eating and inactivity habits, lo and behold our weight returns, and we’reback to where we started. To our dismay, the original weight plus more returns. Thischronic yo-yo approach to being overweight escalates our disappointment and providesus with an opportunity to condemn ourselves and convince ourselves that we will neverachieve our desired weight, no matter what we do. Misery and despondency settle inabout our inability to adhere to a healthier lifestyle.

Depression has increased at a disturbing rate. Most states of depression are situationalin nature and relate to how we are living or not living our lives and the stressors incurred

in the process. Our relationships may be falling apart, our jobs may be lost owing torestructuring or poor performance, our finances may be in the toilet, family pressuresmay be all-consuming, and, to add to our mess, we may not like ourselves too muchbecause we have not achieved our dreams. Once we come to terms with these and otherpressures, we are likely to experience self-doubt, frustration, self-loathing, anger, andeventually depression.

In our society, it appears there exists a simple explanation for our woes, namely thatwe must have low self-esteem. Our job, then, is to improve our self-worth, and ourlives will be better. If our self-worth were increased, we would surely pull ourselvesaway from our screens, change our lifestyles, lose weight and keep it off, satisfactorilyaddress our stressors, and therefore be happier altogether.

Bonny, a former client, declared,

My self-esteem was always wrapped up in what I did, how successful I was, whetherpeople liked me or not. It made life very uncomfortable; I was on edge all the time.And when things didn’t work out I’d always blame myself—I was no good, I wasincompetent, I looked like a fool. Life was a nightmare for me! Then I tried tofigure out how to increase self-esteem, because without it I believed I wouldn’t beable to do anything right.

We’ve come to believe that we need self-esteem to make it in life. We must somehowesteem, value, love, and cherish our true “self,” otherwise we will not be able to moveforward and not be in a position to establish meaningful relationships with others. Self-esteem has also been closely linked to self-confidence, whereby we have convincedourselves, with self-esteem intact, it will launch us on the road to self-assurance andpoise, and, without it, we would surely run into trouble and not be in a position toever achieve anything meaningful in life!

Dr. Ellis, in his profound article, “RET abolishes most of the human ego,” builds avery compelling case against the notions of self-esteem and self-worth. He points outthat many psychotherapy and counseling approaches are obsessed with improving,strengthening, and bolstering the self. Rational emotive therapy (RET), on the otherhand, abolishes this approach and replaces it with a realistic and empirically valid notion of self as a concept of consciousness, existence, and essence. Dr. Ellis arguesvery convincingly about the serious disadvantages of rating self, as we so often do whenthings don’t go the way they should. Instead, claims Dr. Ellis, rating our actions,behaviours, traits, and characteristics, rather than self, would increase happiness andgoal attainment. However, rating self, as we have trained ourselves to do, is indeedwhat leads to emotional disturbance and many neurotic symptoms that often arediagnosed or assessed as depression, adjustment disorder, eating disorder, anxiety, orother problems that plague us today.

As human beings, we have warts, foibles, weaknesses, inadequacies, and frailties thatwe somehow believe will get in our way and prevent us from achieving what we areafter. What gets in the way is our attachment to rating who we are because of ourlimitations and shortcomings. We have thoroughly persuaded ourselves that low self-esteem and lack of self-confidence create misery, whereas self-esteem and self-confidenceare the cornerstones of success and happiness, and without these foundations we are

RET Abolishes Most of the Human Ego 63

lost. However, there is little evidence to support this mystical theory, as Dr. Ellis soarticulately argues. Dr. Ellis, in his article, does appreciate the attachment to self-rating,because it does offer certain advantages; however, he goes on to declare that thedisadvantages far outweigh the advantages and he describes these in detail. Because ofthat evidence, it would be in our best interests to forego rating altogether.

One of the keys to fulfillment, happiness, and goal attainment is to believe in ourselvesas we are, which implies accepting ourselves completely, without condition, in spite ofthe limitations and inabilities that all of us have! Dr. Ellis refers to this as an elegantproposition, namely that, because we are alive and choose to live as happily as we can,that knowledge in and of itself is sufficient as a cornerstone, not only for survival, butalso for pleasure and joy, with a minimal amount of pain.

Conditional self-acceptance, to which most of humanity subscribes, is problematicat best. Simply speaking, it is based on the “if . . . then . . .” philosophy: If others approveof me, then I will approve of myself; if I succeed, then I will like myself more; if I doeverything well, then and only then will I truly be confident; if I am valued, then I willvalue myself and move forward. Fundamentally, if I am seen as better, stronger,healthier, smarter, in essence more perfect in every way, then I will esteem myself and,furthermore, will feel capable enough to break out and better my existence and possiblyachieve something, on the condition that it is safe, of course! Now we can appreciatewhy we struggle to achieve anything.

Once unconditional self-acceptance is endorsed, it frees us up to do what we chooseto in spite of our foibles, which as human beings we have. Take a careful look at ourpoliticians, our business leaders, our elite athletes, our religious leaders—many haveissues, weaknesses, and problems; so why are we any different? Given that we’re notany different, if we truly accept that fact, it liberates us to move on and pay attentionto what is more important, namely the achievement of our goals, rather than judgingourselves.

Brad, another former client indicated,

the toughest thing for me to realize was that I had insecurities like everyone else.For the longest time, I’d walk into meetings anxious because I wanted to impresspeople and wasn’t sure if they liked what I had to say or even cared about what Ihad to say. Or when going out, I’d be concerned about how I looked, how I acted,if others thought I sounded stupid. After the evening was over, I’d go over theevents of the evening in my head and would start to beat myself up for what Ishould have said or could have done that was different and obviously better. Fallingasleep would then be impossible, because I’d be rolling around with a racing mindabout all the mistakes and blunders I’d committed. My breakthrough came whenI finally admitted to myself that I was insecure and more importantly that I wasokay with it, not that I liked it mind you because I wanted to fix it, but that I didn’thave to crap on myself any longer! Now I had the courage to truly spread my wingsand see what I could accomplish, with some discomfort mind you, but that camewith the territory.

64 Sam Klarreich

RET ABOLISHES MOST OF THE HUMAN EGO

Albert Ellis

The vast majority of systems of psychotherapy seem intent on—indeed, almost obsessedwith—upholding, bolstering, and strengthening the human ego. This goes for suchdiverse and seemingly opposed systems as those of Freud (1963), Jung (1954), Adler(1974), Perls (1969), Berne (1964), Rogers (1961), and Branden (1971). Very few systemsof personality change, such as that of Zen Buddhism (Suzuki, 1956), take the oppositestand and try to help humans surrender some aspects of or abolish their egos; and thesesystems tend to have little popularity and engender much dispute.

RET, rational emotive therapy, constitutes one of the very few modern therapeuticschools which has taken something of a stand against what we normally call the egofor a good many years (Ellis, 1962), and that continues to take an even stronger standin this direction as it grows in its theory and its applications (Ellis, 1973,1974, 1975;Ellis and Harper, 1975). Let me try, in this paper, to outline quite precisely the up-to-date RET position and to explain why it attempts to abolish most of the human ego.

Legitimate Aspects of the Human Ego

RET first tries to define the various aspects of the human ego and to validate its“legitimate” aspects. It assumes that an individual’s main goals or purposes include (1)remaining alive and healthy and (2) enjoying himself or herself—experiencing a gooddeal of happiness and relatively little pain or dissatisfaction. We may, of course, arguewith these goals; and not everyone accepts them as “good.” But assuming that a persondoes value them, then he or she may have a valid “ego,” “self,” “self-consciousness,”or “personality” which we may conceive of something along the following lines:

“I exist—have an ongoing aliveness that lasts approximately seventy-five years andthat then apparently comes to an end, so that ‘I’ no longer exist.”

“I exist separately, at least in part, from other humans, and can therefore conceiveof myself as an individual in my ‘own’ right.”

“I have different traits, at least in many of their details, from other humans, andconsequently my ‘I-ness’ or my ‘aliveness’ has a certain kind of uniqueness. Noother person in the entire world appears to have exactly the same traits as I havenor to equal ‘me’ or constitute the same entity as ‘me.’”

“I have the ability to keep existing, if I choose to do so, for a certain number ofyears—to have an ongoing existence, and to have some degree of consistent traitsas I continue to exist. In that sense, I remain ‘me’ for a good number of years,even though my traits change in important respects.”

“I have awareness or consciousness of my ongoingness, of my existence, of mybehaviors, of my traits, and of various other aspects of my aliveness and experi-encing. I can therefore say, ‘I have self-consciousness.’”

“I have some power to predict and plan for my future existence or ongoingness,and to change some of my traits and behaviors in accordance with my basic valuesand goals. My ‘rational behavior,’ as Myles Friedman (1975) has pointed out, to alarge extent consists of my ability to predict and plan for my future.”

“Because of my ‘self-consciousness’ and my ability to predict and plan for my future,I can to a considerable degree change my present and future traits (and hence‘existence’)—I can at least partially control ‘myself.’”

“I similarly have the ability to remember, understand, and learn from my past andpresent experiences, and to use this remembering, understanding, and learning inthe service of predicting and changing my future behavior.”

“I can choose to discover what I like (enjoy) and dislike (disenjoy) and to try toarrange to experience more of what I like and less of what I dislike. I can alsochoose to survive or not to survive.”

“I can choose to monitor or observe my thoughts, feelings, and actions to helpmyself survive and lead a more satisfying or more enjoyable existence.”

“I can have confidence (believe that a high probability exists) that I can remainalive and make myself relatively happy and free from pain.”

“I can choose to act as a short-range hedonist who mainly goes for the pleasuresof the moment and gives little consideration to those of the future, or as a long-range hedonist who considers both the pleasures of the moment and of the futureand who strives to achieve a fair degree of both.”

“I can choose to see myself as having worth or value for pragmatic reasons—becauseI will then tend to accept myself, to go for pleasures rather than pain, to survivebetter, and to feel good.”

“I can choose to accept myself unconditionally—whether or not I do well or getapproved by others. I can thereby refuse to rate ‘myself,’ my totality,’ my‘personhood’ at all, but merely rate my traits, deeds, acts, and performances—forthe purposes of surviving and enjoying my life more, and not for the purposes of‘proving myself’ or being ‘egoistic’ or showing that I have a ‘better’ or ‘greater’value than others.”

These, it seems to me, comprise some valid or legitimate aspects of the human “ego.”Why legitimate? Because they seem to accord with empirical reality—state propositionsthat we can validate by the usual rules of scientific evidence. And because they appearto help people who subscribe to them to attain their usual basic values—again, thevalues of surviving and feeling happy rather than miserable. At the same time, somehighly “invalid” or “illegitimate” aspects of the human “ego” or of self-rating exist.Such as these:

“I not only exist as a unique but as a special person. I rate as better than otherpeople because of my outstanding traits.”

66 Albert Ellis

“I have a superhuman rather than merely a human quality. I can do things thatother people cannot possibly do and deserve to get deified for doing these things.”

“If I do not have outstanding, special, or superhuman characteristics, I have asubhuman quality. Because I do not perform notably, I deserve to get devil-ifiedand damned.”

“The universe especially and notably cares about me. It has a personal interest inme and wants to see me do remarkably well and to feel happy.”

“I need the universe to care about me specially. If it does not, I rate as a lowlyindividual, cannot take care of myself, and must feel desperately miserable.”

“Because I exist, I have to succeed in life and I must obtain love by all the peoplethat I find significant.”

“Because I exist, I must survive and continue a happy existence.”

“Because I exist, I must exist forever, and have immortality.”

“I equal my traits. If I have significant bad traits, I totally rate as bad, and if I havesignificant good ones, I rate as a good person.”

“I particularly equal my character traits. If I treat others well and therefore have a‘good character,’ I rate as a good person; and if I treat others badly and thereforehave a ‘bad character,’ I have the essence of a bad person.”

“I must, to accept and respect myself, prove I have real worth—prove that I havethis worth because I have competence, outstandingness, and the approval ofothers.”

“To have a happy existence, I must have—absolutely need—the things I reallywant.”

These, then, constitute some of the legitimate and illegitimate aspects of ego or self-rating.

And, just as the legitimate aspects lead to survival and happiness, the illegitimateones tend to interfere with your survival and to create considerably less happiness thanyou otherwise would tend to achieve.

The self-rating aspects of ego, in other words, tend to do you in, to handicap you,to interfere with your satisfactions. They differ enormously from the self-individuatingaspects of ego. The latter involve how or how well you exist. You remain alive as adistinct, different, unique individual because you have various traits and performancesand because you enjoy their fruits. But you have “ego” in the sense of self-rating becauseyou magically think in terms of upping or downing, deifying or devil-ifying yourselffor how or how well you exist. Ironically, you think that rating yourself, your “ego,”will help you live as a unique person and enjoy yourself. Well, it won’t! For the mostpart it will let you survive, perhaps—but pretty miserably!

Doesn’t egoism, self-rating, or self-esteem have any advantages? It certainly does—and therefore, probably, it survives in spite of its disadvantages. What advantages doesit have? Well, several: It tends to motivate you to succeed and to win others’ approval.

RET Abolishes Most of the Human Ego 67

It gives you an interesting, preoccupying game of constantly comparing your deeds andyour “self” to those of other people. It often helps you impress others—which has apractical value, in many instances. It may help preserve your life—as when you striveto make more money, for egoistic reasons, and aid your survival with this money. It,self-rating, serves as a very easy and comfortable position to fall into—since humansnaturally, probably from a profound biological tendency, engage in it. It gives you someenormous pleasures—if and when you rate yourself as noble, great, or outstanding. Itmay motivate you to produce notable works of art, science, or invention. It enablesyou to feel superior to others. It sometimes enables you to feel god-like.

Egoism, obviously, has real advantages. To give up self-rating completely wouldamount to quite a sacrifice. We cannot justifiably say that it brings no gains, does notdo social or individual good.

But what about its disadvantages and hassles? Ah, enormous! Let me list just someof the more important reasons why rating yourself as either a good or a bad personhas immense dangers and will almost always do you in:

To work well, self-rating requires extraordinary ability and talent, or virtualinfallibility, on your part. For you can only accurately elevate your ego when you dowell, and concomitantly depress it when you do poorly. What chance do you have ofsteadily or always doing well?

To have, in common parlance, a “fine” ego or “real” self-esteem really requires above-averageness or outstandingness. Only if you have special talent will you likely acceptyourself and rate yourself highly. But, obviously, very few individuals can have unusual,genius-like ability. And will you reach that uncommon level? I doubt it!

Even if you have enormous talents and abilities, to accept yourself or esteem yourselfconsistently, in an ego-rating way, you have to display them virtually all the time. Anysignificant lapse, and you immediately down yourself. And then, when you do downyourself, you tend to lapse more. A truly vicious circle!

When you insist on rating yourself, you basically do so in order to impress otherswith your great “value” or “worth” as a human. But the need to impress others and towin their approval, and to view yourself as a “good person” because you get theirapproval, leads to an obsession that tends to preempt a large part of your life. You seekstatus instead of seeking joy. And you seek universal acceptance, which you certainlyhave virtually no chance of ever getting!

Even when you impress others, and supposedly gain “worth” that way, you tend torealize that you do so partly by acting and falsifying your talents. You consequentlylook upon yourself as a phony. Ironically, then, you down yourself for not impressingothers; but you also down yourself for phonily impressing them!

When you rate yourself and succeed at giving yourself a superior rating, you deludeyourself of having superiority over others. You may indeed have some superior traits;but you devoutly feel that you turn into a truly superior person—or semi-god. Andthat delusion runs your life and gives you an artificial or false sense of “self-esteem.”

When you insist on rating yourself as good or bad, you tend to focus on your defects,liabilities, and failings, for you feel certain that they make you into an R. P., or rottenperson. By focusing on these defects, you accentuate them, often make them worse,interfere with changing them, and acquire a generalized negative view of yourself thatalmost always ends up in arrant self-deprecation.

68 Albert Ellis

When you have ego, or rate yourself, you have the philosophy that you must proveyourself as good; and since there always exists a good chance that you will not, youtend to remain underlyingly or overtly anxious practically all the time. In addition, youcontinually verge on depression, despair, and feelings of intense shame, guilt, andworthlessness.

When you preoccupyingly rate yourself, even if you succeed in earning a good ratingyou do so at the expense of obsessing yourself with success, achievement, attainment,and outstandingness. But this kind of concentration on success deflects you from thegoal of trying to achieve happiness. For some of the most successful people, of course,remain abysmally miserable.

By the same token, in mightily striving for outstandingness, success, and superiority,you rarely stop to ask yourself, “What do I really want—and want for myself?” So youfail to find what you really enjoy in life.

Ostensibly, your focusing on achieving greatness and superiority over others andthereby winning a high self-rating serves to help you do better in life. Actually, it helpsyou focus on your so-called worth and value rather than on your competency andhappiness; and consequently you fail to achieve many things that you otherwise could.Because you have to prove your utter competence, you actually tend to make yourselfless competent—and often to withdraw from competition entirely.

Although self-rating occasionally may help you pursue creative activities, it frequentlyhas the opposite result. For, again, you get yourself so hung up on success and superioritythat you uncreatively and obsessively–compulsively go for those goals rather than thatof creative participation in art, music, science, invention, or other pursuits.

When you rate yourself you tend to feel self-centered rather than act problem-centered. Therefore, you do not try to solve many of the practical and importantproblems in life but largely focus on your own navel and the pseudoproblem of provingyourself instead of finding yourself.

Self-rating generally helps you feel abnormally self-conscious. Self-consciousness, orthe knowledge that you have an ongoing quality and can enjoy or disenjoy yourself,serves as a great human advantage. But extreme self-consciousness, or continually spyingon yourself to see how well you do and how well you can rate yourself for doing well,takes this good trait to an obnoxious extreme and interferes seriously with yourhappiness.

Self-rating encourages a great amount of prejudice. It consists of an overgeneral-ization, where you say that, “Because one or more of my traits seem inadequate, I rateas a totally inadequate person.” This means, in effect, that you feel prejudiced againstyourself for some of your behavior. In doing this, you tend also to feel prejudiced againstothers for their poor behavior—or for what you consider their inferior traits. You thuscan get yourself to feel bigoted about Blacks, Jews, Catholics, Italians, and various otherindividuals, some of whose traits you deplore.

Self-rating leads to necessitizing and compulsiveness. When you believe, “I must downmyself when I have a crummy trait or set of performances,” you concomitantly tendto feel, “I absolutely have to have good traits or performances,” and you feel compelledto act in certain “good” ways—even when you have little chance of consistently doing so.

RET Abolishes Most of the Human Ego 69

In these and many other ways attempting to have ego-strength or award yourselfself-esteem leads to distinctly poor results: meaning, interferences with human life andhappiness. To make matters even worse, as shown in recent RET writings, ego-ratingsor self-ratings have an intrinsic illegitimacy about them, in that accurate or “true” self-ratings or global ratings seem virtually impossible to make (Ellis, 1973, 1974, 1975; Ellisand Harper, 1975). For a global or total rating of an individual involves the followingkinds of contradictions and magical thinking:

As a person, you have almost innumerable traits—virtually all of which change fromday to day or year to year. How can any single global rating of you, therefore,meaningfully apply to all of you—including your constantly changing traits?

You exist as an ongoing process—an individual who has a past, present, and future.Any rating of your you-ness, therefore, would apply only to “you” at a single point intime and hardly to your ongoingness.

To give a rating to you totally, we would have to rate all of your traits, deeds, acts,and performances, and sometimes add or multiply them. But these characteristics getvalued differently in different cultures and at different times. And who can thereforelegitimately rate or weight them, except in a given culture at a given time, and to a verylimited degree?

If we did get a legitimate rating for every one of your past, present, and future traits,what kind of math would we employ to total them, divide by the number of traits, andget a valid global rating? Simple arithmetic ratings, with addition and subtraction?Algebraic ratings? Geometric ratings? Logarithmic ratings? What?

To rate “you” totally and accurately, we would have to know all your characteristics,or at least the “important” ones, and include them in our total? How could we everknow them all? How, for example, could we know all your thoughts? Your emotions?Your “good” and “bad” deeds? Your accomplishments? The states of your physiology?How indeed?

To say that you have no value or appear worthless involves several unprovable (andundisprovable) hypotheses: (1) that you have, innately, an essence of worthlessness; (2)that you never could possibly have any worth whatever; and (3) that you deservedamnation or eternal punishment for having the misfortune of worthlessness. Similarly,to say that you have great worth involves the unprovable hypotheses that (1) you justhappen to have superior worth; (2) you will always have it, no matter what you do;and (3) you deserve deification or eternal reward for having this boon of great worth.No empirical methods of confirming these magical hypotheses seem to exist.

When you posit worth or worthlessness, you almost inevitably get yourself intocircular, empty thinking. If you see yourself as having intrinsic value, you will tend tosee your traits as good, and will have a halo effect. Then you will falsely conclude thatbecause you have these good characteristics, you have intrinsic value. Similarly, if yousee yourself as having worthlessness, you will view your “good” traits as “bad,” and“prove” your hypothesized lack of value.

You can practically or pragmatically hold that “I rate as good because I exist.” Butthis stands as a tautological, unprovable hypothesis, in the same class with the equallyunprovable (and undisprovable) statement, “I rate as bad because I exist.” Assumingthat you have intrinsic value because you remain alive will work and help you feelhappier than if you assume the opposite. But philosophically, it remains an untenable

70 Albert Ellis

proposition. You might just as well say, “I have worth because God loves me,” or “I have no value because God (or the Devil) hates me.” These assumptions cause youto feel and act in certain ways; but they appear essentially unverifiable.

For reasons such as those just outlined, we can make the following conclusions: (1)You do seem to exist, or have aliveness, for a number of years, and you also appear tohave self-consciousness, or awareness of your existence. In this sense, you have a humanuniqueness, ongoingness, or, if you will, ego. (2) But what you normally call your “self”or your “totality” or your “personality” has a vague, almost indefinable quality; andyou cannot legitimately give it a single meaningful rating or report card. You thereforemay have good and bad traits—meaning, characteristics that help you or hinder youin your goals of survival and happiness and that enable you to live responsibly withothers—but you or your “self” really “aren’t” good or bad. (3) When you do give yourselfa global rating, or have “ego” in the usual sense of that term, you can help yourself invarious ways, but on the whole you almost always do much more harm than good, andyou preoccupy yourself with rather foolish, side-tracking goals. Almost all of what wecall emotional “disturbance” or neurotic “symptoms” directly or indirectly results fromyour globally rating yourself or other humans. (4) Therefore, you’d better resist thetendency to rate your “self” or your “essence” or your “totality” and had better stickwith only rating your deeds, traits, acts, characteristics, and performances. In otherwords, you had better abolish most of what we normally call your human ego andretain those parts of it which you can empirically verify and fairly accurately define.

More positively, the two main solutions to the problem of self-rating or “ego” consistof an inelegant and an elegant answer: The inelegant solution involves your making anarbitrary but practical definition or statement about yourself: “I accept my self as goodor rate myself as good because I exist.” This proposition, though unverifiable, will tendto provide you with feelings of self-esteem or self-confidence and has many advantagesand few disadvantages. It will almost always work; and will preclude your having feelingsof self-denigration or worthlessness as long as you live.

More elegantly, you can accept the proposition:

I do not have intrinsic worth or worthlessness, but merely aliveness. I’d better ratemy traits and acts but not my totality or “self.” I fully accept myself, in the sense thatI know I have aliveness and that I will probably live for a number of years, and Ichoose to survive and live as happily as possible, and with minimum needless pain.I only require this knowledge and this choice—and no other kind of self-rating.

Rational emotive therapy (RET) recommends this second, more elegant solution,since it appears more honest, more empirical, and leads to fewer philosophical diffi -culties than the inelegant one. But for those who insist on a self-rating, it recommendsthat they rate themselves as good merely because they live. That kind of “egoism” willget them into very little trouble!

References

Adler, A. (1974). Understanding human nature. New York: Fawcett World.Berne, E. (1964). Games people play. New York: Grove Press.

RET Abolishes Most of the Human Ego 71

Branden, N. (1971). Psychology of self-esteem. New York: Bantam.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Ellis, A. (1973). Growth through reason. Hollywood: Wilshire Books.Ellis, A. (1974). Humanistic psychotherapy: The rational–emotive approach. New York: Julian Press

& McGraw-Hill Paperbacks.Ellis, A. (1975). How to live with a “neurotic.” New York: Crown.Ellis, A., and Harper, R. A. (1975). A new guide to rational living. Englewood Cliffs, NJ: Prentice-

Hall and Hollywood: Wilshire Books.Freud, S. (1963). Collected papers. New York: Collier.Friedman, M. (1975). Rational behavior. Columbia, CL: University of South Carolina Press.Jung, C. (1954). The practice of psychotherapy. New York: Pantheon.Perls, F. (1969). Gestalt therapy verbatim. Lafayette, CA: Real People Press.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.Suzuki, D. T. (1956). Zen Buddhism. New York: Anchor Books.

72 Albert Ellis

5 Expanding the ABCs of RationalEmotive Therapy

INTRODUCTION

Will Ross

Psychologist Albert Ellis’ REBT and ABC theory are almost synonymous. Thus, changesin the model merit special attention and study.

The ABC model maps a relationship between emotional and behavioral triggeringevents and the content of thoughts that link to those events. The model is a criticalpath for separating emotionally toned irrational thinking from emotionally tonedrealistic thinking.

In “Expanding the ABCs of rational emotive therapy” (1985), Ellis updates his famousmodel and bases his refinements on his research and observations, the empiricalliterature, and suggestions by associates who studied and applied the model in workingwith clients. This ABC mnemonic gives a direction for positive change.

A casual observer might think that the ABC model of emotional disturbance waspart of REBT from the onset. In Albert Ellis’ earlier work on rational therapy, he assertedthat humans respond cognitively and behaviorally to aversive life events, and thatperception involves an interaction between thinking, emoting, and behaving. Ellis lateradded the ABC theory to map the process. In this mapping, A is the activating event,B the beliefs about the event, and C the emotional and behavioral consequences. Forexample, how a person defines and evaluates an event integrates with affect andbehavior. A person who views a job loss as merely undesirable predictably has differentemotional reactions compared with another who views job loss as a tragedy and believes,“This should not have happened. I can’t stand this. It’s awful. I’m disgraced.” Theformer view sounds realistic, whereas the latter is pregnant with surplus meaning andtypically carries distressful emotional consequences.

People who irrationally demand and insist that they, others, or the world should,ought, or must be a certain way are more likely to suffer from excess emotional distress.Ellis maintained that this musturbation was at the core of much human disturbance.He argued that disturbed individuals adhere to dogmatic, dysfunctional, demandingideologies that predispose them to filter reality through this core philosophy, promptingpredictable, negative results.

In “Expanding the ABCs of rational emotive therapy,” Ellis emphasizes howcognitions, including inferences and attributions, emotions, and behaviors, not only

influence each other, but may also set off an ABC response in other people. For example,in dysfunctional families and couples, the irrationality of one member can triggernegative cognitive, emotive, and behavioral responses from others, leading to escalatedconflicts.

Because of complex interactions between the various components of the ABC model,Ellis suggests that multiple cognitive, emotive, and behavioral methods are normallyrequired to help clients dislodge ingrained, distressful, demanding, emotive thinkingand behaving. Moreover, maintaining positive changes involves vigilance andreapplications of the REBT approach.

Let’s look at how the ABC model has special value today, and why it will continueto serve the mental health interests of others in the decades ahead.

Present and Future Use of the ABC Model

Albert Ellis’ contributions will continue through books, Internet websites, and otherlearning modalities the public can readily access. In dozens of books written for a layaudience, Albert Ellis has used the ABC model to give his readers insight into theirproblems and show them that, by altering their evaluation of events, they can overcometheir anxiety (Ellis, 1998), their rage (Ellis, 1994), their overeating (Ellis, Abrams, &Dengelegi, 1992), their unassertiveness (Ellis & Lange, 1995; Ellis & Powers, 2000), theirexcessive drinking (Ellis & Velten, 1992), their loneliness (Ellis, 1979), their low self-esteem (Ellis, 2005), their parenting problems (Ellis, Wolfe, & Moseley, 1966), theiroverspending (Ellis & Hunter, 1991), their sexual anxieties (Ellis, 1966), their careerdifficulties (Ellis, 1972), their age-related problems (Ellis & Velten, 1998), theirprocrastination (Ellis & Knaus, 1977), and their general unhappiness (Ellis, 1999). Ellis(Ellis & Abrams, 1994) has even used the ABC model to show lay readers that they cancope with a fatal illness and, indeed, that they can stubbornly refuse to make themselvesmiserable about anything—yes, anything! (Ellis, 1988).

Non-professional readers across the globe have learned to use the ABC model todevelop three kinds of insight (Ellis & Harper, 1997) that are central to the theory andpractice of REBT. First, they learn that activating events (A), along with their inflexibleand exaggerated beliefs (B), contribute to their disturbed feelings and behaviors (C).Second, they learn that activating events (As) in their childhood and adolescence mayhave contributed to their disturbed emotions (C), but it is primarily their lasting beliefs(B) that they cling to today that lead to their unhealthy negative emotions and theirself-defeating behaviors. And third, they learn that by hard work and consistent practicethey can replace their irrational beliefs (B) with rational alternatives to develop healthyemotions and self-helping behaviors (C).

Not content with helping them merely feel better, Albert Ellis has shown how theABC model can help his readers to get better and stay better. Ellis (2001) describesgetting better as:

(1) feeling better; (2) continuing to feel better; (3) experiencing fewer disturbingsymptoms (e.g., depression and needless inhibition); (4) seldom making yourdistress reoccur; (5) knowing how to reduce your distress when it reoccurs; (6)using this knowledge effectively; (7) being less likely to create disturbing reactions

74 Will Ross

when new adversities occur in your life; (8) being less likely to miserabilize yourself,even when unusually bad events arise.

(p. 4)

From my experience as the moderator of an online message board dedicated to self-helpers discussing REBT, and from correspondence I receive from other self-helpers,it appears that, despite its utility and apparent simplicity, many people misunderstandand misuse the ABC model. It seems, as Ellis is at pains to demonstrate in “Expandingthe ABCs of rational emotive therapy,” the ABC model is not as simple as it first appears.

That the ABC model is not as simple as it seems comes as no surprise to long-timestudents of REBT. Almost from REBT’s inception, Ellis (1962) has stressed theinterrelatedness of thoughts, feelings, and actions. In “Expanding the ABCs of rationalemotive therapy,” Ellis expands on his view that thoughts, feelings, and behaviors areintegrally related.

As Ellis points out, most of us are motivated by the goal of leading a long, healthy,and happy life. But our goals are often thwarted by circumstances (A). Although thesecircumstances are often external, they are also frequently internal—they can be ourown thoughts and beliefs (B) or our emotions and actions (C). Similarly, our beliefs(B) do not occur in isolation. They are influenced and at times triggered by the eventsin our life (A) and our emotional state (C). Likewise, our feelings and behaviors (C)are strongly influenced by what is happening in our lives (A) and our evaluation ofthose happenings (B). The tripartite relationship of A, B, and C is characterized by itsintegration and reciprocity. Rather than being linear, the ABC model is circular andbidirectional.

The complex nature of the ABC model becomes further complicated when we interactwith others. Frequently, the activating events (A) in other people’s lives can becomeactivating events in our own lives, setting off our own cognitive, emotional, andbehavioral responses. We respond similarly—with an ABC response—to the feelingsand actions (C) of others. And who among us has not responded—at A, B, and C—to the attitude (B) of another?

Does “Expanding the ABCs of rational emotive therapy” make the effective andefficient practice of REBT easier for the REBT autodidact? Yes and no. Self-helpers whoare willing and able to integrate the expanded model into their understanding ofemotional disturbance and dysfunctional behavior will be greatly rewarded. Byrecognizing the holistic nature of the full ABC model, they are more likely to includecognitive, emotive, and behavioral strategies to comprehensively dispute their irrationalbeliefs. Well-informed self-helpers who are fully aware of the all-embracing impact ofthe biased lessons of their upbringing, their biologically based tendency to upsetthemselves (Ellis, 1976), and their repeated irrational self-indoctrination will fight long,hard, and daily to reinforce new rational beliefs. Their reward will be not only intellectualinsight, but emotional insight. Their new rational beliefs will not only sound right,they’ll feel right.

On the other hand, self-helpers who become distracted and disoriented by the revisionmay lose sight of REBT’s primary activity—substituting irrational beliefs with theirrational alternatives in order to gain relief from unhealthy negative emotions and self-defeating behaviors.

Expanding the ABCs of RET 75

Although not all self-helpers will grasp the complex and holistic nature of the ABCmodel, most will not miss the central tenet of REBT: We feel the way we think. Humanbeings, more so than nonhuman animals, are thoughtful creatures. We can’t help butform an opinion about the events in our lives. And the quality of our lives is determinedto a large extent by the quality of our opinions. If our opinions are characterized byrigid demands and exaggerated negative evaluations, we will almost certainly experienceunhealthy negative emotions and act in ways that sabotage our goals. On the otherhand, if our opinions are flexible and moderate, our emotional and behavioral responseswill be healthy and self-helping.

“Expanding the ABCs of rational emotive therapy” adds new insight into what itmeans to be human. It provides therapists and their clients with a greater understandingof how we disturb ourselves and what we can do to overcome our disturbance. Butequally importantly, it shines an extra light for self-helpers in their quest to lead anethical, rewarding, and joyous life that is guided by reason and compassion.

I am pleased to have had the opportunity to introduce Albert Ellis’ article on theexpansion of the ABCs. I predict that the model will undergo continual refinements,as Ellis would have done were he alive today.

References

Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Carol Publishing Group.Ellis, A. (1966). Sex without guilt. North Hollywood, CA: Wilshire Book Company.Ellis, A. (1972). Executive leadership: The rational–emotive approach. New York: Institute for

Rational Emotive Therapy.Ellis, A. (1976). The biological basis of human irrationality. Journal of Individual Psychology (32),

145–168.Ellis, A. (1979). The intelligent woman’s guide to dating & mating. Secausus, NJ: Lyle Stuart.Ellis, A. (1985). Expanding the ABCs of rational emotive therapy. In M. J. Mahoney & A. Freeman

(Eds.), Cognition and psychotherapy (pp. 313–323). New York: Plenum Press.Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything, yes, anything!

Sydney, NSW: Pan Macmillan.Ellis, A. (1994). Anger: How to live with and without it. Sydney, NSW: Pan Macmillan.Ellis, A. (1998). How to control your anxiety before it controls you. New York: Kingston.Ellis, A. (1999). How to make yourself happy and remarkably less disturbable. Atascadero, CA:

Impact.Ellis, A. (2001). Feeling better, getting better, staying better: Profound self-help therapy for your

emotions. Atascadero, CA: Impact.Ellis, A. (2005). The myth of self esteem: How rational emotive behavior therapy can change your

life forever. Amherst, NY: Prometheus.Ellis, A., & Abrams, M. (1994). How to cope with a fatal illness: The rational management of death

and dying. New York: Barricade Books.Ellis, A., Abrams, M., & Dengelegi, L. (1992). The art and science of rational eating. Fort Lee, NJ:

Barricade.Ellis, A., & Harper, R. A. (1997). A guide to rational living. North Hollywood, CA: Wilshire Book

Company.Ellis, A., & Hunter, P. A. (1991). Why am I always broke? New York: Carol Publishing Group.Ellis, A., & Knaus, W. (1977). Overcoming procrastination. New York: Institute for Rational

Emotive Therapy. (Paperback ed., New York: New American Library).

76 Will Ross

Ellis, A., & Lange, A. (1995). How to keep people from pushing your buttons. New York: CarolPublishing Group.

Ellis, A., & Powers, M. G. (2000). The secret of overcoming verbal abuse. Chatsworth, CA: Wilshire.Ellis, A., & Velten, E. (1992). When AA doesn’t work for you: Rational steps to quitting alcohol.

Fort Lee, NJ: Barricade.Ellis, A., & Velten, E. (1998). Optimal ageing: Getting over getting older. Chicago, IL: Open Court.Ellis, A., Wolfe, J., & Moseley, S. (1966). How to raise an emotionally healthy, happy child. North

Hollywood, CA: Wilshire Book Company.

Expanding the ABCs of RET 77

EXPANDING THE ABCS OF RATIONAL EMOTIVE THERAPY

Albert Ellis

The ABCs of rational emotive therapy (RET) go back to its very beginnings in 1955,and I continually used them with my early rational emotive therapy clients (Ellis, 1962).When the Institute for Rational Emotive Therapy in New York founded its psychologicalclinic in 1968, cognitive homework forms were printed for its clients, and they addedD and E to the original ABCs (Ellis, 1968). As explained in Chapter 3 of HumanisticPsychotherapy: The Rational Emotive Approach (Ellis, 1973), A stands for Activatingevents, Activating experiences, Activities or Agents that people disturb themselves about.B stands for rational Beliefs or realistic Beliefs about the Activating events that tend tolead to a C, appropriate Consequences. iB stands for irrational Beliefs about theActivating events and tends to lead to IC, inappropriate Consequences (especially,emotional disturbances and dysfunctional behaviors). D stands for Disputing irrationalBeliefs—Detecting them, Discriminating them from rational Beliefs, and Debating them(Phadke, 1982). E stands for Effective rational Beliefs to replace people’s irrationalBeliefs and also for Effective appropriate emotions and Effective functional behaviorsto replace their disturbed emotions and dysfunctional behaviors.

The ABCs and the DEs have served RET very well over the last three decades andhave been copied in hundreds of books and articles and used with many thousands ofclients. In their original form, however, they are oversimplified and omit salientinformation about human disturbance and its treatment. Several RET writers have triedto expand them, with some degree of success (Dryden, 1984; Wessler & Wessler, 1980).In this chapter, I shall try to give my own version of how I think they can be usefullyexpanded.

Definitions of the ABCs of RET

Let me start with some definitions involved in the RET outlook on human personalityand behavior and particularly in its view of emotional disturbance. RET holds that humansare purposeful, or goal-seeking creatures (Adler, 1927, 1929; Ellis, 1973) and that theybring to A (Activating events or Activating experiences) general and specific goals (G).Almost always, their basic Goals are (1) to stay alive and (2) to be reasonably happy andfree from pain while alive. Their main subgoals as they strive for happiness include: tobe happy (a) when alone, by themselves, (b) when associating with other people, (c) whenengaging in intimate relationships with others, (d) when earning a living, and (e) when engaging in recreational activities (e.g., sports, study, art, music, drama).

Rational Beliefs (rBs) in RET mean those cognitions, ideas, and philosophies thataid and abet people’s fulfilling their basic or most important Goals.

Irrational Beliefs (iBs) are those cognitions, ideas, and philosophies that sabotageand block people’s fulfilling their basic or most important Goals.

Nonevaluative observations, descriptions, and cold cognitions are people’s observa-tions of what is going on (WIGO) in the world and in their own thoughts, feelings,and actions.

Evaluative assessments, inferences, expectations, and conclusions are people’sevaluations of what is going on (WIGO) in the world. These may be either:

• warm evaluations—involved with people’s desires, wishes, and preferences;• hot evaluations—involved with people’s absolutistic demands, commands, musts,

and necessities.

Activating Events or Activators (A) of Cognitive, Emotional andBehavioral Consequences (C)

The RET theory of personality and of personality disturbances begins with people’strying to fulfill their Goals (Gs) in some kind of environment and encountering a setof Activating events or Activators (As) that tend to help them achieve or block theseGoals. The As they encounter are normally present or current events or their ownthoughts, feelings, or behaviors; but they may be imbedded in (conscious or uncon -scious) memories or thoughts about past experiences. People are prone to seek out and respond to these As because of (a) their biological or genetic predispositions (b)their constitutional history, (c) their prior interpersonal and social learning, and (d) their innately predisposed and acquired habit patterns (Ellis, 1976, 1979).

As (Activating events) virtually never exist in a pure or monolithic state but almostalways interact with and partly include Bs and Cs. People bring themselves (their goals,thoughts, desires, and physiological propensities) to As. To some degree, therefore, theyare these Activating events and the As (their environments) are them. They can onlythink, emote, and behave in a material milieu—as Heidegger (1962) notes, only havetheir being-in-the-world; and they almost always exist in and relate to a social context—live with and relate to other humans. They are never, therefore, pure individuals, butare world-centered and social creatures.

Beliefs (Bs) About Activating Events (As)

According to RET theory, people have almost innumerable Beliefs (Bs)—or cognitions,thoughts, or ideas—about their Activating events (As); and these Bs importantly anddirectly tend to exert strong influences on their cognitive, emotional, and behavioralconsequences (Cs). Although As often seem directly to “cause” or contribute to Cs, thisis rarely true, because Bs normally serve as important mediators between As and Csand therefore more directly cause or create Cs (Bard, 1980; Beck, 1976; Ellis, 1957/1975,1962, 1968; Goldfried & Davison, 1976; Grieger & Boyd, 1980; Grieger & Grieger, 1982;Guidano & Liotti, 1983; Mahoney, 1974; Raimy, 1975; Walen, DiGuiseppe, & Wessler,1980; Wessler & Wessler, 1980). People largely bring their Beliefs to A; and theyprejudicially view or experience As in the light of these biased Beliefs (expectations,evaluations) and also in the light of their emotional Consequences (Cs) (desire, prefer-ences, wishes, motivations, tastes, disturbances). Therefore, humans virtually neverexperience A without B and C, but they also rarely experience B and C without A.

People’s Bs take many different forms because they have many kinds of cognition.In RET, however, we are mainly interested in their rational Beliefs (rBs), which wehypothesize lead to their self-helping behaviors, and in their irrational Beliefs (iBs),

Expanding the ABCs of RET 79

which we theorize lead to their self-defeating (and society-defeating) behaviors. We canlist some of their main (but not only) kinds of Bs as follows:

1. Non-evaluative observations, descriptions, and perceptions (cold cognitions).Examples:

“I see people are laughing.”

2. Positive preferential evaluations, inferences, and attributions (warm cognitions).Examples: “Because I prefer people to like me and they are laughing—”

“I see they are laughing with me.”“I see they think I am funny . . .”“I see that they like me.”“I like their laughing with me.”“Their liking me has real advantages, which I love.”

3. Negative preferential evaluations, inferences, and attributions (warm cognitions).Examples: “Because I prefer people not to dislike me and they are laughing—”

“I see they are laughing at me.”“I see they think I am stupid.”“I see that they don’t like me.”“I dislike their laughing at me.”“Their disliking me has real disadvantages, which I abhor.”

4. Positive absolutistic evaluations, inferences, and attributions (hot cognitions;irrational Beliefs). Examples: “Because people are laughing with me and presumablylike me and I must act competently and must win their approval—”

“I am a great, noble person!” (overgeneralization)“My life will be completely wonderful!” (overgeneralization)“The world is a totally marvelous place!” (overgeneralization)“I am certain that they will always laugh with me and that I will therefore alwaysbe a great person!” (certainty)“I deserve to have only fine and wonderful things happen to me!” (deservingnessand deification)“I deserve to go to heaven and be beautified forever!” (deservingness and extremedeification)

5. Negative absolutistic evaluation, inferences, and attributions (hot cognitions;irrational Beliefs). Examples: “Because people are laughing at me and presumablydislike me and because I must act competently and must win their approval—”

“I am an incompetent, rotten person!” (overgeneralization)“My life will be completely miserable!” (overgeneralization)“The world is a totally crummy place!” (overgeneralization)“I am certain that they will always laugh at me and that I will therefore always bea rotten person!” (certainty)“I deserve to have only bad and grim things happen to me!” (deservingness anddamnation)“I deserve to roast in hell for eternity!” (deservingness and extreme damnation)

80 Albert Ellis

6. Common cognitive derivatives of negative absolutistic evaluations (additional hotcognitions and irrational Beliefs). Disturbed ideas: “Because I must act competentlyand must win people’s approval, and because their laughing at me shows that Ihave acted incompetently and/or have lost their approval—”

“This is awful, horrible, and terrible!” (awfulizing, catastrophizing)“I can’t bear it, can’t stand it!” (I-can’t-stand-it-itis, discomfort anxiety, lowfrustration tolerance)“I am a thoroughly incompetent, inferior, and worthless person!” (self-downing,feelings of inadequacy)“I can’t change and become competent and lovable!” (hopelessness)“I deserve misery and punishment and will continue to bring it on myself!”(damnation)

7. Other common cognitive derivatives of negative absolutistic evaluations (additionalirrational Beliefs). Logical errors and unrealistic inferences: “Because I must actcompetently and must win people’s approval, and because their laughing at meshows that I have acted incompetently and/or have lost their approval—”

“I will always act incompetently and have significant people disapprove of me.”(overgeneralization)“I’m a total failure and completely unlovable.” (overgeneralization; all-or-nonethinking)“They know that I am no good and will always be incompetent.” (non sequitur;jumping to conclusions; mind reading)“They will keep laughing at me and will always despise me.” (non sequitur; jumpingto conclusions; fortune telling)“They only despise me and see nothing good in me.” (focusing on the negative;overgeneralization)“When they laugh with me and see me favorably that is because they are in a goodmood and do not see that I am fooling them” (disqualifying the positive; nonsequitur)“Their laughing at me and disliking me will make me lose my job and lose all myfriends.” (catastrophizing; magnification)“When I act well and get them to laugh with me that only shows that I canoccasionally be wrong; but that is unimportant compared to my great faults andstupidities.” (minimization; focusing on the negative)“I strongly feel that I am despicable and unlovable; and because my feeling is sostrong and consistent, this proves that I really am despicable and unlovable.”(emotional reasoning; circular reasoning, non sequitur)“I am a loser and a failure.” (labeling; overgeneralization)“They could only be laughing because of some foolish thing I have done and couldnot possibly be laughing for any other reason.” (personalizing; non sequitur;overgeneralization)“When I somehow get them to stop laughing at me or to laugh with me and likeme, I am really a phony who is acting better than I am and who will soon fall onmy face and show them what a despicable phony I am.” (phonyism; all-or-nothingthinking; overgeneralization)

Expanding the ABCs of RET 81

People can learn absolutistic evaluations, inferences, and conclusions (hot cognitionsand irrational Beliefs) from their parents, teachers, and others—for example, “I musthave good luck, but now that I have broken this mirror fate will bring me bad luckand that will be terrible!” But they probably learn these irrational Beliefs easily andrigidly retain them because they are born with a strong tendency to think irrationally.More important, people often learn family and cultural rational standards—for example,“It is preferable for me to treat others considerately”—and then overgeneralize,exaggerate, and turn these into irrational Beliefs—for example, “Because it is preferablefor me to treat others considerately I have to do so at all times, else I am a totallyunlovable, worthless person!” Even if all humans were reared utterly rationally, REThypothesizes that virtually all of them would often take their learned standards andtheir rational preferences and irrationally escalate them into absolutistic demands onthemselves, on others, and on the universe in which they live (Ellis, 1958, 1962, 1971,1973, 1976, 1984; Ellis & Grieger, 1977; Ellis & Whiteley, 1979).

Consequences (Cs) of Activating Events (As) and Beliefs (Bs) About As

Cs (cognitive, effective, and behavioral Consequences) follow from the interaction ofAs and Bs. We can say, mathematically, that A × B = C; but this formula may actuallybe too simple and we may require a more complex one adequately to express therelationship.

C is almost always significantly affected or influenced but not exactly caused by A—because humans naturally to some degree react to stimuli in their environments.Moreover, when A is powerful (e.g., a set of starvation conditions or an earthquake) ittends profoundly to affect C.

When C consists of emotional disturbance (e.g., severe feelings of anxiety, depression,hostility, self-deprecation, and self-pity), B usually (not always) mainly or more directlycreates or causes A. Even emotional disturbance, however, may at times stem frompowerful As—for example, from environmental disasters such as floods or wars. Andthey may follow from factors in the organism—hormonal or disease factors, forinstance—that are somewhat independent of or may actually cause Beliefs (Bs).

When strong or unusual As significantly contribute to or cause Cs or whenphysiological factors create Cs, they are usually accompanied by contributory Bs as well.Thus, if people are caught in an earthquake or if they experience powerful hormonalchanges and they therefore become depressed, their As and their physiological processesprobably are strongly influencing them to create irrational Beliefs (iBs), such as “Thisearthquake shouldn’t have occurred! Isn’t it awful! I can’t stand it.” These iBs, in turn,add to or help create their feelings of depression at C.

Cs (thoughts, feelings, and behavioral Consequences) that result from As and Bs arevirtually never pure or monolithic but also partially include and inevitably interact withA and B. Thus, if A is an obnoxious event (e.g., a job refusal) and B is first, a rationalBelief (e.g., “I hope I don’t get rejected for this job”) and second an irrational Belief(e.g., “I must have this job! I’m no good if I don’t get it”), C tends to be, first, a healthyfeeling of frustration and disappointment and, second, unhealthy feelings of severeanxiety, inadequacy, and depression.

82 Albert Ellis

So A × B = C. But people also bring feelings (as well as hopes, goals, and purposes)to A. They would not apply for a job unless they desired or favorably evaluated it. TheirA therefore, partially includes their C. The two, from the beginning, are related ratherthan completely disparate.

At the same time, people’s Beliefs (Bs) also partly or intrinsically relate to and includetheir As and their Cs. Thus, if they tell themselves at B, “I want to get a good job,” theypartly created the Activating event at A (going for a job interview) and they partly createtheir emotional and behavioral Consequence at C (feeling disappointed or depressedwhen they encounter a job rejection). Without their evaluating a job as good they wouldnot try for it nor have any particular feeling about being rejected.

A, B, and C, then, are all closely related and none of them tends to exist without theother two. Another way of stating this is to say—as some psychologists have recentlyclearly stated—that environments only exist for humans (who are quite different fromcertain other animals); and humans only exist in certain kinds of environments (e.g.,where temperatures are not too hot or too cold) and are part of their environment.Similarly, individuals usually exist in a society (rarely as hermits) and societies are onlycomposed of humans (and are quite different when composed, say, of ants or birds).As the systems theory devotees point out, individual family members exist in a familysystem and change as this system changes. But RET also points out that the familysystem is composed of individuals and may considerably change as one or more of theindividual family members change. In all these instances interaction is a key, probablyan essential, concept for understanding and effectively helping people to change.

Similarly with cognition, emotion, and behavior: Thinking as I pointed out in 1956(Ellis, 1958, 1962) importantly includes feeling and behaving. We largely think becausewe desire (a feeling) to survive (a behavior) and to be happy (a feeling). Emotingsignificantly includes thinking and behaving. We desire because we evaluate somethingas good or beneficial and, as we desire it, we move toward rather than away from it(act on it). Behaving to some degree usually involves thinking and emoting. We performan act because we think it is advisable for us to do it and because we concomitantlyfeel like doing it. Occasionally, as certain mystical-minded people claim, there may be100 percent pure thoughts, emotions, or behaviors which have no admixture of theother two processes. If so, they seem to be exceptionally rare. Even when theyoccasionally appear to occur when a person is tapped below the knee and gives a kneejerk reaction without any apparent concomitant thought or feeling—the originalresponse (the knee jerk) seems to be immediately followed by a thought (“Look at that!My knee jerked!”). So pure cognitions, emotions, and behaviors may exist, but rarelyduring waking or conscious states; and even when they are quickly followed by relatedcognitive–affective–behavioral states (Schwartz, 1982).

Humans uniquely are involved in cognitive processes and these often instigate,change, and combine their emotive and behavioral reactions. When they feel and behave,they almost always have some thoughts about their feelings and actions; and thesethoughts lead them to have other feelings and behaviors. Thus, when they feel sadabout, say, the loss of a loved one, they usually see or observe that they are sad, evaluatethis feeling in some way (e.g. “Isn’t it good that I am sad—this proves how much Ireally loved this person” or “Isn’t it bad that I am sad—this shows that I am lettingmyself be too deeply affected”).

Expanding the ABCs of RET 83

When people feel emotionally disturbed at C—that is, seriously anxious, depressed,self-downing, or hostile—they quite frequently view their symptoms absolutisticallyand awfulizingly and irrationally conclude, “I should not, must not be depressed. It’sawful to feel this way! I can’t stand it. What a fool I am for giving in to this feeling!”They then develop a secondary symptom—depression about their depression or anxietyabout their anxiety—that may be more severe and more incapacitating than theirprimary symptom and that may actually prevent them from understanding and workingagainst their primary disturbance. RET assumes, on theoretical grounds, that they oftenuse their cognition processes in this self-defeating manner—because this is a way theynaturally, easily tend to think—and it routinely looks for secondary symptoms andtreats them prior to or along with dealing with clients’ primary symptoms. Theobservable fact that people tend to spy on themselves and condemn themselves whenthey have primary symptoms, and thereby frequently develop crippling secondarysymptoms, tends to support the RET hypothesis that cognition is enormously importantin the development of neurotic feelings and behavior and that efficient psychotherapyhad better usually include considerable rational emotive methodology.

When people develop secondary feelings—for example, feel very anxious about theiranxiety, as agoraphobics tend to do—their secondary feelings strongly influence theircognitions and their behaviors. Thus they feel so strongly that they tend to conclude,“It really is awful that I am panicked about open spaces!” and they tend to behave moreself-defeatingly than ever (e.g. they withdraw all the more from open spaces). This againtends to demonstrate that A (Activating events), B (Beliefs), and C (Cognitive, emotive,and behavioral consequences) are interactive—that thoughts significantly affect feelingsand behaviors, that emotions significantly affect thoughts and feelings, and thatbehaviors significantly affect thoughts and feelings.

In RET, we are mainly concerned with people’s emotional disturbances—bothprimary and secondary disturbances. But the ABC theory also is a personality theorythat shows how people largely create their own normal or healthy (positive or negative)feelings and how they can change them if they wish to and work at doing so. I hopethat the formulations in this paper will add to the ABC theory and make it morecomplex and more useful.

References

Adler, A. (1927). Understanding human nature. New York: Greenberg.Adler, A. (1929). The science of living. New York: Greenberg.Bard, J. A. (1980). Rational emotive therapy in practice. Champaign, IL: Research Press.Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International

Universities Press.Dryden, W. (1984). Rational emotive therapy: Fundamentals and innovations. London: Croom

Heim.Ellis, A. (1958). Rational psychotherapy. Journal of General Psychology, 59, 35–39.Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart & Citadel Press.Ellis, A. (1968). Rational self-help form. New York: Institute for Rational Emotive Therapy.Ellis, A. (1971). Growth through reason. North Hollywood, CA: Wilshire.Ellis, A. (1973). Humanistic psychotherapy: The rational emotive approach. New York: Crown &

McGraw-Hill.

84 Albert Ellis

Ellis, A. (1975). How to live with a “neurotic” (Rev. ed.). New York: Crown. (Original workpublished 1957. North Hollywood, CA: Wilshire.)

Ellis, A. (1976). The biological basis of human irrationality. Journal of Individual Psychology, 32,145–168.

Ellis, A. (1979). The theory of rational emotive therapy. In A. Ellis & J. Whiteley (Eds.), Theoreticaland empirical foundations of rational emotive therapy. Monterey, CA: Brooks/Cole.

Ellis, A. (1984). Rational emotive therapy and cognitive behavior therapy. New York: Springer.Ellis, A., & Grieger, R. (Eds.) (1977). Handbook of rational emotive therapy. New York: Springer.Ellis, A., & Whiteley, J. M. (Eds.) (1979). Theoretical and empirical foundations of rational emotive

therapy. Monterey, CA: Brooks/Cole.Goldfried, M., & Davison, G. (1976). Clinical behavior therapy. New York: Holt, Rinehart &

Winston.Grieger, R., & Boyd, J. (1980). Rational emotive therapy: A skills-based approach. New York: Van

Nostrand Reinhold.Grieger, R., & Greiger, I. (1982). Cognition and emotional disorders. New York: Human Sciences

Press.Guidano, V. F., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York:

Guilford.Heidegger, M. (1962). Being and time. New York: Harper & Row.Mahoney, M. (1974). Cognition and behavior modification. Cambridge, MA: Ballinger.Phadke, K. M. (1982). Some innovations in RET theory and practice. Rational Living, 17(2),

25–30.Raimy, V. (1975). Misunderstandings of the self. San Francisco, CA: Jossey-Bass.Schwartz, R. M. (1982). Cognitive-behavior modification: A conceptual review. Clinical Psychology

Review, 2, 267–293.Walen, S. R., DiGiuseppe, R., & Wessler, R. L. (1980). A practitioner’s guide to rational emotive

therapy. New York: Oxford.Wessler, R., & Wessler, R. L. (1980). The principles and practice of rational emotive therapy. San

Francisco, CA: Jossey-Bass.

Expanding the ABCs of RET 85

6 Group Rational Emotive andCognitive Behavioral Therapy

INTRODUCTION

William Knaus

In “Group rational emotive and cognitive behavioral therapy,” Albert Ellis covers abroad range of topics. I’ll address Ellis’ group leadership style, REBT group structureand norms, group formats, and special group techniques.

Should this chapter be required reading for people who lead groups and those whoteach others to run them? This is a “must read” for clinical and counseling graduatestudents who are enrolled in group therapy and counseling courses. Teachers of grouptherapy will find a rich range of techniques on rational group therapy and how to usethem. Seasoned professionals are likely to find excellent ideas that apply to their grouppractices.

A Leader-Directed Group

In REBT group therapy, the goals include: (1) promote clear thinking, (2) engage groupmembers in problem-solving experiments, and (3) defuse needless emotional distress.Participants explore rational reality perspectives and test new actions in an acceptantatmosphere.

When Albert Ellis led a therapy group, you knew who was in charge. Ellis led byactively modeling rational thinking and behavior and by encouraging others to do thesame. He showed group members how to help themselves and others develop newperspectives, to challenge negative thinking, and to apply methods of scientific inquiryto solve human problems. Group members learned from the group leader, and fromother group members, about how to reconstruct experience in a rational light and howto advance their purposeful and constructive self-interests. Some helped teachthemselves by teaching others.

Although Ellis was active–directive in his approach, he would sit back when the groupwas operating effectively on its own. However, this consummate psychological educatorwould not stay silent for long. It was part of his style to actively interact with his grouptherapy clients.

Ellis thought that therapist forcefulness was a potent change factor. That remains anopen empirical question. There is no compelling evidence that a therapist who uses

REBT concepts in a confident, softer, interactive style would be less effective as an REBTgroup therapist. Indeed, under many group therapy conditions, I’ve observed a softerEllis. He appeared as capable and effective in that role; perhaps more so.

Group Structure and Norms

For decades, Ellis’ REBT heterogeneous groups met at the same time and place. Whengroup members left, others replaced them. Although the group structure remainedrelatively stable, the content changed with Ellis’ evolving philosophy and experimentallytested interventions. Thus, a returning member would see new faces in the group andfind new approaches mixed with familiar REBT concepts and views.

Groups will tend to develop norms and apply pressures toward conformity on those who deviate. In REBT groups, the norms were pre-established by the leader. Thiswas a setting for self-exploration, experimental actions, imitating rational models,overcoming self-disturbing thoughts, and testing new ideas through psychological“homework” assignments that later took place on the streets of life. Ellis-created groupnorms were accepted by the members.

Group members who wanted to bring up a problem would tell Ellis at the start ofthe group session. An efficient Ellis would ensure that each had an opportunity to present.Ellis and the group members would actively problem-solve. Each presenter got apsychological homework assignment. Ellis would record the assignments. The followingweek he’d check what each did and what resulted.

Although Ellis describes transference and countertransference in his article, andalthough he had preferences for some clients over others, the transference issue wasnot prominent in REBT groups. The group focused on solving problems rather thanon “personalities.” However, when a group member’s attitude and style were sociallyinappropriate, group members would point out why it was self-defeating. If the groupwas silent on such matters, Ellis would take the lead.

Group turnover in an Ellis-led group did not appear out of the ordinary; people withhighly challenging disorders, such as borderline personality disorder, appeared to usethe group to help support their sense of stability, and stuck with the group for longerperiods. Many became REBT experts and showed skill in helping others deal withproblems as they worked hard to apply rational principles to themselves.

REBT Group Models

If a basic REBT group therapy structure enables members to identify and correctmisconceptions and to practice helpful new ways of thinking and behaving, then thereare many venues to accomplish this result. Ellis ran different versions of groups. Theyranged from his classic 1.5-hour weekly groups, to marathon groups, to workshopgroups, to groups for therapists in training. He and some of his associates ran theme-centered groups, such as women’s groups, procrastination groups, and so forth.

SMART Recovery groups are based on the REBT model. This theme-centeredhomogeneous group has substance-abuse habits as a common reason for participating.

At first, the SMART group atmosphere appears friendlier and more welcoming thana group Albert Ellis might establish. However, both REBT group therapists and SMART

Group REBT and CBT 87

group leaders face the challenge of welcoming newcomers to the group. Ellis requireda new group member to attend at least one individual therapy session first. Many ofhis regular groups were comprised of his individual clients who were well prepared forthe group.

Both classic REBT and SMART groups use the ABCDE teaching model. The modelis useful to help members slow their conceptual tempo by (1) initially organizing whatthey are experiencing into A, Bs, and Cs; (2) analyzing the information that theyorganized; (3) questioning disputable beliefs; (4) promoting new effects. However, Ellisoutlined the ABCDE system after he initiated and established his therapeutic model.Thus, you could use the model without using the letters.

Albert Ellis and I shared a common vision for teaching rational principles to school-aged children to help them develop life skills to reduce the prevalence of emotionaldistress and disturbances, and promote higher levels of health, happiness, andaccomplishment. Rational emotive education (REE) followed our discussions on thistopic.

REE is a positive school mental health program I developed that uses interactivelearning modules to teach critical thinking and problem-solving. The REE group formatis similar to a classic REBT group in that it is a highly structured approach. However,this educative approach is a guided discovery experimental method with its owncurriculum. Leaders with different natural teaching styles adapt the method to theirstyle.

The learning modules are sequenced and start with “what are feelings and where dothey come from?” Subsequent lessons include building a solid self-concept, frustrationtolerance training, and learning and mistake-making.

Students are encouraged to test the concepts in the world outside of the classroomlaboratory and report back what they learned. This is an ongoing psychologicalhomework assignment for all members of the class.

In addition to learning to apply methods of scientific inquiry to meet spontaneouslyarising personal challenges, preliminary research shows statistically significant gradeincreases. How might it be explained? As classroom group members develop betterpersonal problem-solving skills, this leads to higher levels of self-confidence andfrustration tolerance that translates to a freeing of abilities that apply to getting highergrades. Many alternative explanations are possible, including teachers promoting amore acceptant learning environment as a result of applying the concepts to themselves.

This evidence-supported REE system now has 36 years of research with consistentlyaffirmative findings. It has been tested across diverse populations with no meaningfuldisconfirming evidence.

Were Albert Ellis’ famous Friday Night Workshops a form of group therapy? In thislarge group therapy forum, Albert Ellis asked for a volunteer(s) from the audience topresent a problem. He’d demonstrate how to address it. Next, he would invite theaudience to participate and comment. Thus, he included a group interaction featurein this large group process.

Although the Friday Night Workshop group was an informally organized group, itwas a group. This form of REBT group therapy may have efficacy for a subgroup ofparticipants who learn the methods and apply them.

88 William Knaus

REBT Group Techniques

A participant in an REBT therapy group would experience different cognitive, emotive,and behavioral interventions. The chapter describes a broad range of techniques. Let’slook at three.

Ellis’ signature cognitive system was disputing irrational belief systems (DIBS). Beforea person was in a group for very long, that person could be expected to know thissignature ABCDE approach and how to dispute irrational thinking. This signaturesystem differentiated between classic and REBT-oriented groups, and other grouptherapy formats.

Among the different emotive methods, rational emotive imagery (REI) is a techniquethat the founder of rational behavior therapy, psychiatrist Maxie Maultsby, contributedto the REBT system. Using his adaptation of REI, Ellis might ask a group membervividly to imagine an upsetting experience and recreate the feelings associated with theexperience. Ellis showed how to change the emotion from distress to disappointmentor other emotion that is appropriate to the situation. He’d suggest thinking new rationalthoughts about the situation and experiencing the results of this thinking. This approachhelped build confidence in the theory that by changing your thinking you can changehow you feel.

In vivo desensitization behavioral techniques are a stable part of a rational therapist’sarmamentarium. This behavioral exposure method is a gold standard for defusingphobias and panic, and appears to serve the same function in performance anxietysituations. Ellis occasionally provided opportunities for people to do shame attackingexercises within the group. A person with a public-speaking fear gets practice speakingup in the group and eventually feels less fearful. A person who fears looking foolishintentionally acts foolishly. Both individuals may feel less fearful following repeatexposure experiences.

REBT Group Therapy is Timeless

The REBT group model deserves a special place in the history of group therapy.However, is the approach currently relevant? Will it continue into the future?

For a significant subgroup of clients, group therapy is as effective as individualtherapy. REBT group therapy is an efficient and effective delivery system that can servicemore people and costs fewer dollars than individual counseling methods.

REBT group therapy, in its various forms, is for therapists who seek ways to efficientlydeliver therapeutic services to diverse groups to relieve human suffering. Thus, therewill continue to be a bright future for group therapy leaders who follow evidence-basedREBT practices and have the will, interest, and ability to innovate as Albert Ellis did.

Group REBT and CBT 89

GROUP RATIONAL EMOTIVE AND COGNITIVEBEHAVIORAL THERAPY

Albert Ellis

Abstract

The theory of rational emotive therapy (RET) and of cognitive behavioral therapy(CBT) is briefly explained and is applied to group therapy. It is shown how RET andCBT therapy groups deal with transference, countertransference, levels of groupintervention, process versus content orientation, identifying underlying group processthemes, here-and-now activation, working with difficult group members, activity levelsof therapist and group members, and other group problems. Although they particularlyconcentrate on people’s tendencies to construct and create their own “emotional”difficulties, RET and CBT group procedures fully acknowledge the interactions ofhuman thoughts, feelings, and actions and active-directively employ a variety ofcognitive, emotive, and behavioral group therapy techniques.

History and Theory of Group Rational Emotive and CognitiveBehavioral Therapy

Cognitive behavioral group therapy may have been unsystematically used by some ofthe early group therapists, but it probably formally started in 1959, when I formed my first rational emotive therapy (RET) group. I originated RET in 1955 by weldingsome principles of philosophy and of cognitive psychological behavior therapy (Ellis,1957a, 1957b, 1962). RET, unlike most other therapies, assumes that people do not getdisturbed by their early or later environments but that they have strong innatepredispositions to disturb themselves consciously and unconsciously.

They largely (not completely) do this by taking their preferential goals, standards,and values—which they mainly learn from their families and their culture—andchanging them into explicit and tacit “shoulds,” “oughts,” “musts,” and commands tothemselves, others, and the universe. Moreover, they forcefully, rigidly, and emotionallysubscribe to many grandiose, absolutist musts that fall under three main headings: (1)“I (ego) absolutely must perform important tasks well and be approved by significantothers or else I am an inadequate, worthless person!” (2) “You (other people) musttreat me considerately and kindly or else you are a rotten person!” (3) “Conditions (myenvironment) must give me what I need and never greatly deprive me or else the worldis a terrible place!”

When people needlessly disturb themselves, they produce dysfunctional thoughts(e.g., obsessions), feelings (e.g., panic, depression, and self-hatred), and behaviors (e.g.,phobias and compulsions). Fortunately, they are also born with strong self-changingand self-tendencies. So they can almost always, by themselves and with therapy, lookat their powerful musturbatory thinking, emoting, and acting and can work—yes,work—to change them.

To effect personal change, rational emotive therapy (RET), and a number of formsof other cognitive behavioral therapy (CBT) that followed it in the 1960s and 1970s,

use a wide variety of cognitive, emotive, and behavioral methods to help clients change(Beck, 1976; Ellis, 1962, 1985, 1988; Ellis & Dryden, 1987, 1990, 1991, Ellis & Grieger,1977, 1986; Greenberg & Safran, 1987; Grieger & Boyd, 1980; Mahoney, 1991;McMullin, 1986; Meichenbaum, 1977; Walen, DiGiuseppe, & Wessler, 1980). When Ifirst started to do RET group therapy in 1959, I used almost all the cognitive behavioralmethods that I used previously with my individual clients (Ellis, 1962, 1982, 1990), andother group cognitive behavioral therapists largely followed similar procedures (Lazarus,1968; Rose, 1980; Upper & Ross, 1980). During the last 25 years, a number of outcome studies have been done in which an RET or CBT group and a control group weretreated for various emotional problems and most of these studies showed that RET orCBT group therapy produced significant therapeutic results (Ellis, 1982, 1990; Lyons& Woods, 1991).

RET groups consist of open small groups, time-limited groups for specific kinds ofproblems (e.g., overeating or procrastination), 1- to 2-day rational encountermarathons, 9-hour large group intensives and public demonstrations of real therapysessions. In this article, I shall mainly describe the workings of the small open groups.I lead five of these groups every week at the Institute for Rational Emotive Therapy inNew York. Each group has a maximum of ten regular members, male and female adults,usually from 25 to 60 years of age, almost all of whom are fairly severe neurotic andborderline personalities. Many of them have had prior therapy at the Institute’s clinicor with other therapists, and only a few disruptive individuals are screened at the clinic,rejected for group work, and asked instead to have individual therapy for a while beforethey are allowed to join a group.

As the group’s leader, I usually start off each session by reading the homeworkassignment of one of the members, to discover whether he has done it and, if not, whynot. If he hasn’t, his possible low frustration tolerance (“I shouldn’t have to go to anytrouble to change!”) and his possible self-downing (“I must do the assignment well orI would be no good!”) are explored and disputed, both by me and, it is hoped, byseveral other group members who actively learn how to dispute their own self-defeatingcognitions by forcefully disputing those of the other members.

When a member’s homework is reviewed, and perhaps reassigned, she is free to bringup her other main problem for this week, to report progress, to discuss her goals andplans, to reveal something she has not yet told the group, or to talk about anything shewants to discuss. When she brings up an emotional-behavioral problem—such asanxiety, depression, self-denigration, shyness, procrastination, or addiction—the othermembers and I look for her dogmatic shoulds and for their main attributional andinferential derivations—e.g., “Because I’m not performing as well as I absolutely should,it’s awful, I can’t stand it, I’m an inadequate person, and I’ll always fail and never becompetent and loveable.” Whenever we find that she has one or several of thesedysfunctional core beliefs, we directly and vigorously dispute it, show her how to fightit herself, give her a counteracting rational coping statement with which to replace it,and often suggest an emotive and behavioral homework assignment to use during theweek to dispute it and to decondition herself (preferably in vivo) to her self-sabotagingcognitions, feelings, and actions.

If this same member keeps bringing up her problems week after week and if sheexpresses herself about the others’ problems—as she is steadily encouraged to do by

Group REBT and CBT 91

myself and the other members—she will keep revealing herself, keep putting herself onthe line, keep risking objections from others, keep talking others out of their irrational-ities, and keep working against her self-sabotaging tendencies in between sessions. It ishoped that she will thereby, after a year or so, achieve at least the beginning of aprofound cognitive-emotive behavioral change and acquire, as a sort of second nature,a new, semiautomatic way of responding in a self-helpful instead of a self-destructivemanner to the difficulties and crises that are likely to occur to her and her loved onesfor the rest of her life.

Because RET practitioners almost always employ a good many thinking, feeling, andaction-oriented methods with their individual clients, these are also used with groupmembers, either during the group sessions or as homework assignments. Cognitively,these techniques include active disputing of dysfunctional beliefs, using coping self-statements, “referencing” (making a list and thinking about) the disadvantages ofcompulsions and addictions, reframing, imaging, the filling out of RET self-help reports,modeling, problem solving, using RET bibliotherapy books and pamphlets, cognitivedistraction methods, and using recordings of their own sessions and of other RET talks.Emotively, RET techniques include very forceful coping self-statements, rational emotiveimagery, shame-attacking exercises, role playing, using stories, fables, and analogies,the giving of unconditional acceptance by the therapist, and using honor and rationalhumorous songs. Behaviorally, RET techniques include in vivo desensitization, rein-forcements and penalties, response prevention, relapse prevention, and skill training(Ellis, 1962, 1985, 1988; Ellis & Dryden, 1987, 1991; Ellis & Harper, 1975; Maultsby &Ellis, 1974).

Since the 1960s, RET has included group exercises, which are given regularly to allthe members of the group during the sessions themselves or in special ten-hourmarathons that are held for each group at least once a year (Ellis, 1969, 1990). Theseencounter-type exercises are included to make sure that the sessions are not too didacticand are more activity arousing; to bring out behaviors and feelings that members mightnot voluntarily display; to create risk-taking experiments; to push the members intorelating more closely to each other; to encourage group cohesiveness; to enhance groupsupportiveness; and to foster some highly emotional reactions in the actual presenceof group members.

Process of Group Therapy

Transference

RET views transference, first, as overgeneralization. Thus, because group members wereonce treated badly by their father and treated well by their mother, they may tend toput other males in the same category as their father and may feel hostile or indifferentto men and warm toward women. They may—or may not!—also react to the therapistas a father/mother figure and to other group members as siblings. These are over-generalizations but, unless they are extreme, may not lead to major emotional andbehavioral problems. Because RET is not preoccupied with this kind of transference(as psychoanalysis is), it does not obsessively look for it and consequently invariably“find” it.

92 Albert Ellis

When normal, nondisturbed transference reactions are observed in my groups, Ilargely ignore them; but when they escalate into disturbed reactions in the group itselfor in the members’ personal lives, the other group members and I pounce on thesereactions and show members how destructive they are and how to minimize or eliminatethem. Thus, if Miriam avoids sex–love relationships because her father kept rejectingher, we show her that all males are not her father, that she can sensibly choose a differenttype of man, and that if she makes a mistake and picks a partner who is as unlovingas her father, that doesn’t prove that she needs his love, that she is worthless withoutit, nor that she’ll never be able to have a long-term loving relationship. The group andI dispute her disturbed overgeneralizing but not her normal generalizing.

Similarly, if a male member deifies or devil-ifies me, the group leader, whom he seesas a loved or hated father figure, we point out his disturbed transference reaction, showhim the distorted thinking that lies behind it, and encourage him to adopt lessdysfunctional thoughts, feelings, and behaviors. Or if a woman fights with female groupmembers just as she fights with her sisters, we point out her transference and theirrational cognitions behind it and show how to break her rigid women-are-all-like-my-sisters reaction.

The term transference is also used in psychotherapy to denote the close relationshipthat usually develops between clients and their therapist. I find that such relationshipfactors do develop in my group but not nearly as intensely as they do with my individualtherapy clients. However, RET actively espouses the therapist’s giving all clients closeattention, showing real interest in helping them solve their problems, and—especially—giving what Rogers (1961) calls unconditional positive regard and what I (Ellis, 1973,1985, 1988; Ellis & Harper, 1975) have called unconditional acceptance. So, althoughI am quite often confrontational with group members, I try to show them that I reallycare about helping them; that I will work hard during every session to hear, understand,empathize with them; that I have great faith that they can, despite their handicaps,change; that I can poke fun at their irrationalities without laughing at them; and that Itotally accept them as fallible humans, no matter how badly they often think and behave.I also use my person in my group sessions, and consequently am informal, take risks,reveal some of my own feelings, tell jokes and stories, and generally am myself as wellas a group leader. In this way, I hope to model flexible, involved, nondisturbedbehaviors.

Countertransference

I frankly like and dislike some of my group members more than I do others, and Iespecially tend to dislike members who often come late, act unhelpfully to others, failto do their homework, and behave disruptively in group. When I see that I am feelingthis way, I look for my possibly telling myself, “They shouldn’t be the way they are andare rotten shits for being that way!” I immediately dispute that damning belief andconvince myself, “They should act the poor way that they do, because it is their natureto act that way right now. I dislike what they do but I can accept them with theirunfortunate doings.”

By ridding myself of my demands of my clients, I largely (not completely) overcomemy negative countertransference, and I am able to deal with “bad” group members

Group REBT and CBT 93

more therapeutically. I sometimes, depending on their vulnerability, confront themand honestly tell them, “I try not to hate you, but I really do dislike some of yourbehavior, and I hope for my sake, the group’s sake, and especially your own sake, thatyou change it.” When I find myself prejudicially favoring some members of my groups,I convince myself that they are not gods or goddesses, and I make an effort to keepliking them personally without unduly favoring them in group.

Levels of Intervention

Most of my interventions take place with each individual member as he is telling abouthis homework, talking about his progress and lack of progress, presenting new problemsor returning to old ones. I speak directly to him, ask questions, make suggestions, ferretout and dispute his dysfunctional thoughts, feelings, and behaviors, and suggesthomework. My interventions are mainly about his personal problems, especially as theyrelate to his outside life, but also as they relate to what he says and doesn’t say in group.

I often show the member that her actions (and inactions) in group may well replicateher out-of-group behaviors. Thus, I may say, “Johanna, you speak so low here that wecan hardly hear what you say. Do you act the same way in social groups? If so, whatare you telling yourself to make yourself speak so low?”

My interpersonal interventions include commenting on how group members reactto each other; noting that they often fail to speak up to or interact with other members;noting their warm or hostile reactions to others, and encouraging the former andquestioning the latter; giving them relationship exercises to do during group sessions;having a personal interaction with some of the members; and, especially, pointing outthat their group interactions may indicate how they sabotage themselves in their outsiderelationships and giving them some in-group skill training that may help them relatebetter outside the group.

My intervention within the group as a whole largely consists of giving all of themcognitive, emotive, and behavioral exercises to be done in the group; giving them allthe same homework exercise (such as a shame-attacking exercise) to do before the nextgroup session; giving them a brief lecture on one of the main theories or practices ofRET; explaining to them some of the group procedures and discussing with them theadvantages and disadvantages of these procedures.

Most of the time, as noted above, I intervene on the individual level, but wheninterpersonal problems (such as two or more members failing to relate to each other)arise, I often intervene with duos or trios. I also plan in advance group-as-a-wholeinterventions or else spontaneously promote them as I deem them advisable (or as thespirit moves me!).

Process versus Content Orientation

By far most of the time in my group sessions I use an individualized content focus. Iassume that the group members come to therapy to work on their own individualproblems and mainly to help themselves in their outside lives. Therefore, I induce them largely to talk about the things that are bothering them in their self-oriented and

94 Albert Ellis

inter-personal relationships and, with the help of the group, try to show them exactlyhow they are needlessly upsetting themselves in their daily lives and what they do tothink, feel, and act more healthfully.

The purpose of RET group (and individual) therapy is to show clients how they arenot only assessing and blaming what they do but also damning themselves for doing it;how they are also evaluating others’ behavior and damning these others for “bad”behavior; and how they are noting environmental difficulties and (externally andinternally) whining about them instead of constructively trying to change or avoid them.Therefore, whenever members bring up any undue or exaggerated upsetness, and feelinappropriately panicked, depressed, self-hating, and enraged (instead of appropriatelysad, disappointed, and frustrated), the other members and I focus on showing themwhat they are doing to upset themselves needlessly, how to stop doing this, and howto plan and act on achieving a more fulfilling, happier existence. When they are, as itwere, on stage in the group almost everyone focuses on them and their difficulties andtries to help them overcome these in the group itself and in the outside world. So amajority of the time in each session is spent on dealing with individual members’problems.

When, however, any of the members display a problem that particularly relates tothe group itself, this is dealt with specifically and group-wise. Thus, if a member keepscoming quite late to group or is absent a good deal of the time, I (or other members)raise this as an issue, and we speak to this member about it. We determine, for instance,why he comes late, what core philosophies encourage him to do so, how he defeatshimself and the other members by his lateness, how he can change, and what kind ofhomework assignment in this respect he will agree to carry out. At the same time, thegeneral problem of lateness—as it relates to group and also as it relates to the members’outside life—is also frequently discussed, and it is brought out how latecoming isdisadvantageous to other members and how it interferes with a cohesive and beneficialgroup process.

Similarly, if a group member only speaks about her own problems and doesn’t takethe risk of speaking to the others, disputing their self-defeating thoughts and behaviors,and making some suitable suggestions for their change, she is questioned about thisand shown how and why she is blocking herself in group, and how and why she probablybehaves similarly in her outside life. But the general problem of members being tooreserved (or, sometimes, too talkative) in group is also raised, and various membersare encouraged to speak up about this problem and to give their ideas about how thegroup process would be more effective if virtually all the members talked upappropriately, rather than said too much or too little.

Also, if the group as a whole seems to be functioning poorly—for example, beingdull, uninterested, apathetic, or overly boisterous—I raise this issue, encourage a generaldiscussion of it, get members to suggest alternative ways for the group to act, and checkon these suggestions later to see if they are being implemented. Once in a while I goover some of the general principles of RET—such as the theory that people largelyupset themselves rather than get upset—to make sure that the members as a wholeunderstand these principles and are better prepared to use them during the sessionsand in their outside affairs.

Group REBT and CBT 95

Identifying Underlying Group Process Themes

I keep looking for cues, for underlying issues that are not being handled well in group,such as members only being interested in their own problems and not those of othermembers; their not being alert during the group; their being too negative to othermembers who may not be working at helping themselves improve; their giving onlypractical advice to other members rather than disputing their irrational philosophies;their being too sociable rather than being serious about their own and others problems;their not staying for the after-group session, which immediately follows each regularsession and is led by one of my assistant therapists after I leave the regular group session;and their subgrouping or rudely interrupting others when the group is going on. Iusually intervene soon after these issues arise; and raise the issue either with theindividual who is interfering with the group process or with the group as a whole.

My strategy of intervention is usually direct and often confrontational. Thus, I maysay, “Jim, you always bring up your own problems in group and seem to have notrouble speaking about them. But I rarely hear you say anything to the other groupmembers about their problems. When you sit there silently while the rest of us arespeaking to one of the group members, I suspect that you are saying quite a lot toyourself that you are not saying to the group. Am I right about this? And if I am, whatare you telling yourself to stop yourself from speaking up to the others?”

A more general intervention will also usually be direct and will go something likethis: “Several of you recently are not doing your agreed-upon homework or are doingit very sloppily. Let’s discuss this right now and see if I am observing this correctly and,if so, what can we do about it to see that the homework assignments are more usefuland to arrange that you tend to follow them more often and more thoroughly.”

If the group process is going well and the members are fairly consistently bringingup and working on their problems, both in the group and outside the group, myinterventions are relatively few in regard to the group process. But I frequently question,challenge, advise, and confront members about their individual problems. I am an activeteacher, confronter, persuader, encourager, and homework suggester, and I usually talkmore than any of the other members during a given session. I try to make sure, however,that I do not give long lectures or hold the floor too long. My questions and comments,therefore, are usually frequent but brief. Although I can easily run one of my groupsby myself, without any assistance, because the Institute for Rational Emotive Therapyin New York is a training institute, and because we want all of our trainees to be ableto lead a group by themselves, I am usually assisted by one of our trainees, a Fellow ofthe Institute, who is with me and the group for the first hour and a half of each sessionand who takes over the group by himself or herself for the after-group, which consistsof another 45 minutes. The assistant leader is also trained to make active–directiveinterventions but not to hog the floor at any one time and to encourage the othermembers to keep making interventions, too. A few of the members in each group usuallybecome quite vocal and adept at making interventions, but I tactfully correct them ifthey seem to go too far off base. The assistant leader and I particularly go after thenonintervening members and keep encouraging them to speak up more and moreabout other people’s problems. If they are recalcitrant or resistant in this respect wefairly often give them the assignment of speaking up a minimum of three times in eachsession about others’ issues.

96 Albert Ellis

Here-and-Now Activation

I keep showing the members how their behavior in group often—but by no meansalways—mirrors their behaviors and problems outside the group. Thus, if one memberspeaks sharply to another member, I may say, “Mary, you seem to be angry right nowat Joan. Are you just objecting to her behavior, with which you may disagree? Or areyou, as I seem to hear you doing, damning her for exhibiting that behavior?” If Maryacknowledges her anger at Joan, I (and the other group members) may then ask, “Whatare you telling yourself right now to make yourself angry? What is your Jehovian demandon Joan?” If Mary denies that she is angrily carping at Joan, I may then ask the rest ofthe group, “What do you think and feel about Mary’s reaction to Joan? Am I justinventing her anger or do you sense it, too?”

We then get the group reactions of Mary; and if the group agrees that she probablyis quite angry at Joan, we go back to the question: “What are you telling yourself rightnow to make yourself angry?” The others and I will also try to get Mary to see that inher outside life she is probably more often angry than she acknowledges and that sheis telling herself the same kind of demanding things about those at whom she is angryas she is now telling herself about Joan in the group.

Again, if Ted only offers practical advice to the other members and never helps themto see and to dispute their self-defeating philosophies by which they are upsettingthemselves, I, my assistant therapist, or one of the group members may say to him,“Look, Ted, you just ignored Harold’s perfectionist demands that are making him refuseto work on the novel he is trying to write, and, instead, you only offered him somepractical advice on how to take a writing course. You often seem to do this same kindof thing in group. Now isn’t it likely that in your own life you don’t look for and disputeyour irrational beliefs and that you only look for practical ways of your acting betterwith those irrationalities, so that you do not have to tackle them and give them up?”

Working with Difficult Group Members

One kind of difficult group member is the one who interferes with the group process,such as Mel, who interrupted others, indicated that they were pretty worthless for notchanging their ways, and often monopolized the group. Other members and I pointedthis out to him several times, but be persisted in his disruptive behavior. So we insistedthat he stop and consider what he was telling himself when, for example, he interruptedothers.

His main musturbatory beliefs appeared to be (1) “I must get in what I have to sayimmediately or else I might lose it and never get to say it and that would be awful!”and (2) “If I don’t make a more brilliant statement to the group than any of the othersmake, I am an inadequate person and I might as well shut my mouth and say nothingat all!” We showed Mel how to dispute and change these ideas to preferences but notnecessities that he speak and be heard and that he make fine contributions in group;and we gave him the homework assignment of watching his interrupting tendenciesand forcing himself for a while to speak up in group only after he had given some othermember the choice of speaking up first. After several more sessions he had distinctlyimproved his interruptive tendencies and reported that he was doing the same thingin his group participations and individual conversations outside the group.

Group REBT and CBT 97

Another difficult type of member is the one who rarely completes the homeworkassignment he has agreed to do or else completes it occasionally and sloppily. I (andother group members) then ask him to look for the irrational ideas that he is overtlyor tacitly holding to block his doing these assignments, such as: “It’s hard to do thisgoddamned assignment; in fact it’s too hard and it shouldn’t be that hard! I can getaway with improving myself without doing it, even though other people have to dotheir homework to change. Screw it, I won’t do it.” We keep after this member to lookat the beliefs he holds to block his doing the homework; to make a list of thedisadvantages of not doing it and to go over this list at least five times every day; todispute his irrational beliefs strongly and forcefully to keep telling himself rationalcoping self-statements in their stead; to use rational emotive imagery to make himselffeel sorry and displeased but not horrified and rebellious about having to do thehomework; to reinforce himself whenever he does it and perhaps to also penalize himselfwhen he doesn’t do it; and to use other suitable methods of RET to undercut hisdysfunctional thinking, feeling, and behaving about doing the homework.

Another type of difficult group member is the one who is overly passive, polite, andnonparticipative. I usually do nothing about such a member until she has been in thegroup for several weeks and has had a chance to acclimate herself to its procedures andto some of the principles of RET. But then I directly question her about her passivityand lack of participation; if she acknowledges these behaviors, I encourage her to lookat her blocking thoughts and actively to dispute them. Thus, one member, Josephine,kept telling herself, just before she thought of speaking up in group, “What if I saysomething stupid! They’ll all laugh at me! I’ll look like an utter fool! “They are allbrighter than I and know much better how to use RET, I’ll never be able to say somethingintelligent or to be helpful to the other group members. I’d better quit group and onlygo for individual therapy where it is much easier for me to speak up, because I onlyhave to talk about myself and don’t have to help others with their problems.”

In this case, the group and I did what we usually do: we disputed Josephine’sempirically false or unrealistic attributions and inferences and showed that she wouldn’tnecessarily say something stupid; that the group might well not laugh at her even if shedid; that all the members were not necessarily brighter than she; and that if she kepttrying, she most probably would be able to say something intelligent and to be helpfulto the other members. As usual, however, we went beyond this—as we almost alwaysdo in RET—by showing Josephine, more elegantly, that even if the worst happened,even if she did say something stupid, even if she was laughed at by the group, even ifall the others were brighter than she, and even if she never was able to say somethingintelligent or to be helpful to the others, she still would never be an inadequate orrotten person but would only be a person who was now behaving badly and who couldalways accept and respect herself while remaining unenthusiastic about some of hertraits and behaviors.

This is what we usually try to achieve with difficult clients who continually downand damn themselves and who steadily therefore feel depressed, panicked, andworthless: the group members and I persist in showing her that we accept her as afallible human; and that she can learn to consistently do the same for herself. RETgroup therapy (like RET individual therapy) is particularly oriented toward helping allclients give themselves unconditional self-acceptance: that is, to reject and to try to

98 Albert Ellis

change many of their dysfunctional behaviors but always—yes, always!—to acceptthemselves as humans. Yes, whether or not they perform well and whether or not theyare approved or loved by significant others.

This is one of the cardinal views of RET; and one that often—though, or course, notalways—works well with difficult clients. This aspect of RET is probably more effectivein group than in individual therapy, because all the members of the group are taughtto accept both themselves and others unconditionally: so that when an arrant self-denigrator comes to group she is not only accepted unconditionally by the therapist(who is especially trained to do this kind of accepting) but is almost always also acceptedby the other group members, thus encouraging and abetting her unconditionallyaccepting herself.

Activity Level of Therapist and Group Members

In cognitive behavioral therapy in general and in RET group therapy in particular theactivity level of the therapist tends to be high. I am a teacher, who often shows myclients how they upset themselves and what they can do to change, but I also keepencouraging and pushing them to change. The romantic view in therapy is that if clientsare provided with a trusting and accepting atmosphere they have considerable abilityto change and will healthfully use this ability to get themselves to grow and develop. Itake the more realistic view that they can but that they often won’t choose to modifytheir thoughts, feelings, and behaviors unless I actively and directively push them todo so. Consequently, as noted previously in this article, I speak more than any othergroup member during each session; I purposely and purposively lead the group in“healthy” rather than “unhealthy” directions; and I keep each session going in anorganized, no-nonsense, presumably efficient way. I try to make sure that no one isneglected during each session; that no one monopolizes the group; and that sidetrackinginto chit chat, empty discussion, bombast, endless philosophizing, and other modes ofproblem avoidance is minimized.

As leader, I try to maximize honest revealing of feelings, cutting through defen-siveness, getting to members’ core dysfunctional philosophies, disputing of thesephilosophies, accepting of present discomfort, and the carrying out of difficult in-groupand out-of-group experiential and behavioral assignments. For example, I (or the othermembers) may suggest that Sam, an unusually shy person, go around the room andstart a conversation with every member who is present. I will then direct Sam to doso, will encourage him to keep going around the room, will ask him about his feelingsas he does so, will get him to look at what he is thinking to create these feelings, willask the other members for their reactions to his overtures, and will lead a generaldiscussion on what has just transpired and how Sam and the other members can gainfrom this exercise. Once, when we did this exercise with an exceptionally shy man henot only became much more active in group from that session onward but also, forthe first time in his life, began to approach people in his neighborhood bar, wherepreviously he had always waited for them to approach him. He noted that my activelypersuading him and the group to participate in this encouraging exercise was a realturning point in his life.

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Conclusion

Cognitive behavioral therapy is probably indigenous to most group therapy becausewhen several people regularly meet together with a leader in order to work on theirpsychological problems, they almost always talk about their thoughts, feelings, andbehaviors and try to help each other change their cognitions, emotions, and actions.Moreover, they usually give advice to each other, show how others’ behavior had betterbe changed outside the group, and check to see if their homework suggestions are actuallybeing carried out. Again, they normally interact with each other in the group itself,comment on each other’s in-group behaviors, and give themselves practice in changingsome of their dysfunctional interactions.

Even then, when a therapy group tries to follow a somewhat narrow theory ofpsychotherapy—for example, a psychoanalytic or a Jungian orientation—it tends to bemuch-wider ranging in its actions than it is in its theory, and often takes on a surprisinglyeclectic approach (Bennett, 1984; Yalom, 1985). The advantage of rational emotive andcognitive behavioral group therapy is that they very consciously deal with members aspeople who think, feel, and act, who get disturbed (or make themselves disturbed) inall three interacting ways, and who therefore had better consciously see how they largelyconstruct their dysfunctioning and how they can reconstruct their patterns of living(Ellis, 1991; Ellis & Dryden, 1990, 1991).

RET and CBT group therapy, moreover, in principle accepts the fact that humansare social animals and live interpersonally and in groups. It is therefore desirable, thoughnot absolutely necessary, that they work out their cognitive behavioral problems togetheras well as in individual therapy. Group work also covers a wide variety of goals andproblems. Thus, therapy groups may be homogeneous (e.g., all the members involvedin skill training, alcoholism, or procrastination) or may be heterogeneous (e.g., includeall kinds of disturbed people). While one specific type of treatment is unlikely to behelpful to members of all these different kinds of groups, cognitive behavioral therapyincludes so many different kinds of techniques that it can fairly easily be adapted toaim at any kind of group process. With the use of RET and CBT group treatment, moreopportunity for learning positive and unlearning self-defeating behavior is providedthen one therapist can provide in individual therapy and than one group therapist canprovide in a one-sided form of group process (Ellis, 1962, 1982, 1990; Lazarus, 1968).

From a research standpoint, cognitive behavioral group therapy offers uniquepossibilities for exploring the effectiveness of group techniques. For RET and CBTalways include many specific procedures—such as the distorting of dysfunctionalattitudes, the disclosure of “shameful” feelings, and the assigning of homeworkactivities—and each of these methods can be used and not used in controlledexperiments, to determine how effective or ineffective each of them is in different kindsof groups and settings. If enough of this kind of experimentation is done, the widevariety of methods now used in CBT may eventually be pared down to relatively feweffective ones.

For reasons such as these, then, I think that RET and CBT group therapy will, first,become more popular as the years ago by and, second, be increasingly incorporatedinto or merged with many of the other modes of group treatment. At the same time,cognitive behavioral group therapy (and individual therapy) will continue to change

100 Albert Ellis

as the entire field of psychotherapy grows and develops. Some of its more popularpresent-day methods will wane and other (including not-yet invented) methods willflourish. Like its sister, behavior therapy, and unlike many of today’s other treatmentmethods, CBT favors scientific experimentation and already has led to literally hundredsof controlled studies (Hodon, 1983; Lyons & Woods, 1991). If this characteristiccontinues, as I predict it will, RET and CBT will continue to change and develop.

References

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: InternationalUniversities Press.

Bennett, T. S. (1984). Group psychotherapy. In R. J. Corsini (Ed.), Encyclopedia of psychology(Vol. 2, pp. 81–82). New York: Waley.

Ellis, A. (1957a). How to live with a neurotic: At home and at work (Rev. ed.). (Original workpublished 1957. North Hollywood, CA: Wilshire.)

Ellis, A. (1957b). Outcome of employing three techniques of psychotherapy. Journal of ClinicalPsychology, 11, 344–350.

Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel.Ellis, A. (1969). A weekend of rational encounter. Rational Living, 2, 1–8. (Reprinted in A. Ellis

& W. Dryden, The practice of rational emotive therapy (pp. 180–191). 1987. New York: Springer.)Ellis, A. (1973). Humanistic psychotherapy: The rational emotive approach. New York: McGraw-

Hill.Ellis, A. (1982). Rational-emotive group therapy. In G. M. Gazda (Ed.), Basic approaches to group

psychotherapy and group counseling (3rd ed.; pp. 381–412). Springfield, IL: Thomas.Ellis, A. (1985). Overcoming resistance: Rational emotive therapy with difficult clients. New York:

Springer.Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything—yes, anything!

Secaucus, NJ: Lyle Stuart.Ellis A. (1990). Rational emotive therapy. In I. L. Kutash & A. Wolf (Eds.), The group

psychotherapist’s handbook (pp. 298–315). New York: Columbia.Ellis, A. (1991). The revised ABCs of rational emotive therapy. In J. Zeig (Ed.), The evolution of

psychotherapy (Vol. 2). New York: Brunner/Mazel.Ellis, A., & Dryden, W. (1987). The practice of rational emotive therapy. New York: Springer.Ellis, A., & Dryden, W. (1990). The essential Albert Ellis. New York: Springer.Ellis, A., & Dryden, W. (1991). A dialogue with Albert Ellis: Against dogma. Stony Stratford, Milton

Keynes, England: Open University Press.Ellis, A., & Grieger, R. (Eds.) (1977). Handbook of rational-emotive therapy (Vol. I). New York:

Springer.Ellis, A., & Grieger, R. (1986). Handbook of rational-emotive therapy (Vol. 2). New York: Springer.Ellis, A., & Harper, R. A. (1975). A new guide to rational living. North Hollywood, CA: Wilshire

Books.Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy. New York: Guilford.Grieger, R., & Boyd, J. (1980). Rational emotive therapy: A skills-based approach. New York: Van

Nostrand Reinhold.Hodon, S. D. (1983). Cognitive therapy and research. New York: Plenum.Lazarus, A. A. (1968). Behavior therapy in groups. In G. M. Gazda (Ed.), Basic approaches to

psychotherapy and group counseling. Springfield, IL: Thomas.Lyons, I. C., & Woods, P. J. (1991). The efficacy of rational emotive therapy: A quantitative

review of the outcome research. Clinical Psychology Review, 11, 337–369.

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Mahoney, M. J. (1991). Human change processes. New York: Basic Books.Maultsby, M. C., Jr., & Ellis, A. (1974). Techniques for using rational emotive imagery. New York:

Institute for Rational Emotive Therapy.McMullin, R. (1986). Handbook of cognitive therapy techniques. New York: Norton.Meichenbaum, D. (1977). Cognitive-behavior modification. New York: Plenum.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton-Mifflin.Rose, S. D. (1980). Casebook in group therapy. A behavior-cognitive approach. Englewood Cliffs,

NJ: Prentice-Hall.Upper, D., & Ross, S. (Eds.) (1980). Behavioral group therapy. Champaign, IL: Research Press.Walen, S. R., DiGiuseppe, R., & Wessler, R. L. (1980). A practitioner’s guide to rational emotive

therapy. New York: Oxford.Yalom, I. D. (1985). The theory and practice of group psychotherapy (3rd ed.). New York: Basic

Books.

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7 The Biological Basis of HumanIrrationality

INTRODUCTION

Robert E. Alberti

We may not want to admit that we are often—damned often—irrational, self-defeating,socially immoral, and otherwise destructive of ourselves and others.

(Albert Ellis, 1998)

It seems almost irrational to attempt to introduce a work of Albert Ellis (AE) to readersof an anthology of his work. What introduction could be needed? Still, perhaps thereis value in an effort to put this underappreciated paper into the context of its importancetoday.

As everyone familiar with AE or his work knows, he was a revolutionary, a maverick,a groundbreaker. He demonstrated those qualities time and again in the 30-plus yearsI knew him as a friend and colleague, and as editor and publisher of five of his books.Like the man himself, this thesis was revolutionary—groundbreaking, controversial—when it was presented at American Psychiatric Association (APA) in 1975.

Al’s paper, “The biological basis of human irrationality,” consists of severalcomponents:

• his thesis—that irrationality is so pervasive among human beings as to be almostcertainly biological in origin;

• some 259 examples of human irrationality, grouped into 27 categories, to illustratethe concept;

• his commentary, of particular interest to practitioners, on the irrationality ofpsychotherapist beliefs and behavior;

• evidence for the biological roots of these widely varied failings, presented in 19arguments; and

• his conclusion: “Although we can as yet make no certain or unqualified claim forthe biological basis of human irrationality, such a claim now has enough evidencebehind it to merit serious consideration.”

Consider, for a moment, the social zeitgeist at the time—1975. Vietnam had torn usasunder for more than a decade. Young adults were flaunting newly asserted sexual

freedom. Civil rights for people of color and “liberation” for women were front-pagetopics. Psychotherapy and personal development were popular topics for cocktail partyconversation. Perhaps most importantly for this discussion, the prevailing view inpsychology and psychotherapy—notably in humanistic and behavioral circles—wasthat of tabula rasa. Nurture was all. In fact, AE got more than a little static for thisexposition on the importance of nature. Yet with each passing year, the best sciencesubstantiates his view.

When AE characterized “irrationality” as a biological dimension of the humanorganism, he obviously did not have access to the remarkable results of research on thebrain in the decades since. Neuroscience was in its infancy, and had barely begun todiscover the knowledge about brain function and structure we take for granted today.We’ve learned a lot in 35 years.

Given the state of the art in 1975 in brain science, psychophysiology, and the levelof understanding of human genetic makeup, this piece was prescient. Yet, it was notas much about “biology” as about “universality.” AE saw the human irrationalities hecatalogs here as virtually universal, ubiquitous, claiming that, “irrationalities exist inall societies and in virtually all humans in those societies.” (It’s not clear how muchcross-cultural work had been done on this concept by 1975. Although REBTpractitioners function today throughout Western Europe, in Asia, South America, andSouth Africa, AE offered no citations to the literature to support his “all societies”assertion, and there appears to be no evidence in the literature of the time to documentthat claim to universality.)

If, however, irrationality is really a universal genetic predisposition, why wouldn’twe just accept it as part of the human condition, rather than something to be overcomein psychotherapy? What price do we pay for our irrationality? Sometimes great, some-times small. What about patterns? To be irrational all the time is clearly pathological,but if one is irrational only occasionally, that’s human, is it not? QED.

We may interpret biological universality differently today, of course. Neuroscientistshave shown us that much of our thinking and behavior is indeed genetically determined,hence “biological.” Researchers have, for example, identified a genetically inducedserotonin transporter that, present in greater or lesser degree in the brain, makes itmore or less likely that each of us will act to avoid harm in our lives (Hamer & Copeland,1998). It doesn’t take much imagination to identify some of the ways that gene-basedanxiety—harm avoidance—may produce thoughts and/or behavior we—or Al—mightcharacterize as irrational.

In his recent popular treatise on “what makes us human,” Michael Gazzaniga,University of California at Santa Barbara psychologist noted for his split-brain studies,has observed that, “our social nature is deeply rooted in our biology not simply in ourcognitive theories about ourselves . . . It turns out that no matter how many rationalideas a person is able to come up with, emotion is necessary to make the decision”(Gazzaniga, 2008). Although all emotion is not irrational (sometimes, but not always),it is instructive to contrast the two concepts.

In what might be viewed as the “ultimate” confirmation of AE’s 1975 thesis, a decadelater, DSM III-R offered this concise statement: “all psychological processes, normaland abnormal, depend on brain function” (American Psychiatric Association, 1987).Obvious perhaps, but a key link in the chain from “biological basis” to irrationality.

104 Robert E. Alberti

It’s not hard to construct a long list of client issues that may be biological in origin.Depression, anxiety disorders, eating disorders, antisocial behavior, chronic pain—thelist goes on. How effectively we deal with such therapeutic challenges depends largelyon our diagnostic effectiveness and awareness of the likely etiology of the condition.Adequate consideration given to the client’s biological/genetic propensities is crucial.The big plus today, of course, is that we know now that the plasticity of the humanbrain allows us to change our “biology” by changing our thinking and/or our behavior.Go REBT!

Some readers will find this paper a reiteration of familiar REBT themes. Others maydiscover an AE they didn’t know before. Old or new, there’s something here foreveryone. Practitioners in particular—and in turn their clients—will benefit fromheeding AE’s 14 cautions for “psychotherapeutic helpers.” Those warning signs ofirrational therapist behavior—needing client approval; focusing on helping clients feelbetter; confusing correlation with cause and effect; ignoring the biological bases of humanbehavior; and the others—are as important today as the day they were delivered to askeptical audience at APA.

Find yourself in that list? Read on!

References

American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders(3rd ed.—rev.). Washington, DC: Author.

Ellis, A. (1979). The biological basis of human irrationality: A reply to McBurnett and La Pointe.Journal of Individual Psychology, 35(1), 111–116.

Gazzaniga, M. S. (2008). Human: The science behind what makes us unique (p. 112). New York:HarperCollins.

Hamer, D., and Copeland, P. (1998). Living with our genes: Why they matter more than you think(pp. 79–80). New York: Doubleday.

The Biological Basis of Human Irrationality 105

THE BIOLOGICAL BASIS OF HUMANIRRATIONALITY1

Albert Ellis

Before stating any hypothesis about the basis of human irrationality, definitions of themain terms employed in this article, biological basis and irrationality, are presented.Biological basis means that a characteristic or trait has distinctly innate (as well asdistinctly acquired) origins—that it partly arises from the organism’s natural, easypredisposition to behave in certain stipulated ways. This does not mean that thischaracteristic or trait has a purely instinctive basis, that it cannot undergo major change,nor that the organism would perish, or at least live in abject misery, without it. It simplymeans that, because of its genetic and/or congenital nature, an individual easily developsthis trait and has a difficult time modifying or eliminating it.

Irrationality means any thought, emotion, or behavior that leads to self-defeating orself-destructive consequences—that significantly interferes with the survival andhappiness of the organism. More specifically, irrational behavior usually has severalaspects: (1) The individual believes, often devoutly, that it accords with the tenets ofreality although in some important respect it really does not; (2) people who adhereto it significantly denigrate or refuse to accept themselves; (3) it interferes with theirgetting along satisfactorily with members of their primary social groups; (4) it seriouslyblocks their achieving the kind of interpersonal relations that they would like to achieve;(5) it hinders their working gainfully and joyfully at some kind of productive labor;and (6) it interferes with their own best interests in other important respects (Ellis,1974, 1975a; Maultsby, 1975).

The major hypothesis of this article is as follows: Humans ubiquitously and constantlyact irrationally in many important respects. Just about all of them do so during all theirlives, though some considerably more than others. There is, therefore, some reason tobelieve that they do so naturally and easily, often against the teachings of their familiesand their culture, frequently against their own conscious wish and determination.Although modifiable to a considerable extent, their irrational tendencies seem largelyineradicable and intrinsically go with their biological (as well as sociological) nature.

This hypothesis goes back to the statements of some of the earliest historians andphilosophers and has received adequate documentation over the years by a host ofauthorities (Frazer, 1959; Hoffer, 1951; Levi-Strauss, 1970; Pitkin, 1932; Rachleff, 1973.)Ellis (1962) and Parker (1973) agree with this documentation. The latter noted that“most people are self-destructive, they behave in ways that are obviously against theirbest interest” (Parker, 1973, p. 3). Nonetheless, whenever I address an audience ofpsychologists or psychotherapists and point out this fairly obvious conclusion and stateor imply that it arises out of the biological tendency of humans to behave irrationally,a great many dyed-in-the-wool environmentalists almost always rise with horror, foamat the mouth, and call me a traitor to objective, scientific thinking.

1 Adapted from The Biological Basis of Human Irrationality. Paper presented at the annual meeting of theAmerican Psychological Association, New Orleans, September 1975.

Hence this paper. Following is a brief summary—for the amount of supportingevidence assumes overwhelming proportions and would literally take many volumesto summarize properly—of some of the main reasons behind the thesis that humanirrationality roots itself in basic human nature. The summary is confined to outliningthe multiplicity of major irrationalities and to giving some of the logical and psycho-logical reasons why it seems almost certain that they have biological origins.

First are listed some of the outstanding irrationalities among the thousands collectedover the years. The following manifestations of human behavior certainly do not appearcompletely irrational—for they also have (as what behavior has not?) some distinctadvantages. Some people, such as those Eric Hoffer calls true believers, will even holdthat many of them bring about much more good than harm. Almost any reasonablyobjective observer of human affairs, however, will probably tend to agree that theyinclude a large amount of foolishness, unreality, and danger to our survival or happiness.

1. Custom and Conformity Irrationalities(a) Outdated and rigid customs.(b) Ever-changing, expensive fashions.(c) Fads and popular crazes.(d) Customs involving royalty and nobility.(e) Customs involving holidays and festivals.(f) Customary gifts and presentations.(g) Customs in connection with social affairs and dating.(h) Courtship, marriage, and wedding customs.(i) Puberty rites, Bar Mitzvahs, etc.(j) Academic rites and rituals.(k) Hazings of schools, fraternal organizations, etc.(l) Religious rites and rituals.(m) Customs and rites regarding scientific papers.(n) Circumcision conventions and rituals.(o) Rigid rules of etiquette and manners.(p) Blue laws.(q) Strong disposition to obey authority, even when it makes unreasonable

demands.2. Ego-Related Irrationalities

(a) Tendency to deify oneself.(b) Dire need to have superiority over others.(c) Tendency to give oneself a global, total, all-inclusive rating.(d) Tendency to desperately seek for status.(e) Tendency to prove oneself rather than enjoy oneself.(f) Tendency to believe that one’s value as a human depends on one’s competency

at an important performance or group of important performances.(g) Tendency to value oneself or devalue oneself in regard to the performances

of one’s family.(h) Tendency to value or devalue oneself in regard to the performances or status

of one’s school, neighborhood group, community, state, or country.(i) Tendency to denigrate or devil-ify oneself.

The Biological Basis of Human Irrationality 107

3. Prejudice-Related Irrationalities(a) Strong prejudice.(b) Dogma.(c) Racial prejudice.(d) Sex prejudice.(e) Political prejudice.(f) Social and class prejudice.(g) Religious prejudice.(h) Appearance prejudice

4. Common Kinds of Illogical Thinking(a) Overgeneralization.(b) Magnification and exaggeration.(c) Use of non sequiturs.(d) Strong belief in anti-empirical statements.(e) Strong belief in absolutes.(f) Gullibility and over-suggestibility.(g) Strong belief in contradictory statements.(h) Strong belief in Utopianism.(i) Strong adherence to unreality.(j) Strong belief in unprovable statements.(k) Shortsightedness.(l) Overcautiousness.(m) Giving up one extreme statement and going to the other extreme.(n) Strong belief in shoulds, oughts, and musts.(o) The dire need for certainty.(p) Wishful thinking.(q) Lack of self-perspective.(r) Difficulty of learning.(s) Difficulty of unlearning and relearning.(t) Deep conviction that because one believes something strongly it must have

objective reality and truth.(u) Conviction that because one had better respect the rights of others to hold

beliefs different from one’s own, their beliefs have truth.5. Experiential and Feeling Irrationalities

(a) Strong conviction that because one experiences something deeply and “fs” itstruth, it must have objective reality and truth.

(b) Strong conviction that the more intensely one experiences something themore objective reality and truth it has.

(c) Strong conviction that because one authentically and honestly feels somethingit must have objective truth and reality.

(d) Strong conviction that all authentic and deeply experienced feelings representlegitimate and healthy feelings.

(e) Strong conviction that when a powerful irrational thought or feeling exists (e.g., a mystical feeling that one understands everything in the universe)it constitutes a deeper, more important, and objectively truer idea or emotionthan a rational thought or feeling.

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6. Habit-Making Irrationalities(a) The acquiring of nonproductive and self-defeating habits easily and uncon -

sciously.(b) The automatic retention and persistence of nonproductive and self-defeating

habits in spite of one’s conscious awareness of their irrationality.(c) Failure to follow up on conscious determination and resolution to break a

self-defeating habit.(d) Inventing rationalizations and excuses for not giving up a self-defeating habit.(e) Backsliding into self-defeating habits after one has temporarily overcome

them.7. Addictions to Self-Defeating Behaviors

(a) Addiction to overeating.(b) Addiction to smoking.(c) Addiction to alcohol.(d) Addiction to drugs.(e) Addiction to tranquilizers and other medicines.(f) Addiction to work, at the expense of greater enjoyments.(g) Addiction to approval and love.

8. Neurotic and Psychotic Symptoms(a) Overweening and disruptive anxiety.(b) Depression and despair.(c) Hostility and rage.(d) Extreme feelings of self-downing and hurt.(e) Extreme feelings of self-pity.(f) Childish grandiosity.(g) Refusal to accept reality.(h) Paranoid thinking.(i) Delusions.(j) Hallucinations.(k) Psychopathy.(l) Mania.(m) Extreme withdrawal or catatonia.

9. Religious Irrationalities(a) Devout faith unfounded in fact.(b) Slavish adherence to religious dogma.(c) Deep conviction that a supernatural force must exist.(d) Deep conviction that a supernatural force or entity has special, personal

interest in oneself.(e) Deep conviction in Heaven and Hell.(f) Religious bigotry.(g) Persecution of other religious groups.(h) Wars between religious groups.(i) Scrupulous adherence to religious rules, rites, and taboos.(j) Religious antisexuality and extreme puritanism.(k) Religious conviction that all pleasure equates with sin.(l) Complete conviction that some deity will heed one’s prayers.

The Biological Basis of Human Irrationality 109

(m) Absolute conviction that one has a spirit or soul entirely divorced from one’smaterial body.

(n) Absolute conviction that one’s soul will live forever.(o) Absolute conviction that no kind of superhuman force can possibly exist.

10. Population Irrationalities(a) Population explosion in many parts of the world.(b) Lack of education in contraceptive methods.(c) Families having more children than they can afford to support.(d) Restrictions on birth control and abortion for those who want to use them.(e) Some nations deliberately fomenting a population explosion.

11. Health Irrationalities(a) Air pollution.(b) Noise pollution.(c) Drug advertising and promotion.(d) Poor health education.(e) Harmful food additives.(f) Uncontrolled medical costs and resultant poor health facilities.(g) Unnecessary surgical procedures.(h) Avoidance of physicians and dentists by people requiring diagnostic and

medical procedures.(i) Neglect of medical research.

12. Acceptance of Unreality(a) Widespread acceptance and following of silly myths.(b) Widespread acceptance and following of extreme romanticism.(c) Widespread acceptance and following of foolish, inhumane fairy tales.(d) Widespread acceptance and following of unrealistic movies.(e) Widespread acceptance and following of unrealistic radio and TV dramas and

serials.(f) Widespread Pollyannaism.(g) Widespread Utopianism.

13. Political Irrationalities(a) Wars.(b) Undeclared wars and cold wars.(c) Civil wars.(d) Political corruption and graft.(e) Foolish election and voting procedures.(f) Political riots.(g) Terrorism.(h) Political persecution and torture.(i) Extreme patriotism.(j) Extreme nationalism.(k) Constant international bickering.(l) Sabotaging of attempts at world collaboration and cooperation.

14. Economic Irrationalities(a) Ecological waste and pollution.(b) Poor use and development of natural resources.

110 Albert Ellis

(c) Economic boycotts and wars.(d) Needless employer–employee bickering and strikes.(e) Extreme profiteering.(f) Business bribery, corruption, and theft.(g) Extreme economic status-seeking.(h) Union bribery, corruption, and graft.(i) Misleading and false advertising.(k) Foolish restrictions on business and labor.(l) Inefficiency in business and industry.(m) Addiction to foolish economic customs.(n) Inequitable and ineffectual taxes.(o) Gambling abuses.(p) Foolish consumerism (e.g., expensive dog funerals, funerals, weddings, alcohol

consumption, etc).(q) Production of shoddy materials.(r) Lack of intelligent consumerism information and control.(s) Inefficiently run welfare system.(t) Inefficiently run government agencies.

15. Avoidance Irrationalities(a) Procrastination.(b) Complete avoidance of important things; inertia.(c) Refusal to face important realities.(d) Oversleeping and avoidance of sufficient sleep.(e) Refusal to get sufficient exercise.(f) Lack of thought and preparation for the future.(g) Needless suicide.

16. Dependency Irrationalities(a) Need for approval and love of others.(b) Need for authority figures to run one’s life.(c) Need for superhuman gods and devils.(d) Need for parents when one has matured chronologically.(e) Need for a helper, guru, or therapist.(f) Need for a hero.(g) Need for magical solutions to problems.

17. Hostility Irrationalities(a) Condemning people totally because some of their acts appear undesirable or

unfair.(b) Demanding that people absolutely must do what one would like them to do

and damning them when they don’t.(c) Setting up perfectionistic standards and insisting that people have to follow

them.(d) Commanding that justice and fairness must exist in the universe and making

oneself quite incensed when they do not.(e) Insisting that hassles and difficulties must not exist and that life turns

absolutely awful when they do.

The Biological Basis of Human Irrationality 111

(f) Disliking unfortunate conditions and not merely working to overcome orremove them but over-rebelliously hating the entire system that producedthem and the people involved in this system.

(g) Remembering past injustices and vindictively feuding against the perpetratorsof these injustices forever.

(h) Remembering past injustices in gory detail and obsessing about them andtheir perpetrators forever.

18. Excitement-Seeking Irrationalities(a) Continuing to gamble compulsively in spite of serious losses.(b) Leading a carousing, playboy or playgirl type of life at the expense of other

more solid enjoyments.(c) Engaging in dangerous sports or pastimes, such as mountain climbing,

hunting, or skiing under hazardous conditions.(d) Deliberately having sex without taking contraceptive or venereal disease

precautions.(e) Engaging in college hazing or other pranks of a hazardous nature.(f) Turning in false fire alarms.(g) Dangerous forms of dueling.(h) Engaging in stealing or homicide for excitement-seeking.(i) Engaging in serious forms of brawling, fighting, rioting, or warring for

excitement seeking.(j) Engaging in cruel sports, such as clubbing baby seals or cockfighting for

excitement-seeking.19. Magic-Related Irrationalities

(a) Devout belief in magic, sorcery, witchcraft, etc.(b) Devout belief in astrology.(c) Devout belief in phrenology.(d) Devout belief in mediums and ghosts.(e) Devout belief in talking horses and other talking animals.(f) Devout belief in extrasensory perception.(g) Devout belief in demons and exorcism.(h) Devout belief in the power of prayer.(i) Devout belief in superhuman entities and gods.(k) Devout belief in damnation and salvation.(l) Devout belief that the universe really cares for humans.(m) Devout belief that some force in the universe spies on humans and regulates

their lives on the principle of deservingness and nondeservingness.(n) Devout belief in the unity and union of all things in the world.(o) Devout belief in immortality.

20. Immorality Irrationalities(a) Engaging in immoral and criminal acts opposed to one’s own strong moral

code.(b) Engaging in immoral or criminal acts for which one has a good chance of

getting apprehended and severely penalized.(c) Engaging in immoral and criminal acts when one would have a good chance

of gaining more with less effort at noncriminal pursuits.

112 Albert Ellis

(d) Firmly believing that virtually no chance exists of one’s getting caught atimmoral and criminal acts when a good chance actually exists.

(e) Strong belief that because a good chance exists that one can get away with asingle criminal act a good chance also exists that one can get away withrepeated acts of that nature.

(f) Stubborn refusal to amend one’s immoral ways even though one suffers severepenalties for engaging in them.

(g) Engaging in criminal, assaultive, or homicidal acts without any real sense ofbehaving irresponsibly or immorally.

21. Irrationalities Related to Low Frustration Tolerance or Short-Range Hedonism(a) Strong insistence on going mainly or only for the pleasures of the moment

instead of for those of the present and future.(b) Obsession with immediate gratifications, whatever the cost.(c) Whining and strongly pitying oneself when one finds it necessary to surrender

short-range pleasures for other gains.(d) Ignoring the dangers inherent in going for immediate pleasures.(e) Striving for ease and comfort rather than for greater satisfactions that require

some temporary discomfort.(f) Refusing to work against a harmful addiction because of the immediate

discomfort of giving it up.(g) Refusing to continue with a beneficial or satisfying program of activity because

one views its onerous aspects as too hard and devoutly believes that they shouldnot exist.

(h) Champing at the bit impatiently when one has to wait for or work for asatisfying condition to occur.

(i) Procrastinating about doing activities that one knows would turn outbeneficially and that one has promised oneself to do.

(j) Significantly contributing to the consumption of a scarce commodity that oneknows one will very much want in the future.

22. Defensive Irrationalities(a) Rationalizing about one’s poor behavior instead of trying to honestly admit

it and correct it.(b) Denying that one has behaved poorly or stupidly when one clearly has.(c) Avoiding facing some of one’s serious problems and sweeping them under

the rug.(d) Unconsciously repressing some of one’s “shameful” acts because one will

savagely condemn oneself if one consciously admits them.(e) Projecting one’s poor behavior onto others and contending that they did it,

in order to deny responsibility for it.(f) Using the sour grapes mechanism, and claiming that you really do not

want something you do want, when you find it too difficult to face your notgetting it.

(g) Identifying with outstanding individuals and unrealistically believing that youhave the same kinds of abilities or talents that they have.

(h) Resorting to transference: confusing people who affected you seriously in yourpast life with those whom you have interests in today and assuming that thepresent individuals will act pretty much the same way as the past ones did.

The Biological Basis of Human Irrationality 113

(i) Resorting to a reaction formation: expressing reverse feelings (such as love)for someone for whom you really have the opposite feeling (such as hate).

23. Attribution Irrationalities(a) Attributing to people feelings for you that they really do not have.(b) Attributing certain motives for people’s behavior when they do not actually

have those motives.(c) Attributing to people a special interest in you when they have no such interest.(d) Attributing certain characteristics or ideas to people because they have

membership in a group whose constituents frequently have such character-istics or ideas.

24. Memory-Related Irrationalities(a) Forgetting painful experiences soon after they end, and not using them to

avoid future pain.(b) Embellishing the facts about people’s behavior and inventing exaggerations

and rumors about them.(c) Focusing mainly or only on the immediate advantages or disadvantages of

things and shortsightedly ignoring what will probably happen in connectionwith them in the future.

(d) Repressing one’s memory of important events, so as not to feel responsibilityor shame about their occurring.

(e) Remembering some things too well and thereby interfering with effectivethought and behavior in other respects.

25. Demandingness-Related Irrationalities(a) Demanding that one must do well at certain goals in order to accept oneself

as a human.(b) Demanding that one must win the approval or love of significant others.(c) Demanding that one must do perfectly well at practically everything and/or

win the perfect approval of practically everyone.(d) Demanding that others must treat one fairly, justly, considerately, and

lovingly.(e) Demanding that everyone must treat one perfectly fairly, justly, considerately,

and lovingly.(f) Demanding that the conditions of life must remain easy and that one must

get practically everything one wants quickly, without any undue effort.(g) Demanding that one must have almost perfect enjoyment or ecstasy at all

times.26. Sex-Related Irrationalities

(a) The belief that sex acts have intrinsic dirtiness, badness, or wickedness.(b) The belief that sex acts prove absolutely bad or immoral unless they go with

love, marriage, or other nonsexual relationships.(c) The belief that orgasm has a sacred quality and that sex without it has no real

joy or legitimacy.(d) The belief that intercourse has a sacred quality and that orgasm must come

about during penile–vaginal intromission.(e) The belief that one must have sex competence and that one’s worth as a person

doesn’t exist without it.

114 Albert Ellis

(f) The belief that good sex must include simultaneous orgasm.(g) The belief that masturbation and petting to orgasm have a shameful quality,

not the legitimacy of intercourse.(h) The belief that men can legitimately and morally have more sex or less

restricted sex than can women.(i) The belief that sex competence should occur spontaneously and easily, without

any particular kind of knowledge or practice.(j) The belief that women have little natural interest in sex, remain naturally

passive, and have inferior sexual abilities and capacities.(k) The belief that two people who love each other can have little or no sexual

interest in other individuals.27. Science-Related Irrationalities

(a) The belief that science provides a panacea for the solution of all humanproblems.

(b) The belief that the scientific method constitutes the only method of advancinghuman knowledge.

(c) The belief that all technological inventions and advances prove good forhumans.

(d) The belief that because the logico-empirical method of science does not giveperfect solutions to all problems and has its limitations, it has little or nousefulness.

(e) The belief that because indeterminacy exists in scientific observation, thelogico-empirical method has no validity.

(f) The belief that because science has found evidence and explanations forhypotheses that originally only existed in the human imagination (e.g., thetheory of relativity), it has to and undoubtedly will find evidence andexplanations for other imagined hypotheses (such as the existence of a soulor of God).

(g) The belief that because a scientist gets recognized as an authority in one area(e.g., Einstein as a physicist), he or she must have authoritative views in otherareas (e.g., politics).

(h) The strong tendency of highly competent, exceptionally well-trained scientiststo act in a highly prejudiced, foolish manner in some important aspects oftheir scientific endeavors, and to behave even more foolishly in their personallives.

(i) The strong tendency of applied social scientists—such as clinical psychologists,psychiatrists, social workers, counselors, and clergymen—to behave self-defeatingly and unscientifically in their personal and professional lives.

The foregoing list of human irrationalities, which in no way pretends to exhaust thefield, includes 259 major happiness-sabotaging tendencies. Some of these, admittedly,overlap, so that the list includes repetitions. At the same time, it consists of only a bareoutline; and under each of its headings we can easily subsume a large number of otherirrationalities. Under heading 1(h), for example—irrationalities related to courtship,marriage, and wedding customs—we could easily include hundreds of idiocies, manyof them historical, but many still extant.

The Biological Basis of Human Irrationality 115

Psychotherapy represents one of the most tragic examples in this respect. It ismentioned briefly, under heading 27(i)—science-related irrationalities—as “the strongtendency of applied social scientists—such as clinical psychologists, psychiatrists, socialworkers, counselors, clergymen—to behave self-defeatingly and unscientifically in theirpersonal and professional lives.” This hardly tells the tale! For psychotherapy supposedlyconsists of a field of scientific inquiry and application whose practitioners remainstrongly devoted to helping their clients eliminate or minimize their irrational, self-destructive thoughts, feelings, and behaviors. Actually, the opposite largely appears tohold true. For most therapists seem to have almost innumerable irrational ideas andto engage in ubiquitous anti-scientific activities that help their clients maintain or evenintensify their unreasonableness.

A few major irrationalities of psychotherapeutic “helpers” are: (1) Instead of takinga comprehensive, multimodal, cognitive emotive-behavioral approach to treatment, theyfetishistically and obsessively-compulsively overemphasize some monolithic approach,such as awareness, insight, emotional release, understanding of the past, experiencing,rationality, or physical release (Lazarus, 1971). (2) They have their own dire needs fortheir clients’ approval and frequently tie these clients to them in an extended dependencyrelationship. (3) They abjure scientific, empirically-based analysis for farfetchedconjectures that they rarely relate to factual data (Jurjevich, 1974; Leites, 1971). (4)They tend to focus on helping clients feel better rather than get better by learningspecifically how they upset themselves and how they can stop doing so in the future.(5) They dogmatically assume that their own system or technique of therapy, and italone, helps people; and they have a closed mind to other systems or techniques. (6)They promulgate therapeutic orthodoxies and excoriate and excommunicate deviatesfrom their dogmas. (7) They confuse correlation with cause and effect and assume thatif an individual hates, say, his mother, and later hates other women, his former feelingmust have caused the latter feeling. (8) They mainly ignore the biological bases of human behavior and assume that special situational reasons for all disturbances mustexist and, worse yet, that if one finds these special reasons the disturbances will almostautomatically disappear. (9) They tend to look for (and “find”!) unique, clever, and“deep” explanations of behavior and ignore many obvious, “superficial,” and truerexplanations. (10) They either promulgate the need, on the part of their clients, forinterminable therapy; or they promulgate the myth that easy, quick, miracle cures exist(Le Shan, 1975). (11) They turn more and more to magic, faith healing, astrology, tarotcards, and other unscientific means of “transpersonal” psychotherapy (Ellis, 1973,1975b). (12) They strive for vaguely defined, Utopian goals that mislead and harmclients (Watzlawick, Weakland, & Fisch, 1974). (13) They make irrational, unscientificattacks on experimentally-inclined therapists (Hook, 1975; Strupp, 1975a, 1975b). (14)They apotheosize emotion and invent false dichotomies between reason and emotion(Frankel, 1973; Shibles, 1974; Strupp, 1975b).

This list is not exhaustive, and could easily be doubled or tripled. To repeat the mainpoint: virtually all the main headings and subheadings in the above list of major humanirrationalities have a score or more further subdivisions; and for each subdivision afairly massive amount of observational and experimental confirmatory evidence exists.For example, we have a massive amount of observational evidence that innumerablepeople overeat, procrastinate, think dogmatically, lose considerable amounts of money

116 Albert Ellis

in foolish gambling, devoutly believe in astrology, and continually rationalize abouttheir own inept behavior. And we have considerable experimental evidence that humansfeel favorably biased in regard to those whom they consider attractive, that they backslideafter giving up a habit like overeating, that they go for specious immediate gratificationsinstead of more enjoyable long-term satisfactions, that they repress memories of eventsthey consider shameful, that they frequently attribute feelings to others that these othersdo not seem to have, and that they have an almost incredible degree of suggestibilityin regard to an opinion of the majority of their fellows or of a presumed authorityfigure.

Granted that all the foregoing major human irrationalities—and many more likethem!—exist, one can maintain the thesis that, in all probability, they have biologicalroots and stem from the fundamental nature of humans? Yes, on several important,convincing grounds, which follow:

All the major human irrationalities seem to exist, in one form or another, in virtuallyall humans. Not equally, of course! Some of us, on the whole, behave much lessirrationally than others. But go find any individuals who do not fairly frequently intheir lives subscribe to all of these major irrationalities. For example, using only thefirst ten main headings that apply to personal self-sabotaging, do you know of a singleman or woman who has not often slavishly conformed to some asinine social custom,not given himself or herself global, total ratings, not held strong prejudices, not resortedto several kinds of illogical thinking, not fooled himself or herself into believing thathis or her strong feelings represented something about objective reality, not acquiredand persisted in self-defeating habits, not had any pernicious addictions, remainedperfectly free of all neurotic symptoms, never subscribed to religious dogmas, and neversurrendered to any foolish health habits? Is there a single such case?

Just about all the major irrationalities that now exist have held rampant sway invirtually all social and cultural groups that have been investigated historically andanthropologically. Although rules, laws, mores, and standards vary widely from groupto group, gullibility, absolutism, dogmas, religiosity, and demandingness about thesestandards remains surprisingly similar. Thus, your parents and your culture advise oreducate you, in the Western civilized world, to wear one kind of clothes and, in theSouth Sea Islands, to wear another kind. But where they tend to inform you, “You hadbetter dress in the right or proper way, so that people will accept your behavior andact advantageously toward you,” you irrationally escalate this “proper” (and not tooirrational) standard into, “I must dress properly, because I absolutely need other people’sapproval. I can’t stand their disapproval and the disadvantages that may thereby accrueto me; and if they do not like my behavior that means they do not like me and that Irate as a completely rotten person!” Although your parents and your teachers mayencourage you to think in this absolutistic, self-downing manner, you seem to have theinnate human propensity (a) to gullibly take them seriously; (b) to carry on theirnonsense for the rest of your life; and (c) to invent it yourself if they happen to provideyou with relatively little absolutism.

Many of the irrationalities that people profoundly follow go counter to almost allthe teachings of their parents, peers, and mass media. Yet they refuse to give them up!Few parents encourage you to overgeneralize, make anti-empirical statements, or upholdcontradictory propositions; yet you tend to do this kind of thing continually. Your

The Biological Basis of Human Irrationality 117

educational system strongly encourages you to learn, unlearn, and relearn; yet you havegreat difficulty doing so in many important respects. You encounter strong persuasiveefforts of others to get you to forego non-productive and self-defeating habits, likeovereating and smoking. But you largely tend to resist this constant teaching. You mayliterally go, at your own choosing, for years of psychotherapy to overcome your anxiety or tendencies toward depression. But look at the relatively little progress youoften make!

You may have parents who raise you with extreme scepticism or anti-religioustendencies. Yet, you easily can adopt some extreme religious orthodoxy in your adultyears. You learn about the advisability of regularly visiting your physician and yourdentist from grade school onward. But does this teaching make you go? Does widespreadreading about the facts of life quiet your Pollyannaism or Utopianism—or rid you ofundue pessimism? Thousands of well-documented books and films have clearly exposedthe inequities of wars, riots, terrorism, and extreme nationalism. Have they reallyinduced you to strongly oppose these forms of political irrationality?

Virtually no one encourages you to procrastinate and to avoid facing life’s realities.Dangerous excitement-seeking rarely gets you the approval of others. Does that stopyou from indulging in it? The vast majority of scientists oppose magical, unverifiable,absolutistic, devout thinking. Do you always heed them? You usually know perfectlywell what moral and ethical rules you subscribe to; and almost everyone you knowencourages you to subscribe to them. Do you? Low frustration tolerance and short-range hedonism rarely prove acceptable to your elders, your teachers, your clergymen,and your favorite writers. Does their disapproval stop you from frequently giving in toimmediate gratification at the expense of future gains? Who teaches you to rationalizeand reinforces you when you do so? What therapist, friend, or parent goes along withyour other kinds of defensiveness? But does their almost universal opposition stop you?Do significant others in your life reward you for demanding perfection of yourself orof them, for whining and wailing that conditions must transpire the way you want themto turn out?

Certainly, a good many irrationalities have an important cultural component—or atleast get significantly encouraged and exacerbated by the social group. But a good manyseem minimally taught; and many others get severely discouraged, yet still ubiquitouslyflourish!

As mentioned before, practically all the irrationalities listed in this article hold truenot only for ignorant, stupid, and severely disturbed individuals but also for highlyintelligent, educated, and relatively little disturbed persons. Ph.D.’s in physics andpsychology, for example, have racial and other prejudices, indulge in enormous amountsof wishful thinking, believe that if someone believes something strongly—or intenselyexperiences it—it must have objective reality and truth, fall prey to all kinds ofpernicious habits (including addictions like alcoholism), foolishly get themselves intodebt, devoutly think that they must have others’ approval, believe in the power of prayer,and invent rumors about others which they then strongly believe. Unusually bright andwell-educated people probably hold fewer or less rigid irrationalities than averagemembers of the populace; but they hardly have a monopoly on rational behavior!

So many humans hold highly irrational beliefs and participate in exceptionally self-defeating behaviors so often that we can only with great difficulty uphold the hypothesis

118 Albert Ellis

that they entirely learn these ways of reacting. Even if we hypothesize that they largelyor mainly learn how to behave so badly, the obvious question arises: Why do they allowthemselves to get taken in so badly by the teachings of their culture, and if they doimbibe these during their callow youth, why don’t they teach themselves how to giveup these inanities later? Almost all of us learn many significant political, social, andreligious values from our parents and our institutions during our childhood, but weoften give them up later, after we go to college, read some hardheaded books, or befriendpeople who subscribe to quite different values. Why don’t we do this about many ofour most idiotic and impractical views, which clearly do not accord with reality andwhich obviously do us considerable harm?

Take, for instance, the following ideas, which just a little reflection will show havelittle sense and which will almost always lead to bad results: (1) “If my sister did mein as a child, all women appear dangerous and I’d better not relate to them intimately.”(2) “If I lack competency in an area, such as academic performance, I rate as a totallyworthless individual and deserve no happiness.” (3) “Because you have treated meunfairly, as you absolutely must not, you have to change your ways and treat me betterin the future.” (4) “Since I enjoy smoking very much, I can’t give it up; and althoughothers acquire serious disadvantages from continuing it, I can most probably get awaywith smoking without harming myself.” (5) “Because blacks get arrested and convictedfor more crimes than whites, they all rate as an immoral race and I’d better have nothingto do with them.” (6) “If biological and hereditary factors play an important part inemotional disturbance, we can do nothing to help disturbed people, and their plightremains hopeless.”

All these irrational statements, and hundreds of similar ones, clearly make little orno sense and wreak immense social and individual harm. Yet we devoutly believe themin millions of cases; and even if we can show that some significant part of these beliefsstems from social learning (as it probably does), why do we so strongly imbibe and so persistently hang on to them? Clearly because we have a powerful biological pre -disposition to do so.

When bright and generally competent people give up many of their irrationalities,they frequently tend to adopt other inanities or to go to opposite irrational extremes.Devout religionists often turn into devout atheists. Political right-wing extremists windup as left-wing extremists. Individuals who procrastinate mightily may later emerge ascompulsive workers. People who surrender one irrational phobia frequently turn upwith another equally irrational but quite different phobia. Extremism tends to remainas a natural human trait that takes one foolish form or another.

Humans who seem least afflicted by irrational thoughts and behaviors still revert tothem, and sometimes seriously so, at certain times. A man who rarely gets angry atothers may on occasion incense himself so thoroughly that he almost or actually murderssomeone. A woman who fearlessly studies difficult subjects and takes complicatedexaminations may feel that she can’t bear rejection by a job interview and may fail tolook for a suitable position. A therapist who objectively and dispassionately teaches hisor her clients how to behave more rationally may, if one of them stubbornly resists,act quite irrationally and agitatedly dismiss that person from therapy. In cases like these,unusual environmental conditions often bring out silly behavior by normally saneindividuals. But these individuals obviously react to these conditions because they have

The Biological Basis of Human Irrationality 119

some basic disposition to go out of their heads under unusual kinds of stress—and thatbasic disposition probably has innate elements.

People highly opposed to various kinds of irrationalities often fall prey to them.Agnostics give in to devout, absolutistic thoughts and feelings. Highly religiousindividuals act quite immorally. Psychologists who believe that guilt or self-downinghas no legitimacy make themselves guilty and self-downing.

Knowledge or insight into one’s irrational behavior only partially, if at all, helps onechange it. You may know full well about the harmfulness of smoking—and smoke morethan ever! You may realize that you hate sex because your parents puritanically taughtyou to do so; but you may nonetheless keep hating it. You may have clearcut“intellectual” insight into your overweening egotism but have little “emotional” insightinto how to change it. This largely arises from the basic human tendency to have twocontradictory beliefs at the same time—an “intellectual” one which you lightly andoccasionally hold and an “emotional” one which you vigorously and consistently hold,and which you therefore usually tend to act upon. This tendency to have simultaneouscontradictory beliefs again seems part of the human condition.

No matter how hard and how long people work to overcome their irrational thoughtsand behaviors, they usually find it exceptionally difficult to overcome or eradicate them;and to some degree they always remain exceptionally fallible in this respect (Ellis, 1962;Ellis & Harper, 1975; Hauck, 1973; Maultsby, 1975). We could hypothesize that becausethey overlearn their self-defeating behaviors at an early age, they therefore find it mostdifficult to recondition themselves. But it seems simpler and more logical to concludethat their fallibility has an inherent source—and that their early conditionability andproneness to accepting training in dysfunctional behavior itself represents a significantpart of their innate fallibility! Certainly, they hardly acquired conditionability solelythrough having someone condition them!

It appears reasonably clear that certain irrational ideas stem from personal,nonlearned (or even anti-learned) experiences; that we inventively, though crazily,invent them in a highly creative manner. Suppose, for instance, you fall in love withsomeone and you intensely feel, “know,” and state, “I know I’ll love you forever!” Youcertainly didn’t learn that knowledge—since you not only read about Romeo and Julietbut also read lots of other information, such as divorce statistics, which show that peoplerarely romantically adore each other forever. You consequently choose your “knowledge”out of several other bits of data you could have chosen to “know.” And you mostprobably did so because romantic love among humans frequently carries with it theintrinsic illusion that “Because my feeling for you has such authenticity and intensity,I know it will last forever.” You, at least for the most part, autistically create the falseand irrational “knowledge” that goes with your genuine (and most probably temporary)feelings.

Again, you may get reared as a Jew or a Moslem and may convert yourself toChristianity and conclude, “I feel Jesus as my Savior; and I feel certain that He existsas the Son of God.” Did your experience or your environmental upbringing lead tothis feeling and belief? Or did you, for various reasons, invent it? The natural tendencyof humans seems to consist of frequent dogmatic beliefs that their profound feelingsprove something objectively exists in the universe; and this largely appears an innatelybased process of illusion.

120 Albert Ellis

If we look closely at some of the most popular irrational forms of thinking, it appearsthat humans figure them out. They start with a sensible or realistic observation, andthey end up with a non sequitur type of conclusion. Thus, you start with, “it wouldfeel enjoyable and I would have advantages if Jane loved me.” You then falsely conclude,“Therefore she has to love me, and I find it awful if she doesn’t.” If you begin with aneven stronger observation, “I would find it exceptionally and uniquely enjoyable if Janeloved me,” you have even more of a tendency to conclude, “Therefore she must!” Butno matter how true the first part of your proposition proves, the second part remainsa non sequitur, making no sense whatever.

Similarly, you tend to irrationally conclude, “Because I find order desirable, I needcertainty.” “Because I find failure most undesirable, (1) I must not fail; (2) I did notcause myself to fail—he made me do it; and (3) Maybe I didn’t really fail at all.”“Because it would prove very hard for me to give up smoking, I find it too hard; andI can’t do it.” All these non sequiturs stem from autistic, grandiose thinking—you simplycommand that what you desire must exist and what you find obnoxious must not. Thiskind of autistic thinking largely appears innate.

Many types of irrational thinking largely consist of arrant over-generalizations; andas Korzybski (1933) and his followers have shown, overgeneralizations seem a normal(though foolish) part of the human condition. Thus, you easily start with a sensibleobservation, again: “I failed at that test,” and then you overgeneralize to, “I will alwaysfail; I have no ability to succeed at it.” Or you start with, “They sometimes treat meunjustly,” and you overgeneralize to, “they always treat me unjustly, and I can’t standtheir continual unfair treatment!” Again: this seems the way that normal humansnaturally think. Children, as Piaget (Piaget & Inhelder, 1974) has shown, lack goodjudgment until the age of seven or eight. Adults frequently lack it forever!

Human thinking not only significantly varies in relation to people’s intelligence levelsbut some forms of thinking stem largely from left-brain or right-brain functioning.Both intelligence and left-brain and right-brain functioning have a significant hereditaryelement and do not arise merely out of learned experiences (Austin, 1975; Sperry, 1975).

Some forms of irrationality, such as low frustration tolerance or the seeking of thespecious rewards of immediate rather than long term gratification, exist in many loweranimals as well as in humans. Ainslie (1975) reviews the literature on specious rewardand shows how a decline in the effectiveness of rewards occur in both animals andhumans as the rewards get delayed from the time of choice. Again, a fairly clear-cutphysiological and hereditary element seems obvious here.

Some evidence exists that people often find it much easier to learn self-defeatingthan non-defeating behavior. Thus, they very easily overeat but have great troublesticking to a sensible diet. They can learn, usually from their foolish peers, to smokecigarettes; but if other peers or elders try to teach them to give up smoking or to actmore self-disciplinedly in other ways, they resist this teaching to a faretheewell! Theyfairly easily pick up prejudices against Blacks, Jews, Catholics, and Orientals; but theyrarely heed the teachings of thoroughly tolerant leaders. They quickly conditionthemselves to feel anxious, depressed, hating, and self-downing; but they take anenormous amount of time and effort getting rid of these disturbed feelings. They don’tseem exactly doomed to a lifetime of stupid, foolish, asinine behavior. But pretty nearly!

The Biological Basis of Human Irrationality 121

Conclusion

If we define irrationality as thought, emotion, or behavior that leads to self-defeatingor self-destructive consequences or that significantly interferes with the survival andhappiness of the organism, we find that literally hundreds of major irrationalities existin all societies and in virtually all humans in those societies. These irrationalities persistdespite peoples’ conscious determination to change; many of them oppose almost allthe teachings of the individuals who follow them; they persist among highly intelligent,educated, and relatively little disturbed individuals; when people give them up, they usually replace them with other, sometimes just as extreme—though opposite—irrationalities; people who strongly oppose them in principle nonetheless perpetuatethem in practice; sharp insight into them or their origins hardly removes them; manyof them appear to stem from autistic invention; they often seem to flow from deepseated and almost ineradicable human tendencies toward fallibility, overgeneralization,wishful thinking, gullibility, prejudice, and short-range hedonism; and they appear atleast in part tied up with physiological, hereditary, and constitutional processes.

Although we can as yet make no certain or unqualified claim for the biological basisof human irrationality, such a claim now has enough evidence behind it to merit seriousconsideration. People naturally and easily act rationally and self-fulfillingly (Friedman,1975; Maslow, 1968; Rogers, 1961). Else they probably would not survive. But they alsonaturally and easily act against their own best interests. To some degree, their early andlater environments encourage them to learn self-destructive behaviors. But how can wenot conclude that they have powerful innate tendencies to listen to and agree withantihuman and inhumane teachings and—more importantly—to continue devoutly tobelieve in and idiotically carry on many of these obviously foolish, scientificallyuntenable teachings?

References

Ainslie, G. (1975). Specious reward: A behavioral theory of impulsiveness and impulse control.Psychological Bulletin, 82, 463–496.

Austin, J. H. (1975, August 9). Eyes left! Eyes right! Saturday Review, 32.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart. Ellis A. (1973). What does transpersonal psychology have to offer the art and science of

psychotherapy? Rational Living, 8(1), 20–28.Ellis, A. (1974). Humanistic psychotherapy: The rational emotive approach. New York: Julian Press

and McGraw-Hill Paperback.Ellis, A. (1975a). How to live with a “neurotic” (Rev. ed.). New York: Crown.Ellis, A. (1975b). Why “scientific” professionals believe mystical nonsense. Psychiatric Opinion.Ellis, A., & Harper, R. A. (1975). A new guide to rational living. Englewood Cliffs, NJ: Prentice-

Hall, Hollywood: Wilshire Books.Frankel, C. (1973). The nature and sources of irrationalism. Science, 180, 927–931.Frazer, J. G. (1959). The new golden bough. New York: Criterion.Friedman, M. (1975). Rational behavior. Columbia, CL: University of South Carolina Press.Hauck, P. A. (1973). Overcoming depression. Philadelphia, PA: Westminster Press.Hoffer, E. (1951). The true believer. New York: Harper.Hook, S. (1975). The promise of humanism. The Humanist, 35(5), 41–43.Jurjevich, R. M. (1974). The hoax of Freudism. Philadelphia, PA: Dorrance & Company.

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Korzybski, A. (1933). Science and sanity. Lancaster, PA: Lancaster Press.Lazarus, A. A. (1971). Behavior therapy and beyond. New York: McGraw-Hill.Leites, N. (1971). The new ego. New York: Science House.Le Shan, L. (1975, July). The achievement ethic and the human potential movement. Association

for Humanistic Psychology Newsletter, 13–14.Levi-Strauss, C. (1970). Savage mind. Chicago, IL: University of Chicago Press.Maslow, A. H. (1968). Toward a psychology of being (2nd ed.). New York: Van Nostrand Reinhold.Maultsby, M. C. Jr. (1975). Help yourself to happiness. New York: Institute for Rational Living.Parker, R. S. (1973). Emotional common sense. New York: Harper.Piaget, J., & Inhelder, B. (1974). Psychology of the child. New York: Basic Books.Pitkin, W. B. (1932). A short introduction to the history of human stupidity. New York: Simon &

Schuster.Rachleff, O. (1973). The occult conceit: A new look at astrology, witchcraft and sorcery. New York:

Bell Publishing Company.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.Shibles, W. (1974). Emotion: The method of philosophical therapy. Whitewater, WI: The Language

Press.Sperry, R. W. (1975, August 9). Left-brain, right-brain. Saturday Review, 30–33.Strupp, H. H. (1975a). The therapist’s personal therapy: The influx of irrationalism. The Clinical

Psychologist, 38(3), 1–11.Strupp, H. H. (1975b). Training the complete clinician. The Clinical Psychologist, 28(4), 1–2.Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Principles of problem formation and

problem resolution. New York: W. W. Norton & Company.

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8 Why Rational Emotive Therapy to Rational Emotive BehaviorTherapy?

INTRODUCTION

Steven C. Hayes

What is most interesting about this paper (Ellis, 1999), in which RET became REBT,is not just the inclusion of “behavior” into the definition of rational emotive behaviortherapy. Rather it is what it states and implies about Ellis’ perspective on cognition,emotion, and behavior on the one hand, and the degree to which he was determinedto position REBT as a general approach on the other.

The rationale provided by Ellis for the name change is largely one of inclusion. Theoriginal name, Rational Therapy, seemed to focus exclusively on cognition, and as aresult that name was quickly abandoned. Rational Emotive Therapy seemed much moreinclusive, and it was sustained for a substantial period of time, nearly 40 years. But, inthe present article, Ellis argues that Rational Emotive Therapy is also a misleading name,because it “omits the highly behavioral aspect that Rational Emotive Therapy hasfavored” (1999, p. 154). There can be little doubt that REBT has always included astrong behavioral element. In this article, Ellis documents numerous places in hiswritings where that has been true. As he points out, some of the best-known techniquesin REBT, such as shame-attacking exercises, are in fact behavioral techniques.

I suspect, however, that inclusion is not the only or even the primary reason for the name change. For one thing, a number of other dimensions might have been added. Ellis has long also emphasized the importance of philosophical assumptions, for example. He spoke regularly about possible biological sources of behavior. Heemphasized various family, social, and cultural influences as well. But you do not seeEllis calling for these dimensions also to be specifically included, in the name ofcomprehensiveness.

It seems to me more likely that a key source of interest in the use of the term“behavioral” was twofold. First, the term “behavioral” provided a useful balance to theovergeneralization of the term “rational,” which had come to characterize his approach.Ellis notes early on in the present article that there is no absolute criterion for rationality,and moreover that, in REBT, “rational” always meant cognition that is effective or self-helping, not merely cognition that is empirically and logically valid. This “effective orhelping” perspective is an odd use of the term “rational,” and Ellis admits, if he wereto rename the approach de novo, he would use the term “cognitive” rather than the

term “rational.” “Behavior” helps balance out the misunderstanding of what he meantto say with the term “rational.” Indeed, I suspect that this same concern may be partof why the term “emotive” was added in the 1960s.

The second reason for the interest, I believe, is that Ellis wants REBT to be thoughtof as a comprehensive model of therapy, not just a method. The more comprehensivea model wishes to be, the more there is a pull toward general terms. “Rational” is alreadytoo specific, and Ellis shows his concern over that narrowness in this paper with hisinclusion of such things as “existential choice” or even “irrational methods.” Havingcommitted to this term, however, he is left with the strategy of a more inclusive listing(rational, emotive, behavioral) as the primary means of emphasizing the broad natureof REBT as a model, rather than merely a specific set of methods.

Ellis emphasizes in several places that he does not want his approach reduced to asingle dimension or technical focus. For example, in the section on resistance, he beginsby saying that the REBT practitioners should “learn and practice how to find anddispute their clients’ irrational beliefs” (p. 158) and “learn a number of other cognitive,emotive, and behavioral methods that help clients surrender their irrational beliefs.”These are methods that almost anyone who has read Ellis would associate with REBT. But Ellis does not stop there. He advises using these methods with clients whoresist giving up their irrational beliefs but who still can derive benefit from therapy.And, in a final step that really shows how far Ellis is willing to go, he suggests that“REBT therapists can use techniques from other forms of therapy, including even some‘irrational’ techniques” (p. 158). The example that follows is one that is purposivelystartling: encouraging a client’s irrational belief that allegiance to and collaborationwith the Devil will help him overcome his phobias.

I think Ellis is suggesting that the REBT practitioner is a person who uses cognitive,emotive, and behavioral methods linked to the comprehensive model provided by REBTto accomplish clinical ends, regardless of the method, up to and including methodsthat superficially contradict more expected REBT methods. Ellis emphasizes in this articlethat no set of methods works for everyone, and that both therapists and clients areindividuals. He acknowledges that even “the best methods may not be effective forindividual clients and therapists.” Thus, REBT therapists need to be free to use additionalmethods if they are needed in a specific case, while attempting to understand the needfor their use within their home model. It makes sense for all this material to be in anarticle on why the term “behavior” needs to be in the name, not because such mattersbear directly on the behavioral nature of REBT, but because he is altering the name inpart to indicate that REBT is a model, not just a narrow set of “brand name” methods.

Approaching therapy from a model point of view makes sense when one’s purposeis to encourage the development of new methods within a broader framework. For thatto work, however, the terms and principles within the model need to be well definedand testable, and professionals other than the original developer need to be able todecide whether new methods (a) fit within existing terms and principles, or, if not, (b)whether new terms and principles need to be added to the core of the model. Thehighest test of a model’s ability to pass such a test comes in the decade or two after afounder has died.

As a person looking at REBT from the outside, I am not sure REBT will pass thattest. It seems highly likely that REBT methods will live on for decades to come, but a

Why RET to REBT? 125

model needs to do more than that. It needs to specify which new methods areencompassed within the model and which new principles can be added to it. Thestandard Ellis specifically appeals to in this article in order to add something new,inclusiveness, will not do. Inclusiveness can be used to argue for an unlimited list ofnew terms or concepts, and incoherence is the certain outcome if that path is followed.Yet, if REBT is a model, it needs to be able to develop, grow, and change in a coherentand yet innovative fashion. Whether that is possible, the next years will tell.

Reference

Ellis, A. (1999). Why rational emotive therapy to rational emotive behavior therapy? Psycho -therapy, 36, 154–159.

126 Steven C. Hayes

WHY RATIONAL EMOTIVE THERAPY TORATIONAL EMOTIVE BEHAVIOR THERAPY?

Albert Ellis

Rational emotive behavior therapy (REBT) was wrongly named rational therapy (RT)in 1955 and then rational emotive therapy (RET) in 1961. It has always been exception-ally rational or cognitive, but it also has, from its start, been unusually forceful andemotive and uniquely behavioral with its emphasis on in vivo desensitization. It seesthinking, feeling, and behaving as integrated and holistic processes and always includesa number of cognitive, emotional, and action techniques. Rational emotive behaviortherapy is a preferable and more accurate term than RT or RET.

Why have I now decided, after almost 40 years of creating and using rational emotivetherapy (RET), to change its name to rational emotive behavior therapy (REBT)? I nowsee that I was wrong to call it, for a few years, rational therapy (RT) and then, in 1961,to change it to RET.

Using the term rational itself was probably an error, because it means empirical andlogical, and its use has been rightly criticized by Guidano (1991), Mahoney (1991), andothers because, as the postmodern thinkers point out, we can have no absolute criterionof rationality. What is deemed rational by one person, group, or community can easilybe considered irrational by others.

In REBT, “rational” has always meant cognition that is effective or self-helping, notmerely cognition that is empirically and logically valid (Ellis, 1991; Ellis & Dryden,1997), as some critics point out. If I were to rename RET today I might call it cognitiveemotive instead of rational emotive therapy; but it is a little late for that change, becausecognitive therapy (Beck, 1976) and cognitive behavior therapy (Meichenbaum, 1977)are already well known, and REBT is recognized as different from these other therapies(Ellis, 1990).

RET is a misleading name because it omits the highly behavioral aspect that rationalemotive therapy has favored. In Reason and Emotion in Psychotherapy (Ellis, 1962),which is largely an extended version of several articles on REBT that I published in the1950s, I make many references to its behavioral components, including these:

“The therapist encourages, persuades, cajoles, and occasionally even insists that thepatient engage in some activity (such as doing something he is afraid of doing) whichitself will serve as a forceful counter-propaganda agency against the nonsense hebelieves” (p. 95).

“The rational therapist . . . uncovers the most important elements of irrationalthinking in his patient’s experience and energetically urges this patient into morereasonable channels of behaving” (pp. 103–104).

“REBT” insists on homework assignments, desensitizing and deconditioning actions,both within and without the therapeutic sessions, and on other forms of active workon the part of the patient” (p. 188).

“Vigorous verbal rethinking will usually lead to changed motor behavior; andforcefully repatterned sensory–motor activity will usually lead to changed ideation” (p. 205).

REBT “is, at one and the same time, highly rational–persuasive–interpretive–philosophical and distinctly emotive–directive–active–workcentered” (p. 330).

“Rational emotive therapy is one of the relatively few techniques which include largeamounts of actions, work, and ‘homework’ assignments of a so-called nonverbal nature”(p. 334).

REBT “is a highly active, working form of treatment—on the part of both the therapistand his or her patient” (p. 364).

I also wrote, in an article published in 1975, REBT theory states that “humans rarelychange and keep disbelieving a profound self-defeating belief unless they often actagainst it” (Ellis, 1975, p. 20).

Corsini (1979), among other writers, has made the same point. To help clients changetheir thinking he uses the “betting” technique and insists that if they actually do a“fearful” task that he asks them to do, their cognitions will change. He says, “Do thisand your thoughts and feelings will change.” They reply, “No, this will not happen.”He says, “I’ll bet you two dollars. Do it and if I am wrong, I will pay you and you willbe the judge.” He claims he has never lost one of these bets. Similarly, Landy (1994)uses “disjunctive therapy,” in the course of which clients are to change their behaviorand thus change their thinking. In doing REBT, I have often used this method sincethe mid-1950s.

Actually, REBT has always been one of the most behaviorally oriented of the cognitivebehavior therapies. In addition to employing systematic desensitization and showingclients how to use imaginal methods of exposing themselves to phobias and anxiety-provoking situations (Wolpe, 1990), it favors in vivo desensitization or exposure. REBToften encourages people to deliberately stay in obnoxious situations—for example, apoor marriage or a bad job—until they change their disturbed thoughts and feelingsand then decide whether to flee from these situations. Several of REBT’s emotive–dramatic exercises—for example, its famous shame-attacking exercise (Ellis, 1969,1973)—are also more behavioral than the procedures of other leading cognitivebehavioral therapies.

Since I began to practice it in January 1955, REBT has emphasized an integrated andholistic approach to the human processes of thinking, feeling, and acting. In my firstarticle on “Rational Psychotherapy,” which I presented at the American PsychologicalAssociation Convention in Chicago on August 31, 1956, I included this statement:

The human being may be said to possess four basic processes—perception,movement, thinking, and emotion—all of which are integrally interrelated. Thus,thinking, aside from consisting of bioelectric changes in brain cells, and in additionto comprising remembering, learning, problem-solving, and similar psychologicalprocesses, also is, and to some extent has to be sensory, motor, and emotionalbehavior. Emotion, like thinking and the sensory-motor processes, we may defineas an exceptionally complex state of human reaction which is integrally related toall the other perception and response processes. It is not one thing, but acombination and holistic integration of several seemingly diverse, yet actuallyclosely related, phenomena.

(Ellis, 1958, p. 35)

128 Albert Ellis

That statement put REBT squarely in the cognitive emotive behavioral camp fromthe start, and shows why it has always been, to use Arnold Lazarus’s (1989) term,multimodal in its therapy techniques. Although it stresses the importance of clients’making profound philosophical changes, it often uses emotional–evocative andbehavioral methods, as well as cognitive methods, to help them do so. Similarly, it usesall three modalities to help them make emotional and behavioral changes.

Actually, rational emotive behavior therapy uses a large number of cognitive, emotive,and behavioral methods, probably more than the other cognitive behavior therapies,such as those of Barlow (Barlow & Craske, 1989; Beck, 1976; Meichenbaum, 1977). Atthe same time, it is unusually philosophic and stresses cognitive processes in humandisturbance.

Thus, REBT theorizes that most clients have somewhat similar irrational beliefs (iBs),especially the three major absolutistic musts that frequently plague the human race: (a)“I must achieve outstandingly well in one or more important respects or I am aninadequate person!” (b) “Other people must treat me fairly and well or they are badpeople!” (c) “Conditions must be favorable or else my life is rotten and I can’t standit!” When one, two, or three of these are strongly and consistently held, people tendto make themselves emotionally and behaviorally disturbed.

Men, women, and children, the theory of REBT holds, have biological tendencies toconstruct rational wishes and preferences—such as the desire to be productive andachieving and the desire to relate well to other people. But they also have the choiceof holding and raising their preferences to absolutistic, rigid demands. People have anexistential choice of whether to be relatively preferring or demanding, and consequentlyto act in a healthy, self-helping manner or in an unhealthy, self-defeating manner.Usually, people constructively choose self-helping behaviors and thereby aid theirsurvival and happiness by being proactive and self-actualizing. They easily and oftenfall into obsessive–compulsive additions to their life-enhancing preferences, however,and make themselves self-sabotaging. Why? The reason is that it is difficult to distinguishconsistently between strong desires, which are usually life-enhancing, and rigiddemands, which are often destructive.

The human tendency to create self-sabotaging demands out of self-helping desiresand preferences is exacerbated by a number of common biological and environmentalfactors, including these:

1. Some individuals are born as demanders. At certain times in their lives or acrossthe whole life span, demanders think and feel that they must have what they reallywant, no matter what the cost.

2. Some individuals have, temporarily or permanently, physiological deficiencies thatimpair effectuating an efficient cost–benefit ratio between preferences and theirdemands. For various biological or environmental reasons they have hormonal,neuro-chemical, sensory, or other defects that interfere with normal reasoning andchecking processes. At times it is nearly impossible for such individuals to keeptheir desires from escalating into demands. For example, inherited or acquiredbrain anomalies may drive some people to compulsive alcohol or drug use.

3. Family, social, and cultural influences learned at a young age may stronglyencourage people to engage in behaviors that, under different conditions would

Why RET to REBT? 129

not lead to addiction. For example, in order to win the approval of peers, youthsmay “willingly” addict themselves to smoking, drinking, and criminal acts.

4. Human habituation processes that involve self-defeating behaviors, difficult tobreak, may seem to “force” continuation of the behavior even though destructive.For example, once an individual is habituated to smoking, procrastinating, orstaying up too late at night, it is most difficult to stop making preferences for theseharmful acts into demands to continue the habits.

5. Traumatic events sometimes severely disrupt protective checking mechanisms andprevent turning desires into demands. If, for example, a youngster is fairly wellcontrolled in taking care of herself physically or tending to her school routines,and she is traumatized by rape, incest, or physical abuse, she may stop her self-controlling habits and almost uncontrollably resort to disruptive behaviors.

For many biological and environmental reasons, then, people consistently orsporadically make their healthy desires and preferences into unhealthy, self-sabotagingnecessities. They are prone to do so by their psychophysical makeup, and they areencouraged to do so by various kinds of social reinforcement or conditioning. Do theythen have any real choice in how they think, feel, and behave; or do they, as B. F.Skinner (1971) implied, have very limited freedom and dignity?

REBT holds that they have considerable existential choice. Skinner himself was ahumanist and believed, as he showed in Walden Two, that people had the ability tochange their contingencies of reinforcement and create something of a Utopia forthemselves. In REBT we say that although it is indeed difficult for humans to stopdemanding and go back to strong desiring, thereby making themselves less disturbed,they have the ability to do this constructively. Why? Because not only can they think,but unlike other animals, they can think about their thinking, and think about thinkingabout their thinking. This hardly makes us superhuman, but it gives us at least a modestdegree of free will or choice.

Yes, people can choose to change their ways, though difficult, even when they areborn and reared to be self-defeating. The reason is that they are able to see howdemanding they frequently are and choose to do the hard work and practice that isusually required for change. Being innate constructivists, they can even change theirhabitual destructive tendencies including some of their biological tendencies, even inthe face of neurological deficiencies such as attention deficit disorder and learningdisabilities. But they can learn to improve them and become less deficient. They mayhave endogenous depression, which makes them prone to catastrophic and awfulizingthinking. But they can use REBT and other forms of cognitive behavior therapy toimprove their depressive thinking. They can also take Ritalin, antidepressives, and otherpsychotropic medication, which often rectify some of their neurological and otherphysiological deficiencies.

Practically all people fairly frequently raise their healthy preferences to unhealthydemands, and many of them have biochemical deficits that incline them to think, feel,and behave self-defeatingly—against their own interests and those of the social groupsin which they reside. Still, they can choose to improve themselves emotionally as wellas to grow and develop into a happy and self-actualizing state of existence.

130 Albert Ellis

REBT is no panacea for all human ills. It has its limitations and drawbacks, as haveall kinds of psychotherapy. But it is realistic and less limited by using, as noted above,a large number of cognitive, emotive, and behavioral methods. The addition of newmethods seems to be effective. REBT theory states that most people are conflicted bymaking their desires into demands. They become less disturbed when therapy helpsthem restructure their demands and turn them back to desires.

Other biological, conditioning, and habituation factors are also involved with andmay either create or intensify emotional disturbance. Also, lack of skill training isfrequently involved in dysfunctional behavior. For example, if you want to succeed attennis, you may raise your want to a dire need and make yourself anxious and depressedwhen you do not succeed as you think you must. Because of your anxiety and depression,you may fail to do well at tennis, making yourself more anxious and depressed. Butplaying tennis well also depends on coordination and the physical ability to hit the ballwell, good instruction and learning the rudiments of tennis, and practice playing. Soyour blaming yourself for not playing “well enough” may depend not only on yourdemand that you play quite well, but also on your physical prowess, the kind ofinstruction you have had, and how much time you actually play the game.

Human disturbance is complicated and has many specific aspects. Every disturbedperson has unique reasons for being disturbed. If 100 people have the same problem—say a public speaking phobia—they almost certainly have many different reasons forthe phobia and may require different therapeutic methods to deal with it.

REBT has a somewhat unique theory and practice of what usually causes humandisturbance and what can be done to alleviate it. The REBT therapist assumes that mostclients have absolutistic shoulds and musts and that they can be helped by recognizingthat imperatives lead to needless disturbance. With REBT they learn that they will feeland act better—by getting more of what they want and less of what they do not want—if they clearly acknowledge demands and change them into preferences.

Many clients have special kinds of disorders or may react idiosyncratically to therapy and therefore may not benefit from the usual procedures of REBT or cognitive behavior therapy (CBT). They may be mentally deficient, psychotic, brain injured, or have neurological defects such as attention deficit disorder or special educationaldisabilities. Other clients may resist using various REBT or CBT techniques becausethey are temperamentally opposed to them, will not do required homework, are hostileto the therapist, get neurotic gains from their disturbances, are convinced that they arehopeless, do not want to risk getting better, or for a variety of other idiosyncraticreasons.

Similarly, therapists who try to use the methods of REBT and CBT and do soineffectually may not truly understand them, may be temperamentally opposed to them,will not take sufficient time or energy to apply them, have hostile attitudes toward someof their clients, or may have various other reasons. As many research studies have shown,the success of therapy depends on many relationship factors between clients andtherapists. Negative aspects of the relationship may interfere with REBT and CBTtechniques that are usually effective but do not work for a particular client therapist.

For these and other reasons, clients often spend large amounts of time and moneyin therapy with relatively poor results. Some clients, because of the nature of theirdisturbance and the nature of their temperament, fail to use the potentially best

Why RET to REBT? 131

cognitive, emotive, or behavioral methods that their therapists recommend. Some clientsfavor one or a few techniques that may not be the best for them and even favor irrationalor inelegant methods that rarely work.

What does this mean for therapists who wish to be effective for as many of theirclients as possible? It means that they can specialize in a particular mode of treatment—such as that which is primarily cognitive, experiential, or behavioral—and that theycan honestly believe in and vigorously practice their specialty. Therapists should beprepared, however, for clients to resist their “best” methods and require different andperhaps “inferior” ones. Therapists must recognize that they, too, will at times be averseto using the best methods of a system of therapy and will tend to use them ineffectually.

REBT offers several therapeutic methods that have worked well with most clientsmost of the time. The therapy includes a reserve of other cognitive, emotive, andbehavioral methods that may be useful for particular clients when its most popularmethods are resisted by client, therapist, or both. REBT practitioners are free toexperiment with a wide variety of techniques, some of which may seem irrational. Itis useful to follow Paul’s (1967, p. 117) well-known statement about gauging whichtherapy is effective, by seeing “what treatment by whom, is most effective for thisindividual, under what set of circumstances.” To make this goal achievable, REBTalways has available, as noted, with some unique clients, a large number of therapeuticvaried methods to work with. That is why it accurately merits the name, rational emotivebehavior therapy. The most effective system of psychotherapy will probably alwaysinclude many cognitive, emotive, and behavioral procedures. REBT definitely does, andwill most likely continue, to include this comprehensive array of approaches topsychotherapy.

How can therapists at least partially overcome resistance in themselves and theirclients? First, REBT practitioners can learn and practice how to find and dispute theirclients’ irrational beliefs, particularly their absolutistic shoulds, oughts, and musts. Theycan learn cognitive restructuring and also effectively teach their clients to persistentlyand forcefully practice it.

Second, REBT therapists can learn and practice a number of other cognitive, emotive,and behavioral methods that help clients surrender their irrational beliefs, such asrational emotive imagery (Ellis, 1993; Maultsby, 1971) and shame-attacking exercises(Ellis, 1973, 1996).

Third, they can employ many of these same cognitive, emotive, and behavioraltechniques to help clients who resist giving up their irrational beliefs but who can stillderive considerable benefit from therapy. Therapists can thereby help clients makeinelegant but beneficial therapeutic changes.

Fourth, when all else fails, REBT therapists can use various techniques from otherforms of therapy, including even some “irrational” techniques, to help clients who resistemploying the “best” methods. To take an extreme case, if the client rigidly believesthat only his allegiance to and collaboration with the Devil will help him overcome hisphobias or panic states, and the therapist thinks that this is a very crazy idea but itlooks like the only one that will reduce the client’s suffering, the therapist can“rationally” encourage this irrational belief.

132 Albert Ellis

Conclusion

REBT theory holds that much human disturbance stems from making healthy desiresfor success, approval, and pleasure into absolutistic shoulds, oughts, and musts. Effectivetherapy partly consists of helping a client become fully conscious of dogmatic insistenceand that can change into strong but undogmatic preferences. REBT directly andforcefully specializes in using empirical, logical, heuristic, and other cognitive disputingof these imperatives and the other core irrational beliefs that usually accompany them (Ellis, 1962, 1994, 1996, 1998; Ellis & Blau, 1998; Ellis, Gordon, Neenan, & Palmer,1997; Ellis & Harper, 1997; Ellis & Tafrate, 1997; Ellis & Velten, 1998; Walen,DiGiuseppe, & Dryden, 1992). Because REBT views thinking, feeling, and acting asintegrated and holistic processes, it also routinely employs emotive and behavioraltechniques that actively interrupt clients’ irrational beliefs and provide them withexperiences that encourage them to think and act rationally and selfhelpingly. From itsinception it has been a pioneering cognitive emotive behavioral therapy in spite of thefact that I called it first, rational therapy (RT) and then rational emotive therapy (RET).

In addition, REBT acknowledges that human disturbance is exceptionally complicatedand has both physiological and psychological aspects as well as innate and environmentalinfluences. These influences are importantly interrelated. Moreover, both clients andtherapists are individuals in their own right and react differently to each other and tothe therapy techniques that are employed with them. Therefore, even the best methodsmay not be effective for individual clients and therapists. Both may resist using themeffectively for a number of different reasons.

References

Barlow, D. H., & Craske, M. G. (1989). Mastery of your anxiety and panic. Albany, NY: Centerfor Stress and Anxiety Disorders.

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: InternationalUniversities Press.

Corsini, R. J. (1979). The betting technique. Individual Psychology, 16, 5–11.Ellis, A. (1958). Rational psychotherapy. Journal of General Psychology, 59, 35–49 (Reprinted:

New York: Albert Ellis Institute).Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel.Ellis, A. (1969). A weekend of rational encounter. Rational Living, 4(2), 1–8.Ellis, A. (1973). How to stubbornly refuse to be ashamed of anything (Cassette recording). New

York: Institute for Rational Emotive Therapy.Ellis, A. (1975). The rational emotive approach to sex therapy. Counseling Psychologist, 5(1), 14–22.Ellis, A. (1990). Special features of rational emotive therapy. In W. Dryden & R. DiGiuseppe

(Eds.), A primer on rational emotive therapy (pp. 79–93). Champaign, IL: Research Press.Ellis, A. (1991). Achieving self-actualization. Journal of Social Behavior and Personality, 6(5), 1–18

(Reprinted: New York: Albert Ellis Institute).Ellis, A. (1993). Rational emotive imagery: RET version. In M. E. Bernard & J. L. Wolfe (Eds.),

The RET source book for practitioners (pp. 8–10). New York: Institute for Rational EmotiveTherapy.

Ellis, A. (1994). Reason and emotion in psychotherapy. Secaucus, NJ: Carol Publishing Group.Ellis, A. (1996). Better, deeper, and more enduring brief therapy. New York: Brunner/Mazel.

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Ellis, A. (1998). How to control your anxiety before it controls you. Secaucus, NJ: Carol PublishingGroup.

Ellis, A., & Blau, S. (1998). The Albert Ellis reader. Secaucus, NJ: Carol Publishing Group.Ellis, A., & Dryden, W. (1997). The practice of rational emotive behavior therapy. New York:

Springer.Ellis, A., Gordon, J., Neenan, M., & Palmer, S. (1997). Stress counseling: A rational emotive behavior

approach. London: Cassell.Ellis A., & Harper, R. A. (1997). A guide to rational living. North Hollywood, CA: Melvin Powers.Ellis, A., & Tafrate, R. C. (1997). How to control your anger before it controls you (Two audio

cassettes). Read by Stephen O’Hara. San Bruno, CA: Audio Literature.Ellis, A. & Velten, E. (1998). Optimal aging: Get over getting older. Chicago, IL: Open Court.Guidano, V. F. (1991). The self in process. New York: Guilford.Landy, E. E. (1994). Disjunctive therapy. In R. J. Corsini (Ed.), Encyclopedia of psychology (2nd

ed., vol. 1). New York: John Wiley.Lazarus, A. A. (1989). The practice of multimodal therapy. Baltimore, MD: Johns Hopkins.Mahoney, M. J. (1991). Human change processes. New York: Basic Books.Maultsby, M. C., Jr. (1971). Rational emotive imagery. Rational Imagery, 6(6), 24–27.Meichenbaum, D. (1977). Cognitive-behavior modification. New York: Plenum.Paul, G. L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting

Psychology, 31, 109–118.Skinner, B. F. (1971). Beyond freedom and dignity. New York: Knopf.Walen, S., DiGiuseppe, R., & Dryden, W. (1992). A practitioner’s guide to rational emotive therapy.

New York: Oxford University Press.Wolpe, J. (1990). The practice of behavior therapy (4th ed.). Needham Heights, MA: Allyn &

Bacon.

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Part II

Applications

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9 Psychoneurosis and AnxietyProblems

INTRODUCTION

Edward Garcia and William Knaus

Albert Ellis begins his exploration into anxiety by breaking anxieties and fears downinto categories, such as ego anxiety, discomfort anxiety, and anxiety about anxiety. Henext ties harmful cognitions to each condition, and then cites research findings oncognition in neurosis. He applies his demandingness theory to anxiety.

Ellis saw ego and discomfort anxiety as stemming from fundamentally the same core apprehension, which was failing to be an unassailably perfect person deservingadoration, and freedom from inconvenience and disadvantages. He saw both asgrandiose and asserted that ego and discomfort anxieties were the offshoot of unrealisticdemands and fictions extending from a core premise that life should go smoothly (forme). Threats to this core view prompted vulnerability that fermented into anxiety.

Ellis points out that when people insist on being in control, discomfort-free, andworthy in the eyes of others, they set themselves up for a stressful time. He saw thatresolving the conflict over an exaggerated sense of importance (which may be acompensation for inferiority) and reality was to accept—not like—that it is inherentlyhuman to err, to experience disappointment, and to feel frustrated over barriers thatimpede wishes and desires.

Anxiety can prompt anxiety over anxiety. Ellis addresses these secondary disturbancesby first showing how people become anxious over the possibility of feeling anxious, getanxious over feeling uncomfortable, or grow depressed over feeling depressed. Showingclients how to identify and address this secondary disturbance was a significant Elliscontribution. For some clients, this secondary disturbance was more pernicious thatthe primary anxiety.

We think that part of Ellis’ original formulations remain valid today. However, thereare some caveats to be said and improvements to be made.

Discomfort Dodging and Anxiety Reduction

We anticipate that people will continue to face legitimate threats throughout their lives.However, as the humorist Mark Twain once quipped, “I’ve had a lot of troubles in mylife and most of it never happened.” However, as anxiety-evoking cognitive distortions

can prompt anxieties where no real danger exists. When debilitating, this is a legitimatetarget for therapeutic interventions. REBT is at the forefront of showing clients how toaccept discomfort and address the manufactured or parasitic variety of anxieties thatdrain resources without returning a meaningful benefit.

Some considerations follow:

1. Demandingness is central to Ellis’ views on anxiety. However, this is a theory. A theory is of scientific vintage only if it can be falsified (Popper, 1963). If ademandingness theory can’t be disconfirmed, only temporarily accept it. However,a different theory may apply to the next client.

2. Ellis’ demandingness theory of anxiety applies to a subgroup of anxious people forwhom demandingness is an anxiety generator. However, anxieties come in differentforms, and different people with different anxiety sensitivities experience anxietyin different contexts for different reasons. A theory of powerless thinking, whereone views oneself as vulnerable, may be equally salient in some cases.

3. Anxiety is rarely a simple diagnostic condition separate from other distress condi-tions. It normally coexists with threat sensitivity, and a wide range of coexistingcognitive conditions, such as powerless thinking, self-doubts, and depression. TheREBT therapeutic delivery system is situated to address anxiety and its co-existingconditions.

4. People have different levels of physical and tension tolerance, and this tolerancemay vary based on an individual’s perception and situation. Low tension tolerancemay reflect demandingness thinking or stimulation.

5. In a state of high anxiety, clients tend to focus on how they feel and whateverterrifies them, such as speaking before a group or anticipating making a gaffe at aparty. Focusing on the anticipated threat, and their emotional vulnerability, manyclients skip the step of how their perceptions, definitions, and core beliefs connectwith their emotions and actions. Rational emotive therapists help identify corebeliefs that mingle through the tension, and show clients how to contest them(Knaus, 2006).

6. In our experience, it is relatively simple to help clients intellectually address egoanxieties, such as fear of failure, dreads over substandard performances, or lookinglike jerks to others. Although most can apply methods for challenging irrationalanxiety thinking, they have a great deal more trouble using these principles in the laboratory of life when facing uncomfortable situations. We anticipate thatdiscomfort-dodging maneuvers will continue to extend into procrastination to addanother layer of complexity, where clients put off accepting and addressing theinevitable discomforts of life. Learning to use time ordinarily spent procrastin-ating opens opportunities for proactively coping with adversity and advancingenlightened productive interests (Knaus, 2010).

7. Discomfort anxieties and fears, or a more general form of intolerance fordiscomfort, is often at the core of what is commonly called resistance to change.Some have difficulty in effecting meaningful changes because of their inability totolerate “psychic” or emotional discomfort that they construe as painful. However,difficulty in making changes may not reflect resistances to changing irrational

138 Edward Garcia and William Knaus

beliefs as much as it does facing the emotional discomfort that usually occurs inany change process. We see helping clients accept discomfort as continuing to be an important part of the future of REBT. However, it is not enough to accept discomfort, without engaging in purposeful actions that previously were avoided.

8. Ellis’ concept of anxiety over anxiety will remain salient. This secondary distur-bance, or double trouble, may eclipse the intensity of the primary imaginary terror.Therapists will help their clients wrestle with this two-pronged issue for decadesto come.

9. We predict that the rational emotive approach to addressing anxiety will gainsupport from magnetic resonance imaging studies. Such studies will show increasedcerebral blood flow to the prefrontal orbital cortex during rational problem-solvingsessions. We predict an increase in neuron networks associated with persistence inreasoning and problem-solving to curb parasitic anxieties that drain time andresources.

10. Were it not for a normal human tendency to create false realities and distort realevents to conform to preexisting ideas, most therapist would be out of work. Thetrend to distort is likely to continue until society wakes up and teaches childrenhow to proactively cope, thus preventing needless emotional distresses as they go through life. Rational emotive education (Knaus, 1974) provides a rationalemotive curriculum that supports this proactive life-skills development goal.However, until a more enlightened society adopts new ways to prevent the differentforms of anxiety thinking, rational interventions will continue on the therapeuticagenda.

Uncontrollable Events and Manageable Cognitions

In 1947, the poet W. H. Auden published “The Age of Anxiety.” This age doesn’t seemto die out. Dangers, threats, and social changes are an inescapable part of living in a“civilized” society.

Since 1947, subsequent generations faced uncertainties and threats: mutually assureddestruction; fanatics who stupidly and selfishly believed they’d ascend to heaven forkilling innocent people in the 9/11 destruction of New York’s twin towers. Economiccrises, eroding confidence in the ability of elected public officials to do their job in thepublic interest, and catastrophic documentaries on the world ending in 2012 give somea mix of reasons to look toward the future with apprehension.

The rational emotive therapeutic delivery system has tested tools to help people withpersistent anxiety about real and fantasized future disasters. For example, a TV seriesportrays what would happen if an asteroid hit the earth. Your client has nightmaresand day dreads. Questions, such as whether there is any evidence that there is an asteroidheading for the earth and a disaster is eminent, introduce a reflective step into an anxietythinking process.

Training clients—also the general public—to raise questions about disaster TV showscan be a fun way to help motivate clients to build reasoning skills and simultaneouslyto reduce needless tensions about uncontrollable possibilities.

Psychoneurosis and Anxiety Problems 139

Client–Therapist Relationships

We’ve come a long way since Ellis’ article on psychoneurosis and anxiety, but still haveground to cover. Are some individuals likely to gain ground faster with a forcefulactive–directive therapist? What individuals are likely to improve quicker working witha confident, evocative therapist, who raises pointed rational questions and ties thingstogether when the timing seems right? Is it possible to take a non-directive approachto lead the witness, so to speak, to rational conclusions, as is done in motivationalinterviewing? Is that approach more likely to promote positive behavioral changes, andfor what types of client?

Clients who met with Albert Ellis may have chosen him because of his reputation asan active–directive psychotherapist. Few entered therapy with Ellis expecting to find anolder man with a goatee and Viennese accent sitting behind a couch with a pen andpad of paper in hand, who behaved like a projection screen. Indeed, a common clientcomplaint is that the therapist doesn’t talk enough. Ellis would be a most unlikelytherapist to hear this complaint.

In “Psychoneurosis and Anxiety Problems,” Ellis spends little time with thetherapeutic relationship. Later, in an article on how REBT was augmented over 30 years,he expends a few words on the role of a rational therapist as using general techniquesof therapy, such as relationship building, support, and interpretations (Ellis, 1999).Does this mean that relationship building is a stepchild of his brand of rational therapy?

In REBT, the value of therapeutic relationships tends to get underplayed. But doesthat mean this therapeutic condition is as minimal a factor as the space that Ellistypically devotes to it?

It is important for the therapist to develop a rapport based on trust, and this occursunder conditions where the client is first likely to feel tense about the reasons forentering therapy and in getting used to a new person, the therapist. Rapport is built inmany ways, including jointly and actively engaging a client in problem-solving. It maybe accomplished through skilled interaction, a confident and knowledgeable demeanor,and strategically laying the groundwork for a therapeutic alliance. In this alliance, boththerapist and client cooperatively identify, explore, and refute irrational thoughts.

Relationship building is a significant part of therapist training programs. We predictthat we’ll see an increased integration of rational therapy principles and traditionaltherapy alliance building methods in university therapist training programs. It is likelythat REBT methods will become integrated into such programs, more so than theprograms will become integrated within an REBT framework.

Experiential Challenges

It is not enough for the client to “know about” the power of harmful irrational thinkingand how it inhibits constructive actions; the “know-how” comes from testing new ideasand behaviors in the laboratory of life, outside of the shelter of a therapist’s office. Theuse of homework assignments is a central part of the RET treatment plan, is already asignificant part of many forms of cognitive behavior therapy, and this part of a rationaltherapist’s therapeutic tool chest is likely to continue. Indeed, this form of exposure isthe gold standard for addressing many forms of anxieties and problem-related phobias,and fears.

140 Edward Garcia and William Knaus

Psychological homework assignments have sequential potential. The client maypresent a fear of failure. A logical psychological homework assignment would be toengage the client in failure training to learn how to challenge fear of failure thinking.However, this assignment may surface other issues, such as a fear of uncertainty andneed for guarantees. Subsequent psychological assignments can focus on changing aclient’s more general fear of uncertainty, through psychological assignments that involvemanaging uncertainty for purposes of building high frustration tolerance for ambiguity.

Whatever their purpose, psychological homework assignments may be the morechallenging phase of therapy the therapist faces. Clients are not universally eager toadhere to this experimental prescription for change. Yet it is an important componentof REBT, and most cognitive behavior spins off from this pioneering system.

Educational Methods

We anticipate that future rational emotive therapists will increasingly augment theirtherapeutic tool kit with educational methods to help make rational ideas memorable andto facilitate positive change. For example, the use of stories, music lyrics, poetry, andmetaphors can help the client connect with a problem. The following quote can help aclient connect with a potential benefit from attacking a problem head on: “If you’re goingto go through hell . . . I suggest you come back learning something” (Drew Barrymore).

Educational psychology has much to offer the REBT educative form of psychotherapy.Cognitive learning theories will increasingly be used to augment REBT. We may see anincreasing use of instructional design methods for improving the delivery of REBT self-help methods that appear in books or in interactional forms, as is increasingly seen onthe Internet. However, such changes would best be guided by theory and data.

We assume that people will continue to construe themselves, others, and life eventsin ways that color how they feel and what they do, and that Albert Ellis’ three dimensionsof acceptance (unconditional acceptance of self, others, and life) will continue to givepeople who suffer from anxiety, owing to the demandingness philosophy, an alternative,tension-buffering philosophy.

People who educate themselves in the art and science of making rational inquiries,and who accept only verifiable answers, are more likely to feel in command of themselvesand of the controllable events around them. However, a shift in perspective fromirrational expectations to a scientific view takes time to develop. At first, this shift maybe hard to either accept or to do. That is why positive change is earned, and not granted.That is not likely to change.

References

Auden, W. H. (1947). The age of anxiety. A baroque eclogue. New York: Random House.Ellis, A. (1999). Early theories and practices of rational emotive behavior therapy and how they

have been augmented and revised during the last three decades. Journal of Rational Emotive& Cognitive Behavior Therapy, 17(2), 69–3.

Knaus, W. (1974). Rational emotive educations: A manual for elementary school teachers. NewYork: Institute for Rational Living.

Knaus, W. (2006). The cognitive behavioral workbook for anxiety. CA: New Harbinger.Knaus, W. (2010). End procrastination now. New York: McGraw-Hill.Popper, K. (1963). Conjectures and refutations. London: Routledge.

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PSYCHONEUROSIS AND ANXIETY PROBLEMS

Albert Ellis

The relationship of psychoneurosis and anxiety problems to cognition in general andto what, in particular, people say to themselves as they experience difficult or “traumatic”experiences has been seen vaguely at least for many centuries. Buddha recognized thatpeople make themselves miserable by concentrating too much on the fulfillment oftheir desires, including their goals and values; and he advocated that they becomenonanxious or nonfrustrated by surrendering these values and making themselvesdesireless (achieving Nirvana) or at least less desirous. Epictetus (1890) and MarcusAurelius (1890), a student of Epictetus, even more clearly saw that people’s unrealisticcognitions made them anxious or miserable, and that these could distinctly be changedso that they then made themselves serene or happy. Other philosophers, such as Spinoza(1901) and Russell (1950), have also clearly seen that what we call “emotions” and“emotional disturbance” are largely created by cognitions, and that changing our beliefsand philosophies significantly modifies our disturbances (Ellis, 1977a).

In the realm of psychology and psychotherapy, several outstanding thinkers havearrived at similar conclusions, often without any real knowledge of their philosophicpredecessors. Thus, pioneers like Adler (1927), Kelly (1955), Low (1952), Berne (1957),and Rotter (1954) have stressed the cognitive elements in psychoneurosis and anxiety;and, even more specifically, for the last quarter of a century I have emphasized thesignificance of what people say to themselves, and how they can disturb and undisturbthemselves by cognitive intracommunication (Ellis, 1957a, 1957b, 1962, 1971/1974,1973, 1979a; Ellis & Abrahms, 1978; Ellis & Grieger, 1977). In turn, a number of otherprominent cognitive behavior therapists have gotten on the bandwagon and made theconcept of cognition in psychoneurosis quite popular (Beck, 1976; Davison & Neal,1974; Diekstra & Dassen (1976); Goldfried & Davison, 1976; Greenwald, 1977; Hauck,1975; Knaus, 1974; Lembo, 1976; Mahoney, 1974, 1977; Maultsby, 1975; Meichenbaum,1977; Morris & Kanitz, 1975; Raimy, 1975; Rimm & Masters, 1974; Tosi, 1974).

In this article, I shall review some of the main hypotheses and findings about cognitionand emotional disturbance, and I shall particularly concentrate on several major formsof anxiety and how human thinking significantly helps to create feelings of overconcern,phobias, worthlessness, and various other forms of “nervousness.” Since the field ofhuman neurosis is almost incredibly broad and wide-ranging, I shall not attempt tocover it completely but shall concentrate on several of its major aspects, and on thecognitions and ideas that tend to go with these aspects.

Let me first define some terms in this respect, so that the various forms of anxietythat I shall concentrate on in this chapter will be clearly understood. These forms areas follows:

Ego anxiety. Ego anxiety is perhaps the most dramatic form of nervousness and one ofthe most pernicious because it involves people rating themselves, their essence, andfeeling almost totally worthless or inadequate if they do not perform some task(s) wellenough, or if they are not sufficiently approved or loved by others. When they haveego anxiety, they usually have emotional tension (or, better, hypertension) that results

when they feel (1) that their self or personal worth is threatened; (2) that they shouldor must perform well and/or be approved by others; and (3) that it is awful orcatastrophic when they don’t perform well and/or are not approved by others as theysupposedly should or must be (Ellis, 1978). Ego anxiety is frequently called performanceanxiety, since it is experienced when people feel that they have not performed sometask or project well enough and are pretty rotten individuals for having failed to dobetter on it.

Discomfort anxiety. Discomfort anxiety is a term that I have recently coined and that Idefine as emotional tension (or hypertension) and that results when people feel (1)that their comfort (or life) is threatened; (2) that they should or must get what theywant (and should not or must not get what they don’t want); and (3) that it is awful orcatastrophic (rather than merely inconvenient or disadvantageous) when they don’t getwhat they supposedly must (Ellis, 1978). Discomfort anxiety is usually less dramaticthan ego anxiety, but it is probable that it is just as frequent or even more so, and thatit is a secondary symptom (as I shall note below) of acute or longstanding ego anxiety.

Phobias. Phobias are feelings of anxiety or panic about specific things, situations, orpeople—such as phobias of riding on elevators, appearing in public places, talking insocial groups, speaking in public, taking examinations, etc. Some phobias (e.g., fearsof social situations) largely consist of ego anxiety: the fear that one will do poorly inthese situations and will therefore find himself worthless. Many phobias (e.g., fear ofriding in elevators) largely consist of discomfort anxiety: the fear that one will be highlyinconvenienced or physically harmed in the elevator and therefore has to avoid it at allcosts. But one can also have both anxieties in a given situation by: (1) feeling thatelevators are too dangerous and too uncomfortable to ride in; and (2) feeling that ifone rides in elevators one will act poorly (e.g., show panic), be disapproved by others,and therefore feel ashamed of oneself.

Obsessions. Obsessions frequently result when people are so terrified of something—such as social situations or elevators—that they keep dreading any actual or symboliccontact with this thing, and hence think of it continually, obsessively. Thus, knowingthat one will have to speak in public a few weeks hence, one may think of almost nothingbut that “horrible” experience until the scheduled performance; and then may obsessfor weeks or months about how “terribly” they spoke in public after they have alreadydone so.

Compulsions. Compulsions normally are performed in a rigid, invariant manner todefend against and ward off the anxiety that presumably would have to occur if peopledid not perform them. Thus, if a man is afraid of having dirty hands (and therebyoffending others and proving to them and oneself that one is worthless), he may literallybe compelled to wash his hands 20 or 30 times a day, and even then only partially wardoff his anxiety.

Anxiety about anxiety. Once people make themselves anxious about almost anything,and experience extreme and uncomfortable states of panic about that thing, they know

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that they will be highly disadvantaged if they become anxious again. Therefore, theymake themselves anxious about their anxiety, panicked about the possibility of recurringpanic. Thus, if someone first makes him or herself anxious about riding in elevators,s/he knows that s/he will be highly uncomfortable if forced to ride or even if thinkingabout riding in a lift; hence s/he becomes more anxious than ever about the thoughtor the actuality of elevator rides—and very likely has both ego anxiety (“Isn’t it shamefulthat I am afraid of riding in elevators!”) and discomfort anxiety (“Isn’t it horriblypainful to experience anxiety about riding in elevators!”) whenever anything connectedwith elevators comes to mind.

Anxiety about psychotherapy. Once people see that they are emotionally disturbed andonce they go for psychotherapy, they frequently make themselves quite anxious abouthow they are doing or will do in therapy. Thus, one can put oneself down for not beinga “good” client and responding well to therapy; and one can make oneself “anxious”about the hard work that therapy requires and have abysmally low frustration toleranceor discomfort anxiety about this required work.

Biosocial Elements in Cognition and Anxiety

If cognition plays an extremely important role in the creation and sustaining of neurosisin general and anxiety in particular, as this chapter will contend, the questions may beasked: Why is this so? What makes cognition so important in human affairs and inhuman disturbances?

The first answer to these questions is: Biology does. Humans are born with anunusually large and complex cerebral cortex; and they not only have the power to think,as do innumerable lower animals, but also to think about their thinking and thinkabout thinking about their thinking. This power, moreover, is enormously enhancedby their invention and use of language: of verbal, mathematical, symbolic, and otherforms of language. Again, while other animals have rudimentary language and cancommunicate with each other (and perhaps with themselves) to some extent, humanscan do so to a much greater degree; and they almost invariably do. All human groupsthat we have any knowledge of appear to use language and cognition much more, andin many more complex ways, than do subhuman creatures.

Human biology, moreover, seems to predispose people to social living: to gregarious-ness, teaching, and to culture. Children are very suggestible or easily influenced animals;and so are adolescents and adults. They therefore are greatly influenced by their parents,schools, churches, books, TV shows, and other organizations and modes of masscommunication. Since social learning largely takes place through language and verbalactivities, the natural propensity of humans to think and to affect their emotions andbehaviors by their thinking becomes enormously enhanced by cognitive means; andthe influence of thinking on normal and pathological processes becomes even moreprofound. Even if reared by wolves on a desert island, people would probably thinkmuch more and differently than the wolves. But when reared in families, clans, andcultures, their cognitive processes take over even more and tend to run much of theirother existence (Ellis, 1962, 1977a).

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Human thinking, if it can be said to have a purpose, probably is mainly designed tohelp humans live longer and more successfully, to be alive and happy. But it also hasits liabilities: to a considerable degree it manages to help humans live less long, as whenit addicts them to cigarettes, overeating, alcohol, drugs, etc.; and it helps them live lesshappily, as when it addicts them to anxiety, depression, hostility, and feelings ofworthlessness. Some of their disordered and disturbed thinking may well result fromtheir social learning as Bandura (1977, 1978), Maslow (1962, 1970), Rogers (1961), andothers have pointed out. But much of it, in fact, may also result from their biologicaltendency to think irrationally and to behave dysfunctionally (Ellis, 1976/1977, 1979b).People are so prone to defeat their own chosen goals and values, and do this so widely,in just about every time and clime, that we may well hypothesize that they have a stronginnate tendency to do so; and that even though this tendency may be partially overcomenotably by teaching and by psychotherapy—as I have particularly claimed in many ofmy writings (Ellis, 1962, 1973, 1979a)—they still often and intensely fall back ondisturbing themselves in powerful ways.

Cognitive Elements in Ego Anxiety

Ego anxiety, as I noted above and as I shall now indicate in more detail, has manypronounced cognitive elements, all of which lead to fears of worthlessness. The mainand most important one is what I call musturbation (Ellis, 1979a; Ellis & Abrahms,1978; Ellis & Grieger, 1977; Ellis & Harper, 1975). This arises because people do notmerely wish, want, or prefer to perform important tasks adequately; they insist thatthey must, that they have to do so. They have what Karen Horney (1965) called the“tyranny of the shoulds.”

Whenever people resort to absolutistic, musturbatory thinking, it is virtuallyinevitable that they make themselves emotionally disturbed. For if they don’t do as wellas they think they should or must, they will certainly make themselves anxious or nervousabout doing well, and also anxious about being worthwhile; and even when they doperform adequately, they will have no guarantee whatever that they will continue todo as well in the future; so, once again, they will make themselves distinctly anxious(Ellis, 1979a, 1979c).

More concretely, musturbatory thinking goes as follows. Let us say you rationallystart off with the idea that “It would be highly preferable or desirable that I do well atimportant tasks” (that is, those I have chosen to see as important to my health andhappiness); and “It would be undesirable and deplorable if I fail at such tasks and winthe disapproval of significant people in my life.” This is a rational or sensible orempirically confirmable belief because you can almost always show or prove that if youdo poorly at these tasks and if others disapprove of you you will reap distinctdisadvantages. For example, you will not get or keep a position you want; or will bepaid poorly; or will not have others do various favors for you; or will reap other“disbenefits” by failing to do well. So, for all practical purposes, since you bring toalmost any situation or experience your fairly strong desire to stay alive and to be happy,it is desirable for you to succeed and to be approved by others; and, by the same token,it is undesirable or unfortunate or regrettable if you fail and win others’ disapproval.

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If you were consistently rational, efficient, and sane, therefore, you would not likefailing or being disapproved; and you would feel appropriately disappointed, sorry, sad,and frustrated when you did not do as well as you preferred to do and when othersdisliked you for failing. In RET, we distinctly and specifically differentiate yourappropriate feelings in this respect from your inappropriate feelings of anxiety,depression, hostility, self-downing, and self-pity. We call the former set of feelings oremotions appropriate because they tend to help you, motivate you to go back to youroriginal desires (for success and approval), and to achieve them; while inappropriatefeelings tend to sabotage your goals, and deprive you of motivation (or give youmisguided, desperate motivation), and thereby help you continue to fail in the future.

The basic correlates or supplementary irrational ideas that accompany or follow thisunrealistic demand then include:

“People and the world have no right to treat me in a manner so that I am seriouslydeprived of the things I want or am forced to live with things that I don’t want!”

“Because conditions exist so as to bring about serious deprivations or to force meto live with things I don’t want, the world is a thoroughly rotten place in which tolive!”

“It is awful and horrible when conditions exist, as they must not, and seriouslydeprive me of the things that I want or cause me to experience things that I don’twant!”

And, especially, “I can’t stand it when conditions exist, as they must not, andseriously deprive me of the things that I want or cause me to experience thingsthat I don’t want!”

Ego anxiety and discomfort anxiety are in at least one fundamental way the same;in both there is a fear of something imagined, worthlessness in the case of ego anxietyand pain or frustration in discomfort anxiety. But, discomfort anxiety, or extreme lowfrustration tolerance, is in some ways almost the opposite of ego anxiety: In the lattercondition one ends up by severely condemning oneself because one is not as gloriousand great as one insists that one must be; while in the former condition one ends upby damning other people and the world because they do not treat one as gloriouslyand greatly as one insists that they must. Whereas ego anxiety, therefore, winds up withextreme self-downing and feelings of worthlessness, discomfort anxiety may wind upwith feelings of depression, self-pity, and extreme anger or irritability, as well as anxiety,but with an underlying sense of grandiosity: one feels that the world indubitably stinksbut that oneself is something of a marvelous person who does not deserve this kind ofa stinking world (Ellis, 1978).

Ego anxiety, in other words, starts with feelings of grandiosity—or would-begrandiosity—and finishes up with self-immolation; and discomfort anxiety starts withsimilar feelings of grandiosity and may finish up with the same kind of feelings and/orwith self-pity. You begin by assuming that because you have been given the boon oflife and should be given it forever and assuming that because you can be happy and

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must always be happy, it is horrible, you can’t stand it, and the world is a pretty rottenplace whenever you are not accorded long life and great joy by others or by the universe.Childish grandiosity, which seems to be native to most children, thereby reigns forever!

Once you devoutly believe these fundamental irrational premises, you are prone tobelieve several irrational correlates of discomfort anxiety or low frustration tolerance.These irrational beliefs tend to be along the following lines:

“I need what I want and it is awful when I don’t have it!”

“I must have the power to ward off dangerous and obnoxious conditions!”

“There must be a high degree of order or certainty in the universe.”

“I must not be forced to face life’s great difficulties and responsibilities.”

“Many things are too hard and must not be that hard!”

“I can’t stand my disturbed feelings and must not feel them!”

“Now that I am alive, I must not die!”

Cognitive Elements in Phobias

Phobias, as noted above, may stem from either feelings of ego anxiety or discomfortanxiety, or a combination of both. In phobias about presentations or situations wherethere is a good chance that people will fail or at least not come up to their own (oftenunrealistic) expectations, ego anxiety is largely involved. Thus, in phobias aboutattending social groups, speaking in public, or taking examinations, you usually startwith the basic.

Cognitive Elements in Anxiety About Anxiety

Rational emotive therapy is one of the main psychotherapies that duly emphasizes theelement of anxiety about anxiety—or the secondary symptoms of anxiety that frequentlyfollow the primary symptoms (Ellis, 1962, 1978, 1979a, 1979c, 1979d; Ellis & Abrahms,1978; Ellis & Grieger, 1977; Ellis & Harper, 1975; Grieger & Boyd, 1979). This elementhas also been emphasized by a few other leading therapists, such as Low (1952) andWeekes (1969, 1972, 1977). It is exceptionally important to note this factor in anxietyand in neurosis since it usually is highly important and almost inevitably follows thecontinued or the intense existence of almost any feeling of anxiety.

A good example in this respect exists in the case of agoraphobia. When people areagoraphobic, they first tend to be extremely afraid of open or unfamiliar places, andtherefore confine themselves to their homes or offices. They later often become afraidof many other things, such as trains, automobiles, elevators, etc. Their first level ofanxiety usually is a combination of discomfort anxiety and of ego anxiety. In terms ofthe latter, they tell themselves something like, “I can’t stand open spaces, because thereis little structure there, and in an unfamiliar surrounding I might well make moremistakes than usual. If so, that would be awful and I would be something of a shit!”In terms of the latter, of discomfort anxiety, they tell themselves something like, “I

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can’t stand open spaces, because there is little structure there, and in an unfamiliarsurrounding I have to work harder to do well and to mind my p’s and q’s. It’s too hardand it shouldn’t be that hard! Therefore, I’d better take the easier way out and avoidall open spaces!”

Once they become terrified of open spaces—for either or both of these reasons—they frequently feel extremely uncomfortable (1) when actually in such spaces, or (2)even when thinking about being in them. They then frequently—I would say usually—acquire some degree of ego anxiety and of discomfort anxiety about their extremefeelings of discomfort or about their anxiety.

In terms of ego anxiety, they tell themselves something like, “It’s awful to feel anxiousabout open spaces. Other people are not agoraphobics; and it’s downright silly for meto be one. What an incompetent person I am for having such a foolish fear!” In termsof discomfort anxiety, they say to themselves something along these lines: “It’s awfulto feel anxious about open spaces. Anxiety is very painful; in fact, it’s too painful tobear. How horrible for me to suffer such pain! I absolutely must stay away from openspaces, or even from thinking about open spaces, in order to stave off this horriblypainful anxiety!” (Ellis, 1979d).

Things can get even more complicated than this in terms of one’s secondarysymptoms, or one’s anxiety about anxiety. For just as one can think about one’s thinkingand also think about thinking about one’s thinking, one can go to a tertiary level andconclude: “Not only am I anxious about open spaces, but I can see that I’m anxiousabout my anxiety. That means that I’m really very anxious—and much more so thanare most people. What an idiot I therefore am! Moreover, if I have both anxiety andanxiety about anxiety—both of which are horrible to experience—I just can’t bear thisabominable kind of pain. Oh, woe is me if I continue to have these terrible feelings!”

Ego anxiety and discomfort anxiety, moreover, can easily reinforce and aggravateeach other—especially in the case of agoraphobia. Thus, if you are an agoraphobic youcan say to yourself, “I’m really no good if I act incompetently in open and unfamiliarplaces; and because I’m no good, people will see that I am and will tend to boycott meand not do anything good for me. This means that I will be extremely deprived; and Ican’t stand being deprived! My God, I must not be deprived, I must not be deprived!And the more anxious I am about open spaces, the more I will be boycotted anddeprived; and the more I am deprived, the more anxious I will be. If people see I amincompetent, they are right, and I am pretty worthless; and if they see I can’t stand theanxiety of being agoraphobic or can’t stand the deprivation of their boycotting me,they will think I’m a terrible baby. And that’s awful, if they think I’m a baby and putme down for that! Then they will boycott me all the more—and I can’t stand theirdepriving me for that (or any other) reason!”

Round and round you can easily go: starting with ego anxiety, having discomfortanxiety about that; then creating more ego anxiety about your original anxiety and yourdiscomfort anxiety; then creating more discomfort anxiety about your increased egoanxiety, etc., etc. The interaction of these two neurotic feelings seems endless—andquite often is!

Just as people make themselves anxious about their own inadequacies, about the“unniceties” of others, and about the conditions and hassles of their lives, they alsobring their anxiety-creating cognitions into the realm of psychotherapy. For many of

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them, particularly those who have high degrees of intelligence and education, soon seethat they are anxious and try to do something about their neurotic feelings, either inthe form of self-help procedures or by undergoing some form of individual or grouptherapy. And—what do you know!—they then tend to experience intense ego anxietyas well as discomfort anxiety about their therapeutic endeavors.

Take, for example, people with a simple fear of, for example, escalators. They knowthat they have this fear after having it a short while; they know that escalators are quitesafe means of transportation; and they therefore conclude that they are “foolish” formaintaining their escalator phobias. They also know, in many instances, that if they(1) face their fear of escalators; (2) force themselves, however uncomfortably, to takemany escalator rides; (3) read pamphlets and books on how to overcome fears; and (4)go for intensive psychotherapy, they will most probably overcome their phobia. Butvery frequently they do few or none of these things, and thereby “resist” curingthemselves, for a number of reasons:

They tell themselves that it is utterly foolish to have such a “ridiculous” fear, andthey are ashamed to fully admit that they have it. Consequently, even though they mayavoid riding on escalators, they make rationalizations for doing so (e.g., “My foot issore today and I may harm it,” or “It’s faster walking up the stairs than using theescalator,” or “This is an unusually steep and fast escalator and is one of the few thatreally is dangerous.”). They thereby never quite admit they truly have an escalatorphobia, because of their ego anxiety.

Whenever they admit that they are afraid of escalators and vow to keep riding onthem, they experience feelings of panic. They then tell themselves, “I can’t stand thisfeeling of panic! It will make me do something really awful—such as actually get in aserious escalator accident! It’s too hard to go on the escalators when I feel this way. I’llwait until I feel better about it and then take many rides.” Their discomfort anxietythen prevents them from carrying out their resolution to practice in vivo desensitizationon the escalators.

When they consider riding escalators, they often tell themselves, “I can do it; butI’m sure I’ll feel panicked doing it. Other people will then see that I am panicked; andthat will be shameful! I’d better look around for an escalator that practically no oneever uses, so that no one will see how shamefully panicked I am!” In this instance, theirego anxiety prevents them from curing themselves of their fear.

When they are reading pamphlets or books about overcoming fears of escalators (orof anything else), they frequently feel very uncomfortable (because they are then facingtheir phobia and admitting they have it and putting themselves down for having it),and they abandon the reading because of their discomfort. Here, their discomfortanxiety bolixes up their self-help efforts. They also may have difficulty in reading andunderstanding this material on overcoming fear and may tell themselves, “It’s hard toread this difficult and boring material. In fact, it’s too damned hard—much harder thanit should be! I’ll read it later.” Again, their discomfort anxiety interferes with theirtherapeutic efforts. When they consider going for individual or group therapy, they tellthemselves that seeing a therapist, and particularly letting others know that they seeone, is shameful and that perhaps they’d better not go for that reason. Again: ego anxiety!

In considering therapy or actually undergoing it, they insist that they have tounderstand everything the therapist says and put his/her advice into almost perfect

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effect; and aren’t they horrible people when they don’t understand or don’t perfectlyactualize the therapeutic instructions. So they again refuse to go for treatment, or elsethey quit it prematurely. More ego anxiety!

They inwardly and/or outwardly rave about the horrible hardships of therapy suchas: (1) they have to pay for it; (2) it requires steady appointments; (3) it involveshomework assignments; (4) it calls for their doing hard things that they have neverever done before in their lives; (5) it takes too long; (6) it provides no guarantees ofsuccess; (7) it is often boring. They not only view these hardships as unfortunate andundesirable, but as hassles that should not, must not exist, and that are therefore totallyabominable! More discomfort anxiety!

They frequently compare themselves to other clients who have undertaken therapy,such as their friends or other members of their therapy groups. They tell themselvesthat “I should do as well in therapy as these others are doing; and isn’t it awful whenI am not. That simply proves that I am a hopelessly incompetent individual who willnever learn how to help myself and who will have to suffer this phobia forever!” Again,ego anxiety rears its ugly head!

Whenever they make temporary advances in therapy and then fall back again, theytend to think, “There I go ahead! Falling back! What a rotten person am I!” And:“Obviously, this therapy is too hard for me. I’ll never be able to keep it up! Howimpossible a task when I have to continue to work practically forever!” Here we haveboth ego anxiety and discomfort anxiety.

In many ways, then, and on several important levels, humans tend to create egoanxiety and discomfort anxiety: in regard to their original symptom; in the fabricationof secondary and tertiary symptoms; and about their attempts at helping themselvesget over their symptoms. Again I hypothesize: in relatively mild, short-lived neuroticdisorders, either ego anxiety or discomfort anxiety tends to exist; but in almost all severeand longstanding disorders, both these manifestations hold sway and usually continueto exist in an intense and prolonged manner. Whenever ego anxiety is profound, itleads to such heightened feelings of discomfort (such as panic, horror, and terror) thatpeople conclude that these feelings absolutely must not, should not exist, that it is awfulthat they do, and that life is just too much of a hassle for them to experience almostany enjoyment whatever under these conditions. They then are in the throes ofdiscomfort anxiety. And whenever extreme discomfort anxiety or feelings of lowfrustration tolerance exist, most humans sooner or later tend to put themselves downfor having and indulging in such feelings. They tell themselves cognitions like, “Whata baby I am! I should be able to face my panic and get over it and I obviously cannot.I’m just a rotter and a highly incompetent person!”

By the same token, feelings of discomfort anxiety may easily be followed by discomfortanxiety about discomfort anxiety. If you are horrified about the difficulty of speakingwell in public, you can also easily horrify yourself about the difficulty of having thesehorrible feelings. And ego anxiety may easily be followed by ego anxiety. If you downyourself for being unable to cope with open spaces, you may down yourself for downingyourself! As noted above, ego anxiety and discomfort anxiety powerfully interact; and,whenever one powerfully exists, there is an excellent chance that the other does, too.Moreover, when you experience either ego or discomfort anxiety as a primary symptom,there is a good chance that you will experience either or both as a secondary (and

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perhaps also a tertiary) symptom. And since both ego and discomfort anxiety are largelycreated by irrational beliefs, we can truly say, with the poet, “O what fools we mortalsbe!” Except that, in RET terms, we are not foolish (about this or anything else); wemerely behave foolishly much of the time!

Research Findings on Cognition in Psychoneurosis

It would seem a relatively simple task to check on the cognitions of individuals withemotional problems, and to see whether these significantly differ from, and in whatways they differ from, individuals having less of these problems. Indeed a great deal ofresearch has been done in this area, especially in the realm of the irrational ideas thatI hypothesized some 25 years ago as concomitants of neurotic behavior (Ellis, 1957b,1958, 1962). My first papers on RET outlined from 10 to 12 major irrational ideas thatpresumably accompany, and in some significant ways contribute to or cause, emotionalproblems. A good many researchers expanded on these irrationalities and made theminto paper and pencil tests (Argabite & Nidorf, 1968; Bessai, 1975; Fox & Davies, 1971;Jones, 1968; MacDonald & Games, 1972; Shorkey & Whiteman, 1977). These tests havesubsequently been given to a wide variety of groups of disturbed and “normal”individuals; and they have also been correlated with the test results of some of the otherstandard personality and neurosis scales, such as the Minnesota Multiphasic PersonalityInventory.

Most of the studies of tests of irrationality based on the main RET hypotheses haveproduced statistically significant results. Thus, O’Connell, Baker, Hanson, andErmalinski (1974) found active participants in therapy groups to be significantly morerational than inactive participants. Kassinove, Crisci, and Tiegerman (1977) showedthat older grade school students displayed less irrationality than younger ones. Nelson(1977) indicated that depression was related most strongly to high self-expectations,frustration reactivity, overconcern about possible misfortunes in the future, helplessness,and the total score on the R. G. Jones Irrational Beliefs Test (1968), derived from RETprinciples. Morelli and Friedman (1978) found that positive correlations existed betweenself-reported anxiety and irrationality. Shorkey and Reyes (1978) reported significantcorrelations between a rational behavior inventory and several self-actualizationvariables. Brandt (1976) discovered that basic irrationalities, as posited by me, are cross-cultural and exist in the British as well as the American populace. Nolan (1977) reportedthat selected irrational beliefs were responsible for the observed differences in thenegative effects of anxiety, hostility, and depression of community college students.

Waugh (1976) found a significant correlation between rationality and emotionaladjustment. Fox and Davies (1971) showed highly significant differences in irrationalityscores between a group of normal Canadians and groups of mental hospital patientsand of alcoholics. MacDonald and Games (1972) indicated that the Ellis irrationalvalues scale was “significantly related to neuroticism, anxiety, external locus of control,and many of the California Psychological Inventory subscales.” Barry (1974) found thatprison inmates functioned more from irrational beliefs than a normal populationsample. Eisenberg and Zingle (1975) showed that “individuals who experience maritaldifficulties demonstrate higher degrees of irrational thinking than individuals who donot experience such difficulties.” Zingle (1965) reported that a test of irrationality based

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on RET discriminated school underachievers from normal achievers. Fox (1969) foundthat a rationality Life Orientation Test significantly differentiated between ErichFromm’s designations of individuals with biophilia and necrophilia.

Hoxter (1967) discovered that problem children in a school setting had moreirrational beliefs than nonbehavior problem children in the same setting. Sanche (1968)reported that educationally retarded youngsters had significantly fewer irrational beliefsafter a cooperative schoolwork training program than they did before taking this pro -gram. Sharma (1970) found that underachievers exposed to rational group counselingshowed significantly greater reduction in irrational beliefs than did underachievers not exposed to this kind of counseling. Taft (1968) noted that a group that scored high on the Zingle (1965) Irrational Ideas Inventory exceeded a low irrational-beliefgroup in anxiety. Vargo (1972) found mentally healthy people to be more rational than mentally disturbed people. Winship (1972) showed that a high irrational-belief group in every case exceeded a low irrational-belief group in anxiety proneness. Zingle(1965) found that a group of underachieving students counseled according to an RETorientation showed a significantly greater improvement than did an untreated groupon his own Irrational Ideas Inventory.

Studies such as those just listed give fairly impressive evidence that in tests ofirrationality, based on my originally posited basic irrational ideas, psychoneurotic andother emotionally disturbed groups of individuals are almost always found to differsignificantly from control groups of “normal” or less disturbed individuals; and theseand a good many other studies indicate that when disturbed groups are treated withRET or some variation of cognitive behavior therapy they almost always show significantimprovement on tests of rationality and other personality indicators (Ellis, 1977a, 1977c;DiGiuseppe, Miller, & Trexler, 1977; Murphy & Ellis, 1979).

In addition, literally scores of other studies have been done that indicate that peoplewho are diagnosed as being emotionally disturbed—that is, either in the neurotic,borderline, or psychotic range of behavior—have various kinds of cognitive deficienciesor aberrancies. Thus, researchers have found that disturbed individuals are likely tohave significant degrees of problem-solving difficulty (Platt, Spivack, Altman, & Altman,1974); internally elicited cognitive activity (May, 1977); unplanned, impulsive action (Hill, Foote, Aldons, & MacDonald, 1970); closed-style perceptual orientation(Heilbrun, 1973); inconsistent attitude communication (Newman, 1977); dogmaticthinking (Kemp, 1961); less formal operational capacities (Kilburg & Siegel, 1973); deficitof mnemonic orientation (Larsen & Fromholt, 1976); dispersal behaviors (Horowitz,Sampson, Siegelman, Weiss, & Goodfriend, 1978); poor degree of construct differen-tiation (Hayden, Nasby, & Davids, 1977); disordered thinking (Harrow, 1977); a higherlevel of intrusive and stimulus-repetitive thoughts (Horowitz, Becker, & Malone, 1973);more authoritarian attitudes (Becker, Spielberger, & Parker, 1963); more overinclusivethinking (Craig, 1973); excessive response to strong aspects of meaning and deficientresponse to weak aspects of meaning of words (Chapman, Chapman, & Daut, 1976);deficiency in word association (DeWolfe & McDonald, 1972); deficits in self-editing(Davis & Blaney, 1976); conceptual organization deficiencies and response interferenceproblems (Depue & Fowles, 1974); greater misperceptions about people (Widom, 1976);and a clear abstraction deficit (Braff & Beck, 1974).

152 Albert Ellis

Pioneering hypotheses and studies of self-instruction, or of how children and adultstalk to themselves and thereby control their own behavior, have been done by Vygotsky(1962), Luria (1961), and Arnold (1960); and applications of this idea to people’screation and control of their own emotional and psychosomatic disturbances have beendone by many outstanding investigators, including Beck (1967, 1976), Graham, Lundy,Benjamin, and Kabler (1962), Schachter and Singer (1962), and Velten (1968). I reviewmuch of the literature showing the effect of cognitions on human emotions and onbehavioral change in my article, “Rational emotive therapy: Research data that supportsthe clinical and personality hypotheses of RET and other modes of cognitive behaviortherapy” (Ellis, 1977a). Girodo (1977) also reviews the specific relationship betweencognition and anxiety in his article, “Self-talk: Mechanisms in anxiety and stressmanagement.”

This material, together with literally hundreds of other pertinent studies that couldbe quoted if space permitted, tends to show that human psychoneurosis, and anxietyin particular, is significantly related to cognition; and also (what is beyond the scopeof the present article) that when people change their cognitions, attitudes, ideas,philosophies, or self-talk they also significantly change their disturbed emotions andbehaviors. Of all the hypotheses about emotional disturbance and personality changethat now exist, I would say that this one has, at the moment, immense empirical support.

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DeWolfe, A. S., & McDonald, R. K. (1972). Sex differences and institutionalization in the wordassociation of schizophrenics. Journal of Consulting and Clinical Psychology, 39, 215–221.

Diekstra, R. F. W., & Dassen, W. F. M. (1976). Rationele therapie. Amsterdam: Swets & Zeitlinger.DiGiuseppi, R. A., Miller, N. S., & Trexler, L. (1977). A review of rational emotive psychotherapy:

Outcome studies. The Counseling Psychologist, 7, 64–72.Eisenberg, J. M., & Zingle, H. W. (1975). Marital adjustment and irrational ideas. Journal of

Marriage & Family Counseling, 2, 81–91.Ellis, A. (1957a). How to live with a “neurotic.” New York: Crown. (Republished 1975.)Ellis, A. (1957b). Outcome of employing three techniques of psychotherapy. Journal of Clinical

Psychology, 13, 334–350.Ellis, A. (1958). Rational psychotherapy. Journal of General Psychology, 59, 35–49.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart. (Paperback ed. New

York: Citadel Press, 1977.)Ellis, A. (1973). Humanistic psychotherapy: The rational emotive approach. New York: Crown &

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145–168. (Reprinted in A. Ellis & R. Grieger, Handbook of rational emotive therapy. New York:Springer, 1977).

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Ellis, A. (1977b). How to live with—and without—anger. New York: Reader’s Digest Press.Ellis, A. (1977c). Elegant and inelegant RET. Counseling Psychologist, 7(1), 73–82.Ellis, A. (1978). Discomfort anxiety: A new cognitive behavioral construct. Invited address to the

Association for Advancement of Behavior Therapy Annual Meeting, November 17. New York:BMA Audio Cassettes.

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Ellis, A. (1979d). A note on the treatment of agoraphobics with cognitive modification versusprolonged exposure in vivo. Behaviour Therapy and Research, 17, 162–164.

Ellis, A., & Abrahms, E. (1978). Brief psychotherapy in medical and health practice. New York:Springer.

Ellis, A., & Grieger, R. (1977). Handbook of rational emotive therapy. New York: Springer.Ellis, A., & Harper, R. A. (1975). A new guide to rational living. Engelwood Cliffs, NJ: Prentice-

Hall; Hollywood, CA: Wilshire Books.Epictetus. (1890). The works of Epictetus. Boston, MA: Little, Brown, & Co.Fox, E. E. (1969). A life orientation scale: Correlates of biophilia and necrophilia. Unpublished

doctoral dissertation, University of Alberta.Fox, E. E., & Davies, R. (1971). Test your rationality. Rational Living, 5(2), 23–25.Girodo, M. (1977). Self talk: mechanisms in anxiety and stress management. In C. Spielberger

& I. G. Sarason (Eds.), Stress and anxiety (Vol. 4). Washington, DC: Hemisphere.

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Goldfried, M. R., & Davison, G. C. (1976). Clinical behavior therapy. New York: Holt, Rinehart& Winston.

Graham, D., Lundy, R., Benjamin, L., & Kabler, F. (1962). Some specific attitudes in initialresearch interviews with patients having different “psychosomatic” diseases. PsychsomaticMedicine, 24, 257–266.

Greenwald, H. (1977). Direct decision therapy. San Diego, CA: Edits.Grieger, R., & Boyd, J. (1979). Rational emotive therapy: A skills-based approach. New York: Van

Nostrand Reinhold.Harrow, M. (1977). Is disordered thinking unique to schizophrenics? Archives of General

Psychiatry, 34, 15–21.Hauck, P. (1975). Overcoming worry and fear. Philadelphia, PA: Westminster Press.Hayden, B., Nasby, W., & Davids, A. (1977). Interpersonal conceptual structures, predictive

accuracy and social adjustment of emotionally disturbed boys. Journal of Abnormal Psychology,86, 312–320.

Heilbrun, A. B. (1973). Adaptation to aversive maternal control and perception of simultaneouslypresented evaluative cues. Journal of Consulting and Clinical Psychology, 41, 301–307.

Hill, R., Foote, N., Aldons, J., & MacDonald, R. (1970). Family development in three generations.Cambridge, MA: Shenkman.

Horney, K. (1965). Collected writings. New York: W. W. Norton.Horowitz, L. M., Sampson, H., Siegelman, E. Y., Weiss, J., & Goodfriend, S. (1978). Cohesive

and dispersal behaviors: two classes of concomitant change in psychotherapy. Journal ofConsulting and Clinical Psychology, 46, 556–564.

Horowitz, M. J., Becker, S. S., & Malone, P. (1973). Stress: Different effects on patients andnonpatients. Journal of Abnormal Psychology, 82, 547–551.

Hoxter, A. L. (1967). Irrational beliefs and self-concept in two kinds of behavior. Unpublisheddoctoral dissertation, University of Alberta.

Jones, R. (1968). A factored measure of Ellis’ irrational belief system with personality andmaladjustment correlates. Unpublished doctoral dissertation, Texas Technological College.

Kassinove, H., Crisci, R., & Tiegerman, S. (1977). Developmental trends in rational thinking:implications for rational emotive school mental health programs. Journal of CommunityPsychology, 5, 266–274.

Kelly, G. (1955). The psychology of personal constructs. New York: W. W. Norton.Kemp, C. C. (1961). Influence of dogmatism on counseling. Personnel and Guidance Journal, 39,

662–665.Kilburg, R. R., & Siegel, A. W. (1973). Formal operations in reactive and process schizophrenia.

Journal of Consulting and Clinical Psychology, 40, 371–376.Knaus, W. (1974). Rational emotive education. New York: Institute for Rational Living.Larsen, S. F., & Fromholt, P. (1976). Mnemonic organization and free recall in schizophrenia.

Journal of Abnormal Psychology, 85, 61–65.Lembo, J. (1976). The counseling process: A rational behavioral approach. New York: Libra.Low, A. (1952). Mental health through will training. Boston, MA: Christopher.Luria, A. (1961). The role of speech in the regulation of normal and abnormal behaviors. New York:

Liveright.MacDonald, A., & Games, R. (1972). Ellis’ irrational ideas: A validation study. Rational Living,

7(2), 25–29.Mahoney, M. (1974). Cognition and behavior modification. Cambridge, MA: Ballinger.Mahoney, M. (1977). Personal science: A cognitive learning therapy. In A. Ellis & R. Grieger

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Maslow, A. H. (1970). Motivation and personality (2nd ed.). New York: Harper.Maultsby, M.C., Jr. (1975). Help yourself to happiness. New York: Institute for Rational Living.May, J. R. (1977). Psychophysiology of self-regulated phobic thoughts. Behavior Therapy, 8,

150–153.Morelli, G., & Friedman, B. (1978). Cognitive correlates of multidimensional trait anxiety.

Psychological Reports, 42, 611–614.Morris, K. T., & Kanitz, H. M. (1975). Rational emotive therapy. Boston, MA: Houghton Mifflin.Murphy, R., & Ellis, A. (1979). A comprehensive bibliography of hooks, articles and other materials

on rational emotive therapy and cognitive-behavior therapy. New York: Institute for RationalLiving.

Nelson, R. E. (1977). Irrational beliefs in depression. Journal of Consulting and Clinical Psychology,45, 1190–1191.

Newman, E. H. (1977). Resolution of inconsistent attitude communications in normal andschizophrenic subjects. Journal of Abnormal Psychology, 86, 41–46.

Nolan, E. J. (1977). Toward a theory of low frustration tolerance: a cognitive-emotive approach.EdD thesis, University of Virginia,.

O’Connell, W. E., Baker, R. R., Hanson, P., & Ermalinski, R. (1974). Types of negative nonsense.International Journal of Social Psychiatry, 20, 122–127.

Platt, J. J., Spivack, G., Altman, N., & Altman, D. (1974). Adolescent problem-solving thinking.Journal of Consulting and Clinical Psychology, 42, 787–793.

Raimy, V. (1975). Misunderstandings of the self. San Francisco, CA: Jossey-Bass.Rimm, D., & Masters, J. C. (1974). Behavior therapy. New York: Academic Press.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.Rotter, J. B. (1954). Social learning and clinical psychology. New York: Prentice-Hall.Russell, B. (1950). The conquest of happiness. New York: Pocket Books.Sanche, R. P. (1968). Self-concept and beliefs of educationally retarded youth. MEd thesis, University

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Psychoneurosis and Anxiety Problems 157

10 The Role of Irrational Beliefs in Perfectionism

INTRODUCTION

William Knaus and Vincent E. Parr

Albert Ellis was not the first to identify the pernicious effects of perfectionism. He didcontribute significantly to the development of cognitive interventions to soften thenchange irrational demands and claims that fuse untoward emotional states, such asanxiety, depression, and irrational anger.

Ellis saw that, in the world of perfectionist thinking, it was not enough to performwell, get along with others, and gain reasonable advantages. Instead, one must, ought,should succeed. Instead of accepting life’s probabilities, ambiguities, and uncertainties,one must have guarantees. This perfectionist thinking threatens a normal interest in excelling and substitutes an unrealistic Quixote quest of figuratively hacking atwindmills, believing they are something else.

In this commentary/introduction to our colleague Albert Ellis’ views on perfec -tionism, we’ll look briefly at the human tendency to compare, Laurens Hickok andKaren Horneys’ contributions to our understanding of perfectionism, and then AlbertEllis’ observations and leading contributions to our understanding of this cognitivestate and of how to take corrective action. We’ll share our views with you on thesignificant opportunities for mental health practitioners to help alleviate humansuffering from perfectionism by using REBT methods.

Is Perfection Largely Cognitive?

We normally compare ourselves with others and prior performances to present per -formances. Anyone can compare their appearance against another’s. People commonlycompare ideas and writings of one author with the work of others, and so the list goes on. Practically anything in life is a subject for comparison, including comparinginternalized standards and expectations against processes and outcomes. In the case ofa pernicious form of perfectionist thinking, people levy unrealistic expectations onthemselves, others, and life circumstances. They demand that what may seem reasonableto them, happen. This requiring philosophy is distinctively different from a preferringphilosophy that involves stretching to achieve normal desires and rolling with thepunches when the stretch is not enough.

Laurens Hickok (1854) points to how, with time and patience, an expert sculptorcan perfect a work, or a poet a poem. The finished work is the end product of skill andtime. It is this exterior of things that becomes the visible subject for observation andcomparison. Meanwhile, the “interior” goes unseen. Within this interior world of themind, destructive ideas and images may emerge that come about as a result of comparinghuman frailties with idealized states. Today, we are likely to see this process as a formof cognitive distortions when people filter their experiences through perfectionistexpectations. This is like creating an emotional house of cards that commonly collapsesupon them.

We hold to standards, assume, expect, infer, judge, and interpret. It’s part of humannature that we do this. Neo-analyst Karen Horney made a significant contribution onperfectionism by first pointing out how high-flown expectations can expand into apervasive, exaggerated, “ought to be” perspective associated with sensitivities andfrustrations to gaps between performance and reality; even a success may translate intoa disappointment because it was not good enough (Horney, 1937).

Horney (1945, p. 97) described a pernicious result of comparing the self against anunattainable ideal: “He may have a vague sense that he is making high demands uponhimself, but mistaking such perfectionist demands for genuine ideals he in no wayquestions their validity and is indeed proud of them.” She expanded her views onperfectionism by examining the tyrannical nature of inner dictates, such demanding tobe in control, solve every problem, overcome every difficulty, accomplish in an hourwhat normally takes many (Horney, 1950). She saw tyrannical demands at the root ofmuch human misery.

Horney was strong on analysis, but comparatively weaker on how to change theprocess. She mused in Our Inner Conflicts that even following an analysis, “shoulds”tended to stick.

Here comes Albert Ellis. In Reason and Emotion in Psychotherapy, Ellis (1962) stressedthe central role of perfectionism in human disturbance. He identified 11 irrational beliefsthat, if taken to an extreme, would result in intense emotional distress. A closeexamination of these beliefs shows an element of perfectionism weaving through them.

Ellis asserted that, when people translate their normal human desires and interestsinto dire needs, they unnecessarily distress themselves. He gave significant therapeuticweight to showing people how to first recognize tyrannical “should” thinking, and thento adopt clear-thinking alternatives and his three dimensions of acceptance, of self,others, and life.

Horney appears to have come up short on showing people how to dislodge perfec -tionistic beliefs. Ellis, however, stressed rational ways to challenge them:

If you absolutely insist that it will be catastrophic if you do not completely solveyour basic problems immediately, then, by your very insistence, you will bring onsome catastrophe (such as an acute state of panic or a hopeless state of inefficiency)when, as invariably will happen, this perfect and immediate solution is not at hand

(1962, p. 87)

The threads of Ellis’ earlier work on dislodging perfectionist thinking wove through hissubsequent work.

Role of Irrational Beliefs in Perfectionism 159

In The Role of Irrational Beliefs in Perfectionism, Albert Ellis identified perfectionismthinking as the primary cognitive signature for distress. Ellis found a perniciousperfectionism at the core of most needless human misery, and so a significant part ofhis therapy centered on defusing irrational demands.

When people filter experience through a system of perfectionist prejudgments, theyact with a fundamental belief that disparities between reality and a lofty standard orexpectation should not be and are intolerable or awful if this occurs. This cognitivestructure often dominates perception. It may occur under conditions that a casualobserver might view as either non-stressful or not particularly stressful. Ellis (1997)colorfully called this thinking, “musterbation.”

REBT: Is Its Future Tied to Perfectionism?

Prior to Ellis’ publication of Reason and Emotion in Psychotherapy (Ellis, 1962), the litera -ture on perfectionism was lean. Nevertheless, he emphasized countering perfectionismin his brand of therapy and did so when perfectionism was largely absent from the lexiconof many other therapy systems.

By 1990, the professional literature on perfectionism exploded. Ninety-two percentof the 2,070 reports that appear on the American Psychological Association databaseoccurred after 1989. This burgeoning professional awareness of the significance ofpernicious forms of perfectionism has gone in multiple directions. Psychologists GordonFlett and Paul Hewett helped spur this work by drawing attention to perfectionism,and by differentiating between self- and other-oriented forms of perfectionism. Theyput perfectionism into a researchable focus that has stimulated research.

Contemporary research has branched in different directions. The new direction isthat of studying the relationship between perfectionism, eating disorders, alcohol abuse,depression, anxiety, obsessive-compulsive disorder, and others. The collective resultssuggest that perfectionism is a salient factor in such conditions. Another line of researchis on the relationship between perfectionism and various forms of performance, suchas in cricket players, ballet dancers, opera singers, academic achievement, and burnout.

The field of perfectionism research is plagued by variations in definitions, and theusual problems with poorly controlled studies, limited sample size, the overuse of collegestudent groups, and focusing illusions, where the research draws attention to a particularcondition, thus distorting the results. Nevertheless, in the aggregate, the research issignificantly weighted in the direction of measuring disparities between standards andperformance, or expectations for performance. The general results are reasonablyconsonant with the earlier observations of Hickok, Horney, and Ellis.

The now elevated awareness of the negative effects of pernicious forms of per -fectionism suggests that it is all the more important to look closely at Albert Ellis’ methodsand their application to alleviating this cognitive form of distress. Beyond deliveringtested methods to address perfectionist thinking, REBT interventions appear especiallywell-suited to address co-occurring negative thought patterns in depression, such ashelplessness, hopelessness, worthlessness, and low frustration tolerance thinking thatcommonly intensify a depressive mood. The demonstration of applying multiplerational cognitive and behavioral methods to co-existing cognitive conditions indepression is found in Knaus (2006).

160 William Knaus and Vincent E. Parr

The question is not whether REBT has a present or future role to play in alleviatingthe ill effects of pernicious perfectionist thinking. This research-supported psycho-therapy system is especially suited as a psychotherapy delivery system to addressperfectionism when this state of mind rises to a level where it interferes significantlywith normal functions of daily living, or where perfectionism thinking triggersprocrastination in the service of avoiding discomfort associated with fears of failure,fears of appearing insufficient, or other co-occurring perfectionism-linked mentalmachination that detracts from quality performance and a quality life.

References

Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart.Ellis, A. (1997). Must musturbation and demandingness lead to emotional disorders? Psycho -

therapy, 34(1), 95–98.Hickok, L. P. (1854). Empirical psychology; or the human mind as given in consciousness (2nd ed.,

pp. 155–175). New York: Ivison, Blakeman, Taylor, & Company.Horney, K. (1937). The neurotic personality of our time. New York: NortonHorney, K. (1945). Our inner conflicts. New York: Norton.Horney, K. (1950). Neurosis and human growth. New York: Norton.Knaus, W. (2006). The cognitive behavior workbook for depression. CA: New Harbinger.

Role of Irrational Beliefs in Perfectionism 161

THE ROLE OF IRRATIONAL BELIEFS INPERFECTIONISM

Albert Ellis

The importance of perfectionism in helping people become anxious, depressed, andotherwise emotionally disturbed was at least vaguely seen by the Stoics and Epictetus(Epictetus, 1899; Xenakis, 1969) and has been pointed out by pioneering cognitivetherapists such as Alfred Adler (1926, 1927), Pierre Dubois (1907), and Pierre Janet(1898) for more than a century. It also was noted by the non-Freudian psychoanalystKaren Horney (1950) in her concept of the idealized image.

I was the first cognitive behavioral therapist to specifically include perfectionism asan irrational, self-defeating belief in my original paper on rational emotive behaviortherapy (REBT), presented at the annual convention of the American PsychologicalAssociation in Chicago on August 31, 1956 (Ellis, 1958). Thus, among 12 basic irrationalideas that I included in this paper, I listed perfectionism as

The idea that one should be thoroughly competent, adequate, intelligent, andachieving in all possible respects—instead of the idea that one should do ratherthan desperately try to do well and that one should accept oneself as an imperfectcreature, who has general human limitations and specific fallibilities.

(p. 41)

In my first book for the public, How To Live With a Neurotic (1957), I includedamong the main irrational ideas leading to disturbance,

A person should be thoroughly competent, adequate, talented, and intelligent inall possible respects; the main goal and purpose of life is achievement and success;incompetence in anything whatsoever is an indication that a person is inadequateor valueless.

(p. 89)

I also noted, “Perfectionism . . . Excessive striving to be perfect will invariably lead todisillusionment, heartache, and self-hatred” (p. 89).

In 1962, after practicing, lecturing, and writing on REBT for seven years, I includedin my first book for the psychological profession, Reason and Emotion in Psychotherapy,among 11 main irrational ideas that cause and maintain emotional disturbances:

2. The idea that one should be competent, achieving, and adequate in all possiblerespects if one is to consider oneself worthwhile. . . . 4. The idea that it is awfuland catastrophic when things are not the way one would very much like them tobe. . . . 11. The idea that there is invariably a right, precise, and perfect solution tohuman problems and that it is catastrophic if this perfect solution is not found.

(pp. 69–88)

Obviously, REBT has particularly stressed the irrationality and self-defeatism ofperfectionism from its start. Scores of REBT articles and books have made this pointendlessly, including many of my own publications (Ellis, 1988; Ellis & Dryden, 1997;Ellis, Gordon, Neenan, & Palmer, 1997; Ellis & Harper, 1997; Ellis & Tafrate, 1997; Ellis& Velten, 1998) and publications by other leading REBTers (Bernard, 1993; Dryden,1998; Hauck, 1991; Walen, DiGuiseppe, & Dryden, 1992). Following REBT’s identifica-tion of perfectionism as an important irrational belief, the vast literature has beendevoted in recent years to the findings and treatment of perfectionism; cognitivebehavioral therapy also has frequently emphasized the psychological harm and thetreatment of perfectionism. A. Beck (1976) and Burns (1980) particularly emphasizedits importance, and many other cognitive behaviorists have described it and its treatment(Barlow, 1989; J. Beck, 1995; Flett, Hewitt, Blankstein, & Koledin, 1991; Flett, Hewitt,Blankstein, Solnik, & Van Brunschot, 1996; Freeman & DeWolf, 1993; Goldfried &Davison, 1994; Hewitt & Flett, 1993; Lazarus, Lazarus, & Fay, 1993).

Although I have been one of the main theorists and therapists to emphasize theimportance of perfectionism in emotional and behavioral disturbance, I now see thatI have never described what the rational or self-helping elements in perfectionism are,how they accompany the irrational and self-defeating elements, and why they probably“naturally” exist and impede humanity’s surrendering its strong perfectionistictendencies. Because this entire book is about perfectionism, it might be good if I weremore specific than I have been about these important aspects of it.

The main idea of rationality and irrationality in human behavior stems from theancient notion that humans, in order to stay alive and well-functioning, have severalbasic desires, goals, and preferences—which are often incorrectly called needs ornecessities—that help them do so. Thus, people are commonly said to survive betterand be more effective when they

• have a sense of self-efficacy or self-mastery (ego satisfactions);• actually succeed in getting what they want and avoiding what they don’t want (goal

or accomplishment satisfaction);• get approval and minimal disapproval of other people whom they consider import -

ant (love and approval satisfaction); and• are safe and sound, and not likely to be diseased, hurt, or killed (safety satisfaction).

It is not that people cannot exist or must be completely miserable if they don’t fulfillany or all of these desires and goals; therefore, we had better not call them needs ordire necessities. But it is usually agreed—and we can tentatively accept for the sake ofthe following discussion—that humans tend to be better off (happier) and live longer(survive) when they achieve those four goals than when they fail to achieve them.

Assuming—for the sake of discussion and not to posit any absolute truth—thatpeople are more likely to survive and to be glad they’re alive if they satisfy the fourbasic urges or wants mentioned above, then they can probably justifiably take the firstof these urges or goals—ego satisfaction—and rationally reach the following conclusion:

If I have self-inefficacy and view myself as only being able to function badly, anddefinitely to function imperfectly, I actually will tend to function less well than I amtheoretically able to function. Therefore,

Role of Irrational Beliefs in Perfectionism 163

• I will probably actually get less of what I want and more of what I don’t want asI go through life (because I think I am unable to perform well).

• I will probably get less approval and love from significant other people (because,again, I think I am unable to get it).

• I will probably be in more danger of being harmed and killed by dangerousconditions (because I think I am unable to take precautions and cope with threat).

If, in other words, failing to perform well or perfectly well and succeeding inperforming badly or imperfectly will likely get you less of what you want; less approvalfrom others; and make you less likely to be safe from disease, harm, and death, and ifyour sense of self-inefficacy will impede you from performing well or perfectly well,then it is quite rational (i.e., self-helping) to have a sense of self-efficacy—as manystudies by Bandura (1997) and his followers tend to show. Your wish or desire to havea sense of self-efficacy, and thereby improve your chances of performing well, beingapproved by others, and being safe from harm or death, is therefore a rational belief,not an irrational belief.

You also may have an irrational, self-defeating belief about self-efficacy, however,such as, “Because I desire to have a sense of self-efficacy, I absolutely must have it, elseI am a worthless, unlovable, hopelessly endangered person!” To go one step further,your irrational belief about self-efficacy may be, “Because I desire to have it, I absolutelymust, under all conditions at all times perfectly have it!” Lots of luck with that belief!

What I have said about the goal of self-efficacy also goes for the desire to be efficacious,productive, efficient, and accomplished. Such aims are usually rational in that if youperform well and, perhaps, perfectly well, you will in all likelihood in most of today’sworld (although who knows about tomorrow’s?) get more of what you want, greaterapproval (and also envy and jealousy!), and more security and longer life. So undermost conditions—although hardly all—if you want to achieve those goals, you try toachieve them. As long as you merely wish for, but not demand, their achievement, youwill (says REBT theory) feel frustrated, sorry, and disappointed but not depressed,anxious, or angry when you do not achieve them.

Escalating your desire for success and accomplishment to a demand, and especiallyto a perfectionistic demand, is quite another matter! Listen to this: “I absolutely must—or under all conditions at all times—perfectly achieve my goals!” Or else? Or else youwill tend to conclude that you’ll never get what you want. Or else you’ll be totallyunworthy of approval and love by significant others. Or else you will be in continualdanger of harm and annihilation. Quite a series of “horrors” you’ve predicted—andhelped bring on yourself.

If what I have been saying so far is correct, you can easily and legitimately haverational, sane, self-helping desires for success and achievement—and even for perfectachievement. For example, you can wish for a 100% grade on a test or the approval ofall the people you find significant. That would be nice. But don’t make it necessary!

Once again, you can have desires—even strong desires—for others’ approval. Itprobably would be great if you acted the way they wanted you to act—and if theyalways, under all conditions, perfectly favored you. They might well give you more ofwhat you want and less of what you dislike. Fine! But if you need others’ approval, and

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especially if you need their undying, perfect approval, watch it! Raising your want toa necessity is your irrationality. Quite a difference!

What about your striving for safety, security, good health, and longevity? By all meansstrive—but not desperately, compulsively. If you distinctly want security measures likethese, you will, perhaps, also notice their disadvantages and restrictions. The safer youmake yourself, the more you may sacrifice adventure and experimentation. So you havea choice. A safe, long life is not necessarily a merry one. Caution and concern, as wantsand choices, may have real value for you. But to absolutely need safety is to make yourselfanxious and panicked. And, quite probably, it is likely to bring on some needlessdangers.

What I have been saying so far shows that having self-efficacy, competence, lovability,and safety tend to aid human living. Not always, of course, and with some exceptions.For most of the people most of the time, they are characteristics that seem to havemore advantages than disadvantages. Therefore, few individuals and groups do notstrive for these goals. If they are, in fact, more beneficial than harmful, you are rationalor self-helping when you aim for them. Why, then, should you irrationally and self-sabotagingly do yourself in by frequently escalating your desires to unrealistic and oftenperfectionistic demands? Why do you often turn them into foolish, absolutistic musts?

The usual answer psychologists give to this paradox is a combination of innate,biological tendencies of humans and their early conditioning or rearing. First, forevolutionary, survival reasons they are born wishers and demanders, instead of merewishers. Second, their parents and teachers reinforce their wishing and demandingnessand often help make them worse. Third, they practice both wishing and demandingand become habituated to and comfortable with both behaviors; hence, they continuedesiring and insisting for the rest of their lives.

These all are probably good reasons why both rational preferring and irrationaldemanding are so common among practically all people and lead to great benefits anddetriments. Over the past 55 years of doing psychotherapy with thousands of people,I have figured out some more specific reasons why humans are “demanders” and“musturbators” when they would probably be much less disturbed if they were mainly“preferrers” and “unimperative goal seekers.” Let me present the following ideas ashypotheses that are yet to be tested but will possibly add to our understanding ofperfectionism if they are tested and receive some creditable empirical support:

People have little difficulty in distinguishing their weak or moderate desires fromtheir demands, but they frequently have great difficulty distinguishing their strong,forceful wishes from insistences. When they have a weak or moderate desire to succeedat an important task, to gain social approval, or to be safe from harm, they rarely oroccasionally think that they absolutely must achieve those goals, but when they havestrong desires to do those things, they frequently insist that they have to have them.Why they have weak or strong desires depends on many factors, both biological andenvironmental. But my theory says that once, for any reason, they do have powerfulwishes—or what Wolcott Gibbs, a New Yorker writer, called “a whim of iron”—theyfrequently think, and especially feel, that they must attain them.

A mild or moderate preference to perform well or win others’ approval implies thelegitimacy of alternative behaviors. Thus: “I would moderately like to win this tennismatch but if I lose it’s no big deal, and I can probably go on and win the next one.” “I

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would moderately prefer to have Mary like me, but if she doesn’t, I can live withouther approval and probably get Jane, who is not much different from Mary, to like me.”If you mildly want something and don’t get it, there is a good chance that you can getsomething almost equally desirable instead.

A strong preference, however, often leaves few alternative choices of equal valence.Thus: “I greatly want to win the tennis match, and thereby become champion, so if Ilose it I will lose the championship—which I also strongly want to win—and never gainit at all. Therefore, I must win this match to get what I really want.” “I greatly want to have Mary like me, because she is a special person with whom I could be notablyhappy. Therefore, if Mary doesn’t like me, and I could be close to Jane instead of her,this is a poor alternative, and it will not really satisfy me. Therefore, I must get Maryto like me.”

Strong preferences, consequently, leave little room for alternative choices—or, atleast, equally satisfying ones—and imply that because alternatives don’t exist, you musthave your strong preferences fulfilled. By their very strength, they prejudice you againstalternative choices and make your particular choice seem mandatory instead ofpreferential.

Strong desires encourage you, just because of their strength, to focus, sometimesalmost obsessive–compulsively, on one choice or a special choice and to ignore ordisparage alternative choices. Thus, if you mildly want to win a tennis match, you arefree to think of many other things—such as the pleasure your opponent will have if heor she wins instead of you or the fact that he or she will dislike you if you win. So, youconsider, again, alternative plans to winning the match and may even deliberately loseit. Or you may decide to play golf instead of tennis.

If, however, you strongly desire to win the tennis match—as well as, perhaps, winthe championship along with it—you will tend to focus, focus, focus on the gains tobe achieved by winning and the “horrible” consequences of losing, and your(obsessive–compulsive?) focus will discourage alternative thoughts and selectivelyprejudice you against seriously considering such alternatives. Strong desires, in otherwords, frequently lead to focused thinking and to prejudiced overgeneralization—notalways, of course, but significantly more frequently than mild or moderate desires do.If so, the prejudiced overgeneralization that strong desire encourages leads to the beliefthat because some other performance goal, approval aim, or safety seeking is highlypreferable, it is also necessary. Overfocusing on its desirability encourages seeing it asa dire necessity.

Assuming that my hypothesis that strong desires more often lead to demandingnessand musturbation than do weak desires is supported by empirical findings, what hasall this got to do with perfectionism? My theory goes one step further and says that thebeliefs “I would like to perform well and often to perform perfectly well” are rationaland self-helping in human societies that define certain performances as “good” andthen reward the performer—which seems to be the case in practically all cultures thatsurvive. But the beliefs “I absolutely must perform well and indeed must performperfectly well” are often irrational and self-defeating because, being a fallible humanand living with social restrictions, you frequently will not perform well (according topersonal and social standards) and you certainly won’t be able to function perfectlywell.

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Moreover, your demand for a guarantee of good or perfect performance may wellcreate feelings of anxiety about performing that will interfere with your succeeding;your demand for a guarantee, “I must not be anxious! I must not be anxious!” willlikely make you even more anxious. So demanding, rather than preferring, again won’twork too well to aid your purpose. To insist that you must get something you desireseems “logical” (in terms of motivation). Paradoxically, it is illogical and tends to createanxiety.

My theory about desire hypothesizes that your strong, rather than weak, desires (a)make you more likely to think that those desires absolutely must be fulfilled and (b)make you more likely to think that they must be perfectly fulfilled. If their successfulfulfillment is rationally beneficial to you and if perfect fulfillment is also rationallybeneficial to you—as I have noted above—then it is logical for you to jump from “I absolutely must fulfill my strong desires just because they are so strong”—whichactually is a complete non sequitur—to “I absolutely must fulfill my strong desiresperfectly just because they are so strong”—which again, is a complete non sequitur.

I am theorizing, then, that strong desires, rather than weak desires, are profoundprejudices—that is, they are cognitive emotional biases—that for various reasons oftenencourage people to think, “Because I strongly want success, approval, or safety, and itwould be beneficial for me to have them, I absolutely must have them.” This is a fairlygrandiose and perfectionistic idea itself, because you and I obviously don’t run theuniverse, so whatever we desire, no matter how strongly we prefer it, doesn’t have toexist.

Humans are, however, prone to grandiosity, to demanding that their strong desiresabsolutely must be fulfilled. They often think wishfulfillingly—as Freud (1965) and his psychoanalytic followers have pointed out. More to the point, they often think and feel wish-demandingly: “Because I strongly want it so, it should be that way!” Oncethey escalate their powerful wishes to dire necessities, they frequently take them onestep further: “Because my most important desires are sacred and absolutely must befulfilled, they must be thoroughly, completely, and perfectly fulfilled!” Then they reallyhave emotional and behavioral problems!

Perfectionism, Irrational Beliefs, and Anxiety Sensitivity

Let me consider one more important point. I noted in Reason and Emotion inPsychotherapy (Ellis, 1962) that people who are anxious, particularly those whoexperience panic, frequently make themselves quite anxious about their anxiety andthus have a secondary disturbance about their original disturbance. Why is this socommon among humans? According to REBT theory, they are forcefully thinking “Imust not be anxious! It’s terrible to be anxious! I am an inadequate person for beinganxious!”

For several years, Reiss and his coworkers (Reiss & McNally, 1985) have theorizedthat some people have unusual sensitivity to their own feelings of anxiety, as Ihypothesized in 1962. They have conducted many studies of this secondary symptomof anxiety, which they called anxiety sensitivity, and have confirmed some of myobservations and other clinicians’ observations about it (Cox, Parker, & Swinson, 1996;Taylor, 1995; Wachtel, 1994). Reiss’s theory of anxiety sensitivity somewhat overlaps

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with my theory of strong desire in that it implies that some people who experienceanxiety about anxiety find their anxious feeling so uncomfortable that they “awfulize”about them and thereby produce panic states. Their desire for relief from anxiety is sointense that they demand that they not have it and thereby escalate it.

What, we may ask, makes anxiety-sensitive people so demanding about their anxiety?My theory answers this question as follows:

• Anxiety, and particularly panic, is uncomfortable. It feels bad, disrupts competence,may lead to social disapproval, and often brings on physical symptoms—such asshortness of breath and rapid heartbeat—that make you think you are in realphysical danger, even that you are dying.

• Because it is so uncomfortable, you strongly wish that it not exist—disappear—andthat all its disadvantages disappear with it.

• Because you strongly desire it to go, you insist and demand “I must not be anxious!I must not be panicked!”

• Then, logically (and perversely enough), you make yourself anxious about youranxiety, panicked about your panic.

• Consequently, you increase your uncomfortable symptoms—especially yourphysical symptoms of suffocating and heart pounding.

• You become more panicked than ever.• Your vicious cycle continues.

Finally, because your slightest feelings of panic bring on great discomfort, you mayfrequently conclude “I must never panic at all! I must be perfectly free from anxietyand panic!” The moral: By being acutely aware of your discomfort (and otherdisadvantages) of your feeling of panic, you may demand perfect freedom from panicand may therefore increase the likelihood of your panicking.

My explanations of anxiety about anxiety and panic about panic in the precedingparagraph fit nicely into my theory about strong desire and its relationship todemandingness and perfectionism. However, beware! The explanatory power of mytheory is interesting but may have little connection with empirical findings. Manypsychoanalytic theories fit brilliantly together and support their derived postulates, butthey appear to be little connected with hard-headed facts.

So I believe in and present this theory that when people’s weak desires are thwarted,they commonly lead to healthy negative feelings of disappointment, regret, andfrustration, but when their strong desires are thwarted, they more often lead toabsolutistic musts and demands and thereby to unhealthy feelings of anxiety, depression,rage, and self-pity. It seems to me a plausible and testable theory. It also seems to explainsome reasons for human perfectionism. Now all we have to do is check my theoriesand explanations to see if any evidence backs them. Theorizing is fun. Evidence gatheringis harder.

Perfectionism and Irrational Beliefs in Couples

So far in this chapter I have considered individualistic demands for achievement,approval, and safety but, of course, they exist in couples, in families, and in social respects

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as well. Take couples therapy, which I have done extensively along REBT lines for morethan 40 years. Are husbands, wives, and other partners as demanding and perfectionisticabout their mates as they are about themselves? Frequently, yes, and with frightful resultsfor their relationships.

John, a 36-year-old accountant, gave himself a perfectionistic hard time about hiswork and made himself exceptionally anxious if it wasn’t wholly accurate. He excusedhis perfectionism in this respect by saying that of course it had to be perfectly accurate—because it was accounting and that meant accuracy. But John was also perfectionisticabout his dress, his tennis game, and several other aspects of his life. Because, however,he worked mightily to keep his accounting, his appearance, and his tennis game inorder, he succeeded fairly well in doing so and was only temporarily anxious whenthings got a bit beyond his control. His compulsive striving kept things pretty muchin line.

John, however, was equally perfectionistic about his wife Sally and his two accountingpartners. They, too, had to—yes, had to—perform well, dress well, and even play tenniswell. And often they didn’t, those laggards! John, of course, couldn’t control others ashe strove for his own perfection, so he was frequently enraged against his “careless”wife and partners, much more than he was anxious about his own performances.

I saw John for therapy because his wife and partners insisted that he go—or else. Hewas set for a double divorce. I had a rough time, at first, showing him the folly of hisown performance-oriented perfectionism, because he was willing to strive mightily toachieve it and suffer occasional panic attacks when he didn’t. It was easier to show himthat his demands on others just wouldn’t work. He had little control over others, andthey were going to continue to be just as abominably unperfectionistic—not to mentiondownright sloppy—as they chose. They shouldn’t be that way—but they are.

After several sessions of REBT, John was able to prefer without demanding perfectbehavior from Sally and his partners and therefore to be keenly disappointed but notenraged when they made accounting, tennis, or other errors. He lived with theirimperfections, and no one divorced him. He only slightly gave up his own perfectionisticdemands on himself and continued to perform well in most ways, but he was decidedlymore anxious than he need have been.

John’s wife Sally, whom I also saw for a few sessions, was nondemanding of herselffor the most part but couldn’t stand the obsessive–compulsiveness of John and their12-year-old daughter Electra. They were both carved from the same perfectionisticfamily block (as were John’s father and sister) and had to do many things absolutelyperfectly. Sally couldn’t take their frantically pushing themselves to achieve (which wasbad enough) and their insistence that she, too, be faultlessly on the ball (which wasimpossible!). Although usually easygoing, in this respect she kept inwardly demanding“They must not be that scrupulous! They have to be more tolerant! I can’t bear theirintolerance!”

I showed Sally—and she was much easier to work with than was John—that herintolerance of John’s and Electra’s intolerance was not going to work. Her rage wasgoing to be exceptionally self-upsetting, was not going to change John or Electra, andmight lead to her divorcing John (not so bad) but also to her divorcing Electra (notso good!) and to her own psychosomatic horrors (still worse!).

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Sally saw the light and soon gave up her intolerance of John’s and Electra’s intoler-ance. She still wanted them to but didn’t insist that they be more reasonable, and sheworked with me to change her own demands that her family be less perfectionistic. SoJohn improved in his demands on Sally (and his own partners), and Sally distinctlyimproved in her perfectionistic demands on John and on Electra. John kept some ofhis perfectionistic demands on his own performance but did not let them interfere tooseriously with his family and business relationships.

Perfectionism and Hypercompetitiveness

One reason why John kept insisting that he must perform outstandingly was becausehe was fixated on the kind of competitiveness that I described about perfectionists inthe original edition of Reason and Emotion in Psychotherapy (1962). I said at that time,

The individual who must succeed in an outstanding way is not merely challenginghimself and testing his own powers (which may well be beneficial); but he isinvariably comparing himself to and fighting to best others. He thereby becomesother- rather than self-directed and sets himself essentially impossible tasks (sinceno matter how outstandingly good he may be in a given field, it is most likely thatthere will be others who are still better).

(pp. 63–64)

After practicing REBT for almost 50 years and after studying the results obtained inscores of studies of irrational beliefs, I find this hypothesis more tenable than ever.Hypercompetitiveness is a common trait of “normal” musturbators and especially ofperfectionists. They mainly have unhealthy conditional self-acceptance instead of healthyunconditional self-acceptance. Their main condition for being a “good person” is notableachievement, and to be a “better person” than others requires outstanding achievement.

Actually, to strive desperately to best others and thereby to gain “better” worth as aperson is an undemocratic, fascist-like philosophy. Fascists like Hitler and Mussoliniare seen by many of their followers to be not only better (i.e., more competent) in sometraits, such as physical prowess or blondeness, but are viewed as being superior people.Their essence is supposedly outstandingly good. They are almost diametrically opposedto the concept of unconditional self-acceptance, which means fully accepting andrespecting yourself whether or not you are achieving (Ellis, 1962, 1988; Ellis & Harper,1997; Ellis & Velten, 1998; Hauck, 1991).

Perfectionists, then, tend to be highly conditional self-acceptors who base their worthas persons on hypercompetitively besting others—and, in the process, often lose outon discovering what they personally want to do—and who tend to fascistically denigrateothers. These hypotheses, for which I have found much clinical evidence over the years,merit considerable research efforts.

Perfectionism and Stress

How are perfectionists affected by stressful conditions? More so, I would say, than arerun-of-the-mill nonperfectionists. First, they may demand that stress be minimal—or

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perfectly nonexistent. Second, they may insist that they get perfect solutions to practicalproblems that create stress—such as how to have a perfect job interview, how to get aperfect job, how to deal with bosses or employees perfectly well, and so forth. Third,when stressful conditions—such as business difficulties—occur, they may demand thatthey have perfect solutions for them. They not only greatly prefer these conditions ofsolutions to them but require that they be easily and quickly available—which theynormally are not. Therefore, under conditions that are equally stressful to others,perfectionists “find” more stress, less satisfactory solutions, and more prolongeddifficulties than nonperfectionists find. Their perfectionism contradicts realistic andprobabilistic expectations about the number and degree of stressors that should existand often results in their making a hassle into a holocaust.

About the stressors of their lives, they have the usual irrational beliefs of disturbedpeople but hold them more vigorously and rigidly. Thus, they tend to believe that stressfulsituations absolutely must not exist; that it is utterly awful and horrible (as bad as it couldbe) when they do; that they completely can’t stand them (can’t enjoy life at all becauseof them); are quite powerless to improve them; and rightly should damn themselvesand other people for not removing them or coping beautifully with them.

According to REBT theory, practically all disturbed people at times hold these self-defeating beliefs. But perfectionists seem to hold them more frequently andinsistently—and cling to them as fixed ideas. Consequently, they often require long-term treatment—as Blatt (1995) showed—and, if REBT is used with them, willfrequently require several cognitive, emotive, and behavioral methods before they willsurrender their beliefs. Why? Because a single method of disputing and acting againsttheir irrational beliefs doesn’t seem convincing enough. So a therapist’s use of severaltechniques may finally work better.

By the same token, I have found that if perfectionists who react badly to stressfulconditions are placed in cognitive behavioral group therapy, in which several groupmembers in addition to the therapist actively try to help them give up their rigid beliefsand behaviors, it works better than if they are in individual therapy with only a singletherapist to counter their perfectionism. Again, the issue seems to be that comparedwith nonperfectionists, perfectionists have (a) a stronger desire or preference to do well;(b) a stronger and more rigid demand that they do well; (c) a stronger insistence thatthey do perfectly well under one or more conditions; and (d) a long-term habit ofperfectionistic thinking, feeling, and behaving that resists short-term change. For allthese reasons, they frequently are difficult customers, who can use intensive, prolongedtherapy.

My hypothesis, then, is that perfectionists are more rigid and persistent in theirirrational beliefs than what I call the “nice neurotics.” Many of them—not all—havesevere personality disorders. They have idées fixes (fixed ideas), as Pierre Janet said ofmany severely disturbed people a century ago. And let us honestly admit this beforewe try to fix them.

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References

Adler, A. (1926). What life should mean to you. New York: Greenberg.Adler, A. (1927). Understanding human nature. Garden City, NY: Greenberg.Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.Barlow, D. H. (1989). Anxiety and its disorders: The nature and treatment of anxiety and panic.

New York: Guilford.Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International

Universities Press.Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.Bernard, M. E. (1993). Staying rational in an irrational world. New York: Carol.Blatt, S. J. (1995). The destructiveness of perfectionism: Implications for the treatment of

depression. American Psychologist, 50, 1003–1020.Burns, D. D. (1980). Feeling good: The new mood therapy. New York: New American Library.Cox, B. J., Parker, J. D. A., & Swinson, R. P. (1996). Anxiety sensitivity: Confirmatory evidence

for a multidimensional construct. Behaviour Research and Therapy, 34, 592–598.Dryden, W. (1998). A course in overcoming self-esteem. Chichester, England: Wiley.Dubois, P. (1907). The psychiatric treatment of nervous disorders. New York: Funk & Wagnalls.Ellis, A. (1957). How to live with a neurotic: At work and at home. New York: Crown.Ellis, A. (1958). Rational psychotherapy. Journal of General Psychology, 59, 35-49.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything—Yes, anything!

Secaucus, NJ: Lyle Stuart.Ellis, A., & Dryden, W. (1997). The practice of rational emotive behavior therapy (Rev. ed.). New

York: Springer.Ellis, A., Gordon, J., Neenan, M., & Palmer, S. (1997). Stress counseling: A rational emotive behavior

approach. London: Cassell.Ellis, A., & Harper, R. A. (1997). A guide to rational living (3rd rev. ed.). North Hollywood, CA:

Melvin Powers.Ellis, A., & Tafrate, R. C. (1997). How to control your anger before it controls you. Secaucus, NJ:

Birch Lane Press.Ellis, A., & Velten, E. (1998). Optimal aging. Chicago, IL: Open Court.Epictetus. (1899). The works of Epictetus. Boston, MA: Little, Brown.Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Koledin, S. (1991). Dimensions of perfectionism

and irrational thinking. Journal of Rational Emotive and Cognitive-Behavior Therapy, 9, 185–201.Flett, G. L., Hewitt, P. L., Blankstein, K. R., Solnik, M., & Van Brunschot, M. (1996).

Perfectionism, social problem-solving ability, and psychological distress. Journal of RationalEmotive and Cognitive Behavior Therapy, 14, 245–275.

Freeman, A., & DeWolf, R. (1993). The ten dumbest mistakes smart people make and how to avoidthem. New York: Perennial.

Freud, S. (1965). Standard edition of the complete psychological works of Sigmund Freud. NewYork: Basic Books.

Goldfried, M. R., & Davison, G. (1994). Clinical behavior therapy (3rd ed.). New York: Wiley.Hauck, P. A. (1991). Overcoming the rating game: Beyond self love—Beyond self-esteem. Louisville,

KY: Westminster/John Knox.Hewitt, P. L., & Flett, G. L. (1993). Dimensions of perfectionism, daily stress, and depression:

A test of the specific vulnerability hypothesis. Journal of Abnormal Psychology, 102, 58–65.Horney, K. (1950). Neurosis and human growth. New York: Norton.Janet, P. (1898). Neurosis et idées fixes. Paris: Alcan.Lazarus, A. A., Lazarus, C., & Fay, A. (1993). Don’t believe it for a minute: Forty toxic ideas that

are driving you crazy. San Luis Obispo, CA: Impact.

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Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss & R. R. Bootzin (Eds.),Theoretical issues in behavior therapy (pp. 107–122). New York: Academic Press.

Taylor, S. (1995). Anxiety sensitivity: Theoretical perspectives and recent findings. BehaviourResearch and Therapy, 33, 243–258.

Wachtel, P. L. (1994). From eclecticism to synthesis: Toward a more seamless psychotherapeuticintegration. Journal of Psychotherapeutic Integration, 1, 43–54.

Walen, S., DiGiuseppe, R., & Dryden, W. (1992). A practitioner’s guide to rational—emotivetherapy. New York: Oxford University Press.

Xenakis, J. C. (1969). Epictetus: Philosopher—therapist. The Hague, Netherlands: Martinus Nijhoff.

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11 A Twenty-Three-Year-Old Girl,Guilty About Not Following Her Parents’ Rules

INTRODUCTION

Russell Grieger

This is a three-session transcript of Albert Ellis doing REBT with Martha, a young womanwith guilt, fears of rejection, and self-damning. Though conducted approximately twodecades ago, there is little doubt that, were Dr. Ellis still alive, he would pretty muchconduct these sessions today as he did then. What you will read is both vintage AlbertEllis and classic REBT, both of which provide an exceptional tutorial on the theory andpractice of this groundbreaking form of psychotherapy by the master himself.

Therapeutic Style

Notice Dr. Ellis’ therapeutic style with Martha. With the conviction that people aremired in irrational beliefs, faulty defensive strategies, and self-defeating behavioral habitsfrom which they need guidance to break free, he is relentlessly active, directive,authoritative, incisive, and persistent; after all, if people knew how to get out of theirruts on their own, they would likely do so.

At the same time, Dr. Ellis’ communicates unwavering respect, empathy, andacceptance toward this patient, despite her disturbed ways, but not in the manner ofrelationship-oriented or non-directive therapists. He demonstrates his commitment toMartha’s well-being by being totally focused on helping her solve her problems, andhe shows his caring by reinforcing her when she verbalizes rational belief, supportiveof her ability to work hard to get better, reassuring her that she can succeed if she willmake the effort, and making himself available in time of need.

Note, furthermore, that Dr. Ellis is constantly teaching. In REBT’s active–directivestyle, he educates, instructs, and propagandizes (sometimes by lecture and sometimesby Socratic questioning), but never in a dull, pedantic way. He takes what Martha offersand uses it to boldly teach her what she does to create and sustain her problems, whatwould be a more effective way to think and act, and what she needs to do to bringabout change. This is especially evident in Martha’s third session, in which Ellis instructsher at length in how to do her daily self-therapy.

The Process of REBT

As John Boyd and I delineated in our book, RET: A Skills-Based Approach, Dr. Ellistakes this patient through four roughly sequential stages. Perhaps components wouldbe a more apt term than stages, as Ellis freely bounces back and forth between all four,even during one session.

1. REBT Diagnosis. As shown in this transcript, the REBT therapist is not so muchinterested in diagnostic labels or a patient’s history, but the irrational beliefs thatdrive her symptomology. Using REBT’s famous ABC model, and not a smallamount of his vast experience, Dr. Ellis’ probes for dysfunctional, problematicfeelings and behaviors (at C), the relevant circumstances in her life about whichshe reacts these ways (at A), and, most important, the core perfectionistic,catastrophizing, and/or self-damning beliefs that are at the heart of her problems(at B). Once he has an inkling of all this he is “off to the races.”

2. REBT Insight. Throughout these three sessions, Dr. Ellis takes advantage of multipleopportunities to teach key REBT insights. He (as do all REBT therapists) teachesMartha the following.(a) Her current beliefs, not her past history or her current circumstances, cause

her emotional problems.(b) Exactly what are the particular irrational beliefs she personally endorses and

the direct role they play in her dysfunction.(c) The fact that she strongly endorses and automatically thinks and acts on these

beliefs, thereby requiring frequent, sustained effort to relinquish them.(d) Without being aware, she repeatedly indoctrinates herself with her irrational

beliefs thereby perpetuating her problems.(e) Though she is responsible for causing her problem, she is not blameworthy;

she can unconditionally accept herself despite these and any other mistakesshe makes.

(f) Martha does not have to mindlessly, unquestionably accept her beliefs as validjust because she has always believed them or others say they are true; she wouldbe wise to repeatedly ferret out her irrational beliefs and forcefully challengetheir validity.

(g) Exactly what are alternative, rational beliefs that will free Martha of guilt andanxiety and lead to her ability to make choices consistent with her deepest valuesand desires, in her case anti-perfectionism, unconditional self-acceptance, andenlightened self-interest.

(h) The exact steps to do REBT on her own so that she can continue her therapybetween sessions and do therapy the rest of her life once her formal therapyends.

3. REBT Working Through. Intermingled with Dr. Ellis’ efforts to facilitate insightare frequent, forceful attempts to get Martha to dispute and challenge her variousirrational beliefs. He does it in two ways: (a) by energetically showing her theinaccuracy of her beliefs and encouraging her to act against them; (b) by usingSocratic questioning to help her think through her own beliefs to their fundamentalincorrectness. These are done in the service of detaching her from her disturbance-producing ideologies and opening her mind to the new philosophies noted above.

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4. REBT Re-education. The culmination of REBT is for the client to walk away withnew, rational beliefs that prompt self-enhancing feelings and actions. By frequentquestioning of Martha’s existing beliefs and relentless articulating of better ones,Ellis began the re-education process early and hammers away at it through all threessessions. Though he did not do so with Martha, he almost always assignsbibliotherapy, rational emotive imagery, and written disputation of irrational beliefswith his other patients, culminating in new, effective thinking to the therapy menu.

Ellis’ Comments

How do you top Albert Ellis? You don’t. The numerous comments he intersperses amidstthe dialogue between him and Martha are gems. They take you into his mind as hedoes REBT, providing both cogent instruction and salient information about bothREBT’s process and critical concepts, including REBT’s philosophic core, the essentialelegance of REBT as compared with other psychotherapeutic systems, and REBT’s takeon modeling. They alone are worth the price of admission, and I encourage the readerto pay special attention to them.

Final Thought

I want to end this Introduction with a personal note. When I first began treating peoplewith REBT, I did my best to mimic Albert Ellis, even down to the words he used, hisvocal inflections, and his gestures. I’m sure I am not the only one to do so. After all,he was both a genius and quite a dynamic personality.

Later, when I became more competent and confident, I felt more comfortable doingREBT within the context of my own personality. That is as Dr. Ellis would want it, solong as I did not violate the purpose of REBT, which is to be most effective and efficientin bringing about significant change in people, never encouraging patient dependence,and not facilitating the adoption of one irrational philosophy to replace another.

Nonetheless, what Albert Ellis demonstrates in these three transcribed sessions is ascurrent and relevant today as the day they were recorded. Particularly note how Dr.Ellis never wavers mentally from the framework of one ABC model, whether he isuncovering, disputing, or working to replace Martha’s irrational thinking. This modelis both his conceptual anchor and his process beacon every step of the way.

Note, further, that Dr. Ellis stays true to the three basic insights REBT seeks to impartto each and every client. First, it is the disturbing thoughts people hold that cause theirproblems, not the adversities they face in their life; he teaches this over and over untilthe client gets it. Second, though the client has a learning history behind these beliefs,and though the exploration of these historical events may be interesting and dramatic,the relevant material for therapy are beliefs the client currently holds that cause herpresent anguish; he relentlessly goes after these irrational beliefs. And, third, the clientmust work hard in order to get better; he not only forcefully interrupts his client’sdisturbing thoughts by posing challenging questions and offering memorablealternatives during therapy, but he never lets a client leave a session without givingcognitive and/or behavioral assignments to make therapy an ongoing, daily endeavor.

176 Russell Grieger

Anyone who wishes to learn to practice REBT the correct way, or anyone who alreadypractices REBT wanting to refresh oneself on REBT’s proper methods, would be wiseto study Albert Ellis’ work with Martha. It is all there. As I always do when I readtranscripts, listen to audiotapes, or watch videos of Dr. Ellis’ REBT sessions, I comeaway more enlightened and determined to be more rigorous and vigorous with myown clientele. I am confident you will as well.

Guilty About Not Following Parents’ Rules 177

A TWENTY-THREE-YEAR-OLD GIRL, GUILTYABOUT NOT FOLLOWING HER PARENTS’ RULES

Albert Ellis

This is a recording of the first session with Martha, an attractive twenty-three-year-oldgirl who comes for help because she is quite self-punishing, is both overly impulsiveand compulsive, lies, is afraid of males, has no goals in life, and is very guilty abouther relations with her father and mother—because they demand a great many thingsfrom her, including her adherence to a hard-shelled Baptist religion in which she nolonger believes. Dr. Ellis, as is typical of rational emotive psychotherapists, quicklyzeroes in on her main problems and directly tries to show her that she need not beguilty about doing what she wants to do in life, even if her parents keep upsettingthemselves about her beliefs and actions.

First Session

C1: Well, for about a year and a half since I graduated from college, I’ve had the feelingthat something was the matter with me. Apparently—well, this was told me bysomebody, and the more I think about it the more I think it’s true: I seem to havea tendency toward punishing myself. I’m very accident-prone. I’m forever bangingmyself or falling downstairs, or something like that. And my relationship with myfather is causing me a great deal of trouble. I’ve never been able to figure out wherethe responsibility is and what my relationship with my parents should be.

T2: Do you live with them?C3: No, I don’t. They live in Great Neck. I moved out in MarchT4: What does your father do?C5: He is a newspaper editor.T6: And your mother is a housewife?C7: Yes.T8: Any other children?C9: Yes, I have two younger brothers. One is twenty; the other is sixteen. I’m twenty-

three. The sixteen-year-old has polio, and the other one has an enlarged heart. Myfamily was always very close. We never had much money, but we always had thefeeling that love and security in life are what count. And the first thing that disturbedme was, when I was about sixteen years old, my father began to drink seriously.To me he had been the infallible person. Anything he said was right. And since Imoved out and before I moved out, I’ve wondered where my responsibility to myfamily lies. Because if they would ask me to do something, if I didn’t do it, I wouldfeel guilty about it.

T10: What sort of things did they ask you to do?C11: Well, they didn’t want me to move out; they felt that it just wasn’t right for an

unmarried girl to move out. Also, I’m very impulsive, I’m very compulsive; and Ifind it easier to lie than to tell the truth, if the truth is unpleasant. I think I’m

basically afraid of men and afraid to find a good relationship with a man—I meana relationship that would lead to marriage. My parents have never approved ofanyone I have gone out with. In thinking about it, I wonder whether I, subcon-sciously maybe, went out of my way to find somebody they wouldn’t approve of.

T12: Do you go with anyone now?C13: Yes, two people.T14: And are you serious about either one?C15: Well, that I don’t know. I really don’t. One is sort of serious about me, but he

thinks there’s something the matter with me that I have to straighten out. I havealso at various times been rather promiscuous, and I don’t want to be that way.

T16: Have you enjoyed the sex?C17: Not particularly. I think—in trying to analyze it myself and find out why I was

promiscuous, I think I was afraid not to be.T18: Afraid they wouldn’t like you, you mean?C19: Yes. This one fellow that I’ve been going with—in fact, both of them—said that I

don’t have a good opinion of myself.T20: What do you work at?C21: Well, I’m a copywriter for an advertising agency. I don’t know if this means

anything, but when I was in college, I never could make up my mind what to majorin. I had four or five majors. I was very impulsive about the choice of college.

T22: What did you finally pick?C23: I went to the University of Illinois.T24

: What did you finally major in?C25: I majored in—it was a double major: advertising and English.T26: Did you do all right in college?C27: Yes, I was a Phi Beta Kappa. I graduated with honors.T28: You had no difficulty—even though you had trouble in making up your mind—

you had no difficulty with the work itself?C29: No, I worked very hard. My family always emphasized that I couldn’t do well in

school, so I had to work hard. I always studied hard. Whenever I set my mind todo anything, I really worked at it. And I was always unsure of myself with people.Consequently, I’ve almost always gone out with more than one person at the sametime. I think that it is, possibly, maybe a fear of rejection by one. Also, somethingthat bothers me more than anything is that I think that I have the ability to write,and I wrote a lot when I was in college. Fiction, that is. And I’ve done a little bitsince. But I don’t seem to be able to discipline myself. Instead of spending my timewisely, as far as writing is concerned, I’ll let it go, let it go, and then go out severalnights a week—which I know doesn’t help me. When I ask myself why I do it, I don’t know.

T30: Are you afraid the writing wouldn’t be good enough?C31: I have that basic fear.T32: That’s right: it is a basic fear.C33: Although I have pretty well convinced myself that I have talent, I’m just afraid to

apply myself. My mother always encouraged me to write, and she alwaysencouraged me to keep on looking for something better in everything I do. And

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from the time when I started to go out with boys, when I was about thirteen orfourteen, she never wanted me to get interested in one boy. There was alwayssomething better somewhere else. Go out and look for it. And if somebody didn’tplease me in all respects, go out and find somebody else. I think that this hasinfluenced the feeling that I’ve had that I might be quite interested in one person,but I’m always looking for someone else.

T34: Yes, I’m sure it probably has.C35: But I don’t know what I’m looking for.T36: You seem to be looking for perfection, in a sense—which you’re not going to find.

You’re looking for security, certainty.

I first obtain a moderate degree of background information from Martha—not forthe ordinary kind of diagnosis (since I can quickly see that she is seriously disturbed),but to find a symptom that I can concretely use to show her what her basic philosophyor value system is and how she can change it. I thus ask her, in T30, “Are you afraidthe writing wouldn’t be good enough?” because I assume, on the basis of rationalemotive theory, that there are only a few major reasons why she is not writing, andthat this is probably one of them. Once she admits she has a fear of failure in writing,I emphasize that this is probably a general or basic fear—so that she will begin to seethat her fear of failure is all-pervasive and explains some of the other dysfunctionalbehavior she has been indicating. As soon as I think I have a reasonably good chanceto get in a therapeutic word, I stop Martha, in T36, and flatly tell her that I think she’slooking for perfection and certainty. I hope she will be somewhat startled by thisstatement and will want to go into it further: in which case I intend to show her thather writing fears (and other symptoms) largely stem from her perfectionism. As ithappens, she does not appear ready yet to take up my hypothesis; so I bide my timefor a while, knowing that I will sooner or later get back to forcing her to look at someof the philosophies behind her disturbed behavior.

C37: Well, the basic problem I think that I have is that I seem to have lost sight of goals.I’m tied up in knots about—I’m worried about my family. I’m worried about money.And I never seem to be able to relax.

T38: Why are you worried about your family? Let’s go into that, first of all. What’s tobe concerned about? They have certain demands on you which you don’t want toadhere to.

T39: Oh, we’ll have to knock that out of your head!C40: I was brought up to think that I mustn’t be selfish.C41: I think that that is one of the basic problems.T42: That’s right. You were brought up to be Florence Nightingale—which is to be very

disturbed!C43: I was brought up in a family of sort of would-be Florence Nightingales, now that

I analyze the whole pattern of my family history. Maybe it was just a perversionof other desires. My parents got married because I was on the way. I really thinkthat they loved each other. I don’t know, but I think they did. They were prettyhappy with each other up till a few years ago. When I was a little girl, I was my

180 Albert Ellis

father’s pet. Nobody ever spanked me, hardly anybody said a cross word to me.So I really don’t think I was spoiled. My brother, Joe, who is twenty, had an enlargedheart, from which he has pretty well recovered as a result of an operation; and myparents are now sending him to college. My sixteen-year-old brother has had polio.When I was twelve, I developed an easily dislocatable shoulder; and there’s alwaysbeen one kind of ailment or another in my family. Always. And they have neverbeen able to get out of debt. Never. They were hardly able to help me throughcollege. I incurred all kinds of debts myself in college. And since then I’ve helpedmy family. My father became really alcoholic sometime when I was away in college.My mother developed a breast cancer last year, and she had one breast removed.Nobody is healthy.

T44: How is your father doing now?C45: Well, he’s doing much better. He’s been going to AA meetings, and the doctor he

has been seeing has been giving him tranquilizers and various other types of pillsto keep him going. He spends quite a bit of money every week on pills. And if hemisses a day of pills, he’s absolutely unlivable. My mother feels that I shouldn’thave left home—that my place is in Great Neck with them. I don’t feel that, butthere are nagging doubts, and there are nagging doubts about what I should—

T46: Why are there doubts? Why should you?C47: I think it’s a feeling I was brought up with that you always have to give of yourself.

If you think of yourself, you’re wrong.T48: That’s a belief. It’s a feeling because you believe it. Now, why do you have to keep

believing that—at your age? You believed a lot of superstitions when you wereyounger. Why do you have to retain them? We can see why your parents wouldhave to indoctrinate you with this kind of nonsense, because that’s their belief. Butwhy do you still have to believe this nonsense—that one should not be self-interested; that one should be devoted to others, self-sacrificial? Who needs thatphilosophy? All it’s gotten you, so far, is guilt. And that’s all it ever will get you!

C49: And now I try to break away. For instance, they’ll call up and say, “Why don’t youcome Sunday? Why don’t you come Friday?” And if I say, “No, I’m busy,” ratherthan saying, “No, I can’t come, I will come when it’s convenient,” they get terriblyhurt, and my stomach gets all upset.

T50: Because you tell yourself, “There I go again. I’m a louse for not devoting myselfto them!” As long as you tell yourself that crap, then your stomach or some otherpart of you will start jumping! But it’s your philosophy, your belief your sentenceto yourself—“I’m no goddamned good! How could I do that lousy, stinking thing?”That’s what’s causing your stomach to jump. Now that sentence is a false sentence.Why are you no goddamned good because you prefer you to them? For that’s whatit amounts to. Who said you’re no damned good—Jesus Christ? Moses? Who thehell said so? The answer is: your parents said so. And you believe it because theysaid so. But who the hell are they?

C51: That’s right. You’re brought up to believe that everything your parents say is right.And I haven’t been able to lose myself from this.

T52: You haven’t done it. You’re able to, but you haven’t. And you’re now saying, everytime you call them, the same crap to yourself. And you’ve got to see you’re saying

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this drivel! Every time a human being gets upset—except when she’s in physicalpain—she has always told herself some bullshit the second before she gets upset.Normally, the bullshit takes the form, “This is terrible!”—in your case, “It’s terriblethat I don’t want to go out there to see them!” Or people tell themselves, “I shouldn’tbe doing this!”—in your case, “I shouldn’t be a selfish individual!” Now, thoseterms—“This is terrible!” and “I shouldn’t be doing this!”—are assumptions,premises. You cannot sustain them scientifically. But you believe they’re true,without any evidence, mainly because your parents indoctrinated you to believethat they’re true. It’s exactly the same kind of assumption that people make that“Negroes are no goddamned good!” If you had been raised in the South, you wouldhave believed that. But is it true because you would have been raised to believe it?

C53: No.T54: Then why is it true that one should not be selfish, or should not stick up for oneself

first, and should not consider one’s parents or anybody else second, third, fourth,and fifth?

C55: That’s absolutely right.T56: Yes, but we’ve got to get you to believe it—that’s the point. You don’t believe that.C57: I want to believe that.T58: I know you want to; and once in a while you do believe it. But most of the time,

very forcefully and strongly, you believe the crap with which you were indoctrin -ated. Not only believe it, but keep indoctrinating yourself with it. That’s the realperniciousness of it. That’s the reason it persists—not because they taught it toyou. It would just naturally die after a while. But you keep saying it to yourself.It’s these simple declarative sentences that you tell yourself every time you makea telephone call to your parents. And unless we can get you to see that you aresaying them, and contradict and challenge them, you’ll go on saying them forever.Then you will keep getting pernicious results: headaches, self-punishment, lying,and whatever else you get. These results are the logical consequences of an irrationalcause, a false premise. And it’s this premise that has to be questioned. If you doquestion it, you can’t possibly sustain it.

As soon as Martha, in C45, says that she has nagging doubts about staying at homewith her parents, and that she’s wrong if she thinks of herself first, I jump in with bothfeet and try to show her that this idea is only an opinion, that it cannot be empiricallyjustified, and that it will lead to poor results. I am herewith being classically rationalemotive: not only explicating but attacking Martha’s self-defeating premises and values,and trying to actively teach her how to attack them herself. I make a mistake, however,in T56, by saying “We’ve got to get you to believe it.” I could have better said: “It wouldbe much preferable if we get you to believe it.”

C59: I get so mad at myself for being so illogical.T60: Now, you see, there you go again! Because you are not only saying that you are

illogical, but that you shouldn’t be. Why shouldn’t you be? It’s a pain in the ass tobe illogical; it’s a nuisance. But who says it’s wicked for you to be wrong? That’swhat you’re saying—that’s your parents’ philosophy.

182 Albert Ellis

C61: Yes, and also there’s the matter of religion. I was brought up to be a strict, hard-shelled Baptist. And I can’t quite take it any more. This has been going on for—(Pause) Well, the first seeds of doubt were sown when I was in high school. Nobodyanswered my questions. And I kept asking the minister, and he didn’t answer myquestions. And when I went to college, I started reading. I tried very hard, the firsttwo years in college. I went to church all the time. If I had a question. I’d ask theminister. But pretty soon I couldn’t get any answers. And now I really don’t believein the Baptist Church.

T62: All right, but are you guilty about not believing?C63: Not only am I guilty, but the worst part about it is that I can’t quite tell my parents

that I don’t believe.T64: But why do you have to? What’s the necessity? Because they’re probably not going

to accept it.C65: Well, they didn’t accept it. I was going to get married to a Jewish fellow as soon

as I graduated from college. And, of course, the problem of religion came up then.And I didn’t stand up for what I believed. I don’t know; rather than have scenes,I took the coward’s way out. And when I spend Saturdays and Sundays with themnow—which is rare—I go to church with them. And this is what I mean by lying,rather than telling the truth.

T66: I see. You’re probably going to extremes there—going to church. Why do you haveto go to church?

C67: I always hate to create a scene.T68: You mean you always sell your soul for a mess of porridge?C69: Yes, I do.T70: I don’t see why you should. That leaves you with no integrity. Now it’s all right to

do whatever you want about being quiet, and not telling your parents about yourloss of faith—because they’re not going to approve and could well upset themselves.There’s no use in throwing your irreligiosity in their faces. But to let yourself beforced to go to church and thereby to give up your integrity—that’s bullshit. Youcan even tell them, if necessary, “I don’t believe in that any more.” And if there’sa scene, there’s a scene. If they commit suicide, they commit suicide! You can’treally hurt them, except physically. You can’t hurt anybody else except with abaseball bat! You can do things that they don’t like, that they take too seriously,and that they hurt themselves with. But you can’t really hurt them with words andideas. That’s nonsense. They taught you to believe that nonsense: “You’re hurtingus, dear, if you don’t go along with what we think you ought to do!” That’s drivelof the worst sort! They’re hurting themselves by fascistically demanding that youdo a certain thing, and then making themselves upset when you don’t do it. You’renot doing the hurting—they are. If they get hurt because you tell them you’re nolonger a Baptist, that’s their doing. They’re hurting themselves; you’re not hurtingthem. They’ll say, “How can you do this to us?” But is that true? Are you doinganything to them or are they doing it to themselves?

C71: No, I’m not.T72: But you believe that you’re hurting them. It’s crap!

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Classically, again, I try to show Martha, as is usually done in rational emotive therapythat it is ethical to stick up for herself first, if she chooses to do so, and for her parentssecond. I also emphasize that people, including her and her parents, are not hurt bywords, gestures, and attitudes (at point A) but by the nonsense they tell themselvesabout these verbalizations and meanings (at point B). I saw Martha a dozen years ago,when RET was a very young system of therapy. Today, I might very well take the sametack, but probably be less long-winded about it.

C73: And also, my mother thinks that I should be at home. I was contributing quite abit of my paycheck every week. I got my first job when I graduated. My fatherstarted to work about the same time. He had been out of work. And I just gavethem everything but what I absolutely needed. The debts that I had incurred whenI was in college, I couldn’t really start to pay back. Since then I’ve moved out, andI give them a little; but I just can’t give them much anymore—because I just simplycan’t. And besides that, I’ve gotten sick. I was sick twice this fall. And I have to getmy teeth pulled now, and have to get a full upper plate put in. And I’m underfinancial strain. They make me feel—I guess I can’t say they make me feel guilty.

T74: No; you do!C75: The thing I make myself guilty about is the fact that my father doesn’t earn enough

money to support them.T76: Why should you make yourself guilty because he doesn’t earn enough money?C77: All my life, ever since I can remember, I have. And I don’t know where I got it

from. This I would like to find out because maybe I can get rid of it. I’ve alwaysfelt that I had to make up for my father, because of his lack of financial success inthe world. I don’t know why I have the feeling.

T78: You have it, obviously, because somewhere along the line you accepted theirindoctrination with this kind of philosophy—that you have to make up for yourfamily’s deficiencies. It doesn’t matter exactly how they indoctrinated you; but youdidn’t get it from nowhere. Anyway, you let yourself be indoctrinated with thisnotion. They and society started it—for society helps indoctrinate you, too. Maybeit’s a matter of shame: you think, “If everybody knows my father is so incompetent,they’ll look down on us; and that would be terrible! So I have to make up for hislack in order to show people that we have a perfectly fine family.”

C79: No, it isn’t that. Someone was always sick. And if it wasn’t one person sick, it wastwo. And this went on all the time. There was no time that I can remember wheneverybody was well. They’ve had doctors all the time. And when my brother Teddywas ill, my father spent a great deal of time going from doctor to doctor, and notconcentrating on his—on his own career, I guess.

T80: That may have been because of his own mental disturbance. He’s probably alwaysbeen mentally upset; alcoholics generally are.

C81: He’s always been supporting more people than he can. When his father died, mydaddy was twelve, and he started working part time then. And then all throughhigh school. He supported his mother and his sister all the way up till the time hemarried my mother. And then his mother made him feel guilty about gettingmarried.

184 Albert Ellis

T82: Yes, that’s right; and he’s been pre-alcoholic, in a sense, all his life, because heagreed with his mother that he should feel guilty. He now merely is more guiltythan ever, and therefore has gone over the border into real alcoholism.

C83: The constant pressures, the financial pressures, that were on him—T84: Which he really created—or at least went out of his way to accept!C85: Yes. Because he’s a great writer and could make a lot of money that way. He could

sell everything he writes. But why he doesn’t, I don’t know.T86: Because he’s so disturbed.C87: He is disturbed.T88: He’s always been. And probably, because you were the one member of the family

who was relatively healthy physically, you felt, “I have to make up to the othersfor being this healthy!”

C89: My mother always told me that. You see, I was always healthy until I developedmy easily dislocatable shoulder. And my mother told me that my father almostcame apart at the seams when I got afflicted, too. Because I was always the one hecould look to for his security.

T90: Yes, and that’s exactly the point now. There’s your answer: he looked to you forhis security. That’s where you may have got the concept that you had to be hissecurity. There’s their indoctrination. It’s his expectation that you will take care ofhim and the family; and you’ve always tried to live up to that expectation.

C91: I’ve always tried to live up to their expectations!T92: You’re still trying to live their lives, instead of living yours.C93: I’m realizing that now. And I don’t want to live their lives.T94: Well, I’m afraid that you have to be almost cruel and ruthless with people like your

parents—because otherwise they’ll exploit you forever: and you’ll just be in theold morass. Because they’re going to remain in a morass for the rest of their lives.I doubt whether they will ever change.

C95: I feel that I went to college, and I was doing it practically on my own. My fatheralways gave me five or ten dollars whenever he could; and he paid the phone bills.They tried, but they couldn’t keep up with the expenses. I borrowed money, andI got some scholarships, and I worked in my freshman year. And I thought, “Nowthat I’m in college, I’m not a financial worry of theirs. Now everything will be allright. They’ll be able to get on their feet. There are only four people to support”But it didn’t happen.

T96: You may never be in good financial circumstances, as far as I can see. Your fatheris too mentally disturbed.

C97: They think everything will turn out well.T98: Yes, I’m sure. God is on their side!C99: I tried a little experiment with God—which was one of the things that made me

break off from religion. I always used to pray for what I wanted, because anythingyou want you pray for. So I was always praying. Then one time I said, “I’ll seewhat I can do without praying.” So I studied instead; and I did better!

T100: Right! But people like your parents will never take that risk of trying things withoutcalling upon God to help them.

C101: If there were a God, he never would have cursed anybody like he cursed my family—.

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T102: Yes, if there were a God, he’d be awfully cruel to do this to your family. Becauseyou seem to have every ill in it: alcoholism, cancer, polio, an enlarged heart, adislocatable shoulder—you name it! Every one of five people seems to be sorelyafflicted. You could hardly have a worse setup.

C103: I said once at the dinner table, “You know, somebody up there hates us!” (Laughs)I wanted to come to you because Ronald suggested it because you helped him getover his guilt about his mother. I had the feeling that I should go somewhere tofind out what needed to be done. Because I don’t want to waste any more of mylife.

T104: What needs to be done is relatively simple—but it’s not easy to do. And that is—you’ve already done parts of what needs to be done. You have changed some ofyour fundamental philosophies—particularly regarding religion—which is a bigchange for a human being to make. But you haven’t changed enough of yourphilosophy; you still believe some basic superstitions. Most people—whether Jew,Catholic, or Protestant—believe these superstitions, and your parents believe themeven more than most people do, because they’re more disturbed. The mainsuperstitions are that we should devote ourselves to others before ourselves; thatwe must be loved, accepted, and adored by others, especially by members of ourown family; and that we must do well, we must achieve greatly, succeed, do right.And you firmly believe these major superstitions. You’d better get rid of them!

C105: How do I do that?T106: By seeing, first of all, that every single time you get upset—meaning guilty,

depressed, anxious, or anything like that—every time you get some form of upset,some severe negative feelings, right before you got the feeling, you told yourselfsome superstitious creed—some bullshit. That, for example, you’re no good becauseyou aren’t successful at something; or that you’re a louse because you areunpopular, or are selfish, or are not as great as you should be. Then, when you seethat you have told yourself this kind of nonsense, you have to ask yourself thequestion, “Why should I have to be successful? Why should I always have to beaccepted and approved? Why should I be utterly loved and adored? Who said so?Jesus Christ? Who the hell was he?” There is no evidence that these things shouldbe so; and you are just parroting, on faith, this nonsense, this crap that most peoplein your society believe. And it’s not only your parents who taught it to you. It’salso all those stories you read, the fairy tales you heard, the TV shows you saw.They all include this hogwash!

C107: I know. But every time you try to overcome this, you’re faced with it somewhereelse again. And I realize—I’ve come to realize—you know, the thing that made metry to straighten myself out was that I know I’ve got to learn to have confidencein my own judgment.

T108: While you’ve really got confidence in this other crap!C109: Yes, I’m very unconfident.T110: You have to be—because you believe this stuff.

I continue actively teaching and depropagandizing Martha. Not only do I deal withthe irrational philosophies that she brings up, but I prophylactically mention and attack

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others as well. I keep trying to expose to her a few basic groundless ideas—such as theideas that she must be loved and must perform well—and to show her that hersymptoms, such as her self-sacrificing and her lack of self-confidence, are the naturalresults of these silly ideas.

C111: I have tremendous self-doubts about every part of my existence.T112: Yes, you must, because you have so much of a belief that you must please

others. If you have so much of this belief, you cannot have confidence in you. It’svirtually impossible, for how can you do two opposite things at once—haveconfidence that you are a valuable person to yourself, no matter what others think,and believe that you are not valuable to you unless others approve of you?Confidence in yourself is really a high-class term for not giving that much of adamn what other people think of you. That’s all it is. But you do care terribly aboutwhat other people think of you—about what your parents, especially, think. Butalso, probably, about what many other people think. Because if you were a poordaughter, what would the neighbors think? What would your friends think? You’rereally petrified!

C113: It’s not the neighbors and friends. The thing that ties me up mostly is my parents.T114: Yes, they’re the primary ones. What would they think of you if you acted mainly

in your own behalf? So what, if they think you’re a louse? Let’s even suppose thatthey disinherit you, excommunicate you from the family—

C115: Then I should think, “If they care that little about me, why should I care aboutthem?”

T116: That’s right. That would be tough! But it would just prove that they were benighted.It just would follow from their philosophy, which they’re entitled to hold—howevermiserable it has made them. It would prove that they are fascistically trying to forceyou to believe this philosophy; and because they’re failing, they excommunicateyou. They’re entitled to do so, of course; but you’re entitled to say, “Who needsthem?” Suppose, for example, you lived down south for a while, that lots of peopledidn’t like you because you weren’t against Negroes, and that they called you anigger-lover. What are you going to do—get terribly upset about them?

C117: No, that wouldn’t bother me, because that never entered my life. I mean the factthat they hate Negroes. There are people who hate Negroes who never entered mylife. Because I went to school with Negroes. Nobody ever told me that they werebad. If somebody ever said, “You’re bad because you don’t hate Negroes,” thatwouldn’t bother me because that’s not something—

T118: All right. But why should it bother you if somebody says you’re bad because youdon’t put your parents’ interests before your own?

C119: I guess because I’ve been indoctrinated with this idea.T120: You believe it. It’s exactly like hard-shelled Baptism. In fact, it has some of the

aspects of orthodox religion; for this kind of religion says that the family comesfirst and the individual second; and that you’re supposed to have twenty childrenand not use birth control, and so on. That’s what many orthodox religions, likeCatholicism and orthodox Judaism, teach. Everything for the church, the family—and somewhere, away underneath, the individual is buried.

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C121: But the individual—whatever contributions he has to make, whatever his capa-bilities are—can be lost that way; and I don’t want to be lost.

T122: Not only can he be, he must be lost that way.C123: I don’t want to be self-effacing!T124: Right! Then why do you have to be? Who said you must be? The answer is: your

parents. Who the hell are they? Poor, sick, benighted individuals. They’re noteducated; they’re not sophisticated. They’re probably bright enough, but they’redisturbed. Your father, as we said before, has probably been seriously upset all hislife, in an undramatic manner. More recently, he became dramatically ill. But itdoesn’t come on like that. (Snaps his fingers) You can see the signs clearly overthe years. And your mother has probably been fairly disturbed, too, thoughprobably not as much as he. But that’s the way it is: you were raised in a prettycrazy family. Does that mean you have to kowtow to their beliefs for the rest ofyour life?

C125: No; I want to get away from it. I want to be myself. I don’t want to be—T126: What’s preventing you from being yourself? Nothing can prevent you right now,

if you really want to be. You just would do better, every time the feelings of beingweak arise, to trace them to the indoctrinations of your parents and of your societyand your acceptance of these indoctrinations. And you’d better counter them—because you’re suggesting to yourself, a hundred times a day now, those same creeds.You’ve taken them over, internalized them. And that’s really unfortunate. Becauseit’s now become your belief—you can get rid of it. Not immediately—but you can.Just like you got rid of your religious views.

C127: And I also want to find out—I suppose it’s all basically the same thing—why Ihave been promiscuous, why I lie—

T128: For love. You think you’re such a worm that the only way to get worth, value, isto be loved, approved, accepted. And you’re promiscuous to gain love, because it’san easy way: you can gain acceptance easily that way. You lie because you’reashamed. You feel that they wouldn’t accept you if you told the truth. These arevery common results; anybody who desperately needs to be loved—as you thinkyou do with your crummy philosophy, will be promiscuous, will lie, will do otherthings which are silly, rather than do the things she really wants to do and ratherthan gain her own self-approval.

C129: That’s what I don’t have; I don’t have any.T130: You never tried to get it! You’re working your butt off to get other people’s

approval. Your parents’ first, but other people’s second: That’s why the promiscuity;that’s why the lying. And you’re doing no work whatever at getting your own self-acceptance, because the only way you get self-respect is by not giving that muchof a damn what other people think. There is no other way to get it; that’s whatself-acceptance really means: to thine own self be true!

In my responses to Martha, I epitomize one of the main differences between RETand most other “dynamic” systems of psychological treatment. Whereas a psycho-analytically-oriented therapist would probably have tried to show Martha that herpromiscuity and lying stemmed from her early childhood experiences, I, as a rational

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emotive therapist, believe nothing of the sort. I assume, instead, that her childhoodlying, for example, was mainly caused by her own innate tendencies toward crookedthinking—which in turn led her to react inefficiently to the noxious stimuli her parentsmay have imposed on her. What is important, therefore, is her own reactivity and nother parents’ actions. I also believe, on theoretical grounds, that the reason for Martha’spresent promiscuity and lying is probably her current need to be inordinately loved;and she freely seems to admit (as she also previously did in C19) that my educated guessabout this is true.

If I proved to be wrong in this guess, I would not be perturbed but would look foranother hypothesis—for example, her promiscuity might be a form of self-punishment,because she thought she was unworthy on some other count. As a rational emotivetherapist, I am willing to take a chance on being wrong with my first hypothesis because,if I am right, I will usually save my client a good deal of time. Moreover, by taking awrong tack, I may well help myself and the client get to the right tack. If, however, Itry the psychoanalytic, history-taking path, in order to arrive at the “real” reasons formy client’s behavior (1) I may never find what these “real” reasons are (for they maynot exist, or years of probing may never turn them up); (2) I may still come up withthe wrong reasons; and (3) I may sidetrack the client so seriously that she may neverdiscover what her basic disturbance-creating philosophy is and therefore never doanything about changing it. For a variety of reasons, then, I take a very direct approachwith Martha.

C131: You have to develop a sort of hard shell towards other people?T132: Well, it isn’t really a callous shell. It’s really that you have to develop your own

goals and your own confidence so much that you do not allow the views and desiresof others to impinge that much on you. Actually, you’ll learn to be kinder andnicer to other people if you do this. We’re not trying to get you to be against others,to be hostile or resentful. But you won’t be Florence Nightingale, either! So you’dbetter get, not insensitive, but invulnerable. And the less vulnerable you get to whatothers think of you, actually the more sensitive, kindly, and loving you can oftenbe. Because you haven’t been so loving, really, but largely maintaining a facadewith your parents. Underneath, you’ve been resentful, unloving.

C133: I can be loving, though.T134: That’s right. But you’d better be true to yourself first; and through being true to

yourself—and not being anxious, depressed, and upset—then you’ll be able to caremore for other people. Not all people, and maybe not your parents. There’s nolaw that says you have to love your parents. They may just not be your cup of tea.In fact, it looks like in some ways they aren’t. Tough! It would be nice if they were;it would be lovely if they were people of your own kind, if you could love themand have good relationships. But that may never really be. You may well have towithdraw emotionally from them, to some extent—not from everybody, butprobably from them somewhat—in order to be true to yourself. Because they tendto be leeches, fascists, emotional blackmailers.

C135:Yes, that’s the term: emotional blackmailers. This I know; this has been evidencedall through my life. Emotional blackmail!

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At every point, I try to show Martha that she does not have to feel guilty forwithdrawing emotionally from her parents and doing what she wants to do or thinkingwhat she wants to think. I do not try to get her to condemn her parents or to be hostileto them. Quite the contrary! But I do consistently show her that they have their ownproblems and that she’d better resist their emotional blackmailing. As it turns out, sheseems to have always known this; but my actively bringing it to her attention willpresumably help her to act, now, on what she knows and feels. I am thereby helpingher, through frank and therapist-directed discussion, to get in touch with her realfeelings and to follow them in practice.

T136: Right. And you’ve been accepting this blackmail. You had to accept it as a child—you couldn’t help it, you were dependent. But there’s no law that says you stillhave to accept it. You can see that they’re blackmailing; calmly resist it, withoutbeing resentful of them—because they are, they are. It’s too bad, but if they are,they are. Then their blackmail won’t take effect. And they’ll probably foam at themouth, have fits, and everything. Tough!—so they’ll foam. Well, there’s no questionthat you can be taught to change. We haven’t got any more time now. But thewhole thing—as I said a while ago—is your philosophy, which is an internalizing,really, of their philosophy. And if there ever was evidence of how an abjectphilosophy affects you, there it is: they’re thoroughly miserable. And you’ll be justas miserable if you continue this way. If you want to learn to change yourphilosophy, this is what I do in therapy: beat people’s ideas over the head untilthey stop defeating themselves. That’s all you’re doing: defeating yourself!

I not only reemphasize, at the end of the session, that it is Martha’s views, taken overfrom her parents, that are bolixing her up, but I keep utilizing material from her ownlife to consistently show her what is going on in her head, philosophically, and whatshe’d better do about changing her thinking. This twelve-year-old first interview withMartha indicates how RET, right from the start, encourages the therapist to talk muchmore about the client’s value system than about her symptoms and how it uses theinformation she gives to highlight her own disturbance-creating ideas and to attackthem. I think that this session also shows that although I do not hesitate to contradictMartha’s assumptions at several points, I am essentially supportive in that I keepshowing her (1) that I am on her side, (2) that I think I can help her, (3) that I amfairly sure what the real sources of her disturbances are, and (4) that if she works atseeing these sources and at doing something to undermine them, the chances areexcellent that she will become much less upsettable. My “attack,” therefore, is one thatwould ordinarily be called “ego-bolstering.” Or, in RET terminology, it is one that isdesigned to help Martha fully accept rather than severely condemn herself.

To this end, I consistently have what Carl Rogers (1961) calls “unconditional positiveregard” for Martha, for I accept her in spite of her difficulties and inanities, and believethat she is capable of overcoming her crooked thinking by living and working primarilyfor herself. I also show that I am on Martha’s side, not because I personally find herattractive, bright, or competent, but because I feel that every human has the right tolive primarily for herself and to consider others, including her parents, second.

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Second Session

This is a recording of the second session with Martha, which takes place five days afterthe first session. It shows that she has already made some progress, has calmed downconsiderably, and is now in a better condition to work at some of her basic problems.

T1: How are things?C2: Things are okay. I went to visit my parents on Monday night. And every time I

was tempted to fall prey to their emotional blackmail, I remembered what you said,and I was able to fight it.

T3: Fine!C4: My mother is having a rough time yet, because of having her breast removed. She

hardly says anything. She’s really in a world of fog. She gets confused, and she usesthe confusion to give her a hold on the family. She was putting on a martyr actthe other night; and usually I would have given in to her, but I said, “Quit beinga martyr! Go to bed.” She just looked at me as though I was a strange creature!

T5: And you didn’t get upset by it?C6: No, I didn’t get upset by it. I had the feeling that I was doing the right thing. And

that was, I think, the major accomplishment in the past few days.T7: Yes; well that was quite a good accomplishment.C8: Now if there are any bigger crises that will come, I don’t know how I’ll face them;

but it looks like I can.T9: Yes; and if you keep facing these smaller crises as they arise—and they tend to be

continual—there’s no reason why you shouldn’t be able to face the bigger ones aswell. Why not?

C10: I guess it’s a case of getting into a good habit.T11: Yes, that’s right: getting really to believe that no matter what your parents do, no

matter how hurt they get, that’s not your basic problem. You’re not deliberatelydoing them in; you’re just standing up for yourself.

As often occurs in RET, although this is only the second session, Martha is alreadybeginning to implement some of the major ideas that were discussed during the firstsession and is beginning to change herself. I deliberately support her new notion thatshe can handle herself with her parents, and I keep reiterating that she does not haveto react upsettedly to their views and behavior by getting upset. I thereby am approvingher new patterns and rewarding or reinforcing her. But I am also repetitively teaching—taking every opportunity to reassert that she can think for herself and does not haveto react negatively because her parents or others view her unfavorably.

C12: Well, something else has bothered me, I guess, during the last eighteen months.No, I guess after I finished school. I have the feeling that I can’t express myselfverbally as well as I used to do. I don’t know why this is. Maybe I’m in anatmosphere where—well, you can’t say that they aren’t talking enough. But I reallyfeel that I’ve lost something.

T13: Do you mean when you’re talking to people in business or socially, you can’t expressyourself as well as you used to?

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C14: Yes, I can’t seem to find the right words.T15: Well, part of it is probably true: because you’ve lost confidence in yourself during

some of this while. And when you lose confidence in yourself, you will not be asgood as you were in your performance. Then you look at your not being as goodas you were—and you lose more confidence! That’s the vicious circle that occurs.Now, if you’d stop worrying about how good you are at expressing yourself andjust keep expressing yourself, most of your old ability would probably come backmaybe all of it; you might even get better than you were. But you used to do itless self-consciously; and now you’ve become more self-conscious, more worriedabout how you’re expressing yourself. We all make mistakes and blunders inexpression. But you’re taking yours too seriously. There’s a famous experimentwhich is done with stutterers. You can take a stutterer, a very bad stutterer, andput earphones on him and play noise into the earphones so that he can’t hearhimself talk. Then you can give him something to read, and he often reads itwithout any stuttering!

C16: Oh!T17: Because he can’t worry; he can’t know how badly or well he’s reading. But if you

take off the earphones again, he starts stuttering right away, because he’s then ableto listen to his voice; and he does a little stuttering for the first few words and thensays to himself, “My Lord! This is terrible!” Then he starts stuttering, stuttering,stuttering. Now, you’re paying too much attention to how you’re expressingyourself; and because you’re paying too much attention to it, you’re not expressingyourself well.

My responses, T15 and T17, are really based on pure guesswork, stemming from RETtheory. I know, from clinical experience and from theoretical constructs inducted fromthis experience, why most people fail to express themselves well and what they thinkabout themselves when they fail, so I take the chance of assuming that Martha falls intothe majority group and explain to her what is probably occurring in her case. If ittranspires that I am wrong about her, I can always backtrack and look for a morerealistic explanation. In the interest of economy, however, I hazard the guesses I makeher, and wait to see how she will react to these hypotheses.

C18: Something that I did wrong on Saturday—I found myself telling a lie, just a very,very minor thing. It wasn’t a case where I had decided to tell a lie; it just came outwithout my realizing it.

T19: Well, you’re in the habit, probably. What were the circumstances?C20: Well, I had a date. I went up to Harlem. We met another couple—they were with

us—and then my date got up to dance with the other girl. And the other fellowdidn’t ask me to dance. This happened a couple of times, and I got very annoyed.I felt that he didn’t show any manners, and I was very upset about it.

T21: Was he dancing with his own date?C22: No, he didn’t dance; well, he danced with her a couple of times, but I guess I felt

neglected or something. And then on the way home the subject came up, and Isaid, “Oh, I told him how rude he was.” I told my date that I told the other fellowhow rude he was. And I hadn’t said anything to him at all.

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T23: That’s a very simple business to find out why you lied there. What you were sayingto yourself was, “I should have told him this or something like this”—which,incidentally is wrong, as I’ll show you in a minute. But let’s, anyway, say it. Yousaid to yourself, “I should have told him he was rude.” And then you were ashamedthat you didn’t. So you told your boy-friend that you did. Because if he knew thatyou didn’t, you would have been ashamed. Isn’t that true?

C24: Probably, because I would have said it. I wasn’t sure what he would have thought.T25: Your boyfriend?C26: Yes.T27: But you were concerned with what you would have thought. You were sort of, in

a sense, lying to yourself. Actually, I don’t see why you had to be so concerned.Let’s suppose this guy was rude. We don’t know whether he actually was rude,incidentally, because he may have been afraid to dance with you—he may be apoor dancer, may be worried. But let’s suppose it was just plain rudeness. Whyhaven’t human beings got the right to be rude? Why shouldn’t they be? It wouldbe nice if they weren’t; but if they are, why should you upset yourself?

C28: You’re right.T29: So you see: you were getting yourself upset about nothing. You were working yourself

up into anger and saying, “I’ll fix this guy’s wagon!” And then you didn’t fix hiswagon, so you got angry at yourself for not fixing his wagon. So you lied to yourdate about it. That’s what usually happens in these lies. You do something, or youdon’t do something, of which you’re ashamed. And then you try to make it upwith a lie—which won’t do you any good whatsoever. Why should you be ashamed?Let’s suppose another thing. Let’s suppose the guy was deliberately, consciouslyrude to you, and let’s suppose you had taken him to task for it. Actually, you woulddo better not to—because it’s his problem. But let’s suppose you did—which wouldmean that you made a mistake. So what’s so horrible about you for making amistake?

C30: Well, this is all a part of something that’s bothered me for a long time. I’m alwaysafraid of making a mistake.

T31: Why? What’s the horror?C32: I don’t know.T33: You’re saying that you’re a bitch, you’re a louse when you make a mistake.C34: But this is the way I’ve always been. Every time I make a mistake, I die a thousand

deaths over it.T35: You blame yourself. But why? What’s the horror? Is it going to make you better

next time? Is it going to make you make fewer mistakes?C36: No!T37: Then why blame yourself? Why are you a louse for making a mistake? Who said

so?C38: I guess it’s one of those feelings I have.T39: One of those beliefs. The belief is: “I am a louse!” And then you get the feeling:

“Oh, how awful! How shameful!” But the feeling follows the belief. And again,you’re saying, “I should be different; I shouldn’t make mistakes!” Instead of: “Oh,look: I made a mistake. It’s undesirable to make mistakes. Now, how am I going

Guilty About Not Following Parents’ Rules 193

to stop making one next time?” If you’d use that line, you’d stop making themistakes after a while.

As is usual in RET, I deliberately look for something that Martha says that will enableme to go far beyond the immediate events of her life and her dysfunctional emotionalreactions about these events, and I soon find this thing. I show her that behind herlying about telling off a fellow who was rude to her was probably her feeling of shameabout not telling him he was rude. I could have merely shown her that (1) she feltashamed, and (2) there was no good reason for her to feel this way, since, at worst, shemade a mistake in not speaking up, and she could have accepted herself with this mistake.But I deliberately go far beyond this and show her that she didn’t have to take thisperson’s rudeness seriously in the first place—as it probably had nothing intrinsicallyto do with her but mainly indicated that he had his own problems. Her upsetness,therefore, did not stem from point A, his rudeness, but from point B, her insisting toherself that he shouldn’t be rude. I then go still further and show her that even if hewere consciously and deliberately rude to her and even if she did take him to task, shewould still be foolishly making herself angry about his having a problem.

By going beyond the immediate situation and letting Martha see some of the far-reaching consequences of her own thinking, I smoke her out and get her to admit themain thing I am trying to get at: that she’s always afraid of making mistakes. I thenhave more concrete information to show her, again, that it’s not the mistakes she makesat point A (the activating event) that upset her at point C (the consequence). Rather,it’s the nonsense she tells herself at point B (her belief system): that she’s a bitch, alouse for making such mistakes.

All through the session, therefore, I very consciously use Martha’s material to revealto her her basic irrational philosophies and how she can attack and change them. I tryto interrupt her own viciously circular thinking: “I do poorly. Therefore, I’m a worm!therefore, I can only keep doing poorly. Therefore, I have to keep condemning myself for doing so badly.” And I try to get her to replace it with something like: “I dopoorly. I then wrongly berate myself because of my perfectionistic view about how wellI should do. This self-berating helps me do much worse. Then I wrongly blame myselffor doing worse. Now I can look at what I’m mistakenly believing, can accept myselfwith my fallibilities, and can gradually work at correcting my errors and probably dobetter.”

C40: Well, this is the way it was in school, if I didn’t do well in one particular thing, oreven on a particular test—and little crises that came up—if I didn’t do as well asI had wanted to do.

T41: Right. You beat yourself over the head.C42: Yes.T43: But why? What’s the point? Are you supposed to be perfect? Why the hell shouldn’t

human beings make mistakes, be imperfect?C44: Maybe you always expect yourself to be perfect.T45: Yes. But is that sane?C46: No

194 Albert Ellis

T47: Why do it? Why not give up that unrealistic expectation?C48: But then I can’t accept myself.T49: But you’re saying. “It’s shameful to make mistakes.” Why is it shameful? Why can’t

you go to somebody else when you make a mistake and say, “Yes, I made a mistake”?Why is that so awful?

C50: I don’t know.T51: There is no good reason. You’re just saying it’s so. Recently I wrote an article for

a professional publication, and they accepted it, and they got another psychologistto write a critique of it. He wrote his critique—a fairly savage one—and he pointedout some things with which I disagree, so I said so in my reply. But he pointedout some things which he was right about; where I had overstated my case andmade a mistake. So, I merely said about this in my rejoinder, “He’s right; I madea mistake here.” Now, what’s the horror? Why shouldn’t I make a mistake? Whothe hell am I—Jesus Christ? Who the hell are you—the Virgin Mary? Then, whyshouldn’t you be a human being like the rest of us and make mistakes? It mightall go back to, as you said, the need for approval.

C52: If I don’t make mistakes, then people will look up to me. If I do it all perfectly—T53: Yes, that’s part of it. That is the erroneous belief; that if you never make mistakes

everybody will love you and that it is necessary that they do. That’s right. That’sa big part of it. But is it true, incidentally? Suppose you never did make mistakes—would people love you? They’d sometimes hate your guts, wouldn’t they?

C54: And yet, not all the time. There are times—this is rare, I grant you—but sometimesI’ll stand up, take a stand on something that other people don’t like. But this is sorare!

T55: Yes, but what about the times when you know you’re wrong? Let’s take those times—that’s what we’re talking about. You know you’re wrong, you made a mistake,there’s no question about it. Why are you a louse at those times? Why is it shamefulto admit your mistake? Why can’t you accept yourself as a fallible human being—which we all are?

C56: (Pause) Maybe I have done this on the idea that if I keep telling myself how perfectI am, I won’t realize how imperfect I am.

T57: Yes, but why shouldn’t one accept the fact that one is imperfect? That’s the realquestion. What’s shameful about being imperfect? Why must one be a goddamnedangel—which you’re trying to be?

C58: Probably there’s no good reason.T59: No. Then why don’t you look at that? There’s no good reason. It’s a definitional

thing, saying “To be good, to be perfect. To be a worthwhile human being, I mustbe perfect. If I have flaws, I’m no damned good.” And you can’t substantiate thatproposition. It’s a senseless proposition; but you believe it. The reason you believeit is your society believes it. This is the basic creed of your silly society. Certainly,your parents believe it. If they knew one-sixtieth of your errors and mistakes—especially your sex errors!—they’d be horrified, wouldn’t they?

C60: Yes.T61: You have the same silly horror! Because they think you ought to be a sexless angel,

you think you ought to be.

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C62: (Silence)T63: The devil knows that they’re not very good judges. But you’re taking their idiotic

judgments—the same judgments that have driven your father to drink and madeyour mother utterly miserable. They both have been miserable all your life. That’swhat perfectionism leads to. A beautiful object lesson there! Anybody who isperfectionistic tends to become disturbed, unhappy—ultimately often crazy. Thegospel of perfection!

C61: That’s what I have to work on. Because I don’t want to get like they are.T65: No, but you are partly like they are already—we’ve got to change that. It isn’t a

matter of getting—you’ve already got! Let’s face it. You don’t do the same kind ofbehavior as they do, but you hate yourself when you don’t. You make the mistakes;they don’t make them. But then you say, “I’m no good! How could I have donethis? This is terrible! I’m not Florence Nightingale. I go to bed with guys. I do badthings. I make blunders. How awful!” That’s the same philosophy that they have,isn’t it? And it’s an impossible philosophy, because we’d really literally have to beangels to live up to it. There are no angels! Not even your parents!

I keep showing Martha that she is quite unrealistic and perfectionistic—and that aslong as she continues to be, she will inevitably get the poor results she is getting. I tryto demonstrate that her negative view of herself is merely the result of a definition; sheis “no good” because she defines herself, when she is imperfect, as being no good.

I make something of a mistake, probably, when I tell Martha that she believes she isworthless largely because her parents and her society teach her to believe this. I fail tonote—as I noted in detail in the final chapter of Reason and Emotion of Psychotherapy(Ellis, 1962), which was published a few years after this session with Martha occurred—that practically all humans seem to be born with a tendency to believe this sort of drivel;that they must be pretty perfect and are no good if they are not; and that thereforetheir parents and their society are easily able to convince them that this is “true.”

Clinically, however, I felt when I talked to Martha that she was already prejudiced againsther parents’ views and that she might therefore see the perniciousness of her own ideasif I emphasized how close to those of her parents they were. As a rational emotive therapist,I am a frank propagandist, since I deliberately use appeals that I think will work with agiven client. But I only propagandize in accordance with what appears to be the empiricalreality; that people do define themselves as worthless slobs and that they then do obtainbehavioral results. I do not propagandize only to win Martha’s approval, but todramatically (emotively) bring to her attention the realities of life.

Rational emotive therapists are sometimes accused of foisting on their clients theirown prejudiced views of the world. Actually, they try to base their views on reasonablyobjective considerations—on the facts of human existence and the usual nature ofpeople. And they teach individuals with disturbances to look at these facts and torealistically accept and work with them. But they may teach through dramatic or emotivemethods, in order to put a point over more effectively, taking into consideration thatclients generally hold their wrong-headed views in a highly emotionalized, not easilyuprootable manner.

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C66: (Pause) I guess that’s this great fear of failure. That might have been what waskeeping me from concentrating on writing, which I really want to do. I’m afraidthat I might make a mistake, you know.

T67: Yes, that’s the other grim tragedy. Two things happen if you have a terrible, grimfear of failure. One is, as you just said, you get anxious, unhappy, ashamed. Two,you don’t live; you don’t do the things you want to do. Because if you did them,you might make a mistake, an error, be a poor writer—and wouldn’t that be awful,according to your definition? So you just don’t do things. That’s your parents again.How could they be happy, when they haven’t done anything? And you have beenfollowing the same general pattern. You haven’t taken it to their extremes as yet,but it’s the same bullshit, no matter how you slice it. And in your case you’re afraidto write; because if you wrote, you’d commit yourself. And if you committedyourself, how horrible that would be!

C68: I’ve done a lot of thinking about it, since the last time I saw you. And I’ve goneat the typewriter with sort of a fresh burst of enthusiasm. I’m really anxious to getto it—I want to get home from work so I can. Nothing big has happened, but Ifeel as though if I concentrate on it and keep feeling this way, all I have to do isto keep working at it.

T69: And one of two things will happen. Either you’ll become a good writer, with enoughwork and practice; or you’ll prove that you’re not—which would be a good thing,too. It would be far better to prove you’re not a good writer by working at it thannot to write. Because if you don’t write, you may go on for the rest of your lifehating yourself; while if you really work solidly day after day, and you just haven’tgot it in this area, that’s tough. So you won’t be a writer—you’ll be something else.It would be better to learn by that experience.

C70: That’s right. Because—I don’t know—I felt so different, sitting at the typewriterand working at it, that it got to be enjoyable.

T71: It will!C72: But it was painful before.T73: It was painful because you were making it painful by saying, “My God! Look what

would happen if I failed! How awful!” Well, anything would become painful if youkept saying that.

C74: Another thing that bothers me, I guess—it’s the whole pattern of behavior; theway everything has been in my life. It’s a sort of—“Go ahead and do it now, andthen something will come along and take care of it.” Like my parents always said,“We’ll go ahead and do this, even though we don’t have the money for it, and it’llcome from somewhere.”

T75: Right: “In God we trust!”C76: This is the way I went to college. But I made it.T77: That’s right: you made it. It wasn’t God; it was you.C78: And God had nothing to do with it! (Laughs)T79: That’s right.C80: And I find myself acting still in this way, and not being able to plan things. And

even if I plan them, little things, they don’t seem to come out anyway. But I still

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keep doing things haphazardly, thinking, “Well, go ahead and do it; and it willcome from somewhere.”

T81: Yes; but will it?C82: No, it won’t. God helps those who help themselves.T83: And if you plan and scheme and plot, then a lot of things will ultimately work out.

Because you planned and schemed and plotted and worked. But you’re believingin magic here, aren’t you?

C84: And when I tell myself, “Don’t be silly; you can’t do it, so don’t,” I’m tempted togo ahead and do it anyway.

T85: Yes, because you’re telling yourself stronger and louder: “It’ll take care of itself.Fate will intervene in my behalf. The Lord will provide!”

C86: And I get mad at myself for doing it—T87: That’s illegitimate! Why not say, “Let’s stop the crap!” instead of getting mad at

yourself? How will getting mad at yourself help?C88: It doesn’t. It just causes more tension.T89: That’s exactly right. It doesn’t do any good whatsoever. Let’s cut out all the self-

blame. That doesn’t mean cut out all criticism. Say, “Yes, I am doing this wrongly,so how do I not do it wrongly?”—instead of: “I am doing it wrongly; what a louseI am! I’m no good; I deserve to be punished!”

I persist at showing Martha that she can take chances, do things badly, and still notcondemn herself. At every possible turn, I get back to her underlying philosophiesconcerning (1) failing and defining herself as a worthless individual and (2) unreal-istically relying on the world or fate to take care of difficult situations. She consistentlydescribes her feelings, but I bring her back to the ideas behind them. Then she seemsto accept my interpretations and to seriously consider working against her disturbance-creating ideas. My persistence and determination may importantly induce her totentatively accept my explanations and to use them herself.

It may be noted, in this connection, that I am probably setting a good unneuroticexample for Martha and serving as a good model for her. Modeling, as Bandura (1970)has shown, is an important part of social learning and, hence, of psychotherapy. Whereasindividuals with disturbances usually fail to persist and seem determined to avoidanxiety-provoking situations, I keep displaying persistence and nonavoidance withher—thereby implying that she can behave similarly.

Also, I keep reinforcing Martha’s sane viewpoints (as when she remarks, “God hasnothing to do with it!”) and contradicting her insane views (as when she implies thatshe has to get mad at herself when she acts foolishly). So, to some extent, I am helping“condition” her to a different mode of thinking and reacting. Mostly, however, I amnot trying to induce her to adopt a more scientific approach to life through simple“conditioning” or “suggestion.”

C90: When I am particularly worried about anything, I have very strange dreams. I havedreams that I can’t relate what the problem is, but I have them several times aweek.

T91: There’s nothing unusual about that. They’re probably anxiety dreams. All thedreams say—if you told me what they are, I could show you right away—the same

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kind of things you’re saying to yourself during the day. They’re doing it in a vagueand more abstract way. But that’s all they are, just repetitious of the crap you’retelling yourself during the day. In dreams, our brain is not as efficient as it is whenwe’re awake; and therefore it uses symbols, vague representations, indirectness,and so on. But the dreams tell us the same crap we think during the day.

C92: I had a dream last week that disturbed me. I dreamed that I ran off somewherewith my boss, and his wife found us in bed; and I was so upset over that—I reallywas. Because I never consciously thought of my boss in a sexual way.

T93: That doesn’t mean that that’s what the dream represented, that you thought ofyour boss in a sexual way. There’s a more obvious explanation of the dream. Allthe dream is really saying is: you did the wrong thing and got found out.

C94: I never thought of that.C95: That’s all it was saying, probably. And what’s one of the wrongest things you can

do in our society? Have intercourse with your boss and have his wife find out!That’s all. It probably has little to do with sex at all; and you’re probably not goingaround unconsciously lusting after your boss.

C96: No, I don’t think I am.T97: No. But it would be the wrong move, if you did have sex with him; it might, of

course, jeopardize your job. So that’s all you’re saying in your dream: if I do thewrong thing, I’m no goddamned good; I may lose my job; I may get terriblypenalized; and so on. That’s what you say all day, isn’t it? Why should you nottranslate it into dreams at night? It’s the same crap!

In RET, dreams are not overemphasized and are often used only to a small extent;for, as I say to Martha, they are hardly the royal road to the unconscious (as Freud[1963] believed), but seem to be rather distorted and muddled representations of thesame kind of thinking and feeling that the individual tends to do during his wakinglife. Since they are experienced in symbolic, vague, and ambiguous ways, and since theycan easily be misinterpreted (according to whatever biases the individual therapisthappens to hold), the rational emotive practitioner would rather stick with the client’sconscious thoughts, feelings, and behaviors and with the unconscious (or unaware)thoughts and feelings that can be deduced from them. Dreams are rather redundantmaterial, and can consume a great deal of therapeutic time if they are taken too seriously.Moreover, long-winded dream analysis can easily (and dramatically!) distract the clientfrom what he’d better do most of all: look at his philosophies of life and work hard at changing them. So when dreams are used in RET, they are put in the framework of its general theory. It is assumed that they encapsulate some idea—either a rationaland hopeful idea (for example, that the individual can do better and get better) or an irrational, catastrophizing, or depressing idea (for example, in Martha’s case, thatshe might do the wrong thing with her boss, get penalized, and prove that she is “nodamned good”). This idea is sought out, explained by the therapist, and thencounterattacked.

C98: That dream did worry me.T99: That’s interesting. You got worried about the dream—

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C100: I got worried about the dream because I thought this must meanT101: —that’s right: that “I’m lusting after my boss, and isn’t that terrible!” Well, suppose

you were lusting after your boss. Let’s just suppose, for example—C102: No, I didn’t think, “Wouldn’t that be terrible!” I thought, “Well, I don’t—

consciously.”T103: Yeah? So?C104: And then I thought. “Maybe I am—unconsciously.”T105: So suppose you were? Let’s suppose you were unconsciously lusting after your

boss; not consciously, but unconsciously. What’s the hassle?C106: (Pause) I don’t know.T107: Why would that be bad? You’d just be unconscious of some of your lustful

thoughts. Well, who isn’t? What you should be saying—let’s suppose the dreamwere indicating that you were lusting after your boss, and you understood thedream and found that out—is “Well, isn’t that interesting! I’m lusting after myboss unconsciously. So do me something!” You see—you’re always ready to beatyourself over the head. “Isn’t it terrible! What a louse I am!” Millions of girls areunconsciously lusting after their bosses. Well, what’s wrong with that? As long asthey’re sane enough not to do much about it, not to get into trouble. But you weresaying: “Oh, no! I’m unaware of it. Isn’t this awful! I’m doing something overwhich I have no control!”

C108: It sounds so silly when you say it, but I guess that’s it.T109: It is silly, when you bring it out and look at it in the light.C110: So many of those things that bother people are—T111: Yes, absolutely!

I at first misinterpret Martha’s problem because I think that she thinks she is a terribleperson for lusting after her boss, when she really seems to think that she is doingsomething she can’t control and that her lack of control is terrible. I then try to showher how and why it is not horrible for her to have desires of which she is unaware andcannot control.

The beauty of the rational emotive approach is that no matter what the client seemsto be upset about, the therapist can quickly demonstrate that there is no good reasonfor her upset. Thus, if Martha’s dream represents (1) her lusting after her boss, (2) herbeing out of control, or (3) any other kind of mistake, RET theory holds that she cannotbe a rotter and that she therefore need not be terribly anxious, guilty, angry, ordepressed. She creates her disturbed feelings, not from the dream events, nor from herfoolish motives that may be revealed in these events, nor from the happenings in herreal life, nor from anything except her own attitudes about these events, motives, orhappenings. And I, as her therapist, am concerned much more with her attitudes thanwith the things that are transpiring in her waking or sleeping life. So if RET is consistentlyfollowed, any emotional problem may be tracked down to its philosophic sources (orthe ways in which the individual blames herself, others, or the world); and thesephilosophies may then be challenged, attacked, changed, and uprooted.

C112: Another thing that bothers me: I mentioned before that I was afraid of men, Ithink. But most of the real friends I have made have been members of the opposite

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sex. I always found it difficult to make friends with women. I’ve never particularlyliked very many of them. And in one way I’ve felt very comfortable with the menI made friends with. Yet, when I go out with somebody or date somebody for awhile, I really become unsure of myself with that person—and afraid.

T113: Afraid you’ll do the wrong thing and that he won’t like you?C114: Yes, I guess so.T115: It’s the same crap, isn’t it? “If I do the wrong thing, if I make a mistake, he won’t

like me; and wouldn’t that be terrible! I’ll be utterly bereft because he’ll reject me!”C116: (Silence)T117: Why would you be bereft? Let’s suppose you did the wrong thing, and he didn’t

like you. You make a few mistakes and he says, “To hell with this, dear! I’m breakingthis up now.” Why would that be terrible?

C118: Well, I suppose if I really cared for the person, then I would really think it’s terrible.But I think I let myself get too emotionally tied up with the person I go out with—so that I do tend to emotionally rely on the person.

T119: Emotionally dependent?C120: Yes.T121: Yes, that’s right. But isn’t dependency the same thing? You’re saying, “I can’t stand

on my own two feet, and I need to rely on this person.” Isn’t that what it means?C122: Yes.T123: Why do you need to rely? Why can’t you stand on your own two feet? Even if

you loved the person, why do you have to be at his mercy—the mercy of whetherhe would return your love and would help you?

C124: One shouldn’t be. One should be able to—this is something my mother alwaysencouraged me to be: be able to stand on your own two feet. Because if you relyon a man too much, sooner or later he’s going to run out on you.

T125: No, it’s not entirely true, but I can see how that thought hasC126: some—T127: Yes, she really said a little more than that. She said “He’s going to run out on

you—and that would be dreadful!”T128: And that would be awful!T129: You’d be worthless.C130: No, not that you’d be worthless; but that you’d be stranded.T131: Desolate, deserted, incapable of taking care of yourself! All right, is that true?C132: I suppose if I were married and had children, it would be more true than—T133: Yes, but even that—let’s suppose the worst. Suppose you were married and had

two or three children, and your husband ran out on you. It would certainly be apain in the neck, but why would you be desolate, destroyed?

C134: The worst problem would be the financial problem—how to take care of them.T135: All right, but children don’t starve to death these days. So you’d temporarily have

to get the city to help you.C136: When you look at these things like that, they make so much sense!T137: That’s right. You’re catastrophizing all over the place, because your mother has

completely catastrophized. She’s not going to stop that. As I said, always try tolook on the worst side of it. Suppose you were deserted, left penniless, and so on.

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Hell!—it certainly would be an awful nuisance, but look at the number of womenwho have been deserted in the past ten years—have they all dropped dead orstarved?

C138: NoT139: Then what’s the great hassle?C140: I guess there isn’t any.T141: But your mother thinks there is, and you unthinkingly accept her thought—

because you don’t question her catastrophizing.C142: I sure have to do a lot of revamping of my thinking.

I try to show Martha that it would not be dreadful, as her mother said it would be,if she were deserted by a man—it would merely be highly inconvenient. And Ideliberately try to get her to see that even if the worst possible marital problem occurred,and she and her three children were deserted by her husband, it would not be (exceptby definition) catastrophic. This is one of the most frequently used techniques in RET:the therapist helps the client to get down to the rock-bottom core of her catastrophizingand shows her that no matter what happens, she would still not be utterly lost.

The rational emotive therapist, like many other kinds of therapists, will sometimeshelp clients like Martha see that there is very little probability that certain unfortunateevents (such as loss of love, accidents, or economic deprivations) will occur. But, moreeffectively than virtually any other practitioner, he also is able to show the client thateven if such events do transpire—and, of course, they always could—it still would notbe “horrible” or “terrible.”

Thus, I try to convince clients such as Martha that nothing is “awful.” Because“awfulness,” “horror,” or “terribleness,” when accurately defined, include not only theidea of great inconvenience or disadvantage—which certainly may exist—but also theidea of the illegitimacy or unnaturalness of the client’s being disadvantaged and hertheologically-based belief that she ought not, must not be inconvenienced. If I wereseeing Martha today, I would more strongly emphasize this point to her. I would alsotry to show her that as long as she believes that it is “awful” and “horrendous” to bedeserted by a man, she will tend (1) to obsessively think about this “terrible” hazard,(2) wrongly convince herself that there is a high probability (instead of a merepossibility) of its occurrence, and (3) perhaps act in such a panicked manner with hermost attractive boyfriends that she will actually encourage them to find her anxietyobnoxious and to desert her.

RET, then, usually gives the individual a deeply philosophic answer to the problemsthat she is beset with throughout her life. Whereas certain forms of behaviormodification, such as Wolpe’s (1958; Wolpe and Lazarus, 1966) desensitization method,teach the client that she need not be overconcerned about this or that, the rationalemotive approach teaches her that she need not catastrophize about anything. Even ifreal, overt hazards exist in her life (such as the possibility of her dying of some disease),she can learn to convince herself that (1) she probably won’t suffer in the worst waysshe can imagine, (2) if she, by some outside chance, does suffer in this manner thereis no earthly (or godly) reason why she shouldn’t, and (3) while she is still alive, thechances are high that she can still enjoy herself in spite of her real handicaps, even

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though she may well not be as happy as she would be without them. RET promulgatesa radically different way of looking at troubles, problems, and dangers—one which was partly originated by Epictetus, Marcus Aurelius (Hadas, 1964), and other Stoicphilosophers, but which does not posit any fate or god to which the human beingshould blindly subject himself. It encourages the individual to see potential and actuallife difficulties for what they are—problems to cope with, instead of “horrible” threatsto total existence and entire happiness.

T143: That’s right. You have to do a lot of revamping of your thinking. And you’re avery bright girl—you can do it. You’ve done quite well in this one week, so far.All you have to do is continue that. If you can get through school and achieve PhiBeta Kappa, you can certainly do some thinking for yourself—even though youweren’t raised to. You were raised not to think for yourself; but you’ve done someindependent questioning in regard to religion, and you’ve done it pretty much onyour own. Why can’t you do it in regard to the rest of these crappy philosophies?

C144: Well, I’ll have to, because—talk about Catastrophes—I could really screw up otherthings for myself if I just keep on going this way.

T145: That’s right; that’s what you were heading for—screwing up everything for yourself.C146: I could have gone on saying, “I always knew it would be like this.” When I get

very, very upset about something—well, not every time, but if something seemslike a tragedy, and I just can’t face it, and I don’t know what I’m going to do,especially when I get all disturbed about money—there are times when I think,“Everything is disorganized. I need something to organize my life. Maybe I shouldgo join a church.” Then I think, “What a fool I am!”

T147: Right.C148: The only organization can come from within myself, not—T149: Exactly.C150: —from outside sources.T151: Right. The church isn’t going to help you; you have to think for yourself. The

only way you got disorganized was giving up thinking for yourself, and taking overa great deal of your parents’ thinking. Not all of it, fortunately.

C152: Now I see what a lot of these mistaken beliefs are!T153: Right.C154: I have to do something more about that.T155: Exactly.

I again attempt to reinforce Martha by pointing out better ways of thinking andbehaving to her, having her act on some of these ways, then approving of her actions.However, I am trying not merely to reinforce her behavior, as would be the case inpure behavior therapy. Instead, I am attempting to reinforce her independent thinking.This may seem paradoxical. For reinforcement, as I have previously noted in this book,usually helps the individual to be more suggestible—to go along with what others wanther to do, in order to win these others’ approval. It therefore tends to result in lessindependent thinking. I use some principles of reinforcement with Martha, but at thesame time I use them to help her become less suggestible: first, to her parents and

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people like them, and finally even to me. Unless she makes this final move and evencomes to think independently of me, she has merely exchanged one kind of dependencyfor another, and is not too different from the way she was before. So although I recognizethe dangers (as well as the advantages) of reinforcement, as a rational emotive therapistI use it to uproot basic suggestibility and thus eventually to help Martha become lessreinforceable, less conditionable, and more self-directing.

C156: Well, today I guess you could say that I reverted—well, I haven’t come very far,so I couldn’t have reverted back very far, but today—I’ve been dating two fellowsat the moment. One of them called me today, and he said that he was going to dosomething tonight. And I had thought that he was going to see me, though hehadn’t said anything about it. And I had this unreasonable fit of annoyance. ThenI said, “Why should I get annoyed? It’s no problem of mine. I have no right to feelthat way.” As though I expect everybody to bend to my will, and I don’t give inreturn.

T157: That’s right, exactly. But at least you caught that—didn’t you?C158: Yes.T159: Fine.C160: I felt like a stupid jerk when I realized what I was doing.T161: You’re not a stupid jerk. You’re a human being who makes errors. We all do.

Why shouldn’t you? Nobody is intelligent all the time. We’re all fallible.C162: I didn’t know what to say to you when I came in tonight. I didn’t know where

to start.T163: You normally start the way you did, telling me the progress you’ve made and—

what we’re particularly interested in—your lack of progress, the times where thenew thinking didn’t work, so we can go over it, and get it so it does work. Just likea music lesson. A piano teacher comes and you play your lessons, show whatprogress you’ve made; but you also show where you fouled up, where you didn’tdo so well. And the teacher corrects you; and you try again next week; and theprocess is repeated until corrections aren’t needed any more. You’ve learned a wayof playing the piano. Here, you learn a new philosophy of life, a new way ofthinking.

C164: Last night a fellow called me up. I’m not interested in this person, and he askedme out. I’ve done this several times. I know I should probably say to him, “Don’tcall me,” or “I’m not interested,” or—

T165: “I’m going steady with somebody.”C166: I don’t do this.T167: Why don’t you? What are you telling yourself to stop yourself from doing this?C168: I don’t know. That I’d better hang on to this one, because another one is going

to leave sooner or later; and maybe this one might be worthwhile.T169: But is that true?C170: No, it is not true.T171: If that were true, it would not be so crazy.C172: But it’s not true. And this is something I’ve always done. But you’re sort of saying,

“Since I’m such a rotter, even though—

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T173: I’ve got two guys at the moment, they’re bound to find me out and desert me.Then I’ll have this guy. I couldn’t possibly get a better guy than this—who is apain in the ass. But he’s around and will have me.” Isn’t that what you’re saying?

C174: Yes.T175: Bullshit, isn’t it?C176: Yes.T177: All right, that’s what you’ve got to see. That’s what we have to teach you more

and more to see—that every time you foul up, act idiotically, you’re telling yourself some nonsensical thing. It usually begins with the premise, “Since I am aslob—”

C178: I think I did something else today that’s based on that philosophy. I’m not sure.I got on the bus this morning, and I thought I didn’t lock the door. I couldremember putting the key in the lock, but I couldn’t remember turning it. And Iworked myself up into such a tizzy over that that I went home at lunchtime to seeif I locked the door.

T179: All right, but what’s the hassle? There again, let’s suppose you hadn’t locked it—it’s possible—

C180: But the reason I was so fussed about the door was that I had left the window ajarpreviously, and the apartment was robbed. But before that, and with some otherthing, I’m always running back to see whether I turned the lights out, turned thegas off—

T181: Yes, but when you left the door unlocked, how many times did you leave itunlocked?

C182: I probably neglected to lock it several times.T183: All right; so one of those times you were robbed—for leaving the window, not

the door, open. It’s sort of by accident, but it did happen. So if you do leave thedoor unlocked, what are the chances that somebody will come around, try it, androb your apartment again? It’s possible, but not highly probable. And even let’ssuppose there’s a good chance of this happening. Let’s suppose you left the doorunlocked, and somebody did come around and rob you. There’s no use worryingabout it. The thing to do is calmly to go back at lunchtime and see. But why giveyourself such a rough time? Will that make the chances of robbery any better orworse?

C184: I was in a tizzy all morning over it.T185: You put yourself into a tizzy over it. Now, what’s the hassle?C186: There was no reason to do it.T187: No, there was no reason to give yourself such a hard time. You’re saying to yourself,

“I might have made a mistake, and that would be awful!” That’s what you’re reallysaying. “I deserve to suffer for that stupid mistake I made of not locking the door.”The same crap! Always blaming yourself—always trying to be perfect. Never allowedto act crazily or stupidly. Because that’s what you define as good: “I am a goodgirl. I am worthwhile when I am perfect. When I make the slightest blunder, I’ma louse; I’m no damned good!”

C188: (Long pause) Yes. Maybe this comes from the things my parents told me when Iwas a child: “Be a good girl; do exactly what we say; make us proud of you.”

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T189: Right; that’s where it started. But it now comes from the fact that you’re notchallenging that old philosophy. You’re not around them that much any more;but now you ‘re repeating this drivel to yourself. That’s why it continues!

I keep showing Martha—with material from her own life—that she seems to keepworrying about how things will turn out but is really consistently preoccupied with theirrational idea that she would be a worthless person if she didn’t make them turn outfavorably. No matter what kind of incident she relates, I usually return to the samebasic theme: she may make some kind of error, and she thinks she has to damn herselfif she does. She seems to agree with me almost every time, and even to bring out newmaterial soon after my interpretations, which indicates the same irrational belief—thatshe must be perfect and is a terrible girl if she is not.

Either I am accurately targeting Martha’s real problem or else I am brainwashingher. It is unlikely, from the material she brings up, that the latter is true. But even if Iwere convincing her, somewhat falsely, that she is perfectionistic and that she’d betterlearn to forgive herself for her errors, I am likely to help her considerably with thisidea. I might not be revealing and attacking her main problem, if this occurred. Butthen her chief symptoms would tend to remain, and I would be eventually forced tosurrender my major hypothesis about their causation and to look for other ideas thatwere truly causing her upset.

C190: (Long pause) I guess the main thing is to keep in mind the fact that a lot of thethoughts I have—that is, whenever I get a thought like that, it’s one of these invalidthoughts, and I’d better challenge it.

T191: That’s right, to see that it is invalid. First you start with the feeling—the upset.Then you know, on theoretical grounds, that you have an invalid thought, becauseyou don’t get negative feelings without first having some silly thought. Then youlook for the thought—which is pretty obvious most of the time. You’re invariablyblaming yourself or saying that something is horrible when it isn’t. Then you say,“Why am I a louse? Why is this horrible? Why would it be dreadful if such-and-such a thing happened?” Challenge it; question it; counter it. That’s the process.And if you go through that process, your thoughts can’t persist. Because they’reyour irrational thoughts now. They’re no longer your parents’ ideas. You haveinternalized them.

C192: (Long pause) I guess it has to be done.T193: Yes, it has to be done—for your sake. And you will get immense benefit from

doing it—as you’ve already been deriving this week. It felt good when you actedthat way, didn’t it?

C194: Since I have been back at the typewriter again, I’ve been thinking differently. Ican see myself falling back, as I used to be able to do, into a clear pattern of thought.I mean, I’m not just thinking in symbols and metaphors, but am able to describethings incisively, or at least have descriptive impressions of things.

T195: Yes. That’s because you’re letting yourself go—you’re not pouncing on yourselfso much. You’re giving yourself leeway to think up these descriptions, which youcould have done a few weeks ago but you weren’t doing because you were worriedabout other things—about “Am I doing the writing well?” and so on.

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C196: Yes, you’re right. Not that I’ve done very much in this last week, but I do feel likeI’m loosening up more.

T197: That’s very good progress in one week’s time! All you have to do is keep that up—and go a little further.

C198: And another thing I’ve done: I haven’t called up my father because I felt I had to.And he hasn’t called me—so that means something.

T199: Fine! When would you like to make the next appointment?

Toward the close of this second session, Martha indicates that she is already makinggood progress. Her improvements, of course, may be concomitant with but notnecessarily the result of the therapeutic points that I made during the first session andof her thinking about and working on these points in between the two sessions. But itdoes seem likely that, especially in relation to her handling of her relations with herparents and her decreased guilt about these relations, she is now considerably less upsetthan she was the previous week; and it also looks as though I had specifically helpedher in this respect.

Martha’s apparent progress represents a common occurrence in RET. After one ortwo active–directive sessions, clients frequently report that something they thought theywere never able to do before is now in their repertoire. This does not mean that theyare truly “cured” of their emotional disturbances. But it often does seem to mean thatthey are well on the way to resolving at least one or two major aspects of thesedisturbances.

Even if clients such as Martha are quickly helped, this hardly means that all or mostindividuals who try rational emotive encounters are similarly relieved; many of them,of course, are not. I assume, however, that a certain large minority of people can almostimmediately profit by the RET approach; and I assume that a given individual withwhom I am talking may be one of this minority. If my assumption proves to be correct,fine! If it does not, I am prepared, if necessary, to doggedly continue with the approachfor as many sessions as are desirable—until the client finally begins to see that she iscausing her own upsets, that she can observe the specific meanings and beliefs by whichshe causes them, that she can vigorously and consistently dispute and challenge thesebeliefs, and that she can thereby become considerably less disturbed.

Third Session

The third session with Martha was uneventful. Because she was afflicted with someexpensive physical ailments and had financial difficulties, she decided to discontinuetherapy for a time.

Fourth Session

This is a transcript of the recording of the fourth session with Martha, which takesplace nine months after the third session. She had expected to come back to therapysooner than she actually did, but she was able to get along nicely and didn’t feel impelledto return until she had a specific problem to discuss. She now comes with this problem—her relations with men.

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T1: How are things with you?C2: Pretty well, I would say. I’ve been hearing good things about you from some of

the people I sent to see you. From Matt, in particular. He thinks that you’ve helpedhim immensely.

T3: I’m glad that he thinks so.C4: And I see that you’re making yourself comfortable, as usual. That’s the way I found

you last time: shoes off, feet up.T5: Yes; that’s the way I usually am.C6: I came to you back in January because I needed some help in writing; and also I

didn’t know how to handle my parents.T7: Yes.C8: Well, I think I solved those two problems fairly well. I get along very well with my

parents now. Not because I’m giving in to them at all. I’ve sort of established myselfas a human being, apart from them completely. And I also found some other work.I was working, as I told you, for an advertising agency. But it didn’t have anyinterest for me at the time. I was terribly bored, and I felt I could write on myown. But I was afraid. Then I got an idea for a novel, and a publisher has takenan option on it, and I’ve been working on it ever since. It will be published in thespring by the same publisher who has been having such success recently with severalyoung novelists.

T9: I see. That’s fine!C10: So that’s all working out very well. But there’s something that is bothering me,

that I thought you could help me with. I’ve been thinking of getting married. I’vebeen thinking of marriage in general, first of all. But before that—maybe I’m notquite sure that I really know how to love anybody. Not that I consider that there’sa formula. But I’ve always, in a way, been somewhat afraid of men. The other thingis that there is someone in particular who would like to marry me. And—maybeI’d better tell you how this all happened.

T11: Sure.C12: In trying to analyze it—in trying to figure it out—I guess it all started to go back

to my father. My father was a nice guy, but he has been alcoholic since I was twelve;and he has been getting worse since I last saw you. But I was absolutely adoringto my father when I was a little girl. And then I realized he was a human being,and he fell off the pedestal. Now I don’t know how much can be attributed to that,but I don’t think I ever trusted a man. I guess I was afraid that if I really went forsomebody and sort of devoted myself to that person completely, and if that personthought he owned me, sooner or later he would walk out on me. And this hasalways terrified me, no matter what kind of associations I’ve had. I always have tokeep one step ahead of them.

T13: All right; it would terrify you if you keep saying to yourself, “They’ll find out howworthless I am and leave me!”

C14: I guess you’re right.T15: And if you get rid of that fear—and as you said yourself, a couple of minutes ago,

it is a fear—then you can be pretty sure that you’ll love someone. I don’t knowwhom you’ll love—this person you’re talking about, who wants to marry you, or

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anybody else—but I’m sure you have the capacity to love if you’re not absorbedin, “Oh, my God! What a louse I am! When is he going to find it out?” See?

C16: Well, the fellow I’ve been going with is certainly a very nice person. But when Imet him, I was terrified of him because it came over me, “Uh-oh! I’d better watchout for him!” I put him immediately in this category—“Beware of him!” Once hewas in this category—“Beware of him!”—it didn’t matter how I acted. This sortof released me from acting the way I ordinarily would think of acting. I have notreally been playing fairly and squarely with him. I’ve broken with him a couple oftimes. But a couple of weeks ago I saw him again; and he told me that he lovedme, and he’d like to marry me, but I’d better get some help and figure out why Ithink that men are so untrustworthy. He had just undergone therapy for a yearand a half. First he went to Dr. —, then he went to Dr. —. I think he discussedme with both of them. And they both told him that I needed some help for myselfbefore I could consider any serious steps with any man. I don’t know whether heis the right person. It sounds like the great beautiful dream that I always had. ButI would like to be married—I really would. I don’t think it’s just because ofloneliness. I think I find something missing—there isn’t someone to share thingswith.

T17: There’s no reason you shouldn’t get married, when you overcome this fear—andwhen you really get sent by somebody. As I said a few minutes ago, I’m sure youwill. I still don’t know whether this particular guy will be it, but maybe he is. Howlong have you known him?

C18: Oh, I met him a year ago in May.T19: And what does he do?C20: He’s head of the writing department in an agency.T21: How old is he?C22: He’s thirty-three. I’m twenty-three.T23: Has he been married before?C24: No, he’s never been married. Up until a very short time ago, he never wanted the

responsibility of marriage. I think he was so involved with himself that he neverwanted to give himself to anyone. He concentrated on building a reputation forhimself as a department head. And any woman that he became involved with wasonly in his way. Consequently, he dated all sorts of people that he would neverconsider marrying. This I got from what he has told me about the people he hasdated, and also from what he told me about his therapy.

T25: I take it that he is getting along all right with his job?C26: Oh, yes; he’s very successful.T27: And he has friends?C28: Yes, quite a few.T29: And how do you get along with him when you’re with him?C30: Up until recently, when I started to see him again, I was still afraid that if I were

not on my guard with him, he would just walk out on me—and even if I marriedhim, he would walk out on me. And now I can see him again. I think I can realizethat these fears that I have are unfounded—that there is something within me thatis keeping me from him, except maybe as a dependency on him and also as a

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crutch. I also see that he’s really interested in me now. He cares for me, and it’snot just sex.

T31: How are your sex relations with him?C32: Oh, pretty good.T33: Do you enjoy them?C34: Yes, though I don’t get an orgasm all the time.T35: Few girls are completely satisfied every time. Is he a good lover?C36: Yes.T37: All right. Also, you have not felt too comfortable, and that may have had something

to do with your not being satisfied all the time. If you were more free and lessfearful, you might more often be satisfied.

C38: I guess so.T39: I think it’s quite possible, if you really let yourself go. But you’re inhibited, you’re

holding yourself back—not in all ways, but in many ways—because of your fears.From what you’ve said so far, it doesn’t look like a bad situation.

C40: Another thing that I seem to do: every time I get interested in someone, I findmyself looking at other men. And I think that this might not be a real interest inother men. This might be that I’m trying not to face the relationship and the factthat I’m afraid of men.

T41: Yes, that’s possible. But it’s also possible that if you think of one man in terms ofmarrying him and you still get interested in other men, you may not be so sure asyet, in terms of your experience, that it should be the first one. And therefore you’dlike to try others. Because you haven’t had that many involvements during yourlife, and therefore you might want to have more of a fling—more trials before youget married. So some of what you feel may be normal, and some of it may be yourfear of getting involved. The basic problem still is getting you to be unfearful—torealize yourself that you don’t have to be afraid of anything. And then I don’t seewhy you can’t make it with this guy—or some other guy. I’m not sure which one.So far this fellow looks all right. The only odd thing is that he’s thirty-three yearsold and hasn’t had too much of a relationship with anyone yet. But now he’s hadsome help, and it looks like he’s getting a lot healthier than he was; so that’s fine.

C42: Well, I would like to overcome this, because I don’t like the position where I knowI am afraid to put my faith in it—with him or anybody else. I don’t want to beafraid of them—that they might leave me.

T43: That’s right. For what can they do? The basic thing they can do, as you said before,is reject you. Now, let’s suppose that they do. Let’s suppose that you went withthis guy, and you really let yourself go with him, and he finally did reject you, forwhatever his reasons might be. How does that prove that you’re no good, thatyou’re worthless—which is your conclusion—how does that prove it?

C44: I could always suppose that he was the one who had shortcomings, rather thanme.

T45: But let’s suppose he doesn’t have serious shortcomings, and he rejects you. Howdoes that still prove you’re worthless? Let’s suppose he’s a perfect doll, and thenhe finds out certain things about you and spurns you. Now what does that prove?

C46: I don’t know.

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T47: All it proves is that he doesn’t like you for having these deficiencies. It proves, inother words—assuming that he’s objective about your deficiencies and is notinventing them—that you have certain defects. But how does having these defectsprove that you’re worthless? Or that you’re thoroughly inadequate, that you’re nogood?

C48: It doesn’t.T49: That’s exactly right! And yet that’s what you automatically think every single time:

that it does mean something bad about you. That’s what your parents believe: thatif you are deficient and somebody finds it out, that proves that you’re worthless,as a total human. Isn’t that their philosophy?

C50: I guess so.T51: They’ve told you that in so many words, so many times—as you told me they did

awhile ago. When they found out something about you that they didn’t like—suchas your not running to their beck and call—you were not just a daughter whodidn’t like them that much (which is all that was evident); no, you were a louse—no good! They called you every name under the sun. They tried to make you guilty,you told me. Over the phone, they’d call you several times—and so on. Isn’t thatright? They assume that when someone is deficient in their eyes, that person is aslob. That’s their philosophy: that unless you’re an angel, you are no good.

C52: I guess I just carried it with me. I let myself carry it with me.T53: That’s right. You’ve let yourself carry it with you—which is normal enough. Most

people do. But look at the results! If it had good results, if it really made you happy,we might say, “Go carry it!” But the result is the normal result—or the abnormalresult, in your case. You can’t give to a man because you’re always worrying, “Howworthless I am! And how soon will he see it? And before he sees it, maybe I’d betterdo something to get rid of him.” Which is your logical conclusion from an irrationalpremise, the premise being that if people do find your deficiencies and thereforereject you, you’re totally no good. Actually, there are two premises here. One, thatthey’ll find your deficiencies and therefore will reject you—which is quite anassumption!—two, that if they do reject you, you’re no damned good. These aretwo completely irrational premises. They’re not supported by any evidence. Butyou believe them—and millions of people believe them, as you do—on blind faith.They are essentially the same premises as that of original sin: that you were bornin sin, and you’re going to be found out as a sinner, and all your sinning is goingto be revealed on Judgment Day; therefore, the only thing you can do is keepatoning and repenting all your life, or else keep hiding your sinfulness from otherpeople even if you can’t hide it from God. Again, this is your parents’ philosophy.

C54: Yeah; mine is just as foolish as theirs.T55: Yeah—the same thing!

I try to show Martha that it is not her boyfriend but her own attitudes about herselfthat are upsetting her, and that no matter how defective she is in this or any otherrespect, and no matter how badly her boyfriend (or anyone else) rejects her, she canstill fully accept herself and try to better her relationships. Although I am thereforeruthless about insisting that she acknowledge her deficiencies, I am (in a typical RET

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manner) highly supportive about the possibility of her unconditionally accepting herself.Because of its essential supportiveness, because the rational emotive practitioner alwaysaccepts the client with her failings and tries to induce her similarly to accept herself,RET can be exceptionally direct, evocative, and defense-stripping. Ordinary experientialtherapists and encounter groups can afford to be ruthlessly revealing and confrontingbecause they usually intersperse self-exposure with the therapist’s or the group’s givingthe individual pronounced love, warmth, or approval (Burton, 1969). In RET, thetherapist generally does not give this kind of affection (since there is the always existingdanger that the client will, in getting it, wrongly think he is “good” because the therapistor group cares for him). Instead, the rational emotive therapist (and group) tries togive unconditional acceptance, that is, complete tolerance and lack of condemnationof the client no matter what his faults are. I think an incisive reading of these sessionswith Martha will show that I am rarely loving or warm to her but that I frequentlyshow full acceptance of her.

C56: How do I go about convincing myself that this is wrong?T57: The first thing you’d better do before you convince yourself that this is wrong is

to convince yourself—that is, fully admit to yourself—that you very strongly havethis belief. You can’t very well tackle a belief and change it unless you fully admitthat you have it. After seeing this, the second thing is to see the degree—which isenormous and intense—to which you have it. You can at first do this by inference—by observing your behavior and asking yourself what ideas lie behind it. For yourbehavior itself is not necessarily fearful. It may take the form of your feeling in astate of panic; or it may be defensive.

C58: Well, my behavior is mostly defensive.T59: All right. Then we have to start with your defensive behavior. Look at it, question

it, challenge it, and see—by inference, at first—that it could only be this way ifyou were fearful. For why would you be defensive if you were not, underneath,also afraid of something? If we can get you to see how many times a day you’reunduly restricted, defensive—and therefore fearing—until you see the realfrequency and intensity of your fears, then at least we get you to see what the cancerreally is. You can’t really understand the cancer without seeing the depths of it.Okay, we have the first step, then, which is to make you see fully what the depthsof your cancerous ideation are. Then, as you begin to see this, the second step isto get you to calmly assess it. The first cancer is your defense and your fear behindit. The second cancer is—and this is the reason why so many people are defensive—if you admit to yourself, “My God! What a terribly fearful person I am!” you willthen tend to blame yourself for that. In other words, you say on level number one,“My heavens, I’m a wrongdoing person, am therefore terribly worthless, and I’dbetter not let anyone know this.” So you become defensive because your realphilosophy is: “What a worthless slob I am because I’m imperfect; I havedeficiencies; I have faults.” So the first level is to make yourself fearful because ofyour feelings of worthlessness—the philosophy that human beings who are deficientare no damned good. Then, as a derivative of that first level, you come to thesecond level: “Because I’m deficient, because I’m fearful, because I’m neurotic, I’m

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a louse and am worthless for that reason. So I’d better deny that I’m really thatfearful (a) because people will find out about it and hate me and (b) because I’lluse my fear to prove to myself what a louse I am.”

So first we have to get you to admit the fact that you’re fearful, defensive, andso on that you are a perfectionist who tends to bring on feelings of worthlessness.Then we have to get you to see that by admitting your fear and defensiveness you’renot a louse for having these traits; and to get you to see that simply because youhave a feeling you’re worthless doesn’t mean that you really are. So we have to getyou to (a) admit that you feel like a skunk; (b) objectively perceive—and notblamefully perceive—that you believe you’re one; and (c) (which is really just anextension of (b) start tackling your concept of being a skunk.

In other words, once you start admitting that you’re fearful, you have toconcretely look for the simple exclamatory sentences by which you create yourfears. Because people have emotions and feelings, but these are the results ofsentences, phrases, meanings that they tell themselves. Human beings communicatein some kind of language, and you have to find the concrete language you’re using to create, and to indoctrinate yourself over and over with, your fears. Youexperience these fears originally because you took over, largely from your parentsand from society, the belief that if you’re deficient, you’re no good. And you keepsaying this in some kind of internalized language. Now you have to look at theconcrete language—the actual words, phrases, and meanings that you say toyourself—and analyze your internalized communication, parse it for its logic.

Because your sentences, your concepts are illogical. One of your main beliefs,for example, is, “Because I am deficient, I am worthless.” Now the first part of thissentence is very often true—you are deficient in various ways. But does thisdeficiency prove your worthlessness? No! And if you feel worthless—which youdo when you’re so afraid and guilty in connection with your parents or relatingto a male—then you can dig out your own sentence, “Because I am deficient, I amworthless,” and challenge it, question it, look it in the eye—and then beat it downlogically.

Which really means, instead of saying, “My God! Every time I’m deficient I’mno good; and if my boyfriend found that out, it would be terrible!” you can say toyourself, “All right. So I’m deficient. What’s the horror? How does that prove I’mworthless? What difference does it really make? Why should a human being blameherself for having deficiencies? Why can’t I either change the deficiency—which issometimes possible—or live with it? If I have the wrong color eyes and my boyfrienddoesn’t like it, I’m certainly not going to change that!” And so on.

In other words, instead of unthinkingly accepting these irrational premises whichyour parents indoctrinated you with, and society too, you have to look at themand think about them—question and challenge them. Now if we can get you togo through these processes of admitting your feelings first—facing your fears behindthe defenses and acknowledging your feelings of worthlessness behind the fears—and get you to parse your self-condemning ideas, to see of what they consist, tofind your exact sentences and challenge their meanings, you’ll win out. For youare telling you these beliefs right now; nobody else is telling you very much. Your

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parents do—but in a minor way. That’s not major any more—you are. So if youchallenge your beliefs, they must change—those irrational meanings, those self-sentences, they’ve got to go away. Because you’re the only one who is sustainingthem. Now that’s the problem; and you’ve already done part of this. As a result ofthe few sessions we’ve had—three times, isn’t it?

C60: Three times.T61: Yes, three times. You’ve done this in one aspect of your life, in regard to your

parents. Because they were saying, “What a worthless slob you are for not comingto see us,” and you were saying to yourself, “Oh, yes, I am a worthless slob becauseI’m not bowing low to my parents.” You were then feeling terrible, depressed; youwere practically suicidal when I first saw you some ten months ago—in Januaryof this year. Okay, you’ve done it there, in that important area of your life. You’vechallenged your own sentences. You said, “Yes, I am not the greatest daughter inthe world to them; but that does not prove I am a worthless slut. It just provesthat I am not the greatest daughter in the world, and I don’t have to be. If theydon’t like it, that’s too damned bad.”

And as a result of those few sessions and your own thinking, you’re not botheredmuch by your parents any more, and they’re acting much better—which I toldyou they would. Because you were rewarding them before for their nonsense. Okay,now we’d better get you to broaden that. What you’d better do now is no different—it’s more important, because your parents eventually would die anyway. You’d getover the problem with them then. But you’re not going to die for a long time; andyou’re going to live with this fear, these defenses, these feelings of worthlessness,these constrictions—unless we can get you to do about them what we got you todo about your parents.

It’s a little more difficult in this area, because we don’t have them savagely beatingyou over the head—which is easy for you to see and fight against. We have youcruelly berating yourself—which is not easy to see. But we can see the unhappyresults: your disturbed feelings. And if we can start with them, get you to admitthem, there’s no reason you can’t work this problem through in a similar manner.It’ll probably take a little more time, but it’s the most valuable thing you have to do.

C62: I know, because I feel that this is a very important thing right now. And not justright now, but for the rest of my life.

T63: Right. Eventually you’re going to marry, as you said; and even if you never marrythis fellow—or you do—you’re going to have to face this problem with yourself.

C64: Well, then, should I do this: every time during the day that I think that I’m beingdefensive about something, sort of be watchful for it? Then analyze whatever it isthat I say to myself?

T65: Just ask yourself calmly, at first, when you get a queasy feeling, whether it’s a directfear. Because you’re still going to get those overt fears at times. But especially whenit’s a defense—when you’re saying to yourself something like, “Oh, what does itmatter if so-and-so doesn’t care for me? I can get somebody else.” Then ask yourselfright away: “Now, look. Did I really mean that? Or was I using that as a defenseagainst my fear of his leaving me?” Or when you find yourself looking at other

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men—like the illustration you gave before—ask yourself, “Am I really thatinterested in the other man?” Because you may be—they may be attractive. “Or,really, am I hiding my fear of losing so-and-so by this maneuver?”

Just calmly question your own thoughts and actions, when it seems likely thatthey may be defensive. Now, sometimes you’ll find that you’re not being defensive.Don’t think that everything you do is a defense! Because then you’ll get mixed up.There are some things we do for true, non-defensive motives. You might even sayto yourself, “That guy over there is unusually attractive, and if I only knew himand he turned out to be as bright and sane as he looks on the surface, maybe hewould be better for me than my boyfriend.” Because your boyfriend, I’m sure, hashis flaws; and you might be able to find a better one.

You can usually tell whether you’re defensive by looking at the evidence. Forexample, if you occasionally look at another fellow and say, “He seems to be prettygood; I wonder what he’s like,” there’s no reason to suspect that you are setting updefenses. But suppose every time you’re out with your boyfriend, you keep lookinginterestedly at practically every other fellow you meet. Then it looks suspicious; thenit looks like it isn’t just a matter of your naturally comparing your boyfriend tosomebody who might be better. It’s probably more of your running away stuff.

But also, as I said before, all of your feelings won’t be defenses. Sometimes you’rereally going to feel the emotion itself, without the defenses—such as, emotions ofdepression, anger, anxiety, guilt, and overexcitement. Any negative feeling, whateverit is, we’re interested in. Every time, I contend, when you get a negative feeling,you get it because the split second before you feel it you have told yourselfsomething. And this something, in general, is that something is or may be terrible.That’s why you’re getting the negative response.

If you say that something is or may be good, you’re going to get the feeling ofjoy, elation, love, or something like that. But every time you get depression, anxiety,or guilt, you think, “Something is terrible!” And very often that something is you.“If I do this, it should be perfect!” At other times, when you get angry, you tellyourself, “That son-of-a-bitch is doing this, and that is terrible!”

So we want you to look at these feelings—and that doesn’t necessarily mean thesecond you experience them. Because it might be ten minutes later that you get achance to track them back. You might be angry for ten minutes, without evenrealizing it and without doing anything about it. But you can then, after the fact,say: “Now, look. I was just angry (or anxious, or guilty). What did I say to me tocreate this feeling?” And you start looking for these things that you said to yourself.Then you can find them, parse them, and show yourself just how irrational theyare. If you can’t find them, that’s what I’m here for. Any time you get a feelingthat you can’t track down—a negative feeling—make a note of it and bring it into me. I’ll ask you about the circumstances in which it occurred, and the chancesare that I’ll be able to track it down very quickly to the ideas you’ve been tellingyourself—because I’ve had so much experience in doing this. And, incidentally, itcan’t be one of ten thousand things you’ve told yourself; for all these ten thousandare really derived from a few basic things which are fairly easy to find.

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It may be particularly noted that, from C60 to T65, I do by far the most talking andact very much like a teacher who is lecturing to one individual student. After Marthaasks how she is to convince herself that her own philosophy of life produces inefficientresults, I outline, in detail, the process she’d better take in this respect.

When she notes that a great deal of her behavior is defensive, instead of doing whatmany therapists (especially those of psychoanalytic or experiential persuasion) woulddo and showing her that these defenses will have to be emotively unblocked in thecourse of many sessions, I quickly explain to her what defenses are, how they arise, andhow she can work against them. I thereby give her a kind of homework assignment: toquestion her thoughts and actions, in her real life, and to teach herself to distinguishbetween defensive and non-defensive behaviors.

I explain defense-expunging to Martha because I feel that even if she comes for manytherapeutic sessions and continually is shown how defensive she is, she will hardlysurrender her defensiveness until she regularly and vigorously attacks it herself.Frequently, this material which I teach Martha would be done in question-and-answerform, as in a Socratic dialogue (Diaz-Guerrera, 1959). Thus I might ask, “Let’s supposethat you are out with your boyfriend and that you compare his traits to others, findthem usually to be superior, but conclude that you’d better give him up for one ofthese others. What would that probably indicate?” If Martha did not see that this kindof behavior might well indicate defensiveness, I would keep questioning her andchallenging her answers, until she did begin to see this clearly.

Because, however, Martha is quite bright, because she easily seems to understand thepoints I make and quickly starts acting on some of them, I choose to do more lecturingand less questioning. I assume that I shall thereby save her time and give her morematerial to work with in between sessions. Today, as was not true a dozen years ago,I also often employ tape recordings with clients and give them a recorded tape or cassetteof each session to take home with them to replay several times. In this type of session,I frequently do a considerable amount of lecturing, knowing that the client will get therepetitive advantages of my explanations as he keeps rehearing the tape.

I prophylactically warn Martha that she’d better not assume that everything she doesis pathological and look for hidden meanings all the time. For she may become attractedto some other fellow because he is attractive and not because she is afraid to becometoo involved with her present boyfriend. In this regard, the rational emotive therapisttries to avoid the common psychotherapeutic error of encouraging the client to suspectvirtually all her motives and actions, and thereby to become obsessed with analyzingherself about all kinds of unimportant events and feelings.

C66: Well, this is part of the major problem that I brought up before: that in the otheraspects I was doing poorly in, I seemed to have no goal—that I’d lost sight of mygoal. And also that in my relationship with my parents I was telling myself howincompetent I was and how terrible I was; and you say that it was a low opinionthat I had of myself.

T67: That’s right.C68: And this is an extension of that.

216 Albert Ellis

T69: That’s right; that is the major thing. Your problems with your parents were a bigaspect, but the less crippling aspect of your general problems. Because you livewith yourself all your life—you don’t live with your parents.

C70: Well, this has bothered me for many years.T71: Yes, practically all your life. In fact, I have a theory that the basic problem is

biological as well as social: that we tend, as children, normally to blame ourselvesand others, but particularly ourselves; and that unless something happens to joltus out of this self-condemning, we keep doing it forever. And we have to work,forcefully and vigorously, to jolt ourselves out of doing this. Because, according tothe principles of inertia, human beings will keep doing a thing largely becausethey’ve previously done it. And this is the natural tendency of practically all people,as far as I know: to convince themselves that “because I am imperfect, I’mworthless!”

C72: But actually, your parents bring you up that way. Because you are naughty, youstand in a corner; you don’t get your supper; you get spanked; or someone saysto you, “That wasn’t very nice; that wasn’t very good!”

T73: That’s right. They don’t only spank you—that wouldn’t be so bad, because thenthey would just penalize you—but they also say, “You’re no good!” And the attitudethey take in doing the spanking is an angry attitude; and the whole implication ofthe anger is that you’re worthless. People do this in order to train you, when you’rea child; and it’s a very effective method of training. But look at the enormous harmit does! Incidentally, one of the main reasons we would want you to undo yourself-blaming tendencies is that if you do get married and have children, you willtend to do the same kind of thing to them that was done to you—unless you seevery clearly what was done to you and what you’re doing now to continue it.

C74: And also, I’m absolutely terrified of being somebody’s mother.T75: Yes, that’s right. Just look how incompetent you might be, and how you might

screw it up! And wouldn’t that be awful!C76: You know, I’ve been asking myself that a hundred thousand times.T77: All right; but those are the times we have to clip. Let’s just take that sentence,

“Suppose I was somebody’s mother and brought my child up badly.” That’s whatyou’re saying. How are you ending the sentence?

C78: Wouldn’t that be awful! Wouldn’t I be terrible!T79: That’s right. Now is that a logical conclusion to make from the observed facts?

Even let’s suppose the facts were true—that you did bring up a child badly. Let’ssuppose that. Would it still follow that you’d be a worthless slob?

C80: No, it wouldn’t. Because I’d be defining—that’s what it is—I’d be defining worthlessin terms of whatever it is I lack, whatever it is that I do badly in.

T81: That’s right. The equation you’d be making is: my deficiency equals my worth-lessness. That’s exactly the equation—and it’s a definition. Now is it a truedefinition?

C82: No.T83: It’s a true or an accurate definition if you make it true—if you insist that it’s true.C84: But it’s not necessarily a correct one.

Guilty About Not Following Parents’ Rules 217

T85: That’s right. And what happens when you make that definition?C86: Then you feel worthless, because you define yourself as worthless.T87: Yes, pragmatically, you defeat yourself. If it were a definition that led to good

results, that might be fine. But does it lead to that?C88: No. Because you tend to look at everything negatively, rather than—I hate to say

positively, because it sounds like “positive thinking,” and that’s not it.T89: Yes, let’s say it makes you look at things negatively rather than objectively.C90: Yes, objectively.

From Martha’s responses, I resort to a questioning dialogue, instead of my previoustype of straight lecturing and explaining. I keep asking Martha various questions aboutwhat she’s telling herself, what results she is thereby getting, and whether the thingsshe is saying to herself and the definitions she is setting up about her behavior are reallyaccurate. She shows, by her answers, that she is following what I have previouslyexplained and that she can probably use this material in her future living.

Unless the rational emotive therapist gets around, at some point in the therapeuticprocess, to questioning the client and receiving some feedback from her, there is noevidence that she really understands his main points. She may nod her head, agreeverbally with him, and seem to be going along with everything he says. But until shebegins to stop and think about what he is teaching and begins to give back to him themain RET messages in her own words, little may be accomplished. It is highly important,therefore, that the therapist check the client from time to time to see whether she hasa real understanding of what he is talking about or whether she is merely yessing himand giving empty lip service to some of the concepts he is discussing with her.

T91: That’s exactly right. Instead of saying, objectively, “I have this deficiency; now letme see what I can do about it, because it’s undesirable to retain it,” or instead ofsaying, as I said before, “Let me see how I can accept myself even if I can’t changemy deficiency,” you’re telling yourself, “I’m a slob for having this defect!” That’syour definition. Now, the odd thing is that almost everybody in the United Statesunthinkingly accepts this same definition; and practically no one sees that it is adefinition. They think it’s a fact. Isn’t that amazing? As I always say, if the Martiansor the Venusians ever make it to this earth, they’re going to be shocked!

C92: (laughs) Yes, they are.T93: Amazing, no one seems to question it!C94: No, each child does as his mommy says.T95: Also, a child will lots of times define himself as a blackguard on his own. Because

if he fails and does so lots of times—as he inevitably will—even if Mommy didn’tcall him a slob, he would probably tend to think he is worthless. It’s sort of anormal natural conclusion for a young child who can’t think straight because ofhis youth, to say, “Because I failed at A, B, C, and D, I’m bound to fail at X, Y,and Z; and therefore I’m thoroughly incompetent at everything.” That’s what wecall overgeneralization; and human beings, especially young children, tend toovergeneralize. Now, unfortunately, we also help them to do this, in our society—in fact, in most societies. But they might well do it without social help, though

218 Albert Ellis

probably to a lesser degree. Anyway, it behooves us to help them to think in a lessovergeneralized manner. We’d better take the child who tends to overgeneralizeand calmly show him, a thousand times if necessary, “Look, dear, because you didA, B, C, and D mistakenly, that doesn’t mean—”

C96: “—that you’re going to do X, Y, and Z wrongly.”T97: That’s right! “And even if you do A, B, C, and D badly, and also do X, Y, and Z

wrongly, that doesn’t mean that you’re a louse. It means, objectively, that you havedeficiencies. So you’re not Leonardo da Vinci. Tough!” But we don’t teach themanything of the kind.

C98: No. “You have to excel in everything. If you don’t, that’s bad!”T99: “That’s terrible!” We don’t even say it’s bad. Because it is, of course, objectively

bad; it’s inconvenient; it’s a nuisance when you fail; and you will get certain poorresults if you keep failing. But it doesn’t say anything about you personally, as ahuman being, except that you’re the kind of a creature who often fails. It doesn’tsay that you’re a worm—unless you define it so.

C100: Well, I think I’ll know what to look for.T101: Yes. It will take a little practice. It won’t take very long, I’m sure, in your case,

because you see the outlines, and I think you’re very able to do this kind of thinking,which is highly important. Many people deliberately shy away from doing it, sothey never see it. They’re hopeless because, in a sense, they don’t want to see it;they want the world to change, or others to change, rather than wanting to changethemselves. But you want to see it, and you have seen a large hunk of it already,in dealing recently with your parents. Considering the short length of time that Isaw you and that you’ve been working on it, you’ve done remarkably well. Nowthere’s no reason why you can’t see the bigger hunk of it—which applies to youmuch more than to your relations with your father and mother.

So you go off and look for these things we’ve been talking about. As I said, makea list, if you’re not going to remember the things that come up during the weekthat you bother yourself about. Make a list of the major times when you feel upset,or when you believe you acted defensively instead of feeling overtly upset. Lookfor these things; come in, and we’ll talk about them. I’ll check what you find, justas I’d check your lessons if I were teaching you how to play the piano. You’ll thenbe able to see your own blockings more clearly. There’s no reason why not.

I continue to be encouraging to show Martha that she has been able to make goodprogress so far and that she should be able to continue to do so. But I stress that shewell may not be able to do this entirely on her own at the present time and that thereforeit would be best if she kept coming in to see me, to check her own impressions of whatis bothering her and to make sure that she works concertedly against her internalizedphilosophies that lead her astray.

C102: Because I know I need this right now. I mean I can feel the need for it. Logically,I know that my hang-up with relating to males is a big stumbling block; and thisis something I have to overcome.

T103: Yes. What I would advise you to do is to see me every week or so for therapy, orevery other week or so; and also, if possible, join one of my therapy groups for

Guilty About Not Following Parents’ Rules 219

awhile, where you’ll see and relate to others who have similar problems to yours.You may get some insight into some of the things you’re doing by watching themand showing them how to solve some of their difficulties. That’s another helpfulway, because we’re often just too close to ourselves. But if we see the same kindof behavior in someone else, we say, “Ah, I do that, too!”

C104: When do the groups meet?T105: I have eight different therapy groups. They meet at different times. When are you

available?C106: I work until 6:30 in the evening.T107: All right. Most of my groups are evening groups. The only groups with openings

right now are the Monday group at 8:45 P.M. and a new Wednesday group at 7:00.C108: I think probably Wednesday would be the best. But I can’t start just yet.T109: All right, let me know when you can start. Once you do start, you have to come

regularly once a week to group; and then you can attend individual sessions on amore irregular basis, any time that you want to have them. Being in the groupusually means that you can cut down on the individual sessions.

C110: All right; I’ll let you know about the group when I am ready to join it.T111: When would you like an individual session?C112: Would Thursday night be all right?T113: I can see you at 10:00 P.M.C114: All right.T115: And you just think about these things we have been discussing. And when you

do come to the group, you may not say anything for a couple of sessions, but maymerely listen. But the more you speak up, about your own problems and abouttheirs, the more you will get out of it. Your group is just starting, so things maybe a little confused at first; but it will get straightened out after a few weeks. As Isaid, with this combination of individual and group therapy, I’m sure you’ll getonto your basic problems and work against them quite quickly—especially sinceyou know already that you are able to benefit so much from just those first sessions.

C116: I wanted to come back after the third one, but I was waiting to have my tonsilsout and I was having a very bad time with them, and also financially. Then I gotterribly anemic and went to the doctor once a week for liver shots; and everythingsort of fell in on me physically at that time. But I realize that those three sessionsdid me so much good. It took me about two months to have the problem withmy parents all straightened out. And I also got the idea for the novel, and I’ve beenworking very hard on it ever since.

T117: You’ve been using the material that I gave you. As long as you do this kind ofhomework, things will work. Okay, I’ll see you next week, then.

The client came for one more individual session and several group sessions of therapy,and then felt that she was doing very well and that she could manage things on herown. She returned, over the years, for another session from time to time, mainly todiscuss the problems of her parents, her husband, her children, or other close associates.More than twelve years have now passed since the last session of her original series ofinterviews, and she continues to get along in life remarkably well. She is still in touch

220 Albert Ellis

with me at intervals, largely to refer her friends and relatives for therapy sessions. Shehas reality (rather than emotional) problems with her parents; she is happily marriedand has two lively and seemingly little-disturbed children; she gets along well with herhusband, in spite of his personal hang-ups; and she keeps writing successful books andtaking great satisfaction in her work. She is hardly free from all disturbances, since shestill has a tendency to become overwrought about people treating her unfairly. But sheseems almost fully to accept herself, and most of her original problems are solved orkept on a level of minimum upset. She still marvels at, and keeps telling her newacquaintances about, the relatively few sessions of RET that helped her to look at,understand, and change her basic anxiety-creating and hostility-inciting philosophy oflife.

References

Bandura, A. (1969). Principles of behavior modification. New York: McGraw-Hill.Burton, A. (Ed.) (1969). Encounters. San Francisco, CA: Jossey-Bass.Diaz-Guerrera, R. (1959). Socratic therapy. In Standal, S. W., and Corsini, R. J. (Eds.) Critical

incidents in psychotherapy. Engelwood Cliffs, NJ: Prentice-Hall.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Freud, S. (1963). Collected papers. New York: Collier Books.Hadas, M. (Ed.) (1964). Essential works of stoicism. New York: Bantam Books.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton-Mifflin.Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.Wolpe, J. & Lazarus, A. A. (1967). Behavior therapy techniques. London: Pergamon Press.

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12 Flora: A Case of Severe Depressionand Treatment with RationalEmotive Behavior Therapy

INTRODUCTION

Nosheen K. Rahman

My Head of Department and Mentor, Dr. Muhammad Ajmal in Lahore, Pakistan,introduced me to REBT concepts in the early 1970s when I was completing my Mastersin Psychology. Later, I had the opportunity to be a Fellow at the Albert Ellis Institutein the mid 1970s. The training at the Institute helped me grow up, and I started usingthe RET (as it was then called) concepts to practice, both on myself and on my clientsat the Institute. REBT is a “progressive modality,” where the client is shown through“active–directive counseling” that, no matter what age group you are, you can get outof your emotional misery not by ruminating and blaming your early upbringing, butby starting to take responsibility for your present behavior. The “core cause” of yourmisery resides, in the majority of cases, within you: the way you interpret the environ -ment, the beliefs you carry about yourself, about others, and about the environmentaround you. Take the example of Flora, diagnosed with moderate symptoms, with alife-long history of emotional disturbance and with 10 years of psychoanalytic treatmentbut no respite to her disturbance. Her depression was interpreted as the result ofretroflexed hostility, which was first directed at others but then turned against her ownself when the outer expression proved to be too guilt-provoking. This may be true insome cases, but this insight did not help Flora with her musturbation, feelings ofinadequacy, low self-esteem, and her suicidal ideation. However, her above-averageintellectual ability helped her acquire awareness about REBT from attending a few ofAlbert Ellis’ Friday-night workshops. Flora experienced a new surge of positive energyin herself when she met Ellis for individual therapy. She learned that, despite the factshe was now 48 years old, she had hope of overcoming her emotional disturbance byquestioning and challenging her embedded conscious and unconscious irrational ideas,which were the root cause of her disturbance. Ellis systematically explained her problemsas twofold, the primary being her life-long anxiety, and unexpressed anger at othersand herself, and the secondary being her depression and suicidal ideation due to herprimary problems. Initially, and very aptly, Ellis focused on Flora’s depression andsuicidal ideation about the life-long suffering she experienced owing to her performanceand discomfort anxiety. Her need for competence, her demand for guarantees, and herlow frustration tolerance led to her present disturbance. Ellis then systematically taught

her to change her demands to strong preferences. Initially, he helped her to stop puttingherself down for feeling inadequate in not being able to tackle her anxiety problems.He helped her to learn to live with her anxiety as a bad habit. Later, he systematically,using his “assertive didactic counseling style,” helped her to develop “unconditionalself-acceptance” (USA) and also helped her to increase her tolerance for frustration—no matter how she performed. Consequently, after 12 sessions spread over a period offour-and-a-half months, Flora felt a new “homeostasis,” which she had not experiencedin 10 years of her earlier psychoanalytic treatment. Ellis attacked her problem on allthe three fronts: cognitive, emotive, and behavioral. She started to feel sorry anddisappointed about her feelings of anxiety—but not depressed for having them onceshe developed USA. Later, Ellis helped Flora deal with her life-long problem of anxietyand unexpressed anger. With REBT, her feelings of inadequacy and her original anxietywere remarkably reduced. Ellis is sensitive to the emotional needs of Flora, and in hisinteraction with her he explains how disturbed she is, but at the same time he showsher hope and confidence that she could reduce her disturbance if she puts in hard work.For this she would have to actively dispute her unrealistic thoughts and combat herdisturbance at all levels, including thinking, feeling, and behavior, by putting herself inthe driver’s seat, until she starts believing in the rational thoughts based on desires andpreferences, stops her musturbation and the self-blame game, and starts striving forrealistic long-term goals based on her abilities, interests, and resources.

In this case study, Ellis also made Flora a collaborator or a co-therapist to test his“Theory of Secondary Disturbance” by giving him regular feedback on what was goingon with her. Later, her trust developed for Ellis in the therapeutic relationship helpedher to generalize it to her relationship with the two men she was seeing at the time.She successfully achieved the prime goal of REBT, which was achieving USA with muchease. However, she had much more difficulty in achieving the second important goal,which was developing “high frustration tolerance.” In addition, she also had difficultyin achieving long-range hedonism. The goal of REBT is to focus on the elegant solution,which is to get better, rather than just to feel better, commonly the focus of all othermodalities. It helps people become less prone to anxiety and depression for the rest oftheir lives. However, future research needs to provide empirical evidence to supportREBT’s “Getting Better Hypotheses.” Flora developed “Insight Number 1,” which meantthat her disturbance was caused by her unrealistic demands, and she was determinedto combat them, as her thoughts were within her. With work at all three levels—thinking, feeling, and behaving—her ego became less demanding, and she consequentlybecame less indulgent and more disciplined. Another positive aspect of REBT is that,when individuals achieve Insight Number 1, they also get an “Aha” experience, becausethey realize that, as their thinking is within them, they can learn to control it if theymake an effort, whereas earlier they believed that their disturbance was being controlledby outside forces, which made them feel helpless. Flora continued attending the Friday-night workshops even after termination of her therapy, shared her positive experienceswith other participants, and acted as a role model of REBT for other participants. WhenI was a Fellow at the Albert Ellis Institute, I also got the opportunity to co-lead a Friday-night workshop with Ellis. I found it very effective as, besides providing low-costcounseling in a group form, it helped the participants practice their social skills in thecoffee hour after the workshop.

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REBT in Pakistan

I returned to Pakistan in 1980 after completing my PhD in Educational Psychologyand Fellowship in REBT from the US. On my return to Lahore, I taught at thepostgraduate level at the Centre for Clinical Psychology, University of the Punjab, fromthe mid 1980s until my retirement in 2008. I also practiced REBT in Lahore, from 1980to date. I introduced REBT in Pakistan, and now, out of the three modalities that aretaught at the Centre—Gestalt therapy, behavior therapy and REBT—the majority ofthe students choose REBT in their clinical practice, as they find it to be the mostcomprehensive. Pakistan is an Islamic nation, with a population of 174 million.Approximately 37 percent of its population is under 14 years of age. In Pakistan, thereis a high incidence of depression, especially among women, who comprise more than50 percent of the population: Depression among women is almost three times morecommon, compared with men. This may be owing to the lack of control they have overtheir lives. Pakistan is also a patriarchal and conservative society that emphasizes Islamin its day-to-day functioning.

Despite the cultural differences between Pakistan and the USA, I identified in myclinical practice that the majority of Pakistani clients possess very similar irrationalbeliefs as people living in the USA. However, there are a few variations, which includethe following irrational beliefs:

1. Human beings are measured more by their wealth and social class.2. There is unconditional obedience to those who are significant others and/or elders.3. Males are considered superior to females.4. The English language is considered superior to the Urdu language, which is the

national language of Pakistan.5. There is oppression of married women by in-laws in extended families.

In Pakistan, as in the USA, there are about 10–15 supreme necessities or needs thatpeople commonly impose on themselves and others through conditioning but that areunrealistic. These can be reduced to three dictates, as Ellis in Flora’s case study aptlyexplains:

1. The need to do well in important tasks and the need to win the approval and loveof significant others.

2. The need to treat other people with whom one is in contact considerately andkindly, in precisely the way one would want to be treated oneself; and, if that doesn’thappen, then society as well as the universe would severely damn or punish onefor one’s inconsiderateness or injustice.

3. The need for comfort.

Depressed individuals in Pakistan carry the same “musts” of better performance andlove and attention as found in westernized cultures. People suffering from thesetyrannical musts normally show “horror” for not achieving them, show low frustrationtolerance, and feel worthless by one’s own and others’ ratings. REBT treatment promotesa philosophy of tolerance, of accepting human fallibility, and a focus on long-rangeinstead of short-range hedonism, as illustrated in Ellis’ treatment of Flora.

224 Nosheen K. Rahman

REBT and Islam

I have observed in my clinical practice that there are certain similarities and differencesbetween Islam (the religion practiced in Pakistan) and REBT.

Similarities

1. Both Islam and REBT depict the human being as fallible and prone to makemistakes. Islam condemns the behavior of the person but not the person, which isalso the case in REBT.

2. Both Islam and REBT teach simple living, which includes not indulging in extremesand focusing on desires and preferences, and not to “musturbate and demand” outof life.

3. Social and individual welfare are the goals of both Islam and REBT. Both staunchlybelieve that human intervention makes a difference in the affairs of people. Theapproach is indeed different, though both pursue human and societal betterment.

4. REBT believes that, if there are three causes of misbehavior—deficiency, ignorance,and disturbance—the individual has a right to self-forgiveness. Islam also holdsthe same view towards sinful behavior; however, in this case, the individual asksfor forgiveness from the almighty Allah (God).

5. Both focus on the “Hedonistic Philosophy,” although each has a different objective.In Islam, the goal is to seek pleasure through the approval of Allah (God), and inREBT it is to seek pleasure through the Self.

6. Islam teaches that everyone is responsible for their own acts. REBT also holds thesame view.

Differences

1. Religion is based on “faith.” There are clear-cut shoulds, oughts and musts in everyreligion. They are very clearly defined, such as sex outside marriage, homosexuality,etc. REBT is an empirical approach based on observable facts. A basic REBT premiseis that our world is not perfect. It is what it is. Expecting the world to be differentrarely represents reality.

2. Guilt is perceived as “positive” in Islam. In REBT, a rational regret or guilt in thesense of accountability is normal. When people equate their global worth with theirinfractions and negative acts, they may distract themselves from self-correctionand perpetuate a needless disturbance from a degraded sense of worth.

3. REBT relies on individual initiatives to think clearly, feel better, and do better.Support groups sometimes apply. There appears to be a sense of community, andchanges that are consistent with religious teachings are supported and encouragedwithin the community. Harnessing the power of REBT within a religiouscommunity opens opportunities for depressed people to benefit from the best ofboth worlds.

4. Islam attempts to guide the faithful through education via the scriptures, based onfaith, whereas REBT relies on the gradual accumulation of knowledge throughempiricism, logical processes, and the scientific method. In both cases, learningand education are critical. The difference is in approach.

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REBT Across Cultures and Across Time

Despite the cultural differences between the USA and Pakistan, REBT is a popularmodality for the treatment of emotional disturbance by mental health professionals foreducated clients of both genders. However, in treating depression in Pakistan, individualinitiatives for relief from depression occur within a cultural–social framework wherereligion is a significant part of everyday living. This interpersonal context is an importantresource for people with depression, as is the development of skills in the use of REBT.In combination, both provide a means of gaining relief from depression and inpreventing depression from coming back.

Ellis’ article on helping Flora overcome depression is a brilliant example for therapiststo follow on how to work with clients who suffer from depression. This modelbeautifully applies to people living and working within a culture.

In the area of depression, REBT is uniquely suited as a means of helping people withdepression address psychological, social, and behavioral aspects of a disorder that occursin various forms, across cultures. There is little doubt in my mind that helping peopledevelop anti-depression psychological skills will become increasingly important. In1996, the World Health Organization forecast that, by the year 2020, depressivedisorders in developing countries will pose a serious public health concern, and becomethe most common cause of disability (Murray & Lopez 1996).

Poverty, very poor housing facilities, low educational level, and increased numberof children are clearly associated with depression in the general population of developingcountries (Patel & Kleinman 2003). Members of such societies who learn and applyREBT may significantly free themselves from the stresses of depression that may anchorprogress.

References

Murray, C. J. L., & Lopez, A. D. (Eds.) (1996). The global burden of disease: A comprehensiveassessment of mortality and disabilities from diseases, injuries, and risk factors in 1990 and projectedto 2020. Cambridge: Harvard University Press.

Patel, V., & Kleinman, A. (2003). Poverty and common mental disorders in developing countries.Bulletin of the World Health Organ [online], 81(8), 609–615. ISSN 0042-9686.

226 Nosheen K. Rahman

FLORA: A CASE OF SEVERE DEPRESSION ANDTREATMENT WITH RATIONAL EMOTIVEBEHAVIOR THERAPY

Albert Ellis

About the Disorder

A person with major depressive disorder experiences acute, but time-limited, episodesof severe depressive symptoms. First and foremost, such episodes involve a dysphoricmood whose intensity far outweighs the ordinary ups and downs of everyday life. Thedysphoric mood may appear as extreme dejection or a dramatic loss of interest in mostaspects of life. Depressive episodes last continually for at least two weeks, during whichtime the individual suffers a variety of symptoms. Not only does the individual feelemotionally deflated, but there are a number of physical symptoms that accompanythe dysphoria. These can include a slowing down of bodily movement or, paradoxically,an agitated physical state in which behavior has a frenetic quality. Eating disturbancesare common and people experiencing a depressive episode also show a significantchange in their sleeping patterns.

Low self-esteem and feelings that they deserve punishment are cognitive symptomsthat also characterize depression. The tendency to dwell on one’s past mistakes maylead people with depression to become tyrannized by guilt and unable to believe thatthey are ever really doing well enough. Unable to think clearly or to concentrate, peoplein a depressive episode may be unable to make the most insignificant of decisions.

Dr. Ellis has a unique perspective on the causes and treatment of depression. Hebrings together very different techniques in which the therapist plays a central role incollaborating with the client.—Eds.

Confronting Philosophic Absolutism

Flora came to see me after she had attended two of my Friday Night Workshops at theInstitute for Rational Emotive Therapy in New York and had been struck with the factthat I was extremely active and directive in the course of interviewing volunteers withlive problems and quickly got to the main philosophic sources of their disturbances.She had been in psychoanalytic therapy with three different analysts for the past 10years and was amazed at my ability to zero in on people’s neurotic difficulties in a half-hour public session, showing them what they seemed to be telling themselves createdmost of their problems, and then demonstrating how they could change their abso-lutistic musts and demands by making them only into strong preferences, and therebyquickly stop upsetting themselves. Flora’s analysts had mainly listened to her complaintsduring the past 10 years, had formed intense relationships with her, and had endlesslyexplored her early childhood and her other family relationships, but they had not done much to reveal her self-defeating philosophies and to help her dispute and actagainst them.

Initial Presentation

“I was particularly impressed,” Flora said in the first few minutes of her first session withme, “that you always seemed to know exactly what the volunteers at your workshopswere thinking to upset themselves, and that you quickly helped them to see thesethoughts for themselves. What was also startling in the case of each of the four people I saw you work with, was that you always suspected that they were not only disturbed,but also disturbed about their disturbances. In all my years of psychoanalytic therapy,this was never quite pointed out to me; and now that I’ve seen you point it out to several others, all of whom agreed that you were right, I’m beginning to see that this isalso one of my main problems. I have not only been anxious for practically my wholelife, but I have also been seriously depressed. After watching you in action with severalpeople, I’m beginning to suspect that my depression and my feelings of great inadequacythat go with it mainly stem from my horror of being anxious—from continually puttingmyself down for my anxiety. I may be wrong, but this is the way it now seems to me,and I want to check this out with you and use your system of Rational Emotive BehaviorTherapy—which I see is in many ways the opposite of psychoanalysis—to finallyovercome my depression. Also, of course, to get rid of my lifelong feelings of anxiety.”

I was very happy that Flora had been benefitting from merely observing my publictherapy sessions with several of my Friday Night Workshop volunteers. I thought, fromthe start, that she was probably already getting on the right track—after years of beingsidetracked from it by her classical psychoanalytic therapy—and that, with hercooperation, we might quickly get to the root of her neurotic problems and discoverwhat she could do to work at overcoming them.

Like most of my regular clients, as well as the many people I see for public therapysessions each year, Flora had two major forms of disturbances: First, her originaldisturbance, which led to severe and almost steady anxiety; and second, her disturbanceabout her disturbance, which led to serious feelings of depression, including frequentsuicidal ideation, about her original problems.

According to the theory of Rational Emotive Behavior Therapy (REBT), most peopleare like Flora in this important respect. They consciously and unconsciously choose toupset themselves by taking some of their important desires and goals—such as toperform well and to be loved and accepted by others—and they irrationally (that is,self-defeatingly) make them into grandiose demands: “Because it is good for me tosucceed and to win others’ approval, I absolutely must do so, and it is horrible when Idon’t!” Then, when their unrealistic necessitizing—or what I call musturbation—makesthem feel quite disturbed, and often to act in destructive ways, they note how self-sabotaging they are, take their preference for not behaving that way and make it intoanother dogmatic demand: “I absolutely must not feel disturbed and I ought not behavefoolishly!” They then get—or rather make themselves—upset about their upsetness,and create an emotional problem that is much worse than their original one.1

228 Albert Ellis

1 Dryden, W. (1995). Brief rational emotive behavior therapy. London: Wiley; Ellis, A. (1988). How to stubbornlyrefuse to make yourself miserable about anything—yes, anything! New York: Lyle Stuart; Ellis, A. (1994).Reason and emotion in psychotherapy (Revised and updated). New York: Carol Publishing; Ellis, A. (1996).Better, deeper, and more enduring brief therapy. New York, Brunner/Mazel; Ellis, A., & Harper, R. A. (1997).A guide to rational living. North Hollywood, CA: Wilshire; Walen, S., DiGiuseppe, R., & Dryden, W. (1992).A practitioner’s guide to rational emotive therapy. New York: Oxford University Press.

Not all people and all clients, of course, do this. But probably the majority of themdo—as I often quickly show them. I found it refreshing, therefore, that Flora, in herfirst interview with me, was beginning to see this important facet of human disturbancefor herself, and that her attendance at my Friday Night Workshop was already beginningto pay off.

Case History

Flora was a 48-year-old manager of a dress shop who had been anxious since aboutday one of her life. Her father, an accountant, and her mother, a school teacher, hadbeen very happy to have her as their only child, had given her emotional support allher life, and were still happily married themselves. But they were both highly anxiouspeople: The mother was quite hypochondriacal and the father worried incessantly abouthaving enough money for his approaching retirement, even though the family’s financialcondition was unusually secure. On both sides of her family, her aunts and uncles andgrandparents tended to be well-functioning people, but often very anxious. Several ofthem were also depressed.

Flora, like her parents, married in her early twenties, constantly worried about herhusband being unfaithful, and felt devastated when, after 18 years of marriage, heactually ran off with his secretary, saying that he no longer could stand Flora’s pandemicanxiety and her constant checking on his activities. Her 22-year-old son also tended tokeep a distance from her, though he said he loved her, because she kept nagging himto lead a highly respectable life and to avoid getting into any trouble.

After her husband divorced her, Flora was so hurt and depressed that she stayed outof the dating scene for a few years, although several men were attracted to her andwanted to form a close relationship. She finally started dating Joe, a 50-year-old widowerwho also was wary of deep involvements. He saw her every Saturday night, enjoyedbeing with her sexually and companionably, but refused to get any closer. She convincedherself that this was all right, but she really yearned for a closer relationship and wasafraid to talk to Joe about this, for fear that he would stop seeing her completely.

Recently, another suitor, Ed, showed great interest in Flora, and even talked aboutliving with her and marrying her when his divorce became final. But Flora was veryanxious about seeing Ed, because she would ultimately have to tell Joe about it andmight end up losing both of them. Ed, though a better candidate for a close relationshipthan Joe, had monetary difficulties, and Flora was afraid that if she decided to live withhim, she might not be able to continue enjoying her middle-class life-style and that shewould have great anxiety about their monetary difficulties. So she saw Ed, who lived50 miles away, occasionally, but still saw Joe every Saturday and felt guilty about havingsex with both of them.

Diagnosis

Flora was a college graduate, had done well in school, and I judged her to have highaverage intelligence. On the Millon Multiaxial Inventory II, her main high scores werefor Anxiety Depression, and Avoidant Personality. Her DSM-IV diagnosis is as follows.

Severe Depression and Treatment with REBT 229

Case Formulation

Flora’s case was pretty much as she herself presented it during our first session and wassimilar to hundreds of cases of anxiety, depression, and avoidance that I have seen over the years. For both biological and environmental reasons, she first had severeperformance anxiety. Like most other people in the white middle-class culture in whichshe was raised, she wanted to do well in school, in her social relations, in her marriage,and in her subsequent life. But she almost always raised her strong preference for doingso into an absolutistic demand: “I absolutely must succeed at the important things thatI do, I have to be seen as competent and as being a nice person by significant others, andI must have a guarantee that these others will continue to like and love me and neverreject me. If I don’t succeed in these respects, I am really an incompetent and unlovableperson. So I must always make sure that I am doing well and am respected and loved.”Flora’s demands for guarantees in these respects made her continually anxious andproduced constant feelings that, even when she was doing well, she was not doing wellenough, and therefore she was never really an adequate and acceptable individual.

In addition to her steady performance and relationship anxiety, Flora also had somedegree of discomfort anxiety or low frustration tolerance. She irrationally believed thatshe had to be comfortable and must not be frustrated or deprived of life comforts.Thus, she strongly believed “I must get my important wants fulfilled and must not bedeprived. It’s awful when I am balked or thwarted, and I can’t stand it!” She consequentlywas angry and upset when the conditions of her life were not going well and whenpeople (such as her ex-husband) deprived her of what she wanted—and presumablyshould have!2

Flora clearly was damning herself on two levels: First, for not doing well enough inher own life and wanting guaranteed approval from others; and second, for making herselfso anxious about these “horrible inadequacies.” She was also damning life, and especiallyher love life, for often being “too difficult.” We explored her rage against others, includingher ex-husband, which people like her often create. But although she seemed to be attimes angry at them, she was much more angry at herself for her “awful failings.”3

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Axis I: Generalized anxiety disorderRecurrent depressive disorder

Axis II: Avoidant personality disorderAxis III: Irritable bowel syndromeAxis IV: Relationship difficultiesAxis V: GAF = 55

2 Ellis, A. (1987). A sadly neglected cognitive element in depression. Cognitive Therapy and Research, 11,121–146; Hauck, P. A. (1973). Overcoming depression. Louisville, KY: Westminster.

3 Ellis, A. A sadly neglected cognitive element in depression. op. cit.; Ellis, A. How to stubbornly refuse tomake yourself miserable about anything—yes, anything! op. cit.; Ellis, A. Reason and emotion inpsychotherapy (Revised and updated). op cit.; Hauck, P.A., Overcoming depression. op. cit.

Course of Treatment

REBT is unusually philosophic, because its ABCs of emotional disturbance assume thatpractically all people, when they suffer from or think about adversities (As) and feel asa consequence (Cs) severely upset, have conscious and/or unconscious beliefs (Bs)which largely “cause” their upsetness. Their Bs include, first, rational preferences—such as, “I don’t like failing, and getting rejected and wish that I succeeded.” Second,they include irrational musts and demands—”Therefore I must not fail or I’m no good!”“My living conditions must be better than they are, or else my life is horrible.”

REBT does not question clients’ goals and preferences, but helps them clearly seetheir rigid musts and demands and change them back to preferences—for example,“No matter how much I’d like to succeed, I don’t have to do so, and I’m okay as aperson even when I fail.”

To help people make this kind of profound philosophical change, and to give up their grandiose demandingness, REBT uses a number of cognitive, emotive, andbehavioral methods and is therefore always multimodal. Scores of studies have shownthat REBT, along with Beck’s Cognitive Therapy and Meichenbaum’s CognitiveBehavior Therapy, has been effective with many individuals with severe anxiety,depression, rage, and other disturbances.4

I therefore used several cognitive methods of therapy with Flora and taught her howto use them between sessions and after therapy ended. I especially showed her how toDispute (at point D) her irrational Bs and how to change them. For example, “Whymust I not foolishly make myself anxious about not succeeding and not beingapproved?” Answer: “There’s no reason why I must not be anxious, though I wouldhighly prefer to stop creating such feelings.” “Why is it terrible for me to fail at importantthings and get rejected?” Answer: “It isn’t. It’s distinctly unfortunate and inconvenient,but I can still accept myself and lead an enjoyable life.”

When Flora kept Disputing her irrational Bs, she began to feel sorry and disappointedabout her feelings of anxiety—but not depressed and self-deprecating about havingthem. Once she accepted herself with her anxiety, she found it relatively easy to alsoaccept herself when she failed or got rejected, and to reduce most of her original anxietyand feelings of inadequacy.

Flora was also taught to use several use other cognitive methods of REBT.

Rational Coping Statements

She worked out, wrote down, and steadily told herself several coping statements, suchas: “I want other people to like me, but I do not need their approval.” “I’m a fallible

Severe Depression and Treatment with REBT 231

4 Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive–behavioral therapies. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 428–466). New York: Wiley;Lyons, L. C., & Woods, P. J. (1991). The efficacy of rational emotive therapy: A quantitative review ofoutcome research. Clinical Psychology Review, 11, 357–369; McGovern, T. E., & Silverman, M. S. (1984).A review of outcome studies of rational emotive therapy from 1977 to 1982. Journal of Rational EmotiveTherapy, 2(1), 7–18; Silverman, M. S., McCarthy, M., & McGovern, T. E. (1992). A review of studies ofrational emotive therapy from 1982–1989. Journal of Rational Emotive and Cognitive-Behavioral Therapy,10(3), 111–186.

human who often does foolish things, but I’m never, never a rotten fool for doingthem!”

Recordings

Flora recorded our sessions together and listened to each of them several times to gettheir full impact.

Psychoeducational Study

She read a number of REBT books and pamphlets and listened to cassettes of lecturesand workshops. She kept attending my Friday Night Workshops and other InstitutePublic Workshops.

Modeling

She modeled herself after friends and relatives who were more rational than she was,after effective people she read about, and to some extent after my own remainingunupset when she resisted my disputing her irrational beliefs.

Philosophy

Flora worked on acquiring the philosophy of tolerance, of accepting human fallibility,and of long-range instead of short-range, hedonism.

Flora kept vigorously using several REBT emotive–experiential methods, such as thefollowing.

Rational Emotive Imagery

She imagined some of the worst things that might happen to her—such as failing atan important project—let herself feel very anxious or depressed about this, and thenworked at changing her disturbed feelings to healthy negative ones, such as sorrow anddisappointment.

Shame-Attacking Exercises

She deliberately did some foolish and “shameful” things in public and made herselffeel unashamed and only sorry and regretful about doing them and being criticized byothers for doing so.

Forceful Coping Statements

She said to herself, very forcefully, many rational statements like: “I really want to havethings go my way, but they never, never have to! I can still definitely lead a fine lifewhen I am frustrated!”

232 Albert Ellis

Forceful Disputing of Irrational Beliefs

She stated, on a tape recorder, self-defeating beliefs, such as “I must be liked by allsignificant people at all times!” and she then very strongly disputed them until she trulydisbelieved them.

Reverse Role Playing

I took the role of Flora, held on vigorously to some of her dysfunctional Beliefs, andgave her practice in vigorously talking me out of them.

Unconditional Self-Acceptance

I unconditionally accepted Flora, even when she did badly and didn’t do the REBThomework that she had agreed to do. But I also showed her how to unconditionallyaccept herself whether or not she performed well and whether or not other people(including myself) respected and approved of her.

Interpersonal Relating

Because Flora had an avoidant personality disorder, and was particularly distrustful ofmen, I at first refrained from attempting to get her attached to me and perhaps resistantto such an attachment. I showed her that I liked her for her intelligence and honestefforts to change herself, but was neither going to be fatherly (I was 30 years older thanshe was) nor husbandly. I was very honest with her about how disturbed I thought shewas, but showed confidence that she could overcome her disturbance. I indicated thatseeing her was a good learning experience for me, because her depression about heranxiety tested my theory of the importance of secondary disturbances and gave me achance to partially validate this theory. So I made her into a collaborator, a kind of co-therapist who would look into herself for the data that might confirm or deny mytheory, report these data back to me, and help me check on and expand my theory.She seemed to appreciate this collaborator role and became much more trustful of methan she had been of any of her previous therapists. Her trusting me seemed to helpher be more trustful of the two main men in her life. In turn, I liked and trusted herfor helping me to check on one of my own favorite theories.

Flora and I also used a number of REBT behavioral homework assignments whichshe agreed to do in between sessions, especially these:

In Vivo Desensitization

She tried “risky” situations, like telling both Joe and Ed that she was dating the otherman and would continue to do so until she made up her mind which of them, if eitherone, she chose to be monogamous with.

Severe Depression and Treatment with REBT 233

Staying in Difficult Situations while Working on her Upsetness

She deliberately kept having sex with both partners until she stopped putting herselfdown for doing so, and then decided which one of them was better for her.

Reinforcement

She reinforced herself when she did her cognitive and emotional homework by allowingherself to spend money on herself only after she did it. When she ate too many sweetsand gained more weight than she wanted to, she punished herself by restricting hersocial life until she cut down on her food indulgences.

Skill Training

I talked with Flora about her methods of relating to and managing her relationshipswith men and showed her how she could be more assertive without being aggressive.

Outcome of the Case

Flora had 12 sessions of REBT, over a period of four and a half months. We first workedon her self-deprecation for her symptoms and helped her unconditionally accept herselfwith her severe anxiety. Once she was able to do this, she was also able to stop makingherself anxious and self-deprecating when she didn’t perform “well enough” and whenother people didn’t accept her as well as she presumably should have induced them to do.

Flora actually took only a couple of months to start accepting herself unconditionally,in spite of her long-standing anxiety about not doing well enough and experiencingrejections by significant others. So she did remarkably well in achieving unconditionalself-acceptance, which is almost always a prime goal of REBT.

Paradoxically, she had more difficulty in achieving the second important goal thatis usually worked for in effective therapy: achieving higher frustration tolerance or long-range hedonism. When she reduced her ego-demandingness, she kept insisting thatlife—and sometimes other people—absolutely must give her what she wanted whenshe wanted it. But by continuing to dispute these irrational beliefs on her own and bycontinuing to use REBT materials and workshops, she ultimately decreased her whiningabout life’s “horrors” and made herself less self-indulgent and more disciplined. Threeyears after ending therapy, she still comes regularly to my Friday Night Workshops. Inthe discussion period after I conduct a public session with a volunteer, Flora oftenhelpfully presents some of her own experiences and sensible suggestions to the personwith whom I am counseling.

Empirical Contributions to Understanding Depression

My theory of REBT, which I derived mainly from philosophers, says that people largelydepress themselves by taking their strong desires for success and relationships andirrationally raising them to absolutistic musts and demands. I tested this with manyclients in the 1950s and found it to be basically sound. I also tested my theory that if

234 Albert Ellis

depressed people give up their insistent “musts” and make them into preferences, theybecome significantly less depressed. I conducted a study in 1957 that showed that whenseverely depressed clients were treated by me in classical psychoanalytic, or analytic-oriented, or REBT, they functioned better in REBT, second best in psychoanalyticallyoriented therapy, and worst in classical psychoanalysis.

I collaborated on a number of other studies which showed that REBT was moresuccessful with depressed individuals than other therapies or nontherapy groups. Inthe 1960s, Aaron Beck, using cognitive behavior therapy (which is closely related toREBT), started to conduct many studies, as did other cognitive behavior therapists, that found that REBT and related therapies are effective with severely depressed people.5

During the early 1960s, I saw, from studying my clients and from other research,that severe depression often included an endogenous element and was often accom-panied by personality disorders which also had biological as well as environmental roots.Endogenous depression, as well as reactive depression, encourages many sufferers todenigrate themselves for being depressed and to develop low frustration tolerance. Theydefine their disturbance as hopeless and thereby interfere with their working forcefullyto cope with and alleviate it. I therefore developed several REBT techniques for helpingdepressed individuals (with and without personality disorders) to unconditionally acceptthemselves with their disturbances and to increase their tolerance for frustration.

Irene Elkin and her associates at the National Institute for Mental Health conducteda large collaborative study comparing cognitive therapy, interpersonal therapy, and theantidepressant imipramine. They also used a placebo control group and found fewremarkable differences for the therapy effectiveness among all the groups studied.Individuals in all groups, including the placebo group, were given a good deal of supportand encouragement.6

My interpretation of this and most other studies of depressed (and otherwisedisturbed) people is that they really explore whether people feel better rather than getbetter through therapy. Getting better, as I define it, means not only reporting that theyfeel better at the end of therapy, but that they become less “disturbable” in the future,that is, less prone to disturb themselves about unfortunate events again. REBT specializesin trying to help people become less prone to depression and anxiety for the rest oftheir lives, and in this sense is different from Beck’s cognitive therapy and Klerman’sinterpersonal therapy.7 I predict that future studies of depression will provide empiricalevidence to support REBTs getting better hypothesis. I hope that such research will soonbe conducted.

Severe Depression and Treatment with REBT 235

5 Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York:Guilford Press.

6 Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. op. cit.; Elkin, I. (1994). The NIMH treatment ofdepression collaborative research program: Where we began and where we are. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 114–139). New York:Wiley; Klerman, G. L., Weissman, M. M., Rounseville, B. J., & Chevron, E. S. (1984). Interpersonalpsychotherapy of depression. New York: Basic Books.

7 Ellis, A., Reason and emotion in psychotherapy (Revised and updated), op. cit.; Ellis, A., Better, deeper,and more enduring brief therapy, op. cit; Ellis, A., & Dryden, W. (1997). The practice of rational emotivebehavior therapy (2nd ed.). New York: Springer; Ellis, A., Gordon, J., Neehan, M., & Palmer, S. (1997).Stress counseling: A rational emotive behaviour approach. London: Cassell.

Empirical Contributions to Treatment of Depression

Let me summarize how I usually treat individuals with severe symptoms of depression.I first try to determine, from their initial presentation and from their (and their family’s)history, whether they are mainly reacting to serious losses, disabilities, or traumas, andtherefore have reactive depression. Or, I ask myself, do they suddenly feel depressed,lethargic, and lose interest in many activities out of the blue—for no special reason? Ifso, do they have endogenous—or biochemically related—depression? I also ask themabout present and past medication for emotional or other problems.

If I suspect that they have endogenous depression, I elicit more details about theirpersonal and family history, and discuss with them the advisability of getting apsychopharmacological evaluation by a reputable psychiatrist and of consideringantidepressant (and other) medication. If they resist medication—as many of themdo—I tell them that we will try REBT by itself, which may work quite well if theystrongly and persistently use it. But I also say to myself, “We’ll both try to do our bestwith REBT. If this patient seems to be too disturbed, however, I’ll see if I can latermake it clear that it is also probably advisable to try medication.” Occasionally, whenmy client is nonfunctional or suicidal, I refuse to continue appointments withoutpsychiatric consultation, and sometimes insist on hospitalization.

By far most of the time, whether or not the client is on medication, I actively revealthe chosen and self-created irrational Beliefs that probably instigate the reactivedepression—absolutistic shoulds, musts, and other grandiose demands on the patient,on others, and on external conditions. I briefly explain the ABCs of emotionaldisturbance—as I did in Flora’s case. I show how the patient can independently discoverirrational Bs, actively dispute self-depressing insistences, and considerably reduce themand change them, instead, to healthy preferences.

I particularly show my depressed clients that they frequently have two very debilitatingmusts: One, “I must perform important tasks well and be approved by people I findimportant, or else I am an inadequate, worthless person!” This kind of self-downing ismost common in depressed people.

Two, “People and conditions I live with absolutely must treat me considerately andfairly, give me what I really want, and rarely seriously frustrate me! Or else, I can’t standit, my life is awful, and I can’t enjoy it at all!”

I check my depressed clients to see whether they have either of these two maindysfunctional beliefs—or any of their innumerable variations—and rarely find that theydon’t have them. Even if they are endogenously depressed, their biochemistryencourages them to think crookedly, so that their thoughts, feelings, and behaviors areall involved in their moodiness. So I usually find some of their irrational beliefs in thefirst session to two, show them how these cause or contribute to their depression, andalso start teaching them—as time permits—how to discover and dispute their self-sabotaging beliefs.

In other words, I quickly start teaching these clients some of the main principles ofREBT, tell them to undevoutly consider them, and preferably to experiment withapplying them to their own emotional problems. I explain, as I did in Flora’s case, howundesirable activating events or adversities (A’s) often importantly contribute to clients’negative feelings and behaviors, but that their own beliefs (B’s) and interpretations

236 Albert Ellis

about these A’s also lead to their disturbed consequences (C’s)—and particularly totheir depressed feelings. Often, moreover, the A’s of their lives are presentlyunchangeable and uncorrectable. But not so their B’s. These are almost always in theircontrol and therefore changeable. Thus, they can change their self-defeating demandsthat they must do better and have to experience better conditions to strong healthypreferences. If so, pop goes much of their depression!

I suspect, on the basis of my REBT theory and practice, that most of my depressedclients also use their grandiose musts to create important secondary disturbances. Thus,they often devoutly believe, “I must not feel depressed! It’s awful to be depressed! Ican’t stand my depressed feelings and actions!” They thereby make themselves—yes,make themselves—depressed about their depression. Or anxious, guilty, or enragedabout it. If so, they then have a double whammy—two symptoms for the price of one!Moreover, their depression about their depression usually interferes with their findingand unraveling their original irrational beliefs and blocks their making themselvesbetter.

So I explore this important possibility, show my clients how to ferret it out forthemselves, and if they find it to think, feel, and act against it. Thus, I show them howto first reduce their depression about their depression, and then to reduce or eliminatetheir original depression. Quite a trick! But I find that, interestingly enough, many ofmy clients are at first more likely to conquer their secondary symptom without toomuch trouble. However, they often feel fine about this and yet find it difficult toconvince themselves that their original failures or losses are not awful, but only highlyinconvenient. So it may take them a much longer time to overcome their primarydepression.

As I note in Flora’s case, I almost always employ a number of cognitive, emotive,and behavioral methods to help my depressed clients minimize their disturbances andtheir disturbance about these disturbances. This is because people think, feel, and actdysfunctionally; and their thoughts, feelings, and actions importantly interact with andexacerbate each other. Moreover, although practically all depressed people havesignificant similarities, they also are unique individuals in their own right. What workswith one easily may not work with another. But REBT methods are so many and sovaried that they provide much leeway to use different strokes for different folks. AndI often do vary REBT techniques with each client.

“How long will it take,” many of my clients ask me, “to overcome my depression?”I reply that it “depends on several important factors: first, on how depressed you areand for how long you have been disturbed; second, on whether your biochemistry isseriously out of whack; and third, on the kind, degree, and persistence of the adversitiesin your life. Over these kinds of factors, you have relatively little control. But you dohave a great deal of choice of how you choose to think, feel, and behave about theadversities that afflict you. Like practically all humans, you are born and reared withtwo opposing tendencies. On the one hand, you are easily disturbable, and can upsetyourself over both little and big things. On the other hand, you are born and raisedwith real tendencies to change and to correct your self-defeating behaviors. You arepotentially proactive and self-actualizing, if you use your healthy potentialities.”

“How do I do that?” many of my clients ask.

Severe Depression and Treatment with REBT 237

My response is, “By seeing and using three of REBT’s main insights. Number 1: Seewhat we have been talking about in these sessions. You largely, though never completely,help create your own depression and other disturbances. Especially when you arereactively depressed after suffering losses and failures. Number 2: No matter how andwhy you originally depressed yourself, you still, today, are thinking crookedly, feelinginappropriately, and acting dysfunctionally. So you are continuing to make yourselfdepressed and, often, depressed about your depression.”

“I see. And the third insight for me to achieve?”“Oh, yes, the important third insight. There is usually no way but work and practice—

yes, much work and practice—for you to change your depressed thoughts, feelings, andactions. No magic. No miracles. Only much work and practice.”

“So I have to push myself to change myself?”“Yes, almost always. If you do, within a few weeks or months you will probably make

yourself feel much better—much less depressed. No guarantees—but a high degree ofprobability. However, if you want to achieve what I call the elegant solution to youremotional problems and make yourself both less disturbed and less disturbable, thatusually takes longer.”

“And that is?”“That is, use REBT so strongly and persistently that you first significantly reduce

your depression. Then go on to make a profound philosophical–emotional changewhere you endorse your healthy goals, desires, and preferences and minimize yourabsolutistic musts, insistences, and demands.”

“Can I really do this?”“Not easily! But with continued work and practice, you can. If you do, you then will

rarely depress yourself in the future—no, not never, but rarely. If and when you do,you will give yourself unconditional self-acceptance, refrain from putting yourself down,and return to using the kinds of REBT methods that you used to undepress yourselfbefore.”

“Sounds good.”“And fascinating. You control most of your emotional destiny. If you think you do

and if you work at doing so.”Naturally, I don’t convince all my depressed clients to make themselves significantly

less depressed. Even when I do, I hardly help all of them to make themselves elegantlyless disturbable. But I always try, and I often succeed. So do they.

Recommended Readings

The books included in the notes for this chapter by A. T. Beck, et al., M. E. Bernard, W. Dryden,A. Ellis, P. A. Hauck, G. L. Klerrnan, et al., and S. Walen, et al. are recommended.

In addition:

Bloomfield, H. H., & McWilliams, P. (1994). How to heal depression. Los Angeles, CA: PreludePress.

Burns, D. D. (1980). Feeling good. New York: Morrow.Ellis, A., & Tafrate, R. C. (1997). How to control your anger before it controls you. New York: Birch

Lane Press.Seligman, M. E. P. (1991). Learned optimism. New York: Knopf.Simon, J. L. (1993). Good mood. LaSalle, IL: Open Court.

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13 Using Rational Emotive BehaviorTherapy Techniques to Cope With Disability

INTRODUCTION

Nancy Haberstroh

In “Using Rational Emotive Therapy Techniques to Cope with Disability” (1997), AlbertEllis self-discloses about his own multiple disabilities, models how he coped, andpostulates principles and describes several approaches for using rational emotive therapywith people with disabilities.

Ellis shares a unique perspective about the side of his life where he faced specialchallenges in coping with personal disabilities. He could read for short periods beforehis eyes became tired. He had a diabetic condition and took frequent blood checks,injected himself with insulin, and ate 12 mini-meals a day. Because of his physical frailties,he was unable to participate in physical sports. He made various adjustments in histhinking and coping to control for his disabilities and to operate productively inadvancing REBT, and they follow:

1. He adjusted to some disabilities by finding ways to do more than one thingsimultaneously. For example, taking 5–15 minutes to urinate limited his ability toreach his goals. He developed a system to sit and eat his meal while on the toilet.His ability to do more than one thing allowed him to engage in many active writing,teaching, counseling pursuits that better met his goals to enjoy a happy fulfilledlife.

2. Ellis reports he developed high frustration tolerance by teaching himself that it isunfortunate and certainly not preferable that he has multiple disabilities. ApplyingREBT principles to himself, he tells the reader that it is not horrible or terrible thathe must do these things due to his disabilities. He shared how he worked to develophigh frustration tolerance by accepting that he can’t change his disabilities. UsingREBT, he developed Unconditional Self-Acceptance (USA) and did not downhimself for having disabilities that others do not necessarily have. Ellis found thatmany of the people he worked with who had disabilities tended to make globalnegative judgments of themselves. It was as if they were their disability. They oftenrelate to performance limitations; some tend to see others as putting them down.Many have a low tolerance for frustration. He saw this combination as a one–twopunch for misery. He correctly described the value of judging behavior rather than

the person. He used himself as a model and described how he taught himself torate or evaluate thoughts, feelings, actions, but not himself. He practiced self-acceptance with the tenet: “I am not a bad or inadequate person for having theseflaws and failings.” (Using Rational Emotive Therapy Techniques to Cope withDisability, 1997, p. 19.). Ellis used these two principles to teach his clients withdisabilities to learn unconditional self-acceptance and frustration tolerance.

3. Ellis provided an excellent model of how one can continue to pursue one’s goalswhile following practices necessary to avoid the potential destructive influences ofuncontrolled blood sugar levels. Ellis adopted an effective behavioral strategy inaddition to his positive USA. He would take a few pieces of bread or other non-refrigerated eatables from his most recent meal and put them into his briefcase,so as to have more mini-meal opportunities without going to a store or restaurantduring his travels. One time, Albert Ellis had dinner with my husband and me atour home. After the meal, he politely asked if he might make sandwiches for histrip back to NYC. We had enough leftovers. He made enough sandwiches to lasta few days.

4. He modeled his own REBT work to cope effectively with his own disabilities tohelp his clients to learn these REBT methods. Self-disclosure helped these clientsunderstand that a disability does not eliminate one from enjoying an active, happylife. Ellis relates these principles to coping with an illness (Ellis and Abrams, 1994).When coping with a fatal illness or disabilities, Ellis shows how to challenge beliefsor ideas that the disabilities lessen the person.

Although self-disclosure in therapy needs to be carefully dispensed to clients, Ellisshowed how it can be successfully utilized to help the client to gain perspective and sethis or her own behavioral strategies to cope with the disability/ies.

REBT and Disability Counseling Today: A New Application

As long as people have physical limitations and disabilities, REBT principles can beintroduced where individuals superimpose a psychological disability on top of theirphysical disability.

Learning to live with physical limitations and handicaps may be sufficientlychallenging. These conditions are made more manageable by concentrating on applyingstrengths and capabilities to meet the ordinary and extraordinary challenges of daily living.

Surplus anguish in the forms of self-denigration and intolerance only intensify analready unfortunate situation, and get in the way of meeting reasonable goals for health,happiness, and accomplishment. Ellis’ modeling approach for using the REBT modelfor helping people curb self-inflicted mental adversity has efficacy today and for theforeseeable future.

This article focuses on people of normal intelligence with physical disabilities. REBTalso applies to people with moderate-to-mild intellectual disabilities. For example,rational emotive education (REE) was developed as a positive preventative mental healthschool curriculum for children (Knaus, 1974). It has been applied successfully to teachpeople with intellectual disabilities (mental retardation) capability-specific ways tochallenge erroneous thinking that leads to emotional unsettledness and acting out

240 Nancy Haberstroh

(Knaus & Haberstroh, 1992). The application of this method for high-moderate tomildly intellectually disadvantaged individuals has thus far been underutilized.

Intellectually challenged individuals with low frustration tolerance and deficienciesin self-efficacy may strike out physically with negative consequence, such as jail forphysical assault. These same individuals can and do react differently in similarcircumstances. Some can learn to think about their thinking, and thus impose reasonbetween impulse and reaction. When individuals develop this skill, it is a safety measurefor both the individuals and others. Beyond that, I’ve observed that intellectuallychallenged people who develop rational coping skills are normally better able to usetheir talents and make better choices.

Although the amount of time needed to teach and learn these strategies is typicallylonger than with elementary school children, using over-learning, repetition, and role-playing is effective in teaching people with mild and high-moderate levels of intellectualdisabilities REE life skills. I found that many buy into the system because they see thatthey are learning something that others don’t know, including staff personnel. Thisknowledge provides a unique opportunity for learning a sense of self-empowerment ina world where many are normally under the control of others.

The REE model allows people with intellectual disabilities to practice these techniqueseach week and to report back to the therapist, so that additional opportunities forapplication can be supported. Its application allows people with intellectual disabilitiesto learn and practice at the same time, in a multimodal, interactive model. For example,when learning about emotions, the therapist and individual use a magazine to try todetermine what people in the pictures are likely feeling. Then the therapist and studentpantomime emotions selected randomly from a hat, while the other tries to guess whichemotion is being portrayed. This helps to develop the therapeutic alliance, while show-ing how it is difficult to guess people’s emotions from their body language and facialexpressions. Another important exercise is developing the self-concept pinwheel toshow how a person has many traits and qualities.

In conclusion, let’s return to Albert Ellis as a model for managing adversity due tophysical disabilities. It is noteworthy that, later in life, Ellis faced added physicaladversities. He nearly died following an operation. Thereafter he used a colostomy bag.The inevitable process of aging presented an active-minded Ellis with challenges abouthow to make adjustments so that he could continue to contribute, which he did upuntil the last two months of his life. He lost his hearing.

At his memorial service, his physician spoke about how Albert Ellis lived hisphilosophy of tolerance and acceptance right to the end. It is fair to say, he normallypracticed what he preached.

References

Ellis, A., & Abrams, M. (1994). How to cope with a fatal illness: The rational management of deathand dying. New Jersey, NJ: Barricade Books.

Knaus, W. (1974) Rational emotive education: A manual for elementary school childen. New York:Institute for Rational Living.

Knaus, W., and Haberstroh, N. (1992). A rational emotive-education program to help disruptivementally retarded clients develop self-control. In W. Dryden & L. K. Hill (Eds), Innovationsin rational emotive therapy (pp. 201–217). Newbury Park, CA: Sage.

Using REBT Techniques to Cope With Disability 241

USING RATIONAL EMOTIVE BEHAVIORTHERAPY TECHNIQUES TO COPE WITHDISABILITY

Albert Ellis

[The author shows how he has been partially disabled with diabetes, tired eyes, deficienthearing, and other physical handicaps during most of his 82 years. Instead of allowingthese disabilities to stop him, he has used some of the basic principles and practices ofREBT to accept them and to overcome the human tendencies to indulge in lowfrustration tolerance (LFT) and self-denigration with which people with disabilitiesfrequently, and needlessly, upset themselves.]

I have had multiple disabilities for a long number of years and have always used RationalEmotive Behavior Therapy (REBT) to help me cope with these disabilities. That is oneof the saving graces of having a serious disability—if you really accept it, and stopwhining about having it, you can turn some of its lemons into quite tasty lemonade.

I started doing this with my first major disability soon after I became a practicingpsychologist in 1943, at the age of 30. At age 19 I began to have trouble reading andwas fitted for glasses, which worked well enough for sight purposes but left me witheasily tired eyes. After I read or even looked steadily at people for no more than 20minutes, my eyes began to feel quite fatigued, and often as if they had sand in them.Why? Probably because of my prediabetic condition of renal glycosuria.

Anyway, from 19 years onward I was clearly handicapped by my chronically tiredeyes and could find no steady release from it. Today, over a half-century later, it is stillwith me, sometimes a little better, sometimes a little worse, but generally unrelieved.So I stoically accepted my tired eyes and still live with them. And what an annoyanceit is! I rarely read, especially scientific material, for more than 20 minutes at a time—and I almost always keep my eyes closed when I am not reading, working, or otherwiseso active that it would be unwise for me to shut them.

My main sight limitation is during my work as a therapist. For many years, I haveseen more clients than almost any other therapist in the world. For at our clinic at theInstitute for Rational Emotive Behavior Therapy in New York, I usually see individualand group clients from 9:30 am to ll:00 pm—with a couple of half hour breaks formeals, and mostly for half hour sessions with my individual clients. So during eachweek I may easily see over 80 individual and 40 more group clients.

Do I get tired during these long days of working? Strangely enough, I rarely do. Iwas fortunate enough to pick high-energy parents and other ancestors. My mother andfather were both exceptionally active, on-the-go people until a short time before shedied of a stroke at the age of 93 and he died, also of a stroke, at the age of 80.

Anyway, for more than a half century I have conducted many more sessions withmy eyes almost completely shut than I have with them open. This includes thousandsof sessions I have done on the phone without ever seeing my clients. In doing so, Ihave experienced some real limitations but also several useful advantages. Advantages?Yes, such as these:

With my eyes shut, I can focus unusually well on what my clients are telling me andcan listen nicely to their tones of voice, speech hesitations and speed-ups, and otheraspects of their verbal communication.

With my eyes closed, I can focus better, I think, on what my clients are tellingthemselves to make themselves disturbed: on their basic irrational meanings andphilosophies that are crucial to most of their symptoms.

When I am not looking at my clients I am quite relaxed and can easily avoid botheringmyself about how well I am doing. I avoid rating myself and producing ego problemsabout what a great therapist and noble person I am—or am not!

My closed eyes and relaxed attitude seem to help a number of my clients relax duringthe sessions themselves, to open up to concentrating on and revealing their worstproblems.

Some of my clients recognize my personal disabilities. They see that I refuse to whineabout my adversities, work my ass off in spite of them, and have the courage to acceptwhat I cannot change. They therefore often use me as a healthy model and see thatthey, too, can happily work and live in spite of their misfortunes.

Do not think, now, that I am recommending that all therapists, including those whohave no ocular problems, should often shut their eyes during their individual therapysessions. No. But some might experiment in this respect to see what advantages closingtheir eyes may have, especially at certain times.

Despite the fact that I could only read for about 20 minutes at a time, I startedgraduate school in clinical psychology in 1942, when I was 28, finished with honors,and have now been at the same delightful stand for well over a half century—still withmy eyes often shut and my ears widely open. I am handicapped and partially disabled,yes—but never whining and screaming about my disabilities, and always forging on inspite of them.

In my late sixties my hearing began to deteriorate, and in my mid-seventies I gottwo hearing aids. Even when working in good order, they have their distinct limitationsand have to be adjusted for various conditions, and even for the voice loudness andquality of the voices of the people I am listening to. So I use them regularly, especiallywith my clients, but I am still forced to ask people to repeat themselves or to makethemselves clearer.

So I put up with all these limitations and use rational emotive behavior therapy toconvince myself that they are not awful, horrible, and terrible but only a pain in theass. Once in awhile I get overly irritated about my hearing problem—which myaudiologist, incidentally, tells me will definitely get a little worse as each year goes by.But usually I live very well with my poor auditory reception and even manage to domy usual large number of public talks and workshops every year, in the course of whichI have some trouble in hearing questions and comments from my audiences but stillmanage to get by. Too bad that I have much more difficulty than I had in my youngeryears.

I was diagnosed as having full-blown diabetes at the age of 40, so that has added tomy disabilities. Diabetes, of course, does not cause much direct pain and anguish, butit certainly does lead to severe restrictions. I was quickly put on insulin injections twicea day and on a seriously restricted diet. I, who used to take four spoons of sugar in mycoffee in my prediabetic days, plus half cream, was suddenly deprived of both. Moreover,

Using REBT Techniques to Cope With Disability 243

when I stuck with my insulin injections and dietary restrictions, I at first kept my bloodsugar regularly low but actually lost 10 pounds off my usually all-too-thin body. Aftermy first year of insulin taking, I became a near-skeleton!

I soon figured out that by eating 12 small meals a day, literally around the clock, Icould keep my blood sugar low, ward off insulin shock reactions, and maintain a healthyweight. So for over 40 years I have been doing this and managing to survive pretty well.But what a bother! I am continually, day and night, making myself peanut buttersandwiches, pricking my fingers for blood samples, using my blood metering machines,carefully watching my diet, exercising regularly, and doing many other things thatinsulin-dependent diabetics have to do to keep their bodies and minds in good order.

When I fail to follow this annoying regimen, which I rarely do, I naturally suffer.Over the many years that I have been diabetic, I have ended up with a number ofhypoglycemic reactions, including being carried off three times in an ambulance tohospital emergency wards. And, in spite of my keeping my blood sugar and my bloodpressure healthfully low over these many years, I have suffered from various sequelaeof diabetes and have to keep regularly checking with my physicians to make sure that they do not get worse or that new complications do not develop. So, although Imanage to keep my health rather good, I have several physicians whom I regularly see,including a diabetologist; an internist; an ear, nose, and throat specialist; a urologist;an orthopedist; and a dermatologist. Who knows what will be next? Oh, yes: Becausediabetes affects the mouth and the feet, my visits to the dentist and podiatrist everyyear are a hell of a lot more often than I enjoy making them. But, whether I like it ornot, I go.

Finally, as a result of my advancing age, perhaps my diabetic condition, and whoknows what else, I have suffered for the last few years from a bladder that is easily filledand slow to empty. So I run to the toilet more than I used to do, which I do notparticularly mind. But I do mind the fact that it often takes me much longer to urinatethan it did in my youth and early adulthood. That is really annoying!

Why? Because for as long as I can remember, I have been something of a timewatcher. I figured out, I think when I was still in my teens and was writing away likea demon, even though I had a full schedule of courses and other events at college, thatthe most important thing in my life, and perhaps in almost everyone else’s life, is time.Money, of course, has its distinct value; so does love. But if you lose money or getrejected in your sex-love affairs, you always have other chances to make up for yourlosses, as long as you are alive and energetic. If you are poor, you can focus on gettinga better income; if you are unloved and unmated, you can theoretically get a new partnerup until your dying day. Not so, exactly, with time. Once you lose a few seconds, hours,or years, there is no manner in which you can get them back. Once gone, you can inno way retrieve them. Tempus fugit—and time lost, wasted, or ignored is distinctlyirretrievable.

Ever since my teens, then, I have made myself allergic to procrastination and tohundreds of other ways of wasting time, and of letting it idly and unthinkingly go by.I assume that my days on earth are numbered and that I will not live a second morethan I actually do live. So, unless I am really sick or otherwise out of commission, I domy best to make the most of my 16 daily hours; and I frequently manage to accomplishthis by doing two or more things at a time. For example, I very frequently listen to

244 Albert Ellis

music while reading and have an interesting conversation with people while preparinga meal or eating.

This is all to the good, and I am delighted to be able to do two things at once, tostop my procrastinating and my occasional day dreaming and, instead, to do somethingthat I would much rather get done in the limited time that I have to be active each dayand the all too few years I will have in my entire lifetime. Consequently, when I wasafflicted by the problem of slow urination in my late seventies, I distinctly regrettedthe 5 to 15 minutes of extra time it began to take me to go to the toilet several timeseach day and night. What a waste! What could I effectively do about saving this time?

Well, I soon worked out that problem. Instead of standing up to urinate as I hadnormally done for all my earlier life, I deliberately arranged for most of the times Iwent to the john to do so sitting down. While doing so, I first settled on doing someinteresting reading for the several minutes that it took me to finish urinating. But thenI soon figured out that I could do other kinds of things as well to use this time.

For example, when I am alone in the apartment that I share with my mate, JanetWolfe, I usually take a few minutes to heat up my regular hot meal in our microwaveoven. While it is cooking, I often prepare my next hot meal as well as put it in a micro-wave dish in the refrigerator, so that when I come up from my office to our apartmentagain, I will have it quickly ready to put in the oven again. I therefore am usuallycooking and preparing two meals at a time. As the old saying goes, two meals for theprice of one!

Once the microwave oven rings its bell and tells me that my cooked meal is finished,I take it out of the oven, and instead of putting it on our kitchen table to eat, I take itinto the bathroom and put it on a shelf by the side of the toilet, together with myeating utensils. Then, while I spend the next 5 or 10 minutes urinating, I simultaneouslyeat my meal out of the microwave dish that it is in and thereby accomplish my eatingand urinating at the same time. Now some of you may think that this is inelegant oreven boorish. My main goal is to get two important things—eating and urinating—promptly done, to polish them off as it were, and then to get back to the rest of myinteresting life. As you may well imagine, I am delighted with this efficient arrangementand am highly pleased with having efficiently worked it out!

Sometimes I actually can arrange to do tasks while I am also doing therapy. Myclients, for example, know that I am diabetic and that I have to eat regularly, especiallywhen my blood sugar is low. So, with their permission, I actually eat my peanut butterand sugarless jelly sandwiches while I am conducting my individual and group sessions,and everyone seems to be happy.

However, I still have to spend a considerable amount of time taking care of myphysical needs and dealing with my diabetes and other disabilities. I hate doing this,but I accept the fact that I have little other choice. So I use rational emotive behaviortherapy (REBT) to overcome any tendencies toward low frustration tolerance that Imay still have. I tell myself whenever I feel that I am getting impatient or angry aboutmy various limitations,

Too damned bad! I really do not like taking all this time and effort to deal withmy impairments and wish to hell that I didn’t have to do so. But alas, I do. It ishard doing so many things to keep myself in a relatively healthy condition, but it

Using REBT Techniques to Cope With Disability 245

is much harder, and in the long run much more painful and deadly, if I do notkeep doing this. There is no reason whatsoever why I absolutely must have it easierthan I do. Yes, it is unfair for me to be more afflicted than many other people are.But, damn it, I should be just as afflicted as I am! Unfairness should exist in theworld—to me, and to whomever else it does exist—because it does exist! Too badthat it does—but it DOES!

(Ellis, 1979, 1980)

So, using my REBT training, I work on my low frustration tolerance and accept—yes, really accept—what I cannot change. And, of course, barring a medical miracle, Icannot right now change any of my major disabilities. I can live with them, and I do.I can even reduce them to some extent, and I do. But I still cannot get rid of them.Tough! But it is not awful.

REBT, as you may or may not know, posits that there are two main instigators ofhuman neurosis: First, low frustration tolerance (e.g., I absolutely must have what Iwant when I want it and must never, never be deprived of anything that I really, reallydesire). Second, self-denigration (e.g., when I do not perform well and win others’approval, as at all times I should, ought, and must, I am an inadequate person, a retard,a no-goodnik!).

Many disabled people in our culture, in addition to suffering from the first of thesedisturbances, suffer even more seriously from the second. People with serious disabilitiesoften have more performance limitations in many areas (e.g., at school, at work, andat sports) than those who have no disabilities. To make matters worse, they arefrequently criticized, scorned, and put down by others for having their deficiencies.From early childhood to old age, they may be ridiculed and reviled, shown that theyreally are not as capable and as “good” as are others. So not only do they suffer fromdecreased competence in various areas but also from much less approval than moreproficient members of our society often receive. For both these reasons, because theynotice their own ineptness and because many of their relatives and associates ignoreor condemn them for it, they falsely tend to conclude, “My deficiencies make me adeficient, inadequate individual.”

I largely taught myself to forgo this kind of self-deprecation long before I developedmost of my present disabilities. From my early interest in philosophy during my teens,I saw that I did not have to rate myself as a person when I rated my efficacy and mylovability. I began to teach myself, before I reached my mid-twenties, that I could giveup most of my feelings of shame and could unconditionally accept myself as a humaneven when I did poorly, especially at sports. As I grew older, I increasingly worked ataccepting myself unconditionally. So when I started to practice REBT in 1955, I madethe concept of unconditional self-acceptance (USA) one of its key elements (Balter,1995; Dryden, 1995; Ellis, 1973, 1988, 1991, 1994, 1996; Hauck, 1991).

As you can imagine by what I stated previously in this article, I use my REBT-orientedhigh frustration tolerance to stop myself from whining about disabilities and rarelyinwardly or outwardly complain about this. But I also use my self-accepting philosophyto refrain from ever putting myself down about these handicaps. For in REBT one ofthe most important things we do is to teach most of our clients to rate or evaluate onlytheir thoughts, feelings, and actions and not rate their self, essence, or being. So for

246 Albert Ellis

many years I have followed this principle and fully acknowledged that many of mybehaviors are unfortunate, bad, and inadequate, because they do not fulfill my goalsand desires. But I strongly philosophize, of course, that I am not a bad or inadequateperson for having these flaws and failings.

I must admit that I really hate growing old. Because, in addition to my diabetes, myeasily tired eyes, and my poor hearing, old age definitely increases my list of disabilities.Every year that goes by I creak more in my joints, have extra physical pains to dealwith, slow down in my pace, and otherwise am able to do somewhat less than previously.So old age is hardly a blessing!

However, as I approach the age of 82, I am damned glad to be alive and to be quiteactive, productive, and enjoying. My brother and sister, who were a few years youngerthan I, both died almost a decade ago, and just about all my close relatives are alsofairly long gone. A great many of my psychological friends and associates, most ofwhom were younger than I, unfortunately have died, too. I grieve for some of them,especially for my brother, Paul, who was my best friend. But I also remind myself thatit is great that I am still very much alive, as is my beloved mate, Janet, after more than30 years of our living together. So, really, I am very lucky!

Do my own physical disabilities actually add to my therapeutic effectiveness? I wouldsay, yes—definitely. In fact, they do in several ways, including the following.

1. With my regular clients, most of whom have only minor disabilities or none at all,I often use myself as a model and show them that, in spite of my 82 years and myphysical problems, I fully accept myself with these impediments and give myselfthe same unconditional self-acceptance (USA) that I try to help these clients achieve.I also often show them, directly and indirectly, that I rarely whine about my physicaldefects but have taught myself to have high frustration tolerance (HFT) about them.This kind of modeling helps teach many of my clients that they, too, can face realadversities and achieve USA and HFT.

2. I particularly work at teaching my disabled clients to have unconditional self-acceptance by fully acknowledging that their deficiencies are unfortunate, bad, andsometimes very noxious but that they are never, except by their own self-sabotagingdefinition, shameful, disgraceful or contemptible. Yes, other people may often viewthem as horrid, hateful people, because our culture and many other cultures oftenencourage such unfair prejudice. But I show my clients that they never have toagree with this kind of bigotry and can actively fight against it in their own livesas well as help other people with disabilities to be fully self-accepting.

I often get this point across to my own clients by using self-disclosure and otherkinds of modeling. Thus, I saw a 45-year-old brittle, diabetic man, Michael, who hadgreat trouble maintaining a healthy blood sugar level, as his own diabetic brother andsister were able to do. He incessantly put himself down for his inability to work steadily,to maintain a firm erection, to participate in sports, and to achieve a good relationshipwith an attractive woman who would mate with him in spite of his severe disabilities.

When I revealed to Michael several of my own physical defects and limitations, suchas those I mentioned previously in this article, and when I showed him how I felt sadand disappointed about them but stubbornly refused to feel at all ashamed or

Using REBT Techniques to Cope With Disability 247

embarrassed for having these difficulties, he strongly worked at full self-acceptance,stopped denigrating himself for his inefficacies, shamelessly informed prospectivepartners about his disabilities, and was able to mate with a woman who cared for himdeeply in spite of them.

In this case, I also used REBT skill training. As almost everyone, I hope, knows bynow, REBT is unusually multimodal. It shows people with physical problems how tostop needlessly upsetting themselves about their drawbacks. But it also teaches themvarious social, professional, and other skills to help them minimize and compensatefor their hindrances (Ellis, 1957/1975, 1988, 1996; Gandy, 1995). In Michael’s case, inaddition to teaching him unconditional self-acceptance, I showed him how to socializemore effectively; how to satisfy female partners without having perfect erections; andhow to participate in some sports, such as swimming, despite his physical limitations.So he was able, although still disabled, to feel better and to perform better as a resultof his REBT sessions. This is the two-sided or duplex kind of therapy that I try toarrange with many of my clients with disabilities.

3. Partly as a result of my own physical restrictions, I am also able to help clients,whether or not they have disabilities, with their low frustration tolerance (LFT). As Inoted earlier, people with physical restrictions and pains usually are more frustratedthan those without such impediments. Consequently, they may well develop a highdegree of LFT. Consider Denise, for example. A psychologist, she became insulindependent at the age of 30 and felt horrified about her newly acquired restrictions.According to her physicians, she now had to take two injections of insulin and severalblood tests every day, give up most of her favorite fat-loaded and salt-saturated foods,spend a half-hour a day exercising, and take several other health-related precautions.She viewed all of these chores and limitations as “revolting and horrible,” and becamephobic about regularly carrying them out. She especially kept up her life-long gourmetdiet and gained 20 extra pounds within a year of becoming diabetic. Her doctors’ andher husband’s severe criticism helped her feel guilty, but it hardly stopped her in herfoolish self-indulgence.

I first worked with Denise on her LFT and did my best to convince her, as REBTpractitioners often do, that she did not need the eating and other pleasures that shewanted. It was indeed hard for her to impose the restrictions her physical conditionnow required, but it was much harder, I pointed out, if she did not follow them. Herincreased limitations were indeed unfortunate, but they were hardly revolting andhorrible; I insisted that she could stand them, though never necessarily like them.

I at first had little success in helping Denise to raise her LFT because, as a brightpsychologist, she irrationally but quite cleverly parried my rational arguments. However,using my own case for an example, I was able to show her how, at my older age andwith my disabilities greater than hers, I had little choice but to give up my formerindulgences or die. So, rather than die, I gave up putting four spoons of sugar and halfcream in my coffee, threw away my salt shaker, stopped frying my vegetables in sugarand butter, surrendered my allergy to exercise, and started tapping my fingers seven oreight times a day for blood tests. When Denise heard how I forced my frustrationtolerance up as my pancreatic secretion of insulin went down, and how for over 40years I have thereby staved off the serious complications of diabetes that probably would

248 Albert Ellis

have followed from my previous habits, and from her present ones, she worked on herown LFT and considerably reduced it.

Simultaneously, I also helped Denise with her secondary symptoms of neurosis. Asa bright person and as a psychologist who often helped her clients with their self-sabotaging thoughts, feelings, and behaviors, she knew how destructive her ownindulgences were, and she self-lambasted and made herself feel very ashamed of them,thereby creating a symptom about a symptom: self-downing about her LFT. So I usedgeneral REBT with her to help her give herself unconditional self-acceptance (USA) inspite of her indulging in her LFT. I also specifically showed her how, when I personallyslip back to my predisability ways and fail to continue my antidiabetic exercise andother prophylactic routines, I only castigate my behavior and not myself or personhood.I therefore see myself as a goodnik who can change my no-goodnik actions, and thisUSA attitude helps me correct those actions. By forcefully showing this to Denise, andusing myself and my handling of my disabilities as notable examples, I was able to helpher give up her secondary symptom—self-deprecation—and go back to working moreeffectively to decrease her primary symptom—low frustration tolerance.

I have mainly tried to show in this article how I have personally coped with someof my major disabilities for over 60 years. But let me say that I have found it relativelyeasy to do so because, first, I seem to be a natural born survivor and coper, which manydisabled (and nondisabled) people are not. This may well be my innate predispositionbut also may have been aided by my having to cope with nephritis from my 5th to my8th years and my consequent training myself to live with physical adversity. Second,as noted earlier, I derived an epicurean and stoic philosophy from reading and reasoningabout many philosophers’ and writers’ views from my 16th year onward. Third, Ioriginated REBT in January 1955 and have spent the great majority of my waking lifeteaching it to clients, therapists, and members of the public for over 40 years.

For these and other reasons, I fairly easily and naturally use REBT methods in myown life and am not the kind of difficult customer (DC) that I often find my clientsto be. With them, and especially with DCs who have disabilities and who keepcomplaining about them and not working too hard to overcome and cope with them,I often use a number of cognitive, emotive, and behavioral techniques for which REBTis famous and which I have described in my book, How to Cope With a Fatal Illness(Ellis & Abrams, 1994) and in many of my other writings (Ellis, 1957/1975, 1985, 1988,1994, 1996).

Several other writers have also applied REBT and cognitive behavior therapy (CBT)to people with disabilities, including Rochelle Balter (1995), Warren Johnson (1981),Rose Oliver and Fran Bock (1987), and J. Sweetland (1991). Louis Calabro (1991) haswritten a particularly helpful article showing how the anti-awfulizing philosophy ofREBT can be used with individuals suffering from severe disabilities, such as thosefollowing a stroke, and Gerald Gandy (1995) has published an unusual book, MentalHealth Rehabilitation: Disputing Irrational Beliefs.

The aforementioned writings include a great many cognitive, emotive, and behavioraltherapy techniques that are particularly useful with people who have disabilities.Because, as REBT theorizes, human thinking, feeling, and acting significantly interactwith each other, and because emotional disturbance affects one’s body as well as one’s

Using REBT Techniques to Cope With Disability 249

physical condition affects one’s kind and degree of disturbance, people who are upsetabout their disabilities often require a multifaceted therapy to deal with their upsetstate. REBT, like Arnold Lazarus’ (1989) multimodal therapy, provides this kind ofapproach and therefore often is helpful to people with disability-related problems.

Let me briefly describe a few of the cognitive REBT methods that I frequently usewith my clients who have disabilities and who are quite anxious, depressed, and self-pitying about having these handicaps. I bring out and help them dispute their irrationalbeliefs (iBs). Thus, I show these clients that there is no reason why they must not bedisabled, although that would be distinctly desirable. No matter how ineffectual someof their behaviors are, they are never inadequate persons for having a disability. Theycan always accept themselves while acknowledging and deploring some of their physicaland mental deficiencies. When other people treat them unkindly and unfairly becauseof their disabilities, they can deplore this unfairness but not damn their detractors.When the conditions under which they live are unfortunate and unfair, they canacknowledge this unfairness while not unduly focusing on and indulging in self-pityand horror about it.

Preferably, I try to show my disabled clients how to make a profound philosophicalchange and thereby not only minimize their anxiety, depression, rage, and self-pity forbeing disadvantaged but to become considerably less disturbable about futureadversities. I try to teach them that they have the ability to consistently and stronglyconvince themselves that nothing is absolutely awful, that no human is worthless, andthat they can practically always find some real enjoyment in living (Ellis, 1994, 1996;Ellis & Abrams, 1994). I also try to help them accept the challenge of being productive,self-actualizing, and happy in spite of the unusual handicaps with which they mayunfortunately be innately endowed or may have acquired during their lifetime. Also, Ipoint out the desirability of their creating for themselves a vital absorbing interest, thatis, a long-range devotion to some cause, project, or other interest that will give thema real meaning and purpose in life, distract them from their disability, and give themongoing value and pleasure (Ellis, 1994, 1996; Ellis & Harper, 1975).

To aid these goals of REBT, I use a number of other cognitive methods as well asmany emotive and behavioral methods with my disabled clients. I have described thesein many articles and books, so I shall not repeat them here. Details can be found inHow to Cope With a Fatal Illness (Ellis & Abrams, 1994).

Do I use myself and my own ways of coping with my handicaps to help my clientscope with them? I often do. I first show them that I can unconditionally accept themwith their disabilities, even when they have partly caused these handicaps themselves.I accept them with their self-imposed emphysema from smoking or with their 100 extrapounds of fat from indulging in ice cream and candy. I show them how I bear up quitewell with my various physical difficulties and still manage to be energetic and relativelyhealthy. I reveal some of my time-saving, self-management, and other disciplinemethods that I frequently use in my own life. I indicate that I have not only devisedsome sensible philosophies for people with disabilities but that I actually apply themin my own work and play, and I show them how. I have survived my handicaps formany years and damned well intend to keep doing so for perhaps a good number ofyears to come.

250 Albert Ellis

Conclusion

I might never have been that much interested in rational or sensible ways of copingwith emotional problems had I not had to cope with a number of fairly serious physicalproblems from the age of 5 years onward. But rather than plague myself about myphysical restrictions, I devoted myself to the philosophy of remaining happy in spiteof my disabilities, and out of this philosophy I ultimately originated REBT in January1955 (Ellis, 1962, 1994; Wiener, 1988; Yankura & Dryden, 1994). As I was developingREBT, I used some of its main principles on myself, and I have often used them withother people with disabilities. When I and these others have worked to acquire an anti-awfulizing, unconditional self-accepting philosophy, we have often been able to leadconsiderably happier and more productive lives than many other handicappedindividuals lead. This hardly proves that REBT is a panacea for all physical and mentalills. It is not. But it is a form of psychotherapy and self-therapy especially designed forpeople who suffer from uncommon adversities. It points out to clients in general andto physically disadvantaged ones in particular that however much they dislike the harshrealities of their lives, they can manage to make themselves feel the healthy negativeemotions of sorrow, regret, frustration, and grief while stubbornly refusing to createand dwell on the unhealthy emotions of panic, depression, despair, rage, self-pity, andpersonal worthlessness. To help in this respect, it uses a number of cognitive,emotive–evocative, and behavioral methods. Its results with disabled individuals havenot yet been well researched with controlled studies. Having used it successfully onmyself and with many other individuals, I am of course prejudiced in its favor. Butcontrolled investigations of its effectiveness are an important next step.

References

Balter, R. (1995, Spring). Disabilities update: What role can REBT play? IRETletter, pp. 1–4.Calabro, L. E. (1991). Living with disability. New York: Institute for Rational Emotive Therapy.Dryden, W. (1995). Brief rational emotive behavior therapy. London: Wiley.Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel.Ellis, A. (1973). Humanistic psychotherapy: The rational emotive approach. New York: McGraw-

Hill.Ellis, A. (1975). How to live with a neurotic: At home and at work (Rev. ed.). Hollywood, CA:

Wilshire Books. (Original work published 1957.)Ellis. A. (1979). Discomfort anxiety: A new cognitive behavioral construct. Part 1. Rational Living,

14(2), 3–8.Ellis, A. (1980). Discomfort anxiety: A new cognitive behavioral construct. Part 2. Rational Living,

15(1), 25–30.Ellis, A. (1985). Overcoming resistance: Rational emotive therapy with difficult clients. New York:

Springer.Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything—yes, anything!

Secaucus, NJ: Lyle Stuart.Ellis, A. (1991). Using RET effectively: Reflections and interview. In M. E. Bernard (Ed.), Using

rational emotive therapy effectively (pp. 1–33). New York: Plenum Press.Ellis, A. (1994). Reason and emotion in psychotherapy (Revised and updated). New York: Birch

Lane Press.Ellis, A. (1996). Better, deeper and more enduring brief therapy. New York: Brunner/Mazel.

Using REBT Techniques to Cope With Disability 251

Ellis, A., & Abrams, M. (1994). How to cope with a fatal illness. New York: Barricade Books.Ellis. A., & Harper, R. A. (1975). A new guide to rational living. North Hollywood, CA: Wilshire

Books.Gandy, G. L. (1995). Mental health rehabilitation: Disputing irrational beliefs. Springfield, IL:

Thomas.Hauck, P. A. (1991). Overcoming the rating game: Beyond self-love—beyond self-esteem. Louisville,

KY: Westminster/John Knox.Johnson, W. R. (1981). So desperate the fight. New York: Institute for Rational Emotive Therapy.Lazarus, A. A. (1989). The practice of multimodal therapy. Baltimore, MD: Johns Hopkins

University Press.Oliver, R., & Bock, F. A. (1987). Coping with Alzheimer’s. North Hollywood, CA: Melvin Powers.Sweetland, J. (1991). Cognitive behavior therapy and physical disability. Point Lookout, NY: Author.Wiener, D. (1988). Albert Ellis: Passionate skeptic. New York: Praeger.Yankura, J., & Dryden, W. (1994). Albert Ellis. Thousand Oaks, CA: Sage.

252 Albert Ellis

14 Denial

INTRODUCTION

Joseph Gerstein

First, I should assert that it is a great honor to be asked to participate in this wonderfulproject to honor Dr. Ellis’ memory and memorialize his manifold contributions totheoretical and practical psychology. Second, I am not formally trained in REBT norin “Addictionology” and come by any knowledge I might have in those areas by anavocational involvement as a volunteer in the SMART Recovery Movement (Self-Management And Recovery Training), an REBT-based self-empowerment approach tohelping people with substance or behavioral addictions help themselves.

My experience in this arena comes specifically from having facilitated over 2,000SMART Recovery (SR) meetings in communities and prisons around the world, readingin the area of the addictions, attending a number of conferences in the field of theaddictions, communing with other SR facilitators on a regular basis, especially thosecertified in REBT, my 28 years on the Harvard Medical School Faculty, and my personalexperiences as a practicing physician.

Ellis and Velten indicate at the start that denial is, after all, a subjective descriptorof an observer’s perception of a process that is going on in someone’s (or group’s)head(s) and is suffused with the perceiver’s own biases about the process. Freud, I think,was the first to point out and name the process, although the world literature aboundsthrough the centuries with examples of this phenomenon. Freud attributed the processto subconscious factors, but in modern parlance it quite often occurs at a ratherconscious level.

I was recently impressed with a comic strip that showed a woman, in successivepanels, basically arguing with herself about how she might behave in a given socialsituation. Penultimately, she reaches a rather rational conclusion and then tells herself“That’s probably very good advice.” She then turns out the light and lies back on thepillow. The last panel shows her saying to herself, “I wonder if I’ll follow it?” So thatis the essence of the dichotomy: Some who are rationalizing, but are relatively obliviousto the process, are doing it but are at least vaguely aware of the inappropriateness ofthe ultimately self-defeating or self-destructive behavior. Others are truly oblivious towhat is going on in their heads. Certainly, we deal with both in the addictions arena.

The authors of this paper also categorize two types of denial: denial as related to theexistence of the problem, and, once that is acknowledged, denial of responsibility forthe problem. The major foundation of the latter is the ubiquitous “Disease Theory” ofthe addictions. Both of these types of mental gymnastics allow both the persistence of the behavior and its legitimization, although for some, the latter provides a usefulabsolution of guilt, which may be therapeutically beneficial. Smithwick, who foundeda famous alcoholism treatment center at Roosevelt Hospital in New York City, wasapparently a “hopeless” alcoholic until visited once by an AA-recovering alcoholic in a “drying-out” facility. On being informed that he was the victim of the “disease”of alcoholism rather than the “moral failure” of alcoholism, he apparently was able torecover completely and become a fervent advocate and supporter of AA and of theDisease Concept.

So, whereas some fight tenaciously to reject the sobriquet of “alcoholic,” others findits acceptance liberating and motivating. In SR, we encourage participants toacknowledge simply that they have a significant alcohol (and/or drug) use problem orto label themselves as alcoholics (and/or addicts), if they wish, but encourage the formeras less stigmatizing and less likely to induce intractability and eternal membership inthe “recovering” lifestyle and worldview. Rather, we encourage them to achieve recoveryand go on with a sober lifestyle, indistinguishable from the 50 million adult Americanswho do not use alcohol or the greater number who do not use illicit drugs. There are40 million ex-smokers in the US, very few of whom walk around spouting that theyare former addicts.

Fortunately, as the science of the addictions has advanced, new and valuableapproaches have appeared, both to better understand the process of denial and tocategorize it. Practical applications to counter denial humanely and effectively have alsoemerged.

Previously, it was thought, and almost universally practiced, that confrontation wasthe best, or only, way to get the “denying” client or family member to “cut it out!” Thearchetype of this approach was the Intervention, during which friends, family members,and a counselor would take turns verbally bludgeoning the subject with lurid detailsof his or her despicable and/or dangerous behavior when under the influence andattempting to force her or him into therapy, usually an expensive hospitalization.

The emergence of the CRAFT (community reinforcement and family training)approach of Robert Meyers (Meyers & Wolfe, 2004) has certainly undercut theintervention technique, as has the obvious success of motivational interviewing (Miller& Rollnick, 2002) in “rolling with resistance.” These approaches are calibrated tooutflank the typical human resistance to direct oppositional frontal attack and sidestepusual reflexive parrying of criticism, implied or direct.

CRAFT, which attempts to use ONLY positive reinforcement of appropriate behaviorsand avoid criticism and confrontation over “bad” behaviors, demonstrated a remarkablesuccess of family members or friends in getting people with serious and destructiveaddiction problems into voluntary direct contact with professional therapy, comparedwith two other, more directly aggressive but commonly used methodologies.

The motivational interviewing (Miller & Rollnick, 2002) approach, eschewing almosttotally any confrontational components, has proved remarkably effective in engagingthose more resistant to therapy. It is especially effective in therapeutic interchange with

254 Joseph Gerstein

those in the phases of addictive involvement in which insight and motivation are low,and resistance and lack of incentive to change are high.

Bill Knaus, the instigator of this series, was one of the first to recognize the importanceof an indicator of the degree of motivation to change possessed by a client and mappedhis process of change in 1976. Later, the concept of Stages of Change (still later, Cyclesof Change) was codified and popularized by Prochaska, Norcross, and DiClemente(1994) and has become the relative standard conceptualization of this continuum fromtotal denial of the existence of a problem to total acceptance that the problem existsand a desire to definitively do something about it (pre-contemplation, contemplation,preparation, and action stages). Awareness of the stage of an individual’s desire tochange (or lack of same) is especially crucial in the correctional arena, where treatmentis often coerced, and most subjects are still in the pre-contemplation and contemplationphases.

SR facilitator training emphasizes matching the tool to the relevant stage. For instance,presenting REBT skills via the ABCs to someone in the contemplation phase is unlikelyto be fruitful. “Cost–benefit analysis” and “goals and values” approaches are much morepertinent in this stage. Stages may change abruptly as life events intrude or persist foryears, while negative experiences in a variety of realms gradually accumulate.

There is a special case of “denial” that should be commented on at this point. Therehas often been a tacit assumption within the treatment community that reluctance orrefusal to participate in Alcoholics Anonymous or 12-Step meetings constitutes primafacie evidence of “denial” by the individual of the presence of a problem or the needor desire to do anything about it. Likewise, the signal failure to “admit” that one is analcoholic also is considered evidence of the malady of being “in denial,” an ellipticalphrase that implies the completion phrase “about your drinking,” etc. I have to “fessup” that, in my initial ignorance about this issue and in congruence with my primitivetraining in the area of the addictions, I frequently engaged my patients in the fruitlessexercise of trying to prove to them that their negative experiences with AA and theirresistance to attending such meetings were clear manifestations of the denial of theirproblems, even when they freely admitted to me the seriousness of their problems andexpressed their sincere desire to address them constructively. I believed what I had beentaught, that AA was the only way to get over alcoholism. As a matter of fact, some ofthese individuals who refused to return to AA, for a variety of reasons, not all relatedto religious issues, despite being essentially psychologically bludgeoned by me in mysincere but monolithic therapeutic perspective, got over their addiction and hadproductive, happy lives thereafter without attending AA, several of them without anysubstantive therapeutic interventions at all. The recognition of the deficiency of thismonopolistic approach was one of my major motivations to get involved with a secular,science-based program, SR, when the opportunity presented itself.

The ubiquity and orthodoxy of the Disease Model of the Addictions make itincreasingly difficult to espouse any other explanation of addiction or successfultreatment of same. Certainly, the introduction of this concept gave great solace to manywho suffered profound guilt for their depredations while drunk and their failure toreform and was able to revolutionize some lives. However, now it has become a “devilmade me do it” explanation of all aspects of treatment and recovery, almost completelyignoring the voluntary and self-empowerment attributes of recovery. Gene Heyman’s

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recent, well-researched and substantiated book labeling addictions “disorders”(2009)and giving credence to the self-efficacy concept was vilified by several reviewers beforethey even could have read it, because of its manifest failure to accept the universalapplicability of the Disease Concept. Interestingly, I am frequently harangued by theassertion that the AMA considers alcoholism as a disease. I usually counter by indicatingthat the VA considers it “willful misbehavior,” a sure indication that this argument willnot be resolved by biased institutional players advocating for their own financialadvantage.

Suffice it to say, there is no other disease I know of that someone can rid himself orherself of by deciding emphatically to stop it. This happens daily with drinkers, smokers,and druggers. Certainly, we have to acknowledge, as Dr. Ellis does in this chapter, thetremendous contributions of chemical changes in the brain, cultural influences, geneticpredispositions, family history, etc., etc. But ultimately, “the buck stops here,” in theleft prefrontal lobe, where a decision is made to either succumb to the temptations andto continue the manifestly self-destructive behaviors or, as Hamlet says, “by opposing,end them.” The advantage of this approach, which unfortunately puts the responsibilityfor stopping an addiction directly upon the individual, is that the responsibility for theachievement of recovery also accrues directly to the individual, rather than to a higherpower, therapist, medication, or other external source.

Amazingly, as demonstrated in a simple study by Fraser Ross (personal communica-tion) in a Scottish prison, only three sessions of SR self-help meetings can move themeter dramatically from an external-locus-of-control emphasis, typical of felons, to amarked self-empowerment belief structure. This, then, offers a critically fertile field for the introduction of REBT concepts and processes, which flourish best in a self-empowerment milieu.

Ellis and Velten mention both individual and group approaches to REBT. My initialbias, as a medical practitioner fairly ignorant of REBT/CBT concepts, was that individualtherapy was best, if affordable, and that group therapy was for those who could nottolerate the cost of individual therapy. I now accept that the peer-group approach, withsensible facilitation, is probably the most profound change agent known to mankind.Blending the REBT concept, in which disputing fixed ideas is inherent, with the gentilityof motivational interviewing has proved to be challenging and requires some skill on the part of a facilitator. Tempering the disputations by substituting less pejorativeterms such as “useful” and “helpful,” or “less useful” and “less helpful,” for the ratherperemptory “rational” and “irrational” has proved effective. My wife and colleague,Barbara Gerstein, RN, discovered 20 years ago that one of the reasons why women wereleaving our groups in greater numbers than men was because of the over-vigorousdisputations that were occurring and that seemed to be more offensive to the womenthan the men in the groups (personal communication). Hammering those in theProchaska-designated pre-contemplation and contemplation phases with threats andadmonitions tends to be a non-productive endeavor, especially when utilized byauthority figures. Motivational interviewing provides a sort of mental jiu-jitsu approachto this problem that often overcomes the reflexive oppositional attitude of people in this mode of thinking. Solution-focused therapy (Guterman, 2006) uses similarjudicious questioning to elicit self-produced suggestions for change-inducing behaviors

256 Joseph Gerstein

and tends to avoid externally imposed behavioral ideas, which are usually rejected, asare most authority-initiated endeavors.

Addictions are all about immediate versus delayed gratifications, short-term versuslong-term considerations, and rational analysis of likely outcomes: immediate, intensepleasures versus long-term, more enduring, but less intense gratifications. We have nowbeen able, I think, to graft onto the powerful techniques that Dr. Ellis developed toengender rational thinking in aid of behavioral change, motivational tools to helpovercome denial in its various forms and external-locus-of-control ideologies in orderto allow participants to utilize these techniques optimally. Given the fact that the greatmajority of people with addiction problems are not in the action stage, or even thepreparation stage of change, the SR program has put tremendous effort into its Point1: motivation to change. Only with enhanced motivation can denial in its various guisesbe suppressed sufficiently to engender the engagement necessary to utilize the ABCtechnique and other REBT-based tools and help propel individuals toward recovery.

Many destructive drinkers and druggers are immersed in a social environment inwhich this type of self-indulgent behavior is the norm. Naturally enough, it is difficultfor them to extricate themselves from their environment for long enough for them toview their behavior from a different perspective. Denial is rampant in this sort ofsituation. Visioning can sometimes be a useful adjunct to verbal disquisition in thissituation. Most people are able to vision what they would like their life to be like in 10years and distinguish quite clearly what it will be like if they continue to drink/drug.Again, this can be a very powerful tool in helping people get motivated to change.Images are sometimes more powerful than words, and perhaps not as subject to self-editorializing.

Dr. Ellis’ ABC approach is the fulcrum of the SR program, which is now counteringdenial and its consequences with volunteer facilitators in over 500 groups, meetingweekly around the world, and thousands of daily interactions on the websitesmartrecovery.org.

References

Guterman, J. (2006). Mastering the art of solution-focused counseling. Alexandria, VA: ACA.Heyman, G. (2009). Addiction: A disorder of choice. Cambridge: Harvard University Press.Meyers, R., & Wolfe, B. (2004). Get your loved ones sober: An alternative to nagging, pleading and

threatening. Hazelden, MN.Miller, W., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.).

New York: Guilford.Prochaska, J., Norcross, J. C., & and DiClemente, C. C. (1994). Changing for good. New York:

Morrow.

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DENIAL

Albert Ellis

Denial may be the most used word in the whole chemical-dependency industry. Likethe weather, everybody talks about it. But can they do anything to change it? What isit? What causes it?

Denial has many different meanings. When people use the word they think that theyhave explained something by naming it. At best, they have only named some specificbehaviors. The word tells little about why those behaviors are happening.

To say that someone is “in denial” expresses an opinion about that person’s behavior.For instance, “in denial” can mean “does not agree with me.” Someone may say shedoes not have a problem, but you think she does. Therefore, you say, she is “in denial.”(Another possibility is that you are “in error”!) When correctly used, denial means thatthe denier does not see self-defeating behaviors or actively refuses to admit to them.People “in denial” may not see any connection between their choices and the poorresults they get from them. Sometimes they do not even admit they are getting poorresults. They do not see the connection, but everybody else can.

The question, “How much do you drink?” often gets denying answers. Reasons fordenial are many:

Sometimes the denier’s memory is genuinely poor. Heavy drinking does your brainno favor!

If you drink much of the time, your drinking truly does not stand out in yourmemory. You don’t notice how much you drink because you do it so often that youno longer really pay much attention to it. If someone asked you how many breaths ofair you took each day, could you give an accurate answer?

We humans are great wishful thinkers. Looking back into the past, we tend to seewhat we expect to see and what we want to see. This means you genuinely rememberinaccurately because you want to remember it that way. Obese people, for instance,often swear on stacks of Bibles that they only consume, say, 800 calories a day, and arenot losing weight because of their “metabolism.” Put them in a controlled environment,such as a hospital, give them 800 calories a day, no more, no less, and what happens?Yes, the pounds melt off. They do not count all sorts of calories they habitually takein, and therefore believe they are reporting accurately. This is normal, wishful thinking.It is not a disease. But it can contribute to problems and lead to early death.

Some heavy drinkers who do not agree that they have a problem simply lie aboutthe amount they drink. They may think they are getting away with something and patthemselves on the back.

People also deny their alcohol abuse because they want to keep the positive aspectsof drinking. They believe they need its pleasures. It also takes work and practice to stopdrinking, and that prospect does not thrill most people. They therefore resort to wishfulthinking: “I have to have the positives of alcohol and not have the negatives. If I reallydid have a problem, I would have to give up the positives. Therefore, I don’t have aproblem!”

Problem drinkers in denial may be shocked that they (of all people) get poor resultsfrom drinking. Like everyone else, they want to believe that their habits are okay, not

self-destroying. They often worry, “If I couldn’t stop, then I’d be an alcoholic! But sinceI’m not an alcoholic, that proves it’s okay if I drink.”

For example, Rocky, a client referred from a homeless shelter, complained to me(EV), “Yes, I’ve seen plenty of people end up on the street, but I never thought it wouldhappen to me!”

“Why not?” I asked. “You said you were drinking and using drugs almost aroundthe clock.”

“I always thought I was better than that, but I’m a bum, just like them.”Rocky’s comment shows the major reason people deny (fail to admit) their

responsibility for their poor behavior. Because the only alternative they see (if they doadmit responsibility) is to condemn themselves, not just their poor behavior. So it waswith Rocky—after he could no longer ignore the crummy results of his daily substanceabuse.

To behave self-defeatingly is stupid. When you admit a foolish act, it is very easy tojump to “That makes me a stupid person.” Self-reproach makes you feel depressed andguilty. It wrongly implies that a “weakling” like you can’t change. But you can—if youadmit that you are behaving poorly, are choosing to do so, and can always decide tochange. A person who acts weakly has the inner resources to show more strength later.A weak person is stuck forever!

The Disease Theory Spreads

AA adopted the Disease Theory of “alcoholism” to stop “alcoholics” from self-blame.In 1935, at the height of the Great Depression, AA started as part of the Oxford GroupMovement, an evangelical religious organization whose purpose was to revitalizereligion. The movement was founded and led by Frank Buchman, an unusual butdynamic man who was much more for stamping out self-abuse (masturbation) thanalcohol abuse. Buchman believed that all the world’s problems were moral, noteconomic, social, or political, and that the world could be saved by a “God-controlleddemocracy,” a “theocracy,” or a “God-controlled Fascist dictatorship.” He created amajor public flap with pro-Hitler statements in 1936.

Bill W. and Dr. Bob, AA’s founders, were enthusiastic members of the Oxford GroupMovement, and each had extreme drinking problems. In 1935, Bill W. visited Akron,Ohio, on a business trip and there met Dr. Bob, a proctologist and rectal surgeon. Theyteamed up and changed their lives and helped the lives of untold thousands of otherpeople.

Bill W. and Dr. Bob remained part of the Oxford Group Movement (also known as the Oxford Group, and unrelated to the Oxford Movement of the 19th century)until they branched off in late 1937 to specialize in alcoholics. (The name, AA, camefrom the title of “the Big Book,” published in 1939; the first group to call itself “AA”formed in Cleveland after that). Bill W. and Dr. Bob applied the principles of theOxford Groups to problem drinking. They urged “alcoholics” to admit defeat, take apersonal inventory, confess their defects to another person, make restitution to thosethey harmed, help others selflessly, and pray to God for the power to put these ideasinto practice.

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At the time AA started, people mainly saw alcohol problems as moral weakness andsin. Some physicians, however, viewed drinking as a medical problem. AA’s Bill W.dried out several times at Towns Hospital in New York City, which was run by Dr. William Duncan Silkworth, who viewed problem drinking as an “allergy.” As BillW. reported in his book on AA’s origins, he was drying out in Dr. Silkworth’s hospital,taking the belladonna cure (morphine and belladonna, which in high doses causeshallucinations), when he had his “spiritual awakening” and God appeared to him. Therest is history.

One advantage of the Disease Theory is that it brings medical science into the picture.The Disease Theory’s main advantage, however, is that it gets people off the self-blamehook: “I am not responsible for my behavior, but my Disease makes me act that way.”You will not, of course, damn yourself (and others) for having a Disease (particularlyan allergy) if you thought it made you (and them) misbehave. This is one reason manypeople so ferociously hang on to the Disease Theory: They sensibly fear the self-damningthat easily (though falsely) ties itself to self-responsibility for poor behavior. They knowthat freedom from blame opens the door to self-help. But they fail to realize a flaw inthe Disease Theory: If your disease is responsible, then it may seem a bit odd to say,“My Disease was responsible up to this minute, but from this minute forth I amresponsible.” How, exactly, would that work?

If a Disease caused your poor behavior in the past, why would a Disease decide tostop doing so now? “Well, because now, knowing that I have a Disease, I can takeresponsibility for my own behavior from here on out.” Or “I first have to admit I ampowerless over my Disease, and that gives me the power to take responsibility andcontrol it now.” These arguments seem illogical to many people. What kind of Diseasecould make you drink until you find out you have it, and then (if only you accept yourpowerlessness and a Higher Power) will let you take responsibility and control? WhatDisease knows that you have now made a pact with the Higher Power and that it haddamned well better surrender its power to make you powerless and submit to you andthe Higher Power?

The answer is that it is a special Disease made up for the occasion and useful inreducing self-blame. In 1935 when AA adopted the idea, it was distinctly better thanthe idea that heavy drinkers were morally defective. In this book, however, we willdescribe a much more honest and useful method to ward off self-damning. It does notlead to the (unintended) abuses of the Disease Theory that shock us these days: seeingmayors, college presidents, and Watergate conspirators get caught doing crimes anddiscovering that little or nothing happens to them when they get caught. Why not?Because their Disease “makes” them do drugs or drink and act illegally. Dangerous,violent criminals who get caught and have the right lawyers have jumped on the Diseasebandwagon with “I had a bad childhood” and “I was abused.” Maybe so, but what ofthe millions of people of similar backgrounds who behave responsibly?

This attitude—it’s not my fault or my responsibility—often causes more misbehavior.It damages the fabric of our society because it helps people avoid answering for theirpoor behavior. If “the Devil made me do it!” as comedian Flip Wilson was fond ofclaiming, then you are not to blame and you are not responsible. But you’re stuck—because you don’t learn to behave more responsibly.

260 Albert Ellis

Blaming Outside Conditions

If you see yourself as having internal control, you assume responsibility for yourbehavior—good, bad, or indifferent. If you see yourself as being externally controlled,you find—yes, actively find—something outside yourself to account for your behavior.Then you don’t put yourself down for it. The problem with this “solution” is that yourfate depends on the whims of outside forces. If the external situation gets better, youget better; if it stays the same, you stay the same; if it gets worse, it’s not your fault.Good luck!

Your desire to avoid self-blame fuels not only the Disease Theory but also three otherextremely important theories that lead you to believe that external causes are responsiblefor your addictions and other disturbances. However, the irrational Belief thatsomething outside of you is responsible for your behavior encourages your naturaltendency to addict yourself. It is STINKING THINKING in capital letters. Three popularcop-outs for your problem drinking are:

The Family Disease of “Alcoholism”

A variation on the Disease Theory that explains your current disturbances and addic-tions is “the Family Disease of Alcoholism” and similar notions that your past and yourfamily make you do the bad things you do today. The Adult Child, codependency, andInner Child movements have now invented an all-purpose “cause” of anything you dobadly, namely, “I come from a Dysfunctional Family.” This supposedly makes you anear-hopeless addict.

What about these Diseases? Do real diseases need to remind us that they are diseases?Obviously not. No one says, for instance, “the disease of tuberculosis.” Tuberculosis isa disease. It is a real one, and it does show some tendency to run in families. To say“The disease of . . .” or “The family disease of . . .” is a theory about the origins of heavydrinking that was a way to avoid self-downing in 1935 but that always had its limitations.Not that your family environment is not important. It is.

If a heavy drinker raised you, that can help you become a heavy drinker yourself.But it does not make you take on and carry out your parent’s attitudes about imbibing.If your family upbringing entirely dictated your behavior, you could never changebecause you could never have a new upbringing. Yes, it can feel nice to hold a teddybear at a codependency meeting, but that will not create a new childhood. It isn’t yourcrummy past that makes you disturbed but some of your attitudes about this past.Codependency meetings can easily help you increase rather than uproot those neuroticattitudes.

So, is “alcoholism” a family disease? We think it’s unuseful to think of it that way.True, your family members often behaved poorly and treated you shabbily. (Theyprobably say the same thing about you!) That is unfortunate, but not a disease. It isthe common crummy way that people act. Calling it a disease gives it powers that itdoes not in itself have.

Thousands of people have learned to see themselves as “alcoholics” because theyhave heavy drinkers in their family, sometimes even their distant family, although theythemselves do not even drink! They go for lengthy (and expensive) codependency, Adult

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Child, or Inner Child therapy to cure various Diseases their upbringings supposedlygave them. Disturbances, including addictions, of course, do run in families, becausepeople run in families! Yes, your parents may have set lousy examples for you, but whofollowed their examples back then, and, especially, who follows them now? You. True,you may not have known any better back then, but do you know better now?

Even when, as sometimes happens, you inherited tendencies to addict or disturbyourself, remember that they are only tendencies, not behaviors. You do not have toindulge yourself in them. I (AE) had a mother who indulged in sweets all her life andwas caught, at the age of ninety-three, stealing candy from other residents of her nursinghome! I have such a sweet tooth myself that up to the age of forty I always put fourspoons of sugar and half a cup of cream in my coffee. “You call that coffee!” the realcaffeine drinkers would exclaim. “How disgusting!” I paid them no heed.

At forty, I became diabetic. Since that time, I have taken no sugar in my coffee andvery little cream. Does my inherited tendency to easily addict myself to sugar make meindulge in it? Of course not. Nor does your genetic tendency—if you are one of thosewho really have this tendency—to drink too much make you indulge. You, and onlyyou, can make yourself indulge in that tendency.

The Walking Wounded Inner Child and Adult Child believers often firmly claim tosee that they are responsible for their own behavior. Do they then take charge of theiraddictions? Often not, because they believe, “I have to work through my ‘issues’ andmy ‘stuff’ first,” or “I have to finish my ‘grief work’ and my ‘pain work’ first,”or, “Ihave to really get in touch with my anger at my parents first” (that is, “before I changemy behavior”).

These ideas are modern incarnations by John Bradshaw and other codependencywriters of Sigmund Freud’s psychoanalysis and Arthur Janov’s Primal Scream Therapy.Such codependency writers are caring people, and their books have valid and usefulideas. But they have gone right down the garden path to psychoanalysis. With theirideas, you can (and probably will!) spend forever chasing after the right insights aboutyour gruesome, deprived past, getting your anger out to the proper degree, finishingoff that last little bit of grief and pain work, and draining off the dregs of your “issues”and your “stuff.” It can be satisfying and fun to indulge in that form of “therapy,” andquite dramatic. If you choose to spend your time looking backward, however, you maynever change what you can change: your current behavior. In this book we will showyou ways to change what you can change, namely your current disturbances andaddictions, and to accept what you cannot change, including your past, your family,and your genes.

If you say, “I have to complete my Dysfunctional Family of Origin work” (before Ican change my current behavior), you may be slipping dangerously close to coppingout. Parent-bashing and past-blaming may give you a feeling of vindication, but dothey really help? By blaming others, you still avoid making real changes in your behaviornow. Why so?

Our guess is that there are two likely reasons why you (and millions of others) maytake your Inner Child of the Past much too seriously:

1. When you bash your parents and your past (and what normal person hasn’t?), youbelieve that people who (you think) behave badly, your parents for instance, are

262 Albert Ellis

therefore bad people. If you overgeneralize in this way, you make yourself hostileand self-pitying. Because your Belief System generates the hostility and poor-mefeelings, there is no end to those feelings. You can never get the bad emotions “allout” because you yourself, though unknowingly, recreate more of them by focusingon the damning ideas behind them. Blaming your parents or your past experiencespromotes the idea that external people, places, events, and conditions “caused”your (past and present) disturbed feelings and actions. Moreover, damning othersalso encourages you to damn yourself for your past, present, and future failings.

2. When you bash your parents, your past, and your present environment, you tendto believe that it is easier to blame others and outside forces than to change yourself.We would all like to believe that if we achieve the great insight, namely, that ourparents were mean to us and gave us our screwed-up, “wounded” Inner Child, itwill cure us. Most people like to believe that if they have a good cry, and wail andthump with their foam rubber bats and cling to teddy bears as we’ve seen themdo on public television, all their hurt will go away, they will be healed and mended,and they won’t have to work one day at a time. Lots of luck with that one! Refusalto work and be uncomfortable drives addictions. Screaming about past, present,or future discomfort feeds addictions.

You probably will feel better, at least spent and exhausted (just as after any physicalexercise), after a blame session. You very likely will not get better because you do notDispute, challenge, and change the core, crazy making ideas contained in your stinkingthinking and irrational Beliefs. The Freudian Inner Child therapy approach is extremelyinefficient and time-consuming when it works at all. Further, blame sessions may makeyou worse over the long -term, because they give you still more practice at the crazy-making stinking thinking. Haven’t you practiced it enough already? It’s time to Dispute,challenge, and change those irrational Beliefs (iBs) and self-defeating behavior, and geton with your life.

Even if your family members helped you behave badly, do they need to be in treatmentor even to change at all before you can change? No. Family therapy is important—wedo a great deal of RET couples and family therapy ourselves. Most people were rearedin a family, and most adults still live as part of a family, though often a nontraditionalfamily. It can be quite important to learn to listen better, communicate better, negotiatebetter, and assert oneself better with one’s family members. At times, too, it helps youto try to motivate family members to change. But, alas, some of them refuse to or areunable to do so.

It may, of course, help you if your family members are in treatment or in self-helpgroups with you. Their obnoxious behavior at A (the Activating Events or Adversitiesof your life) may often be the occasion for your decision (B) to destructively drink (C).If your family members did straighten up and fly right it wouldn’t hurt. However, itis not necessary for them to do so for you to work on yourself. Your family membersalso may show you times that they did try to influence you constructively and youwarded off their efforts. Just how responsible were they for your behavior then? Theymay frequently claim that your drinking caused them to behave obnoxiously, and thatyou should change first. However, it is not necessary for you to change for them to behappy. They are responsible for their choices and their feelings.

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The Search for Genetic Causes of “Alcoholism”

How successful has been the search for genetic causes of “alcoholism”? You probablyhave seen newspaper articles and heard experts on TV talk shows firmly stating that“alcoholism” is inherited. Writers in the popular press and in the “alcoholism” treatmentindustry, not biologists or geneticists, advance the extreme biological theory that certaingenes cause you to become “alcoholic.”

Biologists and geneticists, however, tend to see the evidence for biological contribu -tions as slim.

Some studies of adopted children and twins suggest that people may have underlyingbiological reasons for developing at least some kinds of alcohol problems. Even in thesestudies, however, only a minority of the “alcoholics” had an “alcoholic” for either parent.In fact, most “alcoholics” had neither parent a problem drinker. In addition, mostpeople with alcoholic parents did not become “alcoholic” themselves. Further, peoplewho come from the same basic gene pool, for example, Native Americans and Eskimos,on the one hand, and Chinese–Americans, on the other hand, differ widely in theirrates of “alcoholism.”

Marian, a forty-two-year-old teacher, came to my (AE’s) therapy group after twelveyears of psychoanalysis, three years of recovery meetings, and eight months in an AdultChild of an Alcoholic group. Although she had indeed stopped her daily drinkingpattern at about age forty, she still had a weekend binge about once a month and neverlost the thirty extra pounds of stomach and hip fat she kept planning to lose.

In group, Marian kept whining and wailing about her “dysfunctional familyupbringing” because her mother and father were both “serious alcoholics” and her twoolder brothers took everything from pot, to heroin. Seeing them, continually under theinfluence, she insisted, “naturally made me feel unloved and abandoned, and drove meto alcohol and Quaaludes when I was a sophomore in high school. How can I ever beexpected to completely stop drinking with a family background like that? I have a lotof stuff to process.”

For the first several sessions of RET group therapy, the other group members werepatient with Marian and tried to get her to stop her incessant whining. No dice. Finally,Kyle, who hadn’t drunk in the two years after he got into alcohol-related trouble,became a little impatient. “Look! I’ve been listening to this cop-out complaining ofyours for a couple of weeks. Frankly I’m sick of it! So what if your stupid family dranklike fish and used every drug under the sun? Well, mine didn’t, so I can admit that Ichose to drink. I don’t have to blame others. My parents were both Seventh-DayAdventists, pillars of the church. The most respectable people in town. So were all myaunts, uncles, grandparents, and my brothers and sisters. I always hated being squarelike them. I couldn’t stand it! I did everything I could to rebel and be different. So whatdid I do? Started drinking when I was fourteen, got in with the drinking crowd atschool. I kept it up through college. I never stopped till I had the accident and crippledsomeone. How come my highly functional family upbringing didn’t keep me fromdrinking?”

“Yes,” chimed in Jo, a thirty-two-year-old attorney. “Kyle’s right. You think yourfamily was dysfunctional! Mine was Irish Catholic on both sides, but hardly any ofthem went to church. No pot, no coke, nothing like that. Just good old Irish whisky.

264 Albert Ellis

If a single day passed without a drunken brawl or some episode, I don’t remember it.Some times when I’d get home from school, I’d find two or three of them passed outor at least nursing a hangover. My mother’s brother and sister, who never married,lived with us, and my dad’s parents and one of his brothers lived next door. They’reall still alive and they’re all still drinking! So, did I become a basket case who had todrink every time I had a problem? Exactly the opposite. I hate drinking. If I have oneglass of eggnog at Christmas or a sip of champagne on New Year’s Eve, that was a bigdrinking year for me. About the only good thing I got out of my childhood was toknow better than to drink too much. So you should admit that you’re responsible forbeing a drinker.”

Three other members of Marian’s RET group also showed her that their earlychildhood traumas had little to do with their present crooked thinking and emotionalproblems. They urged her to take responsibility for her own drinking and upsets. Withinthe next five months Marian made good progress in this respect. She decided to graduatefrom and quit her Adult Child of an Alcoholic group, stopped bingeing, and got onwith her life.

Many thousands of chronic “alcoholics” and other dyed-in-the-wool addicts have decided to stop the addiction and have made that decision stick. This would not be possible, if inborn tendencies were the only cause of the addictive behavior.Addiction comes from a thinking, feeling, planning, plotting, and scheming humanbeing who wants and insists upon getting certain feelings, who steadfastly refuses to feeluncomfortable without alcohol and who may believe alcohol is necessary for him or herto function.

It is possible some day that a grouping of genes will be discovered that contributessignificantly to one’s tendency to develop “alcoholism.” Such a finding could proveimportant for it might lead to new treatments. However, if brain chemicals “caused”your addictions, wouldn’t it be quite a coincidence that the chemicals changed just atthe time you joined an antiaddiction group like AA, Narcotics Anonymous, RationalRecovery, Women For Sobriety, Men For Sobriety, or Secular Organizations forSobriety?

We take the position that it is likely that certain people have more of a talent thanothers for developing a heavy drinking problem. “Their talents may be inborn, but itis unlikely that it is anything simple, such as their rate of metabolizing alcohol or theirblood alcohol levels.” It makes no practical difference what your particular inborn,nature-given talent is, however, so long as you assume that you have some responsibilityfor using or not using that talent.

A poor alternative to these biological explanations is blame and moralizing. Peoplethink they have to damn themselves if they admit that they choose to drink. The desireto avoid self-blame fuels their Belief that scientists have truly found genetic causes of“alcoholism.” With RET, as we show below, you can choose to accept responsibilityfor what you do without blaming yourself as a person. When I (EV) encounter clientswho are devoted to the idea that they inherited so many “alcoholic” genes that theytherefore are unable to stop drinking, I confront them, using an example from theirown history. For instance, “You mean to tell me a disease, or your genes, hid the liquorbottle under the car seat to keep the highway patrol officer from seeing it? Are you surethat wasn’t you?”

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Yes, we may indeed find genetic contributors to the tendency to persist at drinkingheavily. But contributors contribute; they don’t make you do anything. If they do, youare out of luck—aside from an actual miracle. AA may say, “Expect a miracle,” but wesay, “Don’t wait for one. Set about helping yourself. Keep God in reserve to change thethings that you truly cannot change. You do not need God to pull your hands and yourmouth away from alcohol. You can do that job yourself.”

Biological theories of “alcoholism” may contribute to your disempowerment, to yourgiving up the responsibility and power that you do have. You may wrongly think thatif compulsive drinking has any biological, biochemical, or genetic basis, it proves youcannot possibly stop it. But all human behavior has a biological, biochemical, or geneticbasis: Our bodies are nothing but chemicals. Every thought you think, every word youread on this page, every sound you hear, causes chemical changes in your body. Thiscould not happen without a genetic basis. You also inherit, as a human, a strongtendency to perceive and to think about your problem drinking. And to change yourdestructive behavior. How about using that genetic tendency?

266 Albert Ellis

Part III

Special Issues

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15 Can Rational Emotive BehaviorTherapy (REBT) Be Effectively UsedWith People Who Have DevoutBeliefs in God and Religion?

INTRODUCTION

Arnold A. Lazarus

The familiar aphorism “As you think, so shall you feel” implies that positive thoughtstend to evoke pleasant feelings, while negative thoughts are apt to have the oppositeeffect. When applied to religiosity, it comes as no surprise that those who embrace anangry God model tend to have poor mental health outcomes, whereas those who believein a loving God model are apt to enjoy more positive mental health outcomes (Clay,1996; Pargament, 1997). Thus, a question that is too ambiguous to answer is, “arepeople who have a devout belief in God and religion healthier and happier than thosewho don’t?” Clay (1996) points out, “when you look more closely, you find there arecertain types of religious experiences that seem to be helpful and several types that seemto be harmful.” Ellis, in the present chapter, refers to his “older views about devoutreligiosity being antithetical to good mental health and effective therapy,” which helater changed to “emotional health is significantly affected by the kind of religious andnonreligious beliefs people hold.”

(Of course, the obvious confound of cause and effect has not been adequatelyinvestigated, thus it is possible that some predisposition to poor emotional health alsopredisposes people to embrace the angry God model, whereas individuals with moreemotionally healthy proclivities might be more likely to gravitate to the loving Godmodel.)

Before discussing some specific points in Ellis’ article, I’d like to share two brief casehistories.

Circa 1990, Al Ellis and I were co-presenters at a seminar, and during the lunch breakone of the students asked Al if he disputes and challenges clients when they espousemystical or religious sentiments. During part of his morning presentation, Albert Ellishad emphasized that religiosity was antithetical to good mental health—so his answersurprised us. He discussed a couple who had been his clients. They very much wanteda child, but many years passed before the wife finally became pregnant. She gave birthto a delightful boy who developed into a very bright, loving, handsome, athletic, andadorable 17-year-old who was killed in a freak accident. Al went to pay his respectsand offer his condolences. One of the guests told the bereaved mother how heartbrokenshe felt for her over this senseless, horrible tragedy, to which the mother replied that

it was not a tragedy but a blessing. She explained that her son was such a wonderfuland loving person that God wanted him by his side and sent for him much sooner thanexpected. But in time, she would be together with him again. The student asked Ellisif he then attempted to dispute her wishful and irrational perception. His reply wasthat her views were highly irrational and extremely improbable, but that he would nottouch them with a ten-foot pole.

In contrast, I had treated a woman who belonged to an ultra-religious sect thatpreached highly restrictive prohibitions. Her parents were ardent believers, and she hadblindly followed their path, but it was evident that the ideas with which they hadpreempted her logic lay behind most of her anxiety and depression. She saw God asan angry taskmaster whose extended range of sins went far beyond most Judaic–Christian religions. For example, wearing any form of makeup was a sin; dancing wasstrictly prohibited; and having bad thoughts was tantamount to performing sinful acts.She believed that she was under a 24-hour surveillance by a punitive supreme beingwho scrutinized and evaluated every one of her thoughts, feelings, and actions. Peopleunder the spell and influence of this type of negativity are difficult to reach. All mymethods, techniques, and strategies went nowhere, and my focused disputations fellon deaf ears. I finally resorted to a frontal attack using “nuclear weapons.” I stressedthat if there is indeed a God, the Creator would consider her views most insulting. Theimmeasurable force that created the universe was being likened to a small-minded,petty, and nasty clergyman. The Lord had trillions of events to attend to in the vastrealms of the universe, many of which were far more cataclysmic than our mortal mindscould even begin to imagine. Why, amidst all these vital cosmic events that called forhis/her/its attention and intervention, would God bother whether she wore makeup,went dancing, etc.? I kept on the attack, even stating that it seemed that the God whomshe worshipped and obeyed was in fact the devil masquerading as a deity. These dialogs(usually monologues from me) continued week after week. I was surprised that shekept coming back for more and wondered if I was playing into masochistic needs as apunitive therapist. But slowly she began dropping her rigid and restrictive behaviors,and I was aware that she did not perceive me as attacking her; indeed, she realized that I cared for and respected her, and only her damaging ideas were my adversaries.Ideally, I would have wanted her to become a skeptic who questioned all mystical and supernatural ideas, but I was happy (because she was happy) when she withdrewfrom her religious sect and joined the congregation of a Unitarian church. At thatjuncture, further therapy seemed unnecessary. Her presenting problems—anxiety anddepression—were greatly diminished.

Ellis alludes to the impact of religious rigidity and inflexibility, citing prejudice anddiscrimination as two widespread examples. But he maintains that there are severalreligious philosophies that follow certain REBT teachings, and he refers to “a Godoriented philosophy of unconditional acceptance of others.” In this connection, he cites“Love your enemies, do good to those that hate you” (Luke 6:27); “You shall love yourneighbor as yourself” (Matthew 19:19). My understanding of what Ellis meant by“unconditional acceptance of others” is very different from those biblical injunctions.Similarly, when Ellis finds comparability in various other REBT philosophies and theirpurported God-oriented counterparts, I wonder if he was trying to make peace withreligionists because they far outnumber secularists, skeptics, and atheists. He seemed

270 Arnold A. Lazarus

to be straining to equate the REBT philosophies with God-oriented philosophies. Forexample, regarding Needing Love and Approval, he juxtaposed: (1) “It is highlypreferable to be approved of and loved by significant people and to have good socialskills, but if I am disapproved I can still fully accept myself and lead an enjoyable life”(REBT). (2) “What does it profit me if I gain the whole world and lose my soul? BecauseI love God and God unconditionally loves me, I do not need the love and approval ofother people” (God-oriented philosophy). As with Ellis’ other comparisons, I find theycontain essential elements that differ fundamentally from each other.

At a large seminar, Al and I had a spirited debate about his notions of UOA(Unconditional Other Acceptance), and I argued that there has to be a point at whichone would consider an offense so reprehensible that it would make no sense to offeror provide unconditional acceptance to the transgressor. To claim that Hitler was notevil strikes me as asinine. And who, apart from extreme Islamic followers, would careto offer Osama bin Laden their love and endeavor to do good things for him? Theupshot of this discussion led to my receiving irate emails from several of Al’s ardentfollowers.

In many of his publications and lectures, Ellis has pointed out the dangers andshortcomings of absolutism. In fact, non-absolutistic patterns of thought are one of the cornerstones of REBT. This ties in with scientific thinking, which deals withprobabilities, not absolutes. Anything that is unconditional sounds absolutistic to me.Instead of referring to unconditional self-acceptance or unconditional acceptance ofothers, it would be more in keeping with scientific principles to refer to “broad-basedacceptance,” or “profound acceptance of self and others.” A total acceptance of self andothers, including reprehensible acts of murder, torture, thievery, and the like, strikesme as rigid and absolutistic thinking. The aforementioned sounds almost identical toreligions that do not use the probabilistic language of science but rely on absolutisticnotions of faith.

It seems true that several REBT methods and philosophies are compatible with somereligious beliefs, and therefore REBT practitioners are able to help some devoutreligionists who subscribe to a loving rather than a punitive conception of their God.Nevertheless, their basic tenets are epistemologically different from each other. Towardthe end of his paper, Ellis opines that secular REBT trumps religiously oriented REBT,and he points out that “God-oriented approaches require strong beliefs in superhumanentities and all-encompassing laws of the universe that are unprovable and unfalsifiable.”

Thus, he states that, “secular REBT may be a more pragmatic and more realistic wayof thinking and of behaving than is any form of God-oriented religiosity.” One isreminded of the reputed reply to Emperor Napoleon I of France by Pierre-Simon,Marquis de Laplace, when Napoleon inquired why he hadn’t mentioned God in hisdiscourse on secular variations of the orbits of Saturn and Mars: Laplace said, “Je n’aipas besoin de cette hypothese” (I have no need of that hypothesis).

References

Clay, R. A. (1996). Psychologists’ faith in religion continues to grow. APA Monitor, 27, 48.Pargament, K. I. (1997). The psychology of religion and coping. New York: Guilford Press.

REBT and Devout Beliefs in God and Religion 271

CAN RATIONAL EMOTIVE BEHAVIOR THERAPY(REBT) BE EFFECTIVELY USED WITH PEOPLEWHO HAVE DEVOUT BELIEFS IN GOD ANDRELIGION?

Albert Ellis

Several writers on religion and psychotherapy claim that people who follow a “lovingGod” model and who see God as a partner who works with them to resolve theirproblems are less emotionally disturbed and can benefit more from “rational” systemsof therapy than religionists who have a more negative view of God. Some authors havespecifically written that rational emotive behavior therapy (REBT) includes manyreligious philosophies and that the principles and practices of REBT are similar to thoseendorsed by certain kinds of devout religionists. In this article, the author describes theconstructive philosophies of REBT and shows how they are similar to those of manyreligionists in regard to unconditional self-acceptance, high frustration tolerance,unconditional acceptance of others, the desire rather than the need for achievementand approval, and other mental health goals. It shows how REBT is compatible withsome important religious views and can be used effectively with many clients who haveabsolutistic philosophies about God and religion.

Certain rational emotive behavior therapy (REBT) practitioners have attempted todemonstrate that REBT is compatible with many religious philosophies and that it canbe used by clinicians who accept their clients’ religious orientations and show themhow their disturbance-creating beliefs can be religiously disputed. For almost 40 yearsI have known many therapists, including members of the clergy, who nicely combineREBT teachings with religious teachings and have no difficulty doing so. These recentcontributions considerably add to other attempts (Backus, 1985; DiGiuseppe, Robin,& Dryden, 1990; Hauck, 1972; Johnson, 1993; Lawrence, 1987; Nielsen, 1994; Powell,1976; Robb, 1988; Thurman, 1989) to use REBT with a religious outlook. I think thatthey will encourage other psychotherapists to do the same.

These writings have afforded me another opportunity to review some of my olderviews about devout religiosity being antithetical to good mental health and effectivetherapy and to bring them up-to-date and once again reverse some of them. BecauseI agree with Johnson, Ridley, and Nielsen (2000), and others, I had better review myformer contention that dogmatic and absolutistic religiousness—or what I called“devout religiosity”—tends to be emotionally harmful (Ellis, 1983).

A great deal of everyone’s trouble—including my own trouble—in this area seemsto be definitional. Terms like mental health and religion are omnibus terms that havemultiple meanings. So, if I say that mental health is incompatible with devout religiosity,as I have said on several occasions, I had better define my terms clearly. That, alas, isnot easy to do, because they are ambiguous terms and hard to pin down to prescribeddefinitions.

As I was about to write an article offering a tentative proposal on this topic, to mysurprise, a similar hypothesis appeared in the August 1996 issue of the APA Monitorin an article by Rebecca A. Clay (1996), “Psychologists’ Faith in Religion Begins to

Grow.” Clay noted that Kenneth I. Pargament (1997) had studied people’s use of religionto cope with major life stressors ranging from illness to war to the Oklahoma Citybombing. She wrote:

When you look more closely, you find there are certain types of religious expressionthat seem to be helpful and certain types that seem to be harmful, he [Pargament]said. In several studies involving hundreds of subjects, Pargament has found thatpeople who embrace what could be called “the-sinners-in-the-hands-of-an-angry-God” model do indeed have poorer mental health outcomes. People who feel angrytoward God, believe they’re being punished for sins or perceive a lack of emotionalsupport from their church or synagogue typically suffer more distress, anxiety anddepression, explained Pargament.

In stark contrast are people who embrace the “loving God” model. These peoplesee God as a partner who works with them to resolve problems. They view difficultsituations as opportunities for spiritual growth. And they believe their religiousleaders and fellow congregation members give them the support they need. Theresult? They enjoy more positive mental health outcomes, said Pargament.

(Clay, 1996, pp. 1, 48)

Clay also cited the findings of Lee Kirkpatrick (1997) and Richard Gorsuch (1988).They both noted that people who viewed God as a warm, caring, and lovable friendand saw their religion as supportive were much more likely to have positive outcomesand to stay free from substance abuse than those with a more negative view of God.This point has been backed by a good deal of empirical research, such as that includedin Hood, Spilka, Hunsberger, and Gorsuch (1996), and Batson, Schoenrade, and Ventis(1993).

Even before I read Clay’s article, my review of the work by the authors cited in theprevious paragraph led me to conclusions similar to those of Pargament (1997),Kirkpatrick (1997), and Gorsuch (1988). My view now is that religious and nonreligiousbeliefs in themselves do not help people to be emotionally “healthy” or “unhealthy.”Instead, their emotional health is significantly affected by the kind of religious andnonreligious beliefs that they hold.

I came close to making this same point in my 1983 article, “The Case AgainstReligiosity.” I pointed out there that absolutism is the main core of Irrational Beliefs(IBs), which, in turn, lead to disturbance. I showed that dogmatic atheists (such asdevout communists) as well as rigid religionists (such as Christian or Islamic funda-mentalists) can both be inflexible and absolutistic. Hence, they both tend to bedisturbed. I still believe that my point about connecting absolutism with disturbancehas some validity. Nevertheless, I now see that it is too general and therefore question-able. Hunsberger, Alisat, Pancer, and Pratt (1996) have also shown that religiousinflexibility and rigidity are associated with potential problems, including prejudice anddiscrimination. However, this does not mean that all rigid religionists have emotionalproblems.

Take, for example, someone who devoutly believes that she is always a good person,she deserves to get her main desires fulfilled, and she will definitely succeed at workand love if she keeps trying to do so. Take, also, another person who devoutly believes

REBT and Devout Beliefs in God and Religion 273

that he is always a bad person, that he does not deserve to get his main desires fulfilled,and that he will definitely fail at work and love no matter how hard he tries to succeed.Both these individuals are devout and absolutistic. Both are unrealistic and illogical,but will they both cope with life equally well or disturb themselves to the same extentwhen assailed by some of the grim facts of social reality? Most probably not! The firstabsolutist will most likely be happier and better adjusted than the second one. Why?Because her absolutism, though risky, will tend to help her achieve more practical, andtherefore “better,” results in Western society than will the second person’s dogmatism.

If I am right about this, absolutism is a risky philosophy for practically all people to hold. Because even if they think that they are always good and will definitely suc-ceed at work and love, social reality will frequently not accord with their absolutisticdemands, and they will therefore tend to suffer disillusionment. An absolutistic polly -annaish philosophy seems more practical than an absolutistic pessimistic and damningphilosophy and is more likely to help one cope with adversity (Seligman, 1991).Absolutism, whether religious or secular, does not always lead to emotionally unhealthyresults.

As I reflect on the research and writing mentioned earlier, I see once again that REBT,as I have said for many years, is highly compatible with liberal and nonabsolutisticreligion (Ellis, 1983, 1992, 1994a, 1994b). I now also see, however, that it can becompatible with some forms of absolutistic and devout religiosity. To make this pointclearer, let me take a plunge here and speculate how some of the main principles ofREBT are similar to some aspects, though hardly all aspects, of a dogmatic religiousview. I shall first briefly describe one of the main philosophies of REBT and then statean absolutistic, but still healthy, religious viewpoint that repeats the REBT outlook inGod-oriented language.

In the religious versions that follow the REBT philosophies that I present here, I tryto incorporate some of the attitudes that Nielsen, Johnson, and Ridley (2000) seem toinclude in their REBT-oriented work with disturbed people. I also rephrase someconcepts included in the research that they refer to (Bergin, 1983; Johnson, 1992, 1993;Johnson, DeVries, Ridley, Pettorini, & Peterson, 1994; Johnson & Ridley, 1992; Nielsen,1994). A number of other writers have also pointed out that REBT teachings cansuccessfully be used along with a religious-oriented outlook (Backus, 1985; DiGiuseppe,Robin, & Dryden, 1990; Dryden, 1984; Hauck, 1972; Lawrence, 1987; Lawrence &Huber, 1982; Powell, 1976; Robb, 1988; Stoop, 1982; Thurman, 1989). Borrowing fromall these theorists and clinicians, I have come up with the following samples of religious-oriented philosophies, including absolutistic ones, that can be compared to commonREBT philosophies. My examples of religious philosophies are largely taken fromChristian writings, but some of them are also espoused by Jewish and Islamic sources.Although this brief article does not allow me adequate space to demonstrate how most,and probably all, of these religious philosophies can be supported with specific scripturesor statements from the texts of various religions, I suspect that scriptures would largelysupport them. For example, the New Testament offers many verses that support a God-oriented philosophy of unconditional acceptance of others (e.g., “You shall love yourneighbor as yourself” [Matt. 19:19]; “Love your enemies, do good to those who hateyou” [Luke 6:27]; and “Be merciful” [Luke 6:361]. A table that compares some REBTphilosophies with their God-oriented counterparts appears in the Appendix.

274 Albert Ellis

As can be seen by my attempts to restate some of the basic REBT philosophies inGod-oriented form, people who tend to follow the teachings of REBT can presumablyalso hold absolutistic religious views that overlap with their religious concepts. Mycontention would therefore be that anyone who takes the kind of religious outlook thatI have stated can also be “rational” in the sense that REBT defines rational, that is,having self-helping beliefs, feelings, and behaviors. In this sense, therefore, REBT anddevout religiosity are hardly the same, but they can at least at times be compatible.

If I am right about this, we have a possible explanation for the fact that a goodnumber of members of Christian, Jewish, and other clergy have little trouble in usingREBT principles in their counseling and why many clinicians who favor REBT have notrouble believing deeply in some deity-oriented kind of religion. On the other hand,many devout religionists who adhere to negative and punitive views of God and theuniverse may rarely use REBT in their own lives or with their clients, pupils, andparishioners.

The question still arises: If REBT is compatible with many religious views, will peoplewho use it gain better emotional health and less disturbance if they are purely secularand not also religious? The answer may well be that many secularist clients and self-helpers will benefit more from REBT when it is not combined with God-oriented viewsbecause of their nonreligious convictions. I would guess that both secular humanistsand religious humanists may significantly benefit if they strongly and persistentlypractice REBT, because most humanists follow the REBT philosophies that I havedescribed.

My personal view is that secular REBT has several advantages over religiously orientedREBT and is likely to help those who adopt it achieve a more elegant, lasting, andthoroughgoing solution to their emotional and behavioral problems. This is because Ithink that God-oriented approaches require strong beliefs in superhuman entities andall-encompassing laws of the universe that are unprovable and unfalsifiable. On theother hand, secular-oriented REBT makes fewer unfalsifiable assumptions abouthumans and the world. It is more closely related to checkable observations of howhumans operate, how they manage to live happily and less happily, and what can bedone to help them function less disturbedly. Therefore, secular REBT may be a morepragmatic and more realistic way of thinking and of behaving than is any form of God-oriented religiosity.

On the other hand, several studies such as those summarized by Larson and Larson(1994) and Gorsuch (1988) have shown that religion is associated with a decrease incriminal activity, suicide, drug abuse, and other kinds of serious self-destructivebehavior. So, some evidence exists that God-oriented religiosity may lead to realisticself-helping thinking and action (Propst, Ostrom, Watkins, Dean, & Mashburn, 1992).Few of the positive studies, however, have included consideration of religious absolut -ism, fundamentalism, and rigidity.

Conclusion

Although I have, in the past, taken a negative attitude toward religion, and especiallytoward people who devoutly hold religious views, I now see that absolutistic religiousviews can sometimes lead to emotionally healthy behavior. As several studies have

REBT and Devout Beliefs in God and Religion 275

shown (Batson et al., 1993; Donahue, 1985; Gorsuch, 1988; Hood et al., 1996;Kirkpatrick, 1997; Larson & Larson, 1994), people who view God as a warm, caring,and lovable friend, and who see their religion as supportive are more likely to havepositive outcomes than those who take a negative view of God and their religion.

Rational emotive behavior therapy (REBT) has been found by many religiouslyoriented therapists, including Christian, Jewish, and Islamic practitioners, to be quitecompatible with religious views. Accordingly, I have attempted, in this article, to describesome of the basic constructive philosophies of REBT and to indicate how they are similarto and compatible with basic religious philosophies. This appears to be particularly trueof some of the REBT and benevolent religious philosophies of self-control and change,unconditional self-acceptance, high frustration tolerance, unconditional acceptance ofothers, the desire rather than the dire need for achievement and for approval, theacceptance of responsibility, the acceptance of self-direction, the acceptance of life’sdangers, the philosophy of nonperfectionism, and the philosophy of acceptingdisturbance. There are many remarkable similarities in some of the major religious andREBT attitudes.

Although we cannot empirically investigate human processes that are attributed toGod and other supernatural elements, we can research what will tend to happen topeople who devoutly believe in God and in absolutistic religious concepts. So, by allmeans, let us do a great deal more research into the outcome of using REBT withreligious and nonreligious individuals.

References

Backus, W. (1985). Telling the truth to troubled people. Minneapolis, MN: Bethany House.Batson, C. D., Schoenrade, P., & Ventis, W. L. (1993). Religion and the individual. A social-

psychological perspective. New York: Oxford University Press.Bergin. A. E. (1983). Religiosity and mental health: A critical reevaluation and meta-analysis.

Professional Psychology: Research and Practice, 14, 120–184.Clay, R. A. (1996, August). Psychologists’ faith in religion continues to grow. APA Monitor, 27,

48.DiGiuseppe, R., Robin, M., & Dryden, W. (1990). On the compatibility of RET and Judeo–

Christian philosophy: A focus on clinical strategies. Journal of Cognitive Psychotherapy: AnInternational Quarterly, 4, 355–367.

Donahue, M. J. (1985). Intrinsic and extrinsic religiousness: Review and meta-analysis. Journalof Personality and Social Psychology, 48, 400–419.

Dryden, W. (Ed.) (1984). The work of Howard S. Young [Special issue]. British Journal of CognitivePsychotherapy, 2.

Ellis, A. (1983). The case against religiosity. New York: Institute for Rational Emotive Therapy.Ellis, A. (1992). My current views on rational emotive therapy (RET) and religiousness. Journal

of Rational Emotive and Cognitive-Behavior Therapy, 10, 37–40.Ellis, A. (1994a). My response to “Don’t throw the therapeutic baby out with the holy water”:

Helpful and hurtful elements of religion. Journal of Psychology and Christianity, 13, 323–326.Ellis, A. (1994b). Reason and emotion in psychotherapy (Rev. ed.). New York: Birch Lane Press.Gorsuch, R. L. (1988). Psychology of religion. Annual Review of Psychology, 39, 201–221.Hauck, P. A. (1972). Reason in pastoral counseling. Philadelphia, PA: Westminster.Hood, R. W., Spilka, B., Hunsberger, B., & Gorsuch, R. (1996). The psychology of religion (2nd

ed.). New York: Guilford Press.

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Hunsberger, B., Alisat, S., Pancer, S. M., & Pratt, M. (1996). Religious fundamentalism and religiousdoubts: Content, connections and complexity of thinking. International Journal of the Psychologyof Religion, 6, 39–49.

Johnson, W. B. (1992). Rational emotive therapy and religiousness: A review. Journal of RationalEmotive and Cognitive-Behavior Therapy, 10, 21–35.

Johnson, W. B. (1993). Christian rational emotive therapy: A treatment protocol. Journal ofPsychology and Christianity, 12, 254–261.

Johnson, W. B., & Ridley, C. R. (1992). Brief Christian and non-Christian rational emotivetherapy with depressed Christian clients: An exploratory study. Counseling and Values, 36,220–229.

Johnson, W. B., DeVries, R., Ridley, C. R., Pettorini, D., & Peterson, D. (1994). The comparativeefficacy of Christian and secular rational emotive therapy with Christian clients. Journal ofPsychology and Theology, 22, 130–140.

Johnson, W. B., Ridley, C. R., & Nielsen, S. L. (2000). Religiously sensitive rational emotivebehavior therapy: Elegant solutions and ethical risks. Professional Psychology: Research andPractice, 31, 14–20.

Kirkpatrick, L. A. (1997). A longitudinal study of changes in religious belief and behavior as afunction of individual differences in adult attachment style. Journal for the Scientific Study ofReligion, 36, 207–217.

Larson, D. B., & Larson. S. (1994). The forgotten factor in physical and mental health: What doesthe research show? Rockville, MD: National Institute for Healthcare Research.

Lawrence, C. (1987). Rational emotive therapy and the religious client. Journal of Rational EmotiveTherapy, 5, 13–21.

Lawrence, C., & Huber, C. H. (1982). Strange bed fellows? Rational emotive therapy and pastoralcounseling. Personnel and Guidance Journal, 61, 210–212.

Nielsen, S. L. (1994). Rational emotive therapy and religion: Don’t throw the therapeutic babyout with the holy water! Journal of Psychology and Christianity, 13, 312–322.

Nielsen, S. L., Johnson, W. B., & Ridley, C. R. (2000). Religiously sensitive rational emotivebehavior therapy: Techniques, theory, and brief excerpts from a case. Professional Psychology:Research and Practice, 31, 21–29,

Pargarment, K. I. (1997). The psychology of religion and coping. New York: Guilford Press.Powell, J. (1976). Fully human, fully alive. Niles, IL: Argus.Propst, L. R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Comparative efficacy

of religious and nonreligious cognitive-behavioral therapy for the treatment of clinicaldepression in religious individuals. Journal of Consulting and Clinical Psychology, 60, 94–103.

Robb, H. (1988). How to stop driving yourself crazy with help from the Bible. Lake Oswego, OR:Author.

Seligman, M. E. P. (1991). Learned optimism. New York: Knopf.Stoop, D. (1982). Self-talk: Key to personal growth. Chicago, IL: Revell.Thurman, C. (1989). The lies we believe. Nashville, TN: Thomas Nelson.

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APPENDIXA Comparison of Some Rational Emotive Behavior Therapy (REBT) Philosophies andTheir God-Oriented Counterparts

REBT philosophy God-oriented philosophy

Self-control and change

Because I often make myself undisciplined God gave me some degree of free will and and self-defeating by demanding that I the ability to think for myself and control absolutely must have immediate gratifications, myself, and I can, with God’s help, use this I can give up my short-range “needs,” look for ability to discipline myself. God helps thosethe pleasure of today and tomorrow, and seek who help themselvesout life satisfactions in a disciplined way.

Unconditional self-acceptance (USA)

I can always choose to give myself USA and My God is merciful and will always accept see myself as a “good person” just because I me as a sinner while urging me to go and am alive and human—whether or not I act sin no more. Because God accepts the well and whether or not I am lovable. Better sinner, though not his or her sins, I can yet, I can choose to rate and evaluate only accept myself no matter how badly I my thoughts, feelings, and behaviors but not behave.give myself, my essence, or my total being a global rating. When I fulfill my personal and social goals and purposes, that is good, but I am never a good or bad person.

High frustration tolerance

Nothing is terrible or awful, only at worst With God’s help, I can weather the worst highly inconvenient. I can stand serious stress. If I worship God and frustrations and adversity, even though I uncomplainingly accept life’s tribulations, never have to like them. I will cope better with them.

Unconditional acceptance of others

All humans are fallible, and therefore I can My God and my religion tell me to love myaccept that people will make mistakes and enemies, to do good, and pray for them. do wrong acts. I can accept them with their Blessed are the merciful. mistakes and poor behaviors and refuse to denigrate them as persons.

Achievement

I prefer to perform well and win approval Because I am one of God’s children, I am a of significant others, but I never have to do good person and do not have to accomplish so to prove that I am a worthwhile person. anything to prove myself. Although

rigorous adherence to the rules andsacraments of my religion and obedience toGod are desirable, I will be a worthy personeven if I do not have any notableaccomplishments.

278 Albert Ellis

Needing approval and love

It is highly preferable to be approved of and What does it profit me if I gain the whole loved by significant people and to have good world and lose my soul? Because I love God social skills, but if I am disapproved I can still and God unconditionally loves me, I do not fully accept myself and lead an enjoyable life. need the love and approval of other people.

Accepting responsibility

It is hard to face and deal with life’s difficulties God and my religion ask that I face life’s and responsibilities, but ignoring them and difficulties and responsibilities, no matter copping out is, in the long run, much harder. how hard I may find it to do so. My soul Biting the bullet and facing the problems of will suffer if I am a sluggard but will be life usually becomes easier and more rewarding abundantly gratified if I am diligent and if I keep working at it. responsible.

Accepting self-direction

I prefer to have some caring and reliable I have my own resources to help me take people to depend on, but I do not need to be care of myself, but I also have God to rely dependent and do not have to find someone on and to help me.stronger than me to rely on.

Ability to benefit from and change the past

No matter how bad and handicapping my When I am united with God, I live in a newpast was, I can change my early thoughts, world. The older order has gone, and a feelings, and behaviors today. I do not have new order has already begun for me.to keep repeating and reenacting my past.

Accepting life’s dangers

Life has many possible dangers, discomforts, God is with me and will show me how to and ailments, but I never need to worry deal with the dangers, discomforts, and obsessively about them. Continual worry ailments that may plague me. I need not bewill not help me to solve dangerous problems, anxious about anything if, with prayer and will often interfere with my solving them, and petition, and with thanksgiving, I present even contribute to my making them worse. I my problems to God. Faith in God will can make myself concerned and cautious calm my anxieties.without indulging in obsessive worrying if I give up my demands that my life be absolutely safe and secure at all times.

Nonperfectionism

Doing things perfectly well may be advantageous, Only God is perfect. I am merely a human, but I am far from being a perfect person. So, I not a god, and I can therefore try to do had better try to do well but not think that I well but not demand that I do perfectly have to do perfectly well. No matter how well.desirable perfection may be, it is never necessary.

Accepting disturbance

My disturbed feelings, such as anxiety and God will accept me with my disturbed depression, are quite uncomfortable but they feelings, such as anxiety and depression, and are not awful and do not make me a stupid help me to successfully uproot them. If I am person for indulging in them. If I see them as really disturbed, God’s will will be done, hassles rather than as horrors, I can live with and I can therefore handle my disturbance.them more effectively and give myself a much better chance to minimize them.

REBT and Devout Beliefs in God and Religion 279

16 Will the Real Sensuous PersonPlease Stand Up?

INTRODUCTION

Joel Block

A recent study at Ohio University found that nearly two thirds of restaurants fail inthe first three years. Why do you think so many restaurants go under? And how doesthe restaurant business relate to Dr. Ellis’ article, “Will the Real Sensuous Person PleaseStand Up” that follows my commentary? There is a definite connection. People eat,and, because they eat, some erroneously conclude that they are therefore expert enoughto open a restaurant and serve food to others. These are typically the people who havethe highest probability of failing in their venture.

Although the numbers aren’t quite the same—everyone eats, but not every personhas sex—the majority of adults are sexual, at least to some degree. A number of thosesexed-up adults, likewise, think that, as they are actively sexual, they too are expertsand can enlighten others on sexual matters. They write books, post blogs on the Internet,and may even develop a reputation as a “sexpert.”

Indeed, as Dr. Ellis points out in his article, some of these so-called sexperts sellmillions of books, often misinforming their readers on a grand scale. What’s more,some of these self-proclaimed sexperts even have bona fide degrees that falsely boostthe confidence of their unwitting readers and subscribers. It is likely that moremisguided and misleading nonsense has been written about sexuality than almost anyother subject, save religion.

Along comes Dr. Albert Ellis, a psychologist who leads the very short list of the mostinfluential members of the mental health professions in the twentieth century. Al Ellis,who died at the age of 93 in July 2007, was the real thing, in spades. In “Will the RealSensuous Person Stand Up,” Dr. Ellis offers a sharp-eyed critique of some of the best-selling sex books ever published.

I was three years out of doctoral studies when I met Dr. Ellis. Those three years werean early career whirlwind. Initially, there was a year as a psychologist coordinating themental health services at the adolescent remand shelter on Rikers Island. That was theyear that brought the realization of how much I needed to learn. It was also the yearthat I vowed to eventually find work that I enjoyed. Or, at the very least, a job thatallowed me to go out to lunch! From there, I threw myself into workshops, seminars,and whatever I could find, including six months of intensive training and supervision

in Gestalt therapy, a year of analytic supervision (at the Jamaica Center for Psycho-therapy in New York, where I worked part time), and smaller time allotments topsychodrama, primal scream (yes, I sampled that also!), and, of course, I participatedin the touchy feely encounter group movement that was de rigueur in the early 1970s.

After feasting on every morsel of therapy training I could find without satisfying myhunger, I began the postdoctoral fellowship at Dr. Ellis’ Institute. Despite having astellar graduate-school experience (Syracuse University) and having immersed myselfin the therapeutic flavors of the time, I still did not feel that I had as firm a grasp onthe therapy process as I desired, no less sex therapy. My two years at the Institute—owing to my work schedule, running a drug rehab program during those years, I did20 hours a week at the Institute rather than usual 40 hours in one year—proved to bea major career enhancement.

In fact, although the smorgasbord of therapy approaches I experienced prior to myfellowship with Dr. Ellis was interesting, none of the experiences even scratched thesurface of sex therapy. In contrast, Albert Ellis scrutinized the sexual literature, bothprofessional and commercial, with wit, intelligence, and a sharp eye for nonsense. Not only did he share his thoughts and question ours, the fellows, he served as a modelas he fought against the self-anointed guardians of our sexual morality, those self-righteous zealots who bound (and gagged!) sexual behavior to religious mores. Dr. Elliswent after those who felt that the rest of us needed their guidance to avoid sin. Theirguidance amounted to following rules according to their particular self-righteousmoralistic doctrine. When I think of a contemporary example of a sexual rule maker,“Dr. Laura,” whose mission in life seems to be protecting us from our sexual selves,comes immediately to mind.

Responding to the self-appointed experts and religious zealots with his finely honedpoint of view—that sex between consenting adults was not sinful, did not have to involveintercourse to be legitimate, and didn’t have to be experienced in a specific way, andthat, good heavens, sex did not have to be inculcated with guilt—was something I hadnever been exposed to in any previous training. Indeed, Dr. Ellis was making a strongcase for a liberal view of sex during the McCarthy era. His book Sex Without Guiltcaused quite a stir when it came out in the 1950s. Thinking back to those times, it wasa truly radical look at sexuality, with a bold title that, unlike many books, kept itspromise. Dr. Ellis took more than a few arrows with that publication, but he neverveered from his course; all of his professional life, he fought fraud and hypocrisy inmany areas, including one of our most sensitive, sexuality.

Although many people are very grateful for Dr. Ellis’ work as a strong, stalwart, andintelligent voice fostering a humanistic view on sexual ethics and morality, my gratitudegoes further. Beyond Dr. Ellis’ philosophic take on sexuality, there is his clear teachingvoice. I recall, during my time at the Institute, Dr. Ellis explained and taught a varietyof proven techniques for treating a wide variety of sexual dysfunctions in a mannerthat made for confident application. Interestingly, a number of years ago, I recall readinga report noting that even therapists trained in marital therapy often did not broach theissue of sexuality with the couples they treated and were at some degree of loss if thecouple themselves brought up sexual issues. Aspiring to specialize in couple therapy, Iappreciated that Dr. Ellis was assisting me to stand apart from the crowd by helpingme to put together a valuable tool bag of sexual techniques for working with couples.

Will the Real Sensuous Person Stand Up? 281

Even that, filling my treatment bag with a wide range of techniques for addressingsexual complaints, is not the source of my major gratitude to Dr. Ellis. I might mention,before I continue with Dr. Ellis’ major contribution to my career (and to thousands ofothers’), that we didn’t always agree. There were the small things, things I playfullyreminded him of when I visited him in the rehabilitation facility near the end of hislife, when he was ailing and had been illegally removed from his own institute by aband of psychologists he would have eaten for breakfast in his earlier years. “Al,” I said,“remember all those times when I teased you for using strong language, like ‘fuck’repeatedly when giving a talk to a bunch of Hadassah women?” I continued, “You haveimportant things to say and they miss it. All they talk about is your language!” Duringthose times, Al would at first make a (thin!) case and then relent. “Okay,” he wouldsay, “next time.” Of course, next time he would do the same thing.

In a more serious vein, I don’t agree with what I consider Dr. Ellis’ cavalier attitudeabout the impact of childhood experiences on later life. He doesn’t quite say, “Get overit,” but he comes too close for my liking. I also think that people coming to treatmentwant to feel validated; they are usually hungry for an empathic response to their plight.This doesn’t equate to agreeing with them, but rather demonstrating an understandingof their experience. All of the fellows, myself included, were in group therapy with Al,listened to numerous therapy tapes with his patients, and co-led a therapy group withhim on a weekly basis. This exposure gave me the distinct impression that Al was typicallyitching to get down to business and may have been more predisposed to say, “Stop thewhining,” than to empathize. Actually, I never heard him quite say that, but he couldbe pretty tough and not particularly empathic.

But let’s return to what I consider one of the biggest gifts Dr. Ellis gave me andthousands of others, who passed it on to yet thousands of others. Given, it is importantto avoid being judgmental, not only in word and deed, but authentically, in attitudeas well. Al Ellis was an extraordinary model of an open-minded thinker who wasunusually acceptant of human fallibility. He was also exceptionally knowledgeable aboutsexuality, another critically important ingredient for a sex therapist. And, of course, itis also important for sex therapists to be knowledgeable about the techniques that aremost useful for addressing the common sexual complaints of men and women. Again,Dr. Ellis was a wonderful teacher of those techniques, many of which were his own,original invention.

Those contributions were enormously beneficial in my work as a couple and sextherapist. However, I am forever grateful that, as a result of my years with Dr. Ellis, Iam not one of those sex therapists who solely depend on technique and beingknowledgeable about sexual complaints. Dr. Ellis helped me to become a sex therapistwith an understanding of the dynamics that underlie sexual complaints; he provided atheory of personality and couple dynamics to refer to in my treatment approach. Onceagain, I do not swallow it whole. I have also drawn from systems theory, psychodynamictheory, and from traditional behavioral approaches.

I credit the strong background I gained during my time with Dr. Ellis with landinga position that was a long way from the lack of professional satisfaction I struggled within the early part of my career. Just a few years after finishing my fellowship with Dr.Ellis, I was appointed as a staff psychologist at the Sexuality Center of one of NewYork’s premier teaching hospitals.

282 Joel Block

Some years later, my status at the hospital was boosted to senior psychologist, andI became the supervisor for psychology doctoral interns. I spent nearly two decadesteaching interns, as well as treating individuals and couples in sex therapy. I had comefull circle—hitting the sweet spot, doing what I loved and doing it well—and passedalong the invaluable expertise that I was so fortunate to have gleaned from a therapeuticgenius. Like a good wine, Dr. Ellis’ comprehensive approach to sex therapy has stoodthe test of time; it is as contemporary today as it was more than half a century ago,when he initially began taking his formulations public and calling out for a humanisticview of sexuality.

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WILL THE REAL SENSUOUS PERSON PLEASESTAND UP?

Albert Ellis

The public’s view of the Sensuous Person is (as the public’s view of many things is)exceptionally confused. One would think that before “J”—known to her intimates asJoan (“Terry”) Garrity—started the Sensuous Woman on her way to fame and infamyin the closing months of 1969, no one had ever heard of sensuousness, sensuality, oreven plain damned sexuality. And one would tend to conclude that only now, a fewyears and some twenty-five million books later, have writings on human sexual problemsand how to overcome them come into their own.

Horseshit!How-to-be-a-sexpot-in-ten-easy-lesson books have been popular in the English-

speaking world for well over a hundred years; and in the middle of the nineteenthcentury hell knows how many zillions of pamphlets and books on one “sensuous”technique alone were distributed in the United States. This was the technique of malecontinence, coitus reservatus, or karezza, first promulgated on a large scale by JohnHumphrey Noyes, and leader of the Oneida communal sex and religious colony in NewYork State. According to Noyes and his many followers, if a man read the rightdocuments—especially, Noyes’s famous pamphlet, Male Continence, which waspublished in 1872—and practiced having intercourse without any kind of ejaculationwhatever, he would not only usually prevent his female partner from having unwantedprogeny but would also warm the cockles of her heart and her vaginal tract and bringupon himself an unsurpassed degree of sensuosity and spirituality (and why not haveboth for the price of one?) that no other sexual technique could possibly equal or surpass.

This was hardly the (living) end. Havelock Ellis, a gentleman and a scholar, startedin the 1890s to collect the facts of human sexuality on a hitherto unprecedented scale; and directly and indirectly from his writings stemmed a huge spate of booksbaldly and boldly telling their readers how to roll gracefully, elegantly, and (above all!)impassionedly in the hay while waiting for the years of wedded bliss to go beautifullyby. In the 1920s, Marie Stopes’s Married Love made several English and other publishersrich, and books like H. W. Long’s Sane Sex Life and Sane Sex Living and W. F. RobielsThe Art of Love sold well and were widely discussed.

The 1930s saw Theodore H. Van de Velde’s Ideal Marriage and Hannah and AbrahamStone’s A Marriage Manual run into seemingly endless new printings, and many similarpopular sex manuals kept flowing from the presses in the 1940s and 1950s. With theadvent of cheap paperback books in the United States, some of these treatises began tosell literally millions of copies. Highly questionable books, like Marie Robinson’s ThePower of Sexual Surrender; somewhat prissy but sounder ones, such as Eustace Chesser’sLove Without Fear; and still more down-to-earth and no punches-pulled works likeLeMon Clark’s Sex and You, G. Lombard Kelly’s Sexual Feeling in Married Men andWomen, and my own The Art and Science of Love began to make the facts of life—downto the details of which coital position to use and what kind of chandelier to swing fromwhen using it—exceptionally widely known to all who could, and bothered to, read.

Meanwhile, back at the sex-research factory, things had been going sensationally well.The first time bomb planted by the Kinsey research team working at the Institute forSex Research at Indiana University was set to go off in hundreds of newspapers andpopular magazines early in 1948; and boy, did it sizzle! This was followed by the evenmore dazzling Kinsey volume on the human female in 1953; by other significant Kinsey Institute studies in the 1950s and 1960s; by the first Masters and Johnson book-length report in 1966; by the even more genital-and-soul-stirring Masters and Johnsonreport on sexual inadequacy and how to overcome it early in 1970; and by varioussupplementary full-blown sex studies by Winston W. Ehrmann, Ira L. Reiss, John Cuberand Peggy Harroff, and other hard-headed researchers.

Several more significant trends in the literature of sex became prominent in the 1960s,before the sensuous man-woman-couple-child-dirty-old-man writers began to hack awayfrantically at their typewriters. First, Helen Gurley Brown, long before she ever heardof Cosmopolitan Magazine (and certainly long before Cosmo ever heard of her!) reviveda trend which Dr. Ira S. Wile had started, but never quite managed to get off the groundway back in 1934. Wile collected a series of papers from avant-garde psychologists andsociologists of his day and titled it Sex Life of the Unmarried Adult. Virtually all hisauthors, including himself, stoutly held to the then rather quaint idea that sex was notonly good for those who were legally hitched but that it was also allowable for the greatunhitched legions as well.

Ms. Brown, with a pioneering nod favoring the Women’s-Lib movement that wasstill in the offing (her book Sex and the Single Girl appeared in 1962, while BettyFriedan’s The Feminine Mystique didn’t make its way into the bookstalls until 1964),came out with an unequivocal espousal of the single woman’s sex rights which shooksome of the strongest conservative bastions of American society. This best-sellingvolume was closely followed and solidly supported by several other popular treatisesespousing the single standard of sexual morality, or equal screwing rights for men andwomen—including my own Sex and the Single Man and The Intelligent Woman’s Guideto Man-Hunting (both published in 1963) and Eleanor Hamilton’s Sex Before Marriage:Guidance for Young Adults (1969).

Nothing in any of these books was exactly original and revolutionary—since manysimilar notions had been stoutly espoused by Victoria and Tennessee Claflin, two sisterswho espoused equal rights for women, a single standard of morality, and free love inthe 1870s; by Judge Ben Lindsey of the Denver children’s court in 1925; by Lord BertrandRussell in 1929; by me in The American Sexual Tragedy in 1954; and by many otherreputable and not so reputable writers throughout the ages. What was new andrevolutionary about Helen Gurley Brown’s advocacy of a fucking-is-allright-for-ladies-too morality in 1962 was the number of people who bought it—both literally (in thepaperback edition) and figuratively (in their own assenting noggins). This kind ofpopularity for sexual liberty is unique in modern history.

A second factor in aiding the cause of sensuousness in sex manuals has been theavailability of uncensored, hard-core sex literature, which was pioneered by Grove Pressand which rose to practically epidemic proportions by the late 1960s. What, pray, isthe poor innocent reader of sex books to conclude when, on the one hand, the highlyrespectable Dr. Van de Velde tells him that he can legitimately do anything he wantssexually, as long as he conceives of his noncoital acts as foreplay, and always finishes

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off the sex act with his sacred penis nicely ensconced in his partner’s noble vagina, withboth of them having simultaneous orgasms; while the redoubtable Marquis de Sadekeeps telling him that he and his partner can do anything they damned well please,vaginally or extra-vaginally, and that they can revel in as many orgasms as they like,simultaneously or apart? And, when Van de Velde talks about sex positions in athoroughly antiseptic and boring (albeit elaborately detailed) manner, and when thedevilish Marquis writes about it luridly and graphically enough to set the reader’s juicesoozing into his or her underthings, which of these “authorities” on human sexualitydo you think he or she is going to heed the most? And when this reader searches througha favorite paperback rack for another sex manual, do you think he or she is going tobuy another one that smacks of the saintliness of Van de Velde?

A third notable sex factor that began importantly to influence the late 1960s—andone that itself was partially encouraged by the two factors just discussed—is theWomen’s-Liberation movement. This is no place to argue the sanities and inanities ofsex egalitarianism in general, though it tends to be my bag and I have fought quite afew battles in favor of it over the past three decades. In regard to today’s public’s buyingthe concept of the Sensuous Woman, however, I think there is little doubt that it hasbeen appreciably readied for this purchase by the promulgators of the Women’s-Libmovement since the mid-1960s. For proponents of this view have now pointed outalmost ad nauseam, though hardly without truth, that woman has her own right tosexual enjoyment; that she does not have to be hung up on male supremacist views ofhow she supposedly should get aroused and come to orgasm; that her small clit is oftensexually mightier than his big sword; and that she’d better let her partner know, in nouncertain terms, what she really wants in bed and what he can do to help her get whatshe wants. Any woman who even partially subscribes to this anti-sexist point of viewcan take the vast majority of sex manuals written in the quarter of a century prior toThe Sensuous Woman and calmly and determinedly ram them up Norman Mailer’s ass.

All of which means—what? Simply that the Sensuous Man and the Sensuous Woman,who are being so ubiquitously used as models for today’s bediquette, hardly sprangfull-blown from the reproductive tracts of “J” and her imitators. Sensuous People arelargely a sign of the times. They have a history, and they will have an epilogue. Or, toput it bluntly, they’d better! For the portrait of the sensuously well-endowed and self-conditioned person which is contained in all the books that have so far been avidlygobbled up by the public on how-to-become-the-most-super-sensational-virtuosity-of-Sensuousness-you-ever-could-possibly imagine and-practice-in-your-most-orgiastic-moments is horribly full of holes. In fact, from the standpoint of modern sexual science,it is often completely full of shit. And that is why I am writing the present book: Tomake sure that some of this shit hits the fan, is centrifuged into its valid and invalidparts, and is rendered reasonably harmless instead of being allowed to sloppily remainin its present undiscriminating good-and-bad state.

Do you gather from all this that I am utterly opposed, as a somewhat venerablepsychologist, sexologist, humanist, and social scientist, to most of the concepts that aresomewhat dogmatically and bombastically propounded in the recent sheaf of popularbooks on Sensuosity? If so, you are wrong. In the main, I like these books and thinkthey have done and will continue to do considerably more good than harm. They arebasically (as certainly am I!) unpuritanical. They are unusually, especially as sex books

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go, direct and honest. They contain a considerable amount of important sex informationthat the average reader only dimly, if at all, knows. They look at human behavior witha smile and an appropriately wry sense of humor. They are exceptionally clear andreadable.

But?Ah, BUT—! Well, that will be the purpose of this book: to delineate some of the

important BUTs, citing chapter and verse to show how such books as The SensuousWoman, “M’s” The Sensuous Man, and Robert Chartham’s The Sensuous Couple havea considerable amount of salient information BUT they also have an incredible amountof misinformation. They very beautifully, for the most part, insist that no particularsex method or activity is right, proper, or “normal”—BUT they also lay downinnumerable invariant rules that trap the reader into believing that he really must actin a certain natural or superior manner, and that if he doesn’t he might as well resigncompletely from the sex race, not to mention the human race itself. They allow theindividual who reads them to individualistically be himself or herself and to refrainfrom making grandiose demands—BUT they fairly consistently set up perfectionisticrules of Sensuousness that will encourage even some of the most satisfied and satisfyingsex partners to think that they are woefully lacking in skill and that they’d better giveup that golden goal of being a truly Sensuous Person and settle, probably, for being anUnsensual (not to mention Insensitive) Clod.

Additionally and most importantly, these latter-day apologias for peak experiencesin sensuality and sexuality are surprisingly (God save the mark!) puritanical in manyof their outlooks. They are deplorably sexist in their underpinnings, even though mostof them on the surface present pious espousals of women’s rights. And they are usually—no, not even often but regularly and usually—unpsychological and antitherapeutic intheir views of what the human being is, sexually and nonsexually, and how he and shecan change to become less embarrassed, less self-hating, and more independent-thinkingin a world that still (alas!) is nauseatingly conformist and nonhumanistic.

What do I mean when I use the terms they and these books? I specifically mean thethree fabulously selling “Sensuous” books mentioned above: The Sensuous Woman andThe Sensuous Man, both published in hardcover editions by Lyle Stuart and in paperbackeditions by Dell Books; and The Sensuous Couple, published as a paperback original byBallantine Books. I also mean two other books, which never mention (in fact, in somerespects studiously avoid) such terms as sensuous and sensual, but which in some waysgot the modern sex manual craze really going and which loudly beat the drum, to theaccompaniment of vast publicity campaigns, for unadulterated sexuality—well, at leastheterosexuality.

The first of these is David Reuben’s Everything You Always Wanted to Know AboutSex. But Were Afraid to Ask, which came out several months before The SensuousWoman, broke all records for sales in its hardcover edition (with over a million copiessold in the United States within a year or so of its publication date), and is still vyingwith “J’s” book for the all-time topflight softcover sales performance. The second isDr. Reuben’s follow-up book, Any Woman Can!, which is not doing nearly so well inhardcover as his first sex blockbuster but will probably sell millions of copies inpaperback. When the total sales of these two books are finally in, their author willprobably have earned the honor of being the most widely read “sexologist” in human

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history—even though his illustrious rivals for popularity, such as Havelock Ellis, MagnusHirschfeld, Eustace Chesser, Alfred C. Kinsey, and William Masters and VirginiaJohnson, have turned out far more books and articles than he and have made somesignificant scientific contributions to the field.

Wherever page references to these books occur, they refer to the paperback editions,except for Dr. Reuben’s Any Woman Can! for which the references are to the hardcoveredition.

In addition to considering the real and spurious “contributions” to sexual scienceand sex liberation that have recently been made by the five books listed above, I couldalso consider the other important aspects of the “sensuous” movement that has occurredin the Western world during the past several years and that has been something of aprecursor of the books by Terry Garrity and her imitators and backuppers—and thatis the “touch” movement in modern psychotherapy that got its headstart at EsalenInstitute in the early 1960s and that has since spread like wildfire in encounter groupsthroughout the world. This “please touch” trend (as Jane Howard has called it) receivedits ideological start in the sex-oriented (and, alas, orgone-oriented) theories of WilhelmReich, a highly unorthodox psychoanalyst who, back in the 1930s, put some ants inSigmund Freud’s not-so-sexy pants and got unceremoniously booted out of thepsychoanalytic fold.

In the mid-1960s, Reichism was midwifed into reexistence by such stalwarts asWilliam Schutz, Bernard Gunther, Charlotte Selver, Alexander Lowen, Ida Rolf, andmany other exponents of human knead needs. Psychotherapy tended to become highlyconfused with physiotherapy; and the ground was laid (in more senses than one!) forthe Garrity–Reuben–Chartham kind of “sensuality exercises” that are so much a partof the modern screw-it-yourself books. I have, in a few professional papers and talks,commented critically on this touch-and-show movement in psychotherapy; and oneof these days I shall probably deal with it in more detail. But I shall be lucky to haveenough room in the present volume to deal with the invalidities and asininities of theSensuosity crusade alone, so I shall say relatively little about Reichian predecessors andsuccessors.

In other words: Because of lack of time and space (rather than of inclination) thecritical comments in the present volume will be limited to the five major books whichhave been the best-selling background of the Sensuous Person movement, and I shallrigorously confine myself to the distinct advantages and the enormous limitations ofthis movement. Separating the former from the latter is not easy for an untrainedmember of the public (let alone for many of the “trained” members of the sexologicaland psychotherapeutic profession!). So I shall make a serious attempt to do so in thematerial that follows.

Speaking of professional training, it is not exactly in supreme evidence in the livesof four out of the five best-selling authors whose books I am about to analyze. Dr.David Reuben may well be, as his publishers describe him, a “noted Californiapsychiatrist” (though I suspect that practically all his renown came after rather thanbefore his first book appeared). But I have searched in vain in the scientific literaturefor any wisp of an article, research project, talk, or other professional contribution thathe made to the science of sex prior to authoring Everything You Always Wanted to KnowAbout Sex. But Were Afraid to Ask.

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Terry Garrity, the author of The Sensuous Woman and co-author of The SensuousMan is a charming woman, whom I have known personally for several years and havealways found exceptionally perceptive and bright. At the time of writing her book, shewas a full-time public relations woman (and a crackerjack one at that), and had writtenonly one previous tome, which was not on the subject of sex.

I have immense respect for Terry’s book, The Sensuous Woman, have used it to helpmany of my female clients who are getting relatively little out of their sex lives, havehad it included in our publications list of books sold by the Institute for Rational Living(a public education organization which I direct), and can think of no other work thatis more useful in loosening up the sex attitudes and actions of previously inhibitedwomen. Nonetheless, she is hardly a well-trained sexologist, and it is unsurprising ifshe makes some significant omissions and errors in some of the material she presents.

“M”, the author of The Sensuous Man, has recently been revealed to me by LyleStuart, the publisher of this book, as being mainly John Garrity, Terry’s younger brother,and as partly being Terry herself. John, in his early twenties at the time of writing TheSensuous Man, has previously been a reader and an assistant editor for one of the largeNew York publishers. Since writing the book, he has been a free-lance writer. Clearly,if one judges from his and his sister’s product, he is not a professional psychotherapist,psychologist, physician, or anything else—at least, if one goes by the paucity of thesources to which he refers.

He largely quotes from Masters and Johnson—whose book, Human SexualInadequacy, appeared while he was writing his own tome. And he seems to make useof, without any acknowledgment whatever, material from my writings. He only overtlymentions me to make a snide remark about my book, Sex and the Single Man; but hethen proceeds, as far as I can discern, to adapt a considerable amount of the materialin it, as well as material from my book, The Art and Science of Love. This kind of adapting,in the field of sex manuals, is par for the course. But at least many of the other adaptersgive specific acknowledgments to their main sources. John Garrity rarely does! Anyway,his professional and sexological credentials appear to be nonexistent.

Dr. Robert Chartham, author of The Sensuous Couple, is the only legitimate sexologistamong the main writers on “Sensuousness.” His Ph.D., his publisher tells us, is in “socialscience”—whatever that is! But he has been a social worker, a sex educator, and a writerof several previous sex books; and not too long ago he wrote an incisive critique ofDavid Reuben’s Everything You Always Wanted to Know About Sex for PenthouseMagazine, in which he amply displayed his own sexological skill and Dr. Reuben’s sorrylack thereof. So of all the recent great popularizers of sexual lore, Dr. Chartham is theone who is really kosher!

This lack of professional training and experience on the part of most of the writersof recent sensuosity books is not exactly fatal. Other nonprofessionals have turned outdecent sex treatises, and professionals have certainly turned out poor ones! However,authors in the former rather than in the latter category are likely to make clear-cuterrors; and it at least behooves someone in the sexologist class (of whom there aresurprisingly few in the entire world) to review the well-received writings of those whoare not in this class. That, as noted above, is one of the main purposes of the presentbook.

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Am I a legitimate sexologist in my own right? Well, I should think so. Forconfirmation, I refer you to the biographical data on me which is printed at the endof this book. If this does not suffice, then let me add that I have written well over twohundred articles and some twenty books on sex, love, and marriage problems; I havedone about a dozen research studies in the field (and won a research award from theSociety for the Scientific Study of Sex); and I have been a well-known psychotherapist,with a specialty in sex difficulties and marriage and family counseling, for almost thirtyyears. All this could be a lot of crap, of course; but at least it is a fairly respectable,hard-earned load!

Enough of these preliminaries. Let me now, in the next several chapters, examine indetail some of the major points made in the recent fabulously selling works of Reuben,the Garritys, and Chartham, to see where they scored and where they erred. For thetruly Sensuous Person would better be highly discriminating rather than blunderbussishin the methods and traits he or she adopts to “improve” his or her sensual-sexual life.And if one unselectively employs all the techniques that are enthusiastically depictedin these best-selling books, many of which directly contradict each other, one will beas sensuous and as individualistic as a clam in a crabshell!

If you, then, would like a critique of what the “real” Sensuous Person is and is not,the rest of this book should be your cup of sex. Imitations can be quite satisfying andworthwhile. But there’s nothing like the genuine article itself. Especially if the genuinearticle is great sensuality!

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17 Should Some People Be LabeledMentally Ill?

INTRODUCTION

Irwin F. Altrows

The consummate iconoclast, Ellis considers whether to attack the icon of mental illness.His approach is revealed in the first word of the title—“Should,” for, in Ellis’ world,there are no “absolute shoulds.” Therefore, there is no absolute necessity to maintainor discard the concept of mental illness. Rather, there are “preferential shoulds”—onthe whole, either it is better to maintain the concept or to discard it. With this REBTphilosophy in mind, Ellis systematically presents pros and cons of the use of the“mentally ill” label, comparing the utility of this label with that of historical alternatives(e.g., demonic possession, sin, and evil), and with newer alternatives. Therefore, it maycorrectly be said that Ellis writes as a scientist.

However, he does not stop at a simple listing of pros and cons. Again in line withREBT philosophy, and following the writings of Korzybski (1933), he notes that theeffect of a label is not fixed but dynamic. The effect depends upon the interpretationsand evaluations that are given to the label, both by the designated person and by thosewho influence that person’s life, such as family, potential employers, service providers,and acquaintances. Therefore, it may correctly be said that Ellis writes as a philosopher.

To illustrate the above, Ellis notes that under certain conditions the “mentally ill”designation can be harmful. For example, he states (as later confirmed by Rüsch,Corrigan, Todd, & Bodenhausen, 2010) that harm can result if people so labelederroneously conclude that they are inferior and unworthy. Similarly, Ellis states (as latersupported by Minor, 1973, and Stuart, 2006) that harm can result if potential employerserroneously conclude that the labeled people are thereby dangerous, unreliable, andincompetent. Accordingly, Ellis visualizes a society that promotes appropriately benignand realistic perspectives of such terms as “mentally ill” and, perhaps more importantly,of the designated people. He promotes relevant educational programs, as well as thecontinuing evolution of language that reflects scientific progress. Therefore, it maycorrectly be said that Ellis writes as a therapist, a social activist, and—as discussedbelow—a self-fulfilling prophet.

Ironically, the excellence of Ellis’ 1967 analysis is best demonstrated by the articlethat immediately follows it (Sarbin, 1967). Sarbin had been invited to respond “Becauseof the important issues raised by Albert Ellis regarding the concept of mental illness.”

Sarbin recapitulates and elaborates on Ellis’ points, provides valuable insights into thehistory of the terms “mind” and “mental illness,” but strongly opposes Ellis’ conclusions.However, it seems that Sarbin’s opposition is based on misunderstandings and over-simplifications of Ellis’ arguments, together with a number of unproven assumptions.When these errors are remedied, there appears to be little basis to Sarbin’s objections,especially—as discussed below—in view of subsequent developments in science,rehabilitation, and social policy.

How is Ellis a self-fulfilling prophet? In his 1967 paper, describing his version of amore enlightened world, Ellis anticipates developments that have since taken place.These developments include advances in diagnosis and treatment of mental illness (seeRüsch et al., 2010) that are substantially due to Ellis’ own efforts. The philosophy andlanguage associated with Putting People First (Research and Training Center onMeasurement and Interdependence in Community Living, 2008), endorsed by healthcare professionals of many stripes, is a case in point. Consistent with REBT, PuttingPeople First recognizes that all humans are first and foremost people, and that theirdisabilities, illnesses, or other qualities do not define them. Furthermore, Ellis expressedconcern that the “mental illness” label might be interpreted as indicating that onlypsychiatrists and other physicians can treat people who have such a condition; however,partly owing to Ellis’ dissemination of REBT techniques to a wide variety of professionalsand paraprofessionals, people with mental disorders increasingly benefit frommultidisciplinary and interdisciplinary teams that treat the whole person.

Ellis’ expressed views regarding mental health issues, as applied to the areas of forensicpsychiatry and psychology, have been supported by subsequent developments. Hesupported differential disposition of people who commit crimes, based on whether theyhad mens rea (a “guilty mind”) at the time of the crime or whether they were actingunder the influence of delusions resulting from a mental illness. However, he wasconcerned that people’s civil rights not be abrogated—as has unfortunately been thecase in various places and times—as a result of their being declared “mentally ill” orgiven a similar designation. In the years subsequent to the appearance of Ellis’ paper,many jurisdictions have worked to address the above concerns. For example, in theProvince of Ontario, Canada, the judicial finding of Not Guilty by Reason of Insanity(NGRI) has been replaced by the finding of Not Criminally Responsible (NCR). Underthe former NGRI system, a “mentally ill” accused person might be incarcerated in apsychiatric hospital without proof that he or she had committed the alleged criminal act;furthermore, the person would not be released from the hospital’s (inpatient oroutpatient) care until he or she had “recovered” from the mental illness that hadpresumably contributed to the presumed criminal act. It is small wonder that manymentally disordered people who may have performed criminal actions without mensrea were nevertheless advised by their lawyers not to plead NGRI: Once in the mentalhospital system, even for a relatively minor crime, they might never get out! Therefore,many mentally disordered offenders were sent to prison, a setting totally inappropriateto their needs and incongruent with the psychological facts of their unproven offense.Under current NCR legislation, a mentally disordered accused person must first beshown in court to be the agent of a crime—just as in the case of any accused person—and the NCR verdict diverts the person from the correctional system to the mentalhealth system. Furthermore, the person is released from hospital upon determination

292 Irwin F. Altrows

that he or she no longer presents a significant danger to society, rather than releasebeing linked to recovery from mental illness. Therefore, in line with Ellis’ aspirations,accused persons in Ontario no longer lose their freedom on account of having beendeemed to have a mental disorder. In this instance and others, terms such as “mentalillness” have been largely separated from pejorative connotation and punishingconsequences, but have contributed to humane, rational treatment that benefits thedesignated person and society as a whole.

Did Ellis address all the possible pros and cons of the “mental illness” label? Probablynot, nor would he expect or demand such perfection from himself. For example, whenhis 1967 paper appeared, pharmaceutical companies may have been less influential than they are today in the development of clinical research and practice. It seems to bein the interest of these companies that as broad as possible a scope of human behaviorand experience be defined as “illness” or “disorder,” with medication a first-line treat-ment, perhaps even in cases where the best interests of the labeled person lie elsewhere.For example, some have argued that widespread diagnosis of ADHD and certain otherconditions—often followed by treatment with medication in the absence of significantsocial or environmental changes—has led to huge profits for these companies. Here,one needs to pay special attention to the concern—clearly expressed by Sarbin, as wellas others—that the social context of behavior and its control be carefully considered,and that mental health professionals beware of becoming counter-therapeutic agents.Ellis may not have fully anticipated or addressed this particular issue in the presentpaper. Rather, he has encouraged others—including readers of this tribute book—tocontinue his efforts toward development of a more rational and humane world.

References

Korzybski, A. (1933). Science and sanity: An introduction to non-Aristotelian systems and generalsemantics. Lancaster, PA: International Non-Aristotelian Library.

Minor, J. (1973). The effects of diagnostic labeling on person perception and behavior. Doctoraldissertation, California School of Professional Psychology.

Research and Training Center on Measurement and Interdependence in Community Living.(2008). Guidelines for reporting and writing about people with disabilities (7th ed.). Lawrence:RTC Publications, University of Kansas.

Rüsch, N., Corrigan, P., Todd, A. R., & Bodenhausen, G. V. (2010). Implicit self-stigma in peoplewith mental illness. Journal of Nervous and Mental Disease, 198, 150–153.

Sarbin, T. (1967). On the futility of the proposition that some people be labeled “mentally ill.”Journal of Consulting Psychology, 31, 447–453.

Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry,19, 522–526.

Should Some People Be Labeled Mentally Ill? 293

SHOULD SOME PEOPLE BE LABELED MENTALLY ILL?

Albert Ellis

The question considered is whether it is proper to label some people mentally ill inview of the social discriminations, self-denigration, interference with treatment,impeding of social progress, and unscientific close-mindedness which may ensue whenthis kind of labeling is employed. It is shown that it is not the labeling process itselfwhich is necessarily harmful, but that if such terms as “mental illness” are operationallydefined and if the individuals so described are not negatively evaluated as persons, itmay be possible to employ these terms scientifically and usefully.

For the last two decades there has been increasing objection by a number ofpsychologists and sociologists (as well as an even greater number of nonprofessionalwriters) to labeling certain people as “mentally ill” or “emotionally sick.” Thus, Szasz(1961/1967, 1966) has vigorously alleged that the concept of mental illness “nowfunctions merely as a convenient myth.” Mowrer (1960) has contended that behaviordisorders are manifestations of personal irresponsibility and sin rather than of disease.Whitaker and Malone (1953), as well as many other experiential and existentialpsychotherapists, have held that emotional disturbance is a rather meaningless termbecause practically all therapists are just about as sick as their patients. Keniston (1966)and a number of sociological writers have insisted that individual psycho-dynamics arenot nearly as important as has commonly been assumed in the creation of humanalienation and insecurity, but that our technological society itself lays the groundworkfor the growing estrangement of young people and, to one degree or another, makesus all emotionally aberrant.

The question of whether some individuals are especially “mentally ill” and shouldbe clearly labeled so is of profound importance, since it affects decision making in theareas of hospitalization, imprisonment, psychotherapy in the community, vocationaltraining and placement, educational advancement, and many other aspects of modernlife. Siegel (1966) has recently reported that high school students who are hospitalizedfor emotional disturbance or who undertake psychotherapy without hospitalization,are frequently held to be poor risks for higher education and are consequently refusedadmittance to college. Obviously, labeling a person “mentally ill” has more thantheoretical import.

To my knowledge, no dispassionate discussion of both sides of this question has yetbeen published. I shall, therefore, try to list the main disadvantages and advantages oflabeling certain people “mentally ill,” so that psychologists in general and psychothera-pists in particular may be better able to see and cope with this problem. The mainissues that have recently been raised in connection with diagnosing individuals as“emotionally sick” involve (a) social discrimination against the “mentally ill,” (b) self-denigration by disturbed people, (c) moral responsibility and “mental illness,” (d)prophylaxis and treatment of aberrant individuals, (e) social progress and emotionaldisturbance, and (f) scientific attitude and advancement in regard to labeling people“mentally ill.”

Social Discrimination against the “Mentally Ill”

There are several discriminatory practices which seem to be inevitably connected withlabeling an individual as neurotic, psychotic, or emotionally disturbed. When sodiagnosed, either officially or semiofficially, he is often discriminated against in somepractical ways—is refused jobs, kept out of schools, rejected as a love or marriagepartner, etc. This discrimination is entirely unjust in many cases, since the sick individualis not given a chance to prove that he can succeed vocationally, educationally, orotherwise. In some instances, a person who behaves unconventionally or idiosyn-cratically may be adjudged psychotic and may be forcibly hospitalized.

Consequently, his—and everyone else’s—freedom of speech may be restricted by hisincarceration or threat thereof. Siebert (1967) has noted in this connection:

The thing that has pained me for so long is that while Americans will go to extremelengths to protect a person’s right to speak, there is really very little freedom inthis country to express all of one’s thoughts. I talked to many, many people inmental hospitals who were placed there because they related some personalthoughts to a relative or to a psychiatrist. Few citizens realize how easy it is to pickup a person who has “undesirable” thoughts.

Practically all psychological labels today are inexact. What is more, they keep changingfrom diagnostician to diagnostician and from decade to decade. Thus, most of thepatients whom Freud called neurotic would today be designated as borderline psychoticor schizophrenic reaction. Yet, once a person is psychiatrically labeled, he is treated asif that label were indubitably correct and as if it accurately describes his behavior. Hisremaining inside or outside of a mental institution, being employed or unemployed,or remaining married or unmarried may depend on the particular kind of labeling doneby a given psychologist or psychiatrist who is in a certain mood at a special time andplace.

Labeling some people as emotionally disturbed tends to set up a caste system, withconsequent social discriminations. In most communities of our society, so-called healthyindividuals are socially favored over the “mentally sick.” But in some groups—Bohemian, hippie, criminal, or drug-taking groups—the reverse may be true, and thesick individual may be considered “in” and may be favored over the “square.”

As an escapee from a New York mental hospital points out (Anonymous, 1966),individuals who commit clearly illegal acts, such as trespassing on others’ property andrefusing to support their wives, may be discriminated against once they are judged tobe “mentally ill” by not being held morally responsible for these acts and not beinggiven a stipulated prison term for committing these acts, instead, being indefinitelycommitted to a mental institution. These individuals are thus deprived of their moral(or immoral) choices and of being held accountable for such choices.

Our psychiatric terminology itself, as Davidson (1958) and Menninger (1965) indicate,is highly pejorative. Referring to people with behavior problems by such designa-tions as “anal character,” “sadistic,” “castrating,” “infantile,” “psychopathic,” and“schizophrenic” hardly helps their states of mind and adds grave doubts to the attitudesof life insurance companies, social clubs, officer groups, and other organizations about

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their eligibility. Nor, as Menninger (1965) points out, is the patient, or ex-patient, theonly sufferer from this situation. An entire family can be hurt by the diagnostic labelattached to one of its members, because of the various implications such labels have in the minds of the various groups of people with whom that family comes in contact[p. 45].

With the very best intentions, then, psychologists and psychiatrists who areinstrumental in labeling individuals as “mentally ill” may unwittingly subject theseindividuals to a variety of social and legal discriminations and may seriously interferewith their civil and their human rights. And not all psychiatric intentions are the verybest! Redlich and Freedman (1966), while favoring involuntary commitment ofpsychotics in many instances, admit that “Certainly, commitments in many cases areentirely rational acts; however, in some cases there is evidence that psychiatrists andother involved persons are motivated, in part, by counteraggression toward veryprovocative patients [p. 780].” So, quite apart from the contention of groups helpingex-mental patients (during the last two decades) that many Americans have been andstill are being railroaded by their relatives into institutions when they are not trulydisturbed, there seems to be considerable evidence that commitment procedures leave much to be desired and that various discriminatory mistakes are made in thisconnection.

There is, however, another side to the story. Some individuals in our society, whateverwe choose to call them, are clearly unfit to live unattended in the community—as evenSzasz (1966) admits. Many of them should, perhaps, best be placed in regular prisons,even though today that solution is hardly ideal! Others, such as those who havecommitted no crimes but are obviously on the brink of harming themselves and/orother people, can hardly be incarcerated in jail, nor can they even properly be givendeterminate sentences in a mental hospital. If their behavior is sufficiently aberrant,they may well have to be placed in some kind of protective custody for an indeterminateperiod, and what better place do we have for this kind of treatment than a mentalinstitution?

The main point here is that labeling an individual as “mentally ill,” and thereby beingenabled to send him for therapy either in a suitable institution or as an involuntarypatient in his own community, frequently subjects him to unfair legal and socialdiscrimination. Nonetheless, many other people, and sometimes this individual himself,may be unfairly discriminated against if this kind of procedure is not in some wayfollowed. Take, for example, the case of a suicidal individual. Morgenstern (1966) states:

Since suicide is not only irrational—it punishes oneself for rage directed at others—but is also irrevocable, the psychiatrist and society have the human obligation toforce reconsideration. All of us are at times tempted to do the irrational and theirrevocable, and I would doubt that, having been stopped, we were ungrateful. [p. 41.]

The seriously disturbed person, in other words, may well be unfairly discriminatingagainst himself, even to the point of irrevocably harming himself in some major ways.Is it not, therefore, fair under these conditions to judge him ill and forcibly restrain

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him from his self-sabotaging, even at the expense of possibly discriminating againsthim in other ways?

Granted that this question may have no utterly agreed-upon, clear-cut answer, hereis another that warrants asking: Assuming that legal and social discriminations mayaccrue to the individual who is labeled “mentally ill,” is it not sometimes necessary todiscriminate against him in this manner in order to prevent him from needlesslyharming others? Mrs. Hyman Brett (1966), in a letter to the New York Times followingits publication of Szasz’ article, “Mental Illness is a Myth” (1966), puts this questionin more detail:

What about the freedom and the liberties of the relatives of the mentally ill personwho consistently refuses care? At the same time that we refuse to tamper with thementally ill person’s freedom are we not tampering with theirs? By returning thementally ill member to his family we are chaining his relations to a life of dread,despondency, and frustration. When we allow the neurotic or psychotic the freedomto reject care we are allowing him at the same time another very special freedom:the freedom to drive his family over the border line into the realm of mental illness,too. For though his condition may not be a danger to society, it is a very graveand definite threat to the emotional stability of the members of his family [p. 4].

Mrs. Brett may exaggerate here, since family members of a “mentally ill” individualmay, at least to some extent, choose whether or not to be unduly influenced by hisillness. Her general point, however, seems to have some validity. For in giving a highlydisturbed person his full civil rights, we may easily impinge upon those of others whomhe may incessantly annoy, frustrate, maim, and even kill, his behavior ranging fromplaying his radio very loudly all night to mowing down some of his neighbors with amachine gun. Just as the protection of the civil rights of Jews or Negroes does notextend to their rights to libel, injure, or slay non-Jews and non-Negroes, so may thecivil rights of highly idiosyncratic individuals have to be curtailed when they infringeupon the similar rights of not-so-idiosyncratic others.

Self-Denigration by Disturbed People

Perhaps the most pernicious aspect of a person’s being labeled “mentally ill” is that henot only tends to be denigrated by other members of his social group, including eventhe professionals who diagnose him, but also that he almost always accepts theirestimations of himself and makes them his own. This is exceptionally unfair andpernicious; even if he can unmistakably be shown to be disturbed, he is obviously notentirely responsible for being so, but has been born and/or reared to be sick and is notto be condemned for his state of being.

It is true that an individual, unless he is in a state of complete breakdown, is somewhatresponsible for his acts, since he performed or caused them and usually has some degreeof choice in doing or not doing them. Not every psychotic murders, and under the oldMcNaughten rule there was some justification for our courts holding certain disturbedpeople responsible for their crimes, as long as it could be shown that they were aware

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of what they were doing when they committed these crimes and that they had somechoice in their commission. There is no reason, however, why even thieves andmurderers have to be condemned in toto or held to be worthless persons for their mis -deeds. They are, like all of us, intrinsically fallible humans and to demand that they (or we) be infallible is unrealistic. They, moreover, are much different from and greaterthan their performances, and although we can legitimately measure and evaluate anindividual’s products, there is no way—as Hartman (1959, 1962) has shown—of accur -ately assessing his self.

Finally, when we do assess a person as a whole for his performances, we inevitablymake it impossible for him to have self-respect; for as soon as he does something wrong,which, being fallible, he soon must, we label him as bad and, thereby, strongly implythe fact that as a bad person he has no other choice than to keep doing wrong acts againand again (Ellis, 1962).

This is what frequently happens when we pejoratively label an individual “mentallyill.” Instead of indicating to him that some of his behavior is inefficient or mistaken,we insist that he is psychotic or sick, whereupon he logically concludes that he isprobably unable to do anything efficiently or right, gives in to his illness, and keepsperpetuating ineffectual behavior that he actually has the ability to change or stop. Tothe degree that he feels denigrated by the label of “mental illness,” he is likely to feelhopeless about acting in anything but a sick manner and likely to continue to act in anegative manner that is congruent with this label. Self-deprecation, as practically allpsychologists and professionals agree, is one of the main causes of disturbed behavior.Labeling an individual as emotionally ill or schizophrenic often tends to exacerbate this cause.

It must be admitted, on the other hand, that people in our society are predisposedto condemn themselves in toto when they perceive that their performances are wrongor ineffective and that one of the best ways to help them to ameliorate or stop theirself-denigration is to show them that they are basically immature or sick. They thenare likely to conclude either that they are not truly responsible for their misdeeds orthat even though they are responsible, they are not to be blamed or condemned. It isperhaps a sad commentary on our society that the only individuals who are notconsigned to everlasting Hell for their sins are little children and sick adults, but thefact is that we do largely exonerate “mentally ill” people for their misdeeds and forgivethem their sins. Until society’s attitudes in this respect significantly change, labeling aperson “ill” has distinct advantages (as well as disadvantages) in minimizing his self-denigration.

Moral Responsibility and “Mental Illness”

Mowrer (1960) and Szasz (1961/1967, 1966) has persuasively argued that if we cavalierlyand indiscriminately label an individual “mentally ill,” we are thereby glossing over thefact that he is still responsible for a good deal of his behavior, that it is quite possiblefor him to change his performances for the better, and that (in Mowrer’s terms) he isnot likely to improve his condition until he fully acknowledges his sins and activelysets about making reparations and correcting them. By focusing on the illness of certain individuals, these writers would contend, we give them rationalizations for being

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the way they are and fail to teach them how to modify their self-destructive and immoraldeeds.

Ellis (1962), Glasser (1965), Morgenstern (1966), and various other psychotherapistshave recently emphasized the point that people are personally responsible for the socialconsequences of their behavior and that unless they admit that they can largely controltheir own destinies, in spite of the strong parental and societal conditioning factors thatexisted during their childhood, they are not likely to change their ineffectual behavior.As Morgenstern (1966) points out, labeling a person as “mentally ill” and involuntarilycommitting him to a mental institution frequently “reinforces the immature wish to avoid this responsibility, by blaming the illness for failure to achieve desired goals[p. 4].”

As usual, however, there is another side to the story. Ausubel (1961) heartily concurswith Mowrer that “personality disorders . . . can be most fruitfully conceptualized asproducts of moral conflict, confusion, and aberration [p. 70],” but he seriously questionsthe notion that these disorders are basically a reflection of sin; he demonstrates thatmost immoral behavior is committed by individuals who would never be designatedas ill or disturbed and that many people who display disordered behavior are notparticularly sinful or guilty. Moreover, Ausubel points out that not all “mentally sick”persons are truly responsible for their behavior:

It is just as unreasonable to hold an individual responsible for symptoms of behaviordisorder as to deem him accountable for symptoms of physical illness. He is nomore culpable for his inability to cope with socio-psychological stress than hewould be for his inability to resist the spread of infectious organisms. In thoseinstances where warranted guilt feelings do contribute to personality disorder, thepatient is accountable for the misdeeds underlying his guilt, but is hardlyresponsible for the symptoms brought on by the guilt feelings or for unlawful actscommitted during his illness. . . . Lastly, even if it were true that all personalitydisorder is a reflection of sin and that people are accountable for their behavioralsymptoms, it would still be unnecessary to deny that these symptoms aremanifestations of disease. Illness is no less real because the victim happens to beculpable for his illness. A glutton with hypertensive heart disease undoubtedlyaggravates his condition by overeating and is culpable in part for the often fatalsymptoms of his disease, but what reasonable person would claim that for thisreason he is not really ill [pp. 71–72]?

Prophylaxis and Treatment of Aberrant Individuals

In several important ways labeling an individual as “mentally ill” may interfere withthe treatment of any behavior problem he may display and may hinder the preventionof emotional disorder. For example:

Calling a person “mentally sick” frequently enhances his feelings of shame about his“illness,” so that he defensively refuses to admit that he has serious behavior problemsand therefore does not seek help with these problems.

A person who is set apart as being emotionally aberrant may become so resentful ofthis kind of segregation that he may refuse to acknowledge his “persecutors’” efforts

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to help him and may get into hostile encounters with them and others that only serve to increase his living handicaps.

In many instances, the “mentally ill” individual is forcibly incarcerated in aninstitution where he is kept from doing many things he enjoys and where his conditionmay become aggravated rather than improved.

Labeling a person as psychotic may easily imply, to himself and those who may beable to help him, that life is hopeless and that little can be done to get him to changehis behavior. As Menninger (1965) indicates, psychological treatment today is carriedout by many people in addition to psychologists and psychiatrists, and the cooperationof family members is often urgently needed. “Schizophrenia” and “mental illness” aresuch impressive labels that they induce many people to feel that only highly trainedprofessionals, if indeed anyone, can work with sick people and to ignore the fact thatless trained individuals can often be specifically shown how to help troubled humans.

By being encouraged to label other people as sick, many of us fail to consideradequately our own problem areas. If we are not seen as being totally ill, we easilyassume that we have few or no shortcomings; when we can easily label others as neuroticor psychotic we tend to assume that we are not in the least in such a class. By an all-or-none labeling technique, we tend to gloss over our own correctable deficiencies.

Labeling individuals as “mentally ill” often bars them from various social, vocational,and educational situations where they would best learn how to help themselves. Itsometimes interferes with adequate research into treatment, while focusing on moreprecise research into diagnosing or labeling. It consumes psychological and psychiatricmanpower which might better go into treatment.

If people have close relatives who are labeled psychotic, they sometimes become soafraid of going insane themselves that they actually bring on symptoms of disturbanceand begin to define themselves as “mentally ill.”

On the other side of the ledger, if we have a clear-cut concept of “mental disease”and if we unequivocally refer to certain kinds of behavior as neurotic or psychotic,many benefits in preventing and treating “emotional disturbance” are likely to accrue.For instance:

1. If needlessly self-defeating and overly hostile behavior does exist and is to be foughtand minimized, the individual who exhibits it has to acknowledge (a) that it existsand (b) that he is to some degree responsible for its existence and, hence, canchange it. This is what we really mean when we say that an individual is “mentallyill”—that he has symptoms of mental malfunctioning or illness. More operationallystated, he thinks, emotes, and acts irrationally and can usually uncondemninglyacknowledge and change his acts. If this, without any moralistic overtones, is thedefinition of “mental illness,” then it can distinctly help the afflicted individual toaccept himself while he is ill and to work at changing for the better.

2. When an individual fully accepts the fact that he is emotionally disturbed, he oftenstarts to improve (Redlich & Freedman, 1966). Why? Because (a) to some extenthe knows why he is behaving ineffectively: (b) he can begin to define in more detailexactly what his sickness consists of and what he is doing to cause and maintainit; (c) he may accept his symptoms with more equanimity and tend to be less guilty

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about creating them: (d) he may be much more inclined to seek professional help,just as he would if he were physically ill.

By accepting the concept of “mental illness,” a person can often accept and helpothers who are neurotic or psychotic. I have seen many parents with highly disturbedchildren who, after learning that their child’s peculiar behavior is the result of a deep-seated disturbance which is biologically as well as environmentally rooted, becameenormously less guilty and were able to sympathetically accept their child and do theirbest to help him ameliorate his symptoms.

There is an essential honesty about the full acceptance of states of “emotional illness”that is itself often curative. In the last analysis, almost all neurosis and psychosis consistsof some fundamental self-dishonesty (Glasser, 1965; London, 1964; Mowrer, 1960,1964) or some self-deceptive defense that one raises against one’s perfectionistic andgrandiose leanings (A. Freud, 1948; S. Freud, 1963). When, therefore, one fully facesthe fact that one is “mentally ill,” that this is not a pleasant way to be, and that one ispartially responsible for being so, one becomes at that very point more honest withoneself and begins to get a little better.

Accepting the fact that he is emotionally sick may give an individual an incentive toimprove his lot. Most confirmed homosexuals in our society utterly refuse to admitthat their homosexuality is a symptom of disturbance (Benson, 1965; Wicker, 1966).They mightily inveigh against clinicians such as Adler (1917), Bieber et al. (1962), andEllis (1965a), who insist that they are sick. As a result, relatively few mixed homosexualscome for psychotherapy, and of those who do come only a handful work to changetheir basic personality structure and to become heterosexually interested and capable.At the same time, many phobiacs admit their disturbance, come for therapy, and aresignificantly helped (Redlich & Freedman, 1966; Wolpe, 1958). This is not to say thatall those who accept the idea of their being “mentally ill” work hard at becoming better.Far from it! But their chances are often improved, compared to those who insist thatthey are no more disturbed than is anyone else.

Psychotherapists are often more effective when they face the fact that their patientsare “mentally ill.” When they look upon these patients as merely having behaviorproblems, they work moderately hard with them and often become disillusioned at thepoor results obtained. When they acknowledge that their patients often have basic,deep-seated emotional disorders, they know they are in for a long hard pull, work withgreater vigor, expect many setbacks and limited successes, and take a realistic ratherthan an over-optimistic or over-pessimistic therapeutic view.

Whether we like it or not, it sometimes seems to be necessary for some individualsto be adjudged “mentally ill” and even to be forcibly incarcerated, if they are to betreated effectively. A dramatic case in point is the recent one of the Texas resident,Charles Whitman, who killed 16 innocent bystanders shortly after he had gone for oneinterview with a psychiatrist and failed to return for further treatment, although he wasfound to be potentially homicidal. Redlich and Freedman (1966) remark:

As therapeutic interventions increase in intensity and scope, we more frequentlyencounter the question of a person impulsively leaving treatment when thereappears to be a good chance that he could further improve his status and diminish

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his self-destructive behavior. Without some element of restraint, such a personmight not have received therapeutic help at all. Nonetheless, it is probably best,both for society and for therapy of the patient, that coercion be restricted to theminimum necessary for the protection of life [p. 752].

Redlich and Freedman note how difficult it often is, as in the case of James Forrestal,Secretary of the Navy, who committed suicide while under psychiatric observation ina naval hospital, to adequately supervise persons of high position and eminence whoare seriously disturbed. While their book was going through the press, Hotchner’s(1966) Papa Hemingway appeared. According to Hotchner, Hemingway, because of hisliterary genius, was treated with unusual leniency by psychiatrists at the Mayo Clinic,and the day after he returned home from the Clinic he shot and killed himself. Thereis little doubt in Hotchner’s mind that Hemingway might have lived for many moreyears if he had been honestly adjudged “mentally ill” and had been involuntarily treated.

If the facts of “mental illness” are forthrightly faced and it is recognized that numerousindividuals in our population are predisposed, for biosocial reasons, to be severelydisturbed, educational prophylaxis will tend to be stressed. For if none of us is trulysick, just because all humans have some problems of adjustment, it seems futile to teachpeople the principles of mental hygiene, methods of sound thinking, about themselves,and ways of coping with reality. But if it is accepted that all of us are a bit “touched”and that some of us are more so, greater efforts toward prevention of “mental illness”may become the rule.

If the concept of emotional disturbance is admitted, proper surveillance of pre -disposed individuals can be instituted for preventive, protective, and curative reasons.Thus, if a child or adolescent is known to have tendencies toward severe illness, he can be specifically watched to see when these are breaking out. He can be kept out ofsituations where he may inflict damage on others, can at times be placed in protectivecustody to safeguard himself and others, and can be regularly treated to minimize hissick tendencies. In this respect, I recall a patient who was referred to me by a psychologistalmost 20 years ago because, although he was only moderately disturbed, his twinbrother had just been institutionalized with a diagnosis of paranoid schizophrenia. Isaw this patient steadily for a couple of years and since that time have been seeing hima few times a year. I believe that it is largely as a result of my treating him and seeinghim through a number of incipient crises during these years that he has been helpedto remain only moderately ineffective and never to be in danger of a serious break,although in my opinion he is clearly a borderline schizophrenic. Similarly, otherincipient psychotics can, if recognized early enough, be helped to remain perenniallyincipient and prevented from overtly breaking down.

Social Progress and Emotional Disturbance

If we label people who display various adjustment problems or idiosyncratic ways ofliving as “mentally ill,” we may impede social progress in various ways. Many of theworld’s great statesmen, innovators, and creative artists have been “crackpots” whomight well have been diagnosed as neurotic or psychotic and whose contributions tothe world could have been (and in some cases actually were) sadly curtailed because

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of such labels. Thus, Dorothea Dix, who helped reform our mental hospital procedures,was opposed because she was deemed a “screwball,” and Richard Wagner had difficultygetting some of his works performed because he was considered a “madman.” In ourown way, highly qualified people may not be elected to public office because of theirunconventional and “crackpotty” views. Diplomats may not take with sufficientseriousness the statements of the Hitlers of the world because these leaders are seen asmaniacs. Notable inventions may go unused because their inventors are considered“crazy.”

Actually, an individual’s aberrant or peculiar characteristics may have distinctadvantages as well as disadvantages. Rank (1945, 1958) held that what is normally called neurosis is a creative process that may lead to beneficial and exciting aestheticproductions, and several other writers have noted the creative aspects of some psychoticstates, but once an idiosyncratic individual in our society is labeled “mentally ill,” it isassumed that his illness is wholly pernicious and that it must quickly be interruptedand abolished.

The very concept of illness or disease, as applied to emotional malfunctioning, maybe socially retrogressive, since it limits thinking in this area. As Albee (1966), Rieff(1966), and several other students of mental health have recently shown, the medicalor disease model of human disorder is restrictive and misleading, in that it implies thatthe afflicted individual has a specific handicap caused by a concrete organism or eventand that his troubles can fairly easily be diagnosed and cured, as is the case in manyphysical disorders. Actually, what has been called “mental illness” appears to havemultifarious causative factors and appears to be interrelated with the individual’s entireexistence and his global philosophy of life. It is therefore best understood and attackedon a philosophical, sociological, and psychological level rather than a narrow medicallevel, and those who practice psychotherapy (in itself a bad word because of its medicalorigins and implications) would aid their patients (another medical term!) in particularand the art of mental healing (!!) in general if they forgot about the illness or diseaseaspects of ineffectual behavior and focused in a more global way on the causes andamelioration of such behavior.

Viewing disorganized thought, emotion, and action as “mental illness” may againlimit social and psychotherapeutic progress by supporting the concomitant view thatonly psychiatrists and other physicians are truly equipped to treat the emotionallydisturbed, when, actually, some of the best theoreticians and practitioners in the fieldhave been psychologists, social workers, marriage counselors, clergymen, and variousother kinds of nonmedical workers. Social progress is at present probably being seriouslyhampered in the field of mental health by professional opposition to nonprofessionals,such as intelligent housewives and college students, who have been found to be quitehelpful with sick individuals but who have often been kept from doing very much inthis respect because their patients are designated as being “mentally ill” (Ellis, 1966).

As usual, much can be said in opposition to the view that diagnosing people as“emotionally sick” tends to hinder social and therapeutic progress. First, there is nogood evidence to support Rank’s (1945, 1958) view that neurosis is a creative processand that it should be cherished if artists and their public are to continue to make greatprogress. Nor is there any reason to believe that many of the outstanding innovators

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of the past and present would not be ignored and opposed by their contemporarieseven if the latter could not call them “mentally ill” or “crazy.”

As for the concept of “mental disease” aiding social reaction and blocking therapeuticprogress, Menninger (1965) points out that modern medicine is not atomistic butholistic and that good physicians see disease in a broad, almost nonmedical (in the oldsense of the term) way. He quotes Virchow, “Disease is nothing but life under alteredconditions,” and Engel, “Disease corresponds to failures or disturbances in the growth,development, functions, and adjustments of the organism as a whole or of any of itssystems,” (Menninger, 1965, p. 460) to show that the medical model of “mental illness”that Albee (1966) so severely criticizes is no longer typical of modern psychiatrists.

Ausubel (1961, p. 70) contends that to label personality disorder as disease not onlywould not hinder social and therapeutic progress but that the Szasz–Mowrer view ofthe “myth of mental illness” would “turn back the psychiatric clock twenty-five hundredyears.” The most significant and perhaps the only real advance registered by mankindin evolving a rational and humane method of handling behavioral aberrations has beenin substituting a concept of disease for the demonological and retributional doctrinesregarding their nature and etiology that flourished until comparatively recent times.Conceptualized as illness, the symptoms of personality disorders can be interpreted inthe light of underlying stresses and resistances, both genic and environmental, and canbe evaluated in relation to specifiable quantitative and qualitative norms of appropriatelyadaptive behavior, both cross-culturally and within a particular cultural context. Itwould behoove us, therefore, before we abandon the concept of mental illness andreturn to the medieval doctrine of unexpiated sin or adopt Szasz’ ambiguous criterionof difficulty in ethical choice and responsibility, to subject the foregoing propositionto careful and detailed study.

Ausubel (1961, p. 69) also points out that labeling individuals with aberrant behavior“mentally ill” does not preclude nonmedical personnel from helping these individuals,since “an impressively large number of recognized diseases are legally treated today byboth medical and non-medical specialists (e.g., because it has been neatly categorized,to diseases of the mouth, face, jaws, teeth, eyes, rigidify our thinking in the field ofmental illness).” Consequently, even if we maintain the concept of “mental illness,” we can justifiably allow and encourage all kinds of professionals and nonprofessionalsto treat the ill.

Scientific Advancement and the Label of “Mental Illness”

There would seem to be several impediments to the use of the scientific method andto the advancement of science when we label individuals “mentally ill.” For one thing,this kind of labeling leads to over-categorization and higher-order abstracting, whichobscures scientific thought and leads to countless human misunderstandings (Korzybski,1933, 1951). To say that an individual is bad because his behavior is poor is to fabricatea sadly overgeneralized and invariably false description of him, as it is most unlikelythat all his behavior—past, present, and future—was, is, or will be poor. Similarly, tolabel a person as a genius is to describe loosely and inaccurately, because it is likely that(at most!) he displays certain aspects of genius in only some of his productions—evenif his name is Leonardo da Vinci; it is most probable that in many or most of the other

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aspects of his life, for example, his playing pingpong, making love, and cooking a soufflé,he is far from displaying many aspects of genius (Ellis, 1965b).

This kind of overgeneralizing distorts reality and causes the unrealistic (and oftenunfair) condemnation or deification of a human as a whole for relatively isolated partsor aspects of his functioning. Just as an individual’s good deeds do not prove that he,on the whole, is a genius, so his bizarre or dysfunctional acts fail to show that he istotally “mentally ill” or incompetent. Designating him in this manner may, therefore,lead to misapprehension and misunderstanding of his sick and healthy behavior.

Labels of all kinds promote close-mindedness rather than open-minded, experi-mental, scientific attitudes. Calling an individual “mentally ill” tends to put him in aniche, from whence his removal may never be considered. It encourages us to diagnosean individual’s condition and then to forget about it because it has been neatlycategorized, to rigidify our thinking in the field of mental health itself, and to help usforget that the patient’s “illness” is more of a hypothesis than a well-established fact.

Szasz (1961/1967) has contended that the concept of “mental illness” is antitheticalto science because it is demonological in nature, in that it follows the lines of religiousmyths in general and the belief in witchcraft in particular and because it uses a reifiedabstraction, “a deformity of personality,” to account causally for disordered behaviorand human disharmony. Many other writers, such as Ellis (1950) and LaPiere (1960),have held that the Freudian terms, in which most forms of emotional disturbance areput today (e.g., “weak ego” and “punishing superego”), are reifications that have noactual substance behind them and are hence mythical and misleading entities. The entirefield of “mental health” appears to be replete with these kinds of myths.

While some of these objections to the diagnosis of “mental disease” are important(and others seem to be trivial), there is much to be said in favor of the notion thatcategorizations of this sort are, when carefully made, reasonably accurate and quitehelpful to the cause of scientific advancement. Arguments in this connection includethe following:

1. Although it is inaccurate to state that the individual in our culture who is usuallylabeled “mentally ill” is a much different kind of person from the healthy individual,or that he exhibits entirely aberrant behavior, or that he is a bad or lower kind ofperson because he sometimes behaves oddly, the fact remains that there is almostalways some significant difference between the actions of this ill individual andthose of another who is well. What is more, the existing difference is one that canusually (if not always) be detected by a trained observer, is fairly consistentlyevident, and leads to definite behavior of a self-defeating or antisocial nature. Ifthe individual with aberrant behavior is not in any way to be labeled “mentallyill,” neurotic, psychotic, or something similar, the peculiarity, undesirability, andimprovability of his behavior is likely to be overlooked, some segment of realitywill thereby be denied, and the essence of science—observation and classification—will be rejected.

2. There is considerable and ever-increasing scientific evidence to show that althoughthe term “mental illness” itself is vague, the major characteristics which aresubsumed under its rubric, such as compulsion, over-suspiciousness, phobia,depression, and intense rage, do exist and have observable ideational and

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physiological correlates. Thus, feelings of depression are usually accompanied bythe individual’s belief that “When I do the wrong thing, I am no good and willprobably always remain worthless,” and “If significant people in my life do notapprove of me, I can’t approve of myself.” These feelings are, in addition, frequentlyaccompanied by fatigue, poor appetite, insensitivity to stimulation, ineffectiveperformance, etc. Objectively, therefore, some individuals can be described as beingconsistently depressed and in that sense, at least, may be thought of as being“mentally ill.”

3. Some kind of general factor of emotional distress appears to exist in certainindividuals, since they are observed to display various major symptoms (e.g.,hostility, anxiety, and depression), while other individuals are practically symptomfree. Thousands of years of observation would seem to attest to the existence ofthis general factor, as many of the descriptions of peculiar people in past centuriesare amazingly similar to modern clinical descriptions. Recently, moreover, a greatdeal of evidence has accumulated which tends to show that people who displaysevere behavior problems are to some degree biologically different from others(Chess, Thomas, & Birch, 1965; Greenfield & Lewis, 1965; Redlich & Freedman,1966) and that they can be reliably selected from the general population (JointCommission on Mental Illness and Health, 1961). To ignore this evidence of“mental illness” would seem to be highly unrealistic; to acknowledge it would beto accept people as they truly are.

Although all self-defeating human behavior may well have elements of social learningand may be best understood, as Szasz contends, by being studied in a sociologicalcontext and in the light of social deviance, the fact remains that the individual himselfcontributes significantly to what he accepts or rejects from his culture and, at times,may therefore be justifiably deemed sick or disordered. Anyone of us, as Messer (1966)observes, may be neurotically influenced by dramatic television commercials whichconvince us that we have acid indigestion when we experience abdominal discomfort.Few of us would conclude, however, that the discomfort represents a demon tearingaway the lining of our stomachs and that unless the pain stops we must cut ourselvesopen to get at this demon. Those few, who gratuitously add their own distortedperceptions and thoughts to their socially imbibed neurotic ideas, may justifiably bediagnosed as psychotic, even though some of their notions (e.g., that demons couldexist) are partially derived from their cultures.

Although we may concede Szasz’ (1961/1967) points that what we usually call “mentalillness” is largely an expression of man’s struggle with the problem of how he shouldlive and that human relations are inherently fraught with difficulties, Ausubel (1961)demonstrates that, there is no valid reason why a particular symptom cannot bothreflect a problem in living and constitute a manifestation of disease. Some individuals,either because of the magnitude of the stress involved, or because of genically orenvironmentally induced susceptibility to ordinary degrees of stress, respond to theproblems of living with behavior that is either seriously distorted or sufficientlyunadaptive to prevent normal interpersonal relations and vocational functioning. Thelatter outcome—gross deviation from a designated range of desirable behaviorvariability—conforms to the generally understood meaning of mental illness (p. 711).

306 Albert Ellis

Discussion

It would appear that there are important disadvantages as well as advantages in labelingpeople “mentally ill.” Many of the disadvantages result from our tendency to includein the terms “mental illness,” “neurosis,” and “psychosis” not only a description of thefact that the afflicted individual behaves self-defeatingly and inappropriate to his socialgroup, but also the evaluative element that he is bad, inferior, or worthless for sobehaving. If this evaluative element were not gratuitously added, the term “mentalillness,” even though an abstraction that is not too precise, might have descriptive,diagnostic, and therapeutic usefulness. It is a kind of shorthand term which can be usedto describe the usual and fairly consistent state of a person who keeps driving himselfto act ineffectually and bizarrely.

Thus, instead of saying, “He is mentally ill,” we could say, “He is a human beingwho at the present time is behaving in a self-defeating and/or needlessly antisocial mannerand who will most probably continue to do so in the future, and, although he is partiallycreating or causing (and in this sense is responsible for) his aberrant behavior, he isstill not to be condemned for creating it but is to be helped to overcome it.” This secondstatement is more precise, accurate, and helpful than the first one, but it is oftenimpractical to spell it out in this detail. It is, therefore, legitimate to use the firststatement, “He is mentally ill,” as long as we clearly understand that it means the longerversion.

A good solution, then, to the problem of labeling an individual “mentally ill” is tochange the evaluative attitude which gives the term “mental illness” a prejorative toneand to educate all of us, including professionals, to accept “emotionally sick” humanbeings without condemnation, punishment, or needless restriction. This to some degree, has already occurred, since the attitude that most of us take toward disturbedpeople today is much less negative than that taken by most people a century or moreago: much, however, remains to be accomplished in this respect. Meanwhile, what isto be done? For psychologists, psychiatrists, psychiatric social workers, and otherprofessionals, the following conclusions are in order:

The term “mental illness,” or some similar label, is likely to be around for some time,even though continuing efforts can be made to change current psychological usage.

An individual who is “mentally ill” may be more operationally defined as a personwho, with some consistency, behaves in dysfunctional ways in certain aspects of his life,but who is rarely totally “disturbed” or uncontrolled.

It is highly dangerous to evaluate a “mentally ill” person as you would evaluate hisacts or performances. If he is sufficiently psychotic, he may not even be responsible forhis acts. If he is less disturbed, he may be responsible but not justifiably condemnablefor his deeds, since they are only a part or an aspect of him, and to excoriate him intoto for these deeds is to make an unwarranted and usually harmful overgeneralizationabout him.

Although most “mentally ill” individuals perform bizarre and unconventional acts,not all people who perform such acts are sick or ill. Neurosis or psychosis exists notbecause of an individual’s deeds, but because of the overly anxious, compulsive, rigid,or unrealistic manner in which he keeps performing them.

Should Some People Be Labeled Mentally Ill? 307

Most “mentally ill” individuals are variable from day to day and changeable fromone period of their lives to another. The fact that they act inappropriately today doesnot mean that their behavior was equally dysfunctional yesterday nor that it will be sotomorrow. Such people usually have considerable capacities for growth and can changeradically for the better (as well as for the worse).

People, no matter how “mentally ill” they may be, are always human. We owe themthe same kind of general respect that we owe to all human beings, namely, giving themthe rights to survive, to be as happy as possible in their handicapped conditions, to behelped to function as well as possible and to develop their potentials, and to be protectedfrom needlessly harming themselves and others.

If these approaches to individuals with severe emotional problems are kept solidlyin the forefront of our consciousness then our question of whether to label them as“mentally ill” may well become academic.

References

Adler, A. (1917). The homosexual problem. Alienist & Neurologist, 38, 285.Albee, G. (1966, May). In B. Saper (Chm.), Caste versus competence in the field of mental health.

Symposium presented at the meeting of the New York State Psychological Association, NewYork.

Anonymous. (1966, July 3). Letter. New York Times Magazine, 33.Ausubel, D. P. (1961). Personality disorder is disease. American Psychologist, 16, 69–74.Benson, O. (1965). In defense of homosexuality. New York: Julian Press.Bieber, I., Lain, H. J., Dince, P. R., Drellich, M. G., Grand, H. G., Gundlach, R. H., et al. (1962).

Homosexuality. New York: Basic Books.Brett, H. (1966, July 3). Letter. New York Times Magazine, 33.Chess, S., Thomas, A., & Birch, H. G. (1965). Your child is a person. New York: Viking Press.Davidson, H. Dr. (1958). Whatsisname. Mental Hospitals, 9, 8.Ellis, A. (1950). An introduction to the scientific principles of psychoanalysis. Provincetown, MA:

Journal Press.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Ellis, A. (1965a). Homosexuality: Its causes and cure. New York: Lyle Stuart.Ellis, A. (1965b). Showing the patient that he is not a worthless individual. Voices, 1(2), 74–77.Ellis, A. (1966). Should nonprofessionals be trained to do psychotherapy? Newsletter of the Division

of Clinical Psychology of the American Psychological Association, 19(2), 10–11.Freud, A. (1948). The ego and the mechanisms of defense. New York: International Universities

Press.Freud, S. (1963). Collected papers. New York: Collier Books.Glasser, W. (1965). Reality therapy. New York: Harper & Row.Greenfield, N. S., & Lewis, W. C. (1965). Psychoanalysis and current biological thought. Madison,

CA: University of Wisconsin Press.Hartman, R. S. (1959). The measurement of value. Crotonville, NY: General Electric Company.Hartman, R. S. (1962). The individual in management. Chicago, IL: Nationwide Insurance

Company.Hotchner, A. E. (1966). Papa Hemingway. New York: Random House.Joint Commission on Mental Illness and Health. (1961). Action for mental health. New York:

Basic Books.Keniston, K. (1966). The uncommitted. New York: Harcourt, Brace & World.

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Korzybski, A. (1933). Science and sanity. Lancaster, PA: Lancaster Press.Korzybski, A. (1951). The role of language in the perceptual process. In R. R. Blake & G. V.

Ramsey (Eds.), Perception (pp. 170–205). New York: Ronald Press.LaPiere, R. (1960). The Freudian ethic. London: Allen & Unwin.London, P. (1964). Modes and morals of psychotherapy. New York: Holt, Rinehart, & Winston.Menninger, K. (1965). The vital balance. New York: Viking Press.Messer, A. A. (1966, July 3). Letter. New York Times Magazine, 33.Morgenstern, F. V. (1966, July 3). Letter. New York Times Magazine, 4.Mowrer, O. H. (1960). “Sin,” the lesser of two evils. American Psychologist, 15, 301–304.Mowrer, O. H. (1964). The new group therapy. Princeton, NJ: Van Nostrand.Rank, O. (1945). Will therapy and truth and reality. New York: Knopf .Rank, O. (1958). Beyond psychology. New York: Dover Publications.Redlich, F. C., & Freedman, D. X. (1966). The theory and practice of psychiatry. New York: Basic

Books.Rieff, R. (1966, May). In B. Saper (Chm.), Caste versus competence in the field of mental health.

Symposium presented at the meeting of the New York State Psychological Association, NewYork.

Siebert, A. (1967). Are you my friend? Portland: Author.Siegel, M. (1966, January 9). Statement. New York Times, 11.Szasz, T. S. (1966, June 12). Mental illness is a myth. New York Times Magazine, 7–13.Szasz, T. S. (1967). The myth of mental illness. Dell. (Original work published 1961. New York:

Hoeber.)Whitaker, C. A., & Malone, T. A. (1953). Roots of psychotherapy. New York: McGraw-Hill.Wolpe, J. (1958). Psychotherapy of reciprocal inhibition. Stanford, CA: Stanford University Press.

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18 How Rational Emotive BehaviorTherapy Belongs in theConstructivist Camp

INTRODUCTION

Richard L. Wessler

In this chapter Albert Ellis explains why his rational therapy system is properly classifiedas “constructivistic,” not “rationalistic” as its name implies, and is consistent with a“postmodern” philosophy of science rather than “logical positivism.” These shifts canbe traced to his abandoning his initial definition of “rational,” and employing severaldifferent definitions.

In Ellis’ seminal work, the original edition of Reason and Emotion in Psychotherapy(1962), he defined irrational as “senseless ideas . . . dogmatically upheld values . . .superstitions and prejudices . . . illogical social teachings.” He had found plenty ofirrational, guilt-inducing beliefs in the 1950s, when he was a leading sexologist andauthor of such works as Sex Without Guilt and The American Sexual Tragedy.

People unthinkingly adopt irrational ideas and fail to reflectively examine them.Critical thinking is not based on faith; instead, it requires logical reasoning from reliableevidence. This form of reasoning is known in philosophy as “logical positivism” or“logical empiricism.”

The early version of rational therapy proposed independent thinking as thecornerstone of psychotherapy. To put this in historical perspective, psychotherapy atthe time was dominated by psychoanalysis and other forms of psychodynamic therapy(especially in psychiatry), and non-directive or client-centered therapy (especially inpsychology and counseling). Both focused on what the professional did to help people,not what people could do to help themselves.

Ellis said that people could be taught to think for themselves and apply reason todeal with emotional disturbances. He had been frustrated with practicing a form ofdynamic therapy when he directly addressed a patient to the effect, “You will continueto be disturbed until you change your philosophy of living.” In other words, changewhat you believe about the world and yourself by rejecting rote-learned beliefs andreplace them with well-thought-out, rational ones.

He continued to teach scientific thinking (i.e., logical positivism) as therapeutic. Onenon-empirical, non-logical belief received his special attention: belief in God. Religion,he maintained, is a source of disturbance, and atheism or the rejection of religiousdogma was a cure. This view is consistent with his newer definition of “irrational.”

A belief is irrational if it contains an absolute must or should: There are no absolutevalues, because there is no Supreme Rule-maker to give them. Instead of using evidenceand logic (i.e., critical thinking), he urged people to look for their shoulds and musts,because he believed they caused emotional disturbance.

Responsive to the criticism that his therapy was too rational and ignored emotionalprocesses, Ellis changed the name of his system to Rational Emotive Therapy, butcontinued to emphasize the role of cognition in controlling emotional responses. Aboutthe same time as Ellis was developing his system of therapy, the psychiatrist Aaron T.Beck independently created Cognitive Therapy as a nonchemical treatment fordepression. Although the two approaches agreed that thought content was the mediatingfactor and proximal cause of disturbance, they employed different types of cognitionin their theoretical accounts. Descriptive and inferential cognitions are used in Beck’ssystem, and evaluative cognitions are highlighted in Ellis’ work.

For example, when a patient complained “nobody likes me,” Beck would take thestatement as an hypothesis and assign the task of surveying people the person knowsto verify or not that he/she is liked. By contrast, Ellis would identify the irrational beliefthat he/she must be liked by others, de-emphasizing whether the initial statement wasfactual or not. (Further, Beck listed such logical errors as overgeneralization, selectiveabstraction, and dichotomous thinking as contributing to depressed mood. Beck’sapproach is more in the spirit of logical positivism than Ellis’.)

The must-statements have three derivatives, according to Ellis: awfulizing/catastro-phizing, I-can’t-bear-it-or-me, and self-downing. The challenge to the complainer tois prove that an event or experience is truly awful, or that he/she cannot stand it, thepractice known as “disputing.” However, there can be no proof. Facts can be verifiedor not with empirical data; statements about values cannot be.

By shifting the definition of “rational” from “senseless ideas” to must-statements andtheir derivatives, Ellis moved away from logical positivism. He had to, because there isno scientific way to prove one’s values. Although he continued to say that he taught“the scientific method” to patients, he actually presented them with a debate they couldnot possibly win. Disputing is not an objective inquiry into one’s thinking, but rathera persuasive device intended to surrender irrational beliefs and reap therapeutic benefits.Rational therapy was becoming less rational, in the traditional meaning of the term,and more something else.

Ellis eventually noted that his system of therapy was becoming more “constructive”in character. “Constructive” refers to the mental constructs one uses to depict one’ssubjective reality. These are ideas about oneself, other people, the world in general, andcorrelational or cause-and-effect relationship between events.

Personal construct theory had been around since the 1940s, but was eclipsed by thethen-prevalent behaviorism. Behavior therapy emerged from the application ofprinciples of learning and conditioning to dysfunctional behaviors, not “mental illness,”because strict behaviorism rejected mental constructs as unscientific and unnecessaryto account for observable events. Constructivism focused on subjective reality,behaviorism on objective reality. Ellis’ rational therapy did not focus on either realityso much as it focused on people’s value systems. His question was not what is real, butwhat is good.

How REBT Belongs in the Constructivist Camp 311

What, then, is an irrational value system? The brief answer is, one that makes demandson self, others, and the world by attempting to fulfill absolute musts and shoulds.However, Ellis hit upon an additional definition of irrational: beliefs that fail to aid andabet one’s goals or purposes. This is a pragmatic and outcome-based definition, butone that is removed from the usual meaning of irrational, which is incoherent orillogical. Clearly, logical positivism was being left behind.

In the revised edition of Reason and Emotion in Psychotherapy (1994), Ellis discussesgoals that all humans presumably share. Any idea that thwarts these goals is thereforeirrational. There is no provision for identifying and respecting the individual’s personalgoals, which may exist in addition to commonly held goals. This is significant, becauseconstructivism focuses on the individual’s personal, idiosyncratic version of reality. Thefocus is on the individual, not on people in general.

Ellis places rational therapy in the “constructivist camp,” but it only partially belongsthere. In constructivism, the mind is active in the construing of personal reality. One’sconstruction may be a fiction, and it may be resistant to verification, but it is powerfulwhen it gives meaning and direction to a person’s life. Constructivist therapies allowthe person to become aware of his/her constructions, without the therapist’s imposingviews and values on the person. It is better to allow the person to explore and findhis/her own voice and grow unimpeded by either society’s or by a professional’s versionof what is real or best. These are non-directive and noninterpretive approaches thatrespect the person’s wisdom and potentials for growth. They are also inefficient andperhaps even harmful, in Ellis’ opinion.

Constructivism holds that objective reality is unknowable, if it exists at all. Similarly,a postmodernist philosophy of science states science can only portray reality proba -bilistically and imperfectly, a very appealing position applied to post-Newtonian physics.Its appeal to Ellis was its rejection of absolute knowledge.

For Ellis, nothing was absolute, not knowledge (not even his own, which he humblyacknowledged), and especially not values. In other words, postmodern philosophy istotally consistent with the atheism Ellis earlier proposed as a cure for neurosis. It is yetanother way to deny a Supreme Rule-maker (and Rule-enforcer in an afterlife). As Ellissaid on many, many occasions, “there are no musts in the universe”; the reason is, ofcourse, that no Being exists to put them there. And, belief in absolute values (mustsand shoulds) leads to emotional disturbance.

Postmodern philosophy was an attractive replacement for the logical positivism thatEllis had moved away from. Perhaps it also seemed less shocking than atheism toAmericans, a large majority of whom profess a belief in God. And, postmodernism hasbecome the preferred philosophy in academia, and has led to curricula that teachmulticulturalism and situational ethics. Many, if not most, professors in America’scolleges and universities agree that no one system of values is better than another, aliberal point of view often expressed by their students as “anything goes.” Right andwrong are matters of personal interpretation, not God-given commandments.

There is another plausible explanation for Ellis wanting to be in the “postmodernistcamp.” Identifying one’s work with a philosophy of science gives it a certain gravitas.The work can appear more scientific than it truly is. Rational therapy was neverscientific, always philosophic.

312 Richard L. Wessler

From its inception, through numerous revisions, rational therapy remained rootedin Ellis’ personal philosophy. He derived nothing from psychological science, itsprinciples, or empirical findings. (A case can be made that his paradigm of emotion ispsychological, in that he saw cognition as a mediator between stimulus and response.But this seems more coincidental than consciously adopted from theories of emotionor research.)

Ellis posed as a scientist who prized scientific methodology, but he did not functionas a scientist. He did no research to test his theoretical formulations, although he calledfor all of his hypotheses to be researched (and does so in this chapter). He did nooutcome studies to check on the results of his therapy techniques. He ignoreddisconfirming evidence when it was presented.

Further, the hypotheses he proposed were filled with ambiguities and escape clauses.Words such as “usually, rarely, not necessarily always” appear as qualifiers thatsimultaneously assert and deny a hypothesis. His system of therapy could never becomescientific, because its fundamental assumption (that absolutistic musts are at the coreof emotional disturbance) cannot be researched. It is not possible to objectively verifythat a person believes an absolute must-statement. We can only infer, not observe,other people’s beliefs.

Describing rational therapy as “postmodern” was his late attempt to add anotherlayer of respectability to his work. Many years after adding the modifier “emotive” torational therapy, he added “behavior” as well. Thus Rational Emotive Behavior Therapy(REBT) took its place among the by-now-mainstream psychological therapies. Itsadmission to the group was paved by the popularity of cognitive therapy and its fusionwith behavior therapy. Cognitive Behavior Therapy is now the go-to treatment for manydisorders, in addition to depression, and Ellis wanted to be known as one of its founders.

The trouble with REBT is that it was not derived from behavioral principles or fromcognitive psychology research. (Construct theory and behaviorism are not compatible,in that one adopts mental constructs and the other rejects them, but this inconsistencyis rarely referred to.) Ellis makes little use of learning and conditioning in explaininghow people develop. His rationale for adding the B to REBT is that he always usedbehavioral homework, e.g., in vivo desensitization.

True, he advocated many techniques, some of which could be called behavioral. Inthis chapter, he describes his work as exceptionally multimodal and flexible, as hequickly adapts a variety of techniques to suit the individual client. We are left to takehis word as truthful, for no one knows what goes on behind the closed doors of thetherapist’s office, except the people inside.

I would like to offer independent verification, but I cannot. During the roughly 10years (1973–1982) I was his student and later director of training, I did not witness the flexibility and creativity he claims. He did not discuss a variety of procedures insupervision, nor did he teach them in workshops. What he did do, I respectfully label“Applied Stoic Philosophy.” I am confident that he helped many people with hisapproach.

I, too, apply Stoic philosophy, but with a different set of assumptions developed inthe years after I left the Ellis “camp.” Here are some of my disagreements. For furtherdiscussion, see my brief entry in the Encyclopedia of Psychotherapy (Vol. I, Elsevier

How REBT Belongs in the Constructivist Camp 313

Science) and my book Succeeding with Difficult Clients: Applications of CognitiveAppraisal Therapy (Academic Press).

I came to doubt the role of must-statements in disturbance. In other words, I rejectedthe salience of irrational beliefs. As this feature is central, no one who rejects it can doauthentic REBT. (This point may be more important for psychotherapy research thanpractice.) I retain the idea that evaluative cognitions (appraisals) are closely linked withemotion, and that appraisals of self, others, events, the future, etc., are key targets oftherapy interventions.

I also began to question the utility of unconditional self-acceptance (USA) as a wayto self-worth. Humans seem to be innate evaluators of everything, including themselves;USA may be an unattainable ideal. But even if it is attainable, I wondered, is it ideal?No, all sorts of bad behavior might be justified by USA. Self-worth is a moral question,and it deserves a moral answer. I propose to empower the person by making self-definedworth depend on that which is totally controlled by the individual: his or her owndecisions and actions. This is conditional self-acceptance: Do what you think is rightand value yourself for so doing. Self-respect, self-trust, and self-accountability will result.

I found that feelings can influence cognitions, and not just serve as mediators of emotion. Thus, a person who “needs” to feel miserable can find some thoughts oractions to justify that feeling. The person “needs” to feel a certain way because it isfamiliar. Life-long emotional habits provide a sense of security and motivate us to re-experience them. They are derived from attachment to family and other social groups;our thoughts, feelings, and actions provide an identity that assures the security ofcontinued membership in the group, even when the group no longer exists.

In practice, I never sounded like Albert Ellis, and in time I came to think less likehim as well. I think my work is closer to his original rational therapy than to his laterelaborations, but with many additions from my decades of experience as an academicpsychologist (but not a scientist) and as a psychotherapist who appreciates otherapproaches and learns from them.

Finally, does it matter that REBT is constructivistic and postmodernistic? Not to me,but it mattered a great deal to Albert Ellis.

314 Richard L. Wessler

HOW RATIONAL EMOTIVE BEHAVIOR THERAPYBELONGS IN THE CONSTRUCTIVIST CAMP

Albert Ellis

Although I was formerly in the logical positivist camp, I now consider myself largely a postmodernist and constructivist. Rational Emotive Behavior Therapy, which Ioriginated as the first modern Cognitive Behavior Therapy, was always constructivistin that it holds, with Kelly (1955), that people have strong innate tendencies to solvetheir life problems and to actualize themselves. They also have inborn as well as acquiredpowerful tendencies to defeat themselves and the social groups to which they belong,but they can use their constructive proclivities to defeat their defeatism and to makethemselves and their social group healthier and happier (Ellis, 1962, 1990a, 1994, 1996a; Ellis & Dryden, 1997; Ellis, Gordon, Neenan, & Palmer, 1997; Ellis & Harper,1997; Ellis & Tafrate, 1997). Some of the main constructivist and postmodern viewsinclude these:

Perhaps some kind of indubitable objective reality or thing in itself exists, but weonly seem to apprehend or know it through our fallible, personal–social, different, andchanging human perceptions. We do not have any absolute certainty about what realityis or what it will be—in spite of our often being strongly convinced that we do.

Our views of what is good or bad, what is right and wrong, what is moral andimmoral are, as George Kelly (1955) pointed out, largely personal–social constructions.Kelly held that the identification of universal truths is an impossible task and that allethical beliefs have a constructionist nature. I agree.

Although human personality has some important innate and fairly fixed elements italso largely arises from relational and social influences. It is much less individualisticthan it is commonly thought to be.

People are importantly influenced or conditioned by their cultural rearing. Theirbehaviors are amazingly multicultural and there is no conclusive evidence that theirdiverse cultures are right or wrong, better or worse (Ivey & Rigazio-DiGilio, 1991;Sampson, 1989).

Either/or concepts of goodness and badness often exist and are rigidly held, but theytend to be inaccurate, limited, and prejudiced. More open-minded apperceptions ofhuman and nonhuman reality tend to show that things and processes exist on a both/andand an and/also basis. Thus almost every human act or condition has its advantagesand disadvantages. Even helpful acts have their bad aspects. Giving a person money,approval, or therapy may encourage him or her to be weaker, more dependent, andless self-helping. Berating a person may encourage her or him to become stronger, lessdependent, and more self-helping. Because monolithic either/or solutions to problemshave their limitations, we had better consider the range of alternate and/also solutionsand test them out to see how well—and badly—they work.

Unfortunately—or fortunately—all the solutions we strive to achieve for ourproblems depend on our choosing goals and purposes from which to work. Such goalsand purposes are just about always arguable, never absolute. Even the near-universalhuman goal of survival is debatable, for some of us stress individual and others stress

group or social survival. And at least a few people choose suicide, and a few think thatthe annihilation of the whole human race—and perhaps of the entire universe—ispreferable. So we can arrive here at a consensus but not any absolute agreement ofwhat goals and purposes are better and worse.

These postmodernist views have recently been promulgated by a host of writers(Bartley, 1984; Feyerband, 1975; Gergen, 1995; Hoshmand & Polkinghorne, 1992;Popper, 1985; Simms, 1994). They have also been applied to the field of mental healthcounseling and psychotherapy by a number of other writers (Ellis, 1994, 1996a, 1996b,1996c; Gergen, 1991; Guterman, 1994; Ivey & Goncalves, 1988; Ivey & Rigazio-DiGilio,1991; Kelly, 1955; Mahoney, 1991; Neimeyer & Mahoney, 1995). Postmodernism is animportant—and growing—aspect of today’s psychotherapy.

How Rational Emotive Behavior Therapy is Constructivist

Rational Emotive Behavior Therapy (REBT), along with other cognitive behaviortherapies—such as those of Beck (1976), Maultsby (1984), and Meichenbaum (1977)—has been criticized as being rationalist and sensationalist by a number of critics(Guidano, 1991; Guterman, 1994, 1996; Mahoney, 1991; Neimeyer & Mahoney, 1995).I have refuted this charge and tried to show that REBT is quite constructivist, and insome ways is actually more so than many of the other constructionist therapies (Ellis,1991, 1994, 1996a, 1996b, 1996c). The following paragraphs discuss a number of factorsthat make it particularly constructivist.

Kelly (1955), Guidano (1991), Mahoney (1991), and other constructivist therapistsshow that disturbed people generate deep cognitive structures and had better be helpedto adopt alternative models of the self and the world so that their deep structures can work in a more flexible and adaptive manner. REBT more specifically holds thatthe rigid, absolutistic musts and necessities by which people usually upset themselvesare not merely learned from their parents and culture but are also created by their ownconstructivist, and partly biological, tendencies.

REBT therefore holds that both clients and their therapists had better work hard,preferably in a highly active–directive and persistent manner, to help bring aboutprofound philosophic, highly emotive, and strongly behavioral changes. Discoveringand disputing their automatic self-defeating thoughts, as most cognitive behavioraltherapies do, is not enough. In addition, they had better be helped to see that theycreate core dysfunctional philosophies and that they can constructively change by think -ing, by thinking about their thinking, and by thinking about thinking about theirthinking (Dryden, 1995; Ellis, 1990a, 1994, 1996a; Ellis & Dryden, 1997).

In dealing with people’s basic problems about self-worth, REBT agrees with theconstructivist and existentialist position of Heidegger (1962), Tillich (1953), and Rogers(1961) that humans can define themselves as good or worthy just because they chooseto do so. But it also shows them how to construct a philosophically unfalsifiable positionof choosing life goals and purposes and then only rating and evaluating their thoughts,feelings, and actions as good when they fulfill and as bad when they fail to fulfill theirchosen purposes. In this REBT solution to the problem of unconditional self-acceptance(USA), people can choose to view their self or essence as too complex and multifacetedto be given any global rating. It exists and can be enjoyed without the rigidities and

316 Albert Ellis

dangers of either/or evaluation (Ellis, 1994, 1996a; Ellis & Dryden, 1997; Ellis & Harper,1997; Ellis & Tafrate, 1997).

Constructivists like Guidano (1991) and Hayek (1978) emphasize people’s tacitobservations and reactions to life problems, and REBT has always agreed thatunconscious and tacit processes create both disturbance and problem solving (Ellis,1962; Goleman, 1995). But REBT also particularly emphasizes and abets people’s innate and acquired constructive abilities to design, plan, invent, and carry throughbetter solutions to life’s problems and to self-actualization. It shows clients how tomake themselves aware of their unconscious constructivist self-defeating tendencies—and also how to use their conscious intentions and plans to lead a happier—moreconstructivist—life.

Mahoney (1991), Guidano (1991), Robert and Greg Neimeyer (Neimeyer &Mahoney, 1995), and other constructivists often hold that because people are naturalconstructivists—with which I agree—active–directive cognitive behavior therapy mayinterfere with their natural ability to change. But this is like saying that because children(and adults) have natural abilities to solve problems and help themselves, their parentsand teachers should give them little if any instruction! REBT takes a both/and insteadof an either/or position here, holding that clients do have considerable natural abilityto make themselves both disturbed and less disturbed, and teaches them how to helpthemselves minimize their disturbances. Moreover, while encouraging them to use theirself-aiding tendencies—which obviously they are usually doing badly when they cometo therapy—it tries to give them greater understanding—and determination—tocollaborate with the therapist to help themselves more. It also stresses therapist andclient efficiency in their choice and practice of the multitude of therapeutic techniquesnow available.

Constructionist approaches often put down science—especially rational science—and in some ways they make good points. Science has many advantages but is hardlysacrosanct. REBT holds, with postmodernists, that science has its limitations, especiallybecause the objective truths that it often claims to reveal are at bottom person-centeredand include important subjective aspects. Science, however, is important forpsychotherapy. For if we can agree on what the main goals of counseling and therapyare—which is not as easy as it may at first seem!—scientifically oriented observation,case history, and experimentation may check our theory and show us how accuratelyour goals are achieved. Not certainly—but at least approximately. So science has itsusefulness, and REBT—along with other cognitive behavior therapies—uses scienceand rationality and also other criteria to check its theories and to change them and itspractices. Healthy constructivism includes rational scientific method while abjuringdogmatic scientism.

My personal change from logical positivism to postmodernism began in 1976 whenMichael Mahoney sent me a copy of his book Scientist as Subject, and I saw that Bartley(1984), Popper (1985), and other philosophers rightly showed that logical positivismwas not consistent with some of its own postulates. Even before that, however, I wasbeginning to get uncomfortable with it.

I had determined, on the basis of clinical experience, that people’s basic problemsusually arose when they raised their preferences for success, love, and comfort intorigid, absolutistic musts and demands (Ellis, 1962, 1972/1990b). But the so-called truths

How REBT Belongs in the Constructivist Camp 317

of logical positivism seemed a little too rigid and absolutistic; and the postmodernistswere more in tune with the flexible thinking that REBT was recommending for clientsand other people. The main backing for some of its ideas seemed to come from thepostmodernist idea that there were no eternal verities and that no matter how true ahypothesis appeared to be it could always be supplanted by later evidence and by theslant humans gave to this evidence.

I particularly saw that “proper” behavior related to one’s basic choices and desires.Thus one of my clients wanted the certainty that his wife “truly” loved him and I showedhim that he could only get a high degree of probability that she did. Certainty did notseem to exist; and if it did, it might not last. Moreover, even if he had it, it woulddepend upon his definition of “true love.” Did he mean passionate love, sexy love,companionate love, or all of the above? Did he mean long-lasting intense love, long-lasting moderate love, short-lasting intense love, or what? “True love” had any numberof definitions—depending on the lover.

The kind and degrees of love he wished for were largely a matter of his choice; andif he achieved this choice, it might later change, and it had advantages and disadvantages,depending on the conditions of his life. The best I could do for this client was to helphim define more clearly (not perfectly) what he wanted and help him achieve it at thattime—without the certainty that he would gain it and that it would last!

The client was helped to be less rigid about his demands and all was well. But I sawthat not only had human desires better be less imperative but also that there were amyriad of them, and that they could change. One woman’s meat was another woman’spoison. Therefore, general and universal rules for human conduct did not seem to exist.REBT could, with some degree of probability, tell people that if they hold rules of livingrigidly and absolutely they are likely to get into trouble. But it could not tell them whatto prefer or desire.

REBT, moreover, has always been somewhat postmodern and constructivist in thatit largely follows Epictetus’ two-thousand-year-old idea, “People are disturbed not bythe things that happen to them but by their views of these things.” It therefore takes aphenomenological stand rather than an objectivist position. And its unabsolutisticview—that it is healthy to have strong wants and preferences but unhealthy to raisethem to grandiose commands—is particularly consonant with the postmodern positionthat desires are not sacrosanct.

For these reasons—and more that could be presented—REBT tries to be as construc -tivist as, and in some ways more constructivist than, other therapies. Whether it actuallysucceeds in this respect only further study, including scientific and experi mental study,will show.

The foregoing positions sound, to my prejudiced ears, like open-minded, flexible,and postmodern views. I favor them and try to follow them in my life and in my theoryand practice of therapy. With some difficulty! For although I am willing to live withanswers and rules that I realize are not final, utterly consistent, and indubitably correct,I would like to have some degree of probability that the ethics I choose for my life andmy therapy relationships are reasonably correct and beneficial. Kelly (1955) thoughtthat although we cannot be certain about the goodness or rightness of our morals, wecan still have probabilistic faith that they are workable. I tend to agree with him.

318 Albert Ellis

The trouble with postmodern ethics, as a number of critics have pointed out, is thatthey can easily be taken to relativist and even anarchic extremes (Fuchs & Ward, 1994;Ginter, 1996; Haughness, 1993; Raskin, 1995). Humans seem to require fairly clear-cutsocial rules when they live and work together; and counselors and therapists especiallyhad better adopt and follow fairly strict ethical standards. Active–directive therapistslike me are particularly vulnerable in this respect, because we tend to be moreauthoritative, more didactic, and more forceful than passive, quiescent therapists are.Therefore, we are often accused of being more authoritarian, self-centered, and harmfulthan passive therapists. I don’t quite agree with this allegation and could write a bookon the enormous harm that is often done by passive therapists, who often keep clientsin needless pain and solidly block what they can do to change themselves. But let mefully admit that directive therapy has its distinct dangers and show how I, partly fromtaking a postmodernist outlook, ethically deal with these dangers.

An Active–Directive Approach

Let us take one of the very important problems of therapy, and one that has distinctethical considerations, to see how I use postmodern views to handle it. As a therapist,shall I mainly be a fairly passive listener, hear all sides of my clients’ problems, explorewith them the advantages of their doing this and not doing that, have faith in theirown ability to make presumably good decisions for themselves, and patiently wait forthem to do so? Or should I instead more active–directively zero in on what I think aremy clients’ core disturbances, show them what they are specifically thinking, feeling,and doing to needlessly upset themselves, and directly challenge them and teach themhow to think, feel, and behave more effectively?

A number of schools of therapy—especially classical psychoanalysis, Rogerian person-centered, and cognitive-experiential therapy—largely favor the more passive approach,while a number of other schools—especially behavior therapy, cognitive behaviortherapy, problem-solving, and Gestalt therapy—largely favor the more active–directiveapproach. Which one is more ethical and which shall I use?

As almost everyone in the field of therapy already knows, I—and REBT, the specialform of therapy that I use—favor active–directive methods. I consider these to be ethicaland efficient for several reasons.

Most clients—especially those with severe personality disorders—are disturbed for bothbiological and environmental reasons. They are innately prone to anxiety, depression,and rage and they also learn dysfunctional thoughts, feelings, and behaviors. Theypractice them so often that they have great difficulty changing even when they gainconsiderable insight into their origin and development. Therefore, they had better betaught how they are probably upsetting themselves and taught specific and generalmethods to change themselves (Ellis, 1994; Ellis & Dryden, 1997; Ellis et al., 1997).

Clients are usually in pain when they come to therapy. Active–directive methods, asresearch has shown, tend to be more effective in a brief period of time than morepassive methods are (Elkin, 1994; Hollon & Beck, 1994; Lyons & Woods, 1991;Silverman, McCarthy, & McGovern, 1992). There is also some evidence that theactive–directive methods of cognitive behavior therapy may lead to a more lasting

How REBT Belongs in the Constructivist Camp 319

change than some of the more passive techniques tend to produce (Hollon & Beck,1994; Weishar, 1993).

Therapy is often expensive. It seems ethical to help clients benefit from it as quicklyas feasible—which is what active–directive methods tend to do (Ellis, 1996a).

More passive therapists—such as classical analysts and Rogerian person-centeredpractitioners—have often appeared to be passive while actually sneaking in more activemethods. They may therefore not be as honest compared to more active therapists whofully acknowledge their directiveness.

In REBT terms, passive techniques such as relating warmly to clients instead offocusing on their specific dysfunctioning may help them feel better but not get better.Clients often enjoy being endlessly listened to rather than urged to change, and feelconditionally better because their therapist approves of them rather than beingunconditionally self-accepting, whether or not their therapist likes them (Ellis, 1990a,1972/1990b, 1991, 1994, 1996a).

Actively showing clients how to function better often helps them achieve a sense of self-efficacy. This may not amount to unconditional self-acceptance, but nonetheless maybe quite therapeutic (Bandura, 1986).

Active therapy may push clients to do difficult beneficial tasks—such as in vivodesensitization—that are quite beneficial but that they would rarely do on their own.Clients often change more when they first make themselves uncomfortable and thenlater become comfortable with their new behaviors. Active–directive therapy is likelyto do more than passive therapy to encourage them to uncomfortably change (Ellis,1994, 1996a; Ellis & Dryden, 1997).

For all these advantages of active–directive therapy, I had better acknowledge itspossible disadvantages, including these:

• It may be too directive and interrupt clients’ innate proactive propensities to workon their own problems and to actualize themselves.

• It may induce clients to use methods that the therapist strongly believes in but thathave little efficacy or that may even be iatrogenic.

• It may encourage clients to try suggested methods too quickly without giving themproper thought and preparation.

• It may lead clients to adopt goals and values that the therapist sells them on andtherefore not really to fulfill themselves.

• It may tempt directive therapists to go to authoritarian, one-sided, and evenrighteous extremes and to neglect important individual differences, multiculturalinfluences, and other aspects of individual and group diversity.

• It may put too much power and responsibility on the therapist, disrupt a potentiallycollaborative and cooperative client–therapist relationship, and detract from thehumanistic aspects of counseling.

Even though much published evidence shows that active–directive therapy is oftenquite advantageous and effective, we can postmodernistically question whether atbottom, these results are really effective, good, deep, or lasting. These terms havemultiple meanings, some of which directly contradict other meanings of the same term.Which of these meanings shall we accept as true?

320 Albert Ellis

My personal solution to this issue is to take an and/also rather than an either/orapproach. Thus, in accordance with REBT theory, I usually zero in quite quickly onmy clients’ basic or core philosophies—especially on their dysfunctional or irrationalbeliefs—and show them how to differentiate these from their rational and functionalpreferences, as well as how to use several cognitive, emotive, and behavioral methodsto dispute and act against these beliefs.

But I also show them some important other sides of their dysfunctional thinking,feeling, and behaving. Even their highly irrational ideas—their absolutistic shoulds,oughts, or musts—have advantages and virtues. “I must perform well or I am worthless!”produces anxiety and avoidance, but it is also motivating, energizing, and brings somegood results. Likewise, even questionable ideas—such as the Pollyannaish beliefs, “Dayby day in every way I’m getting better and better” or “No matter what I do kind Fatewill take care of me”—may jolt one out of a depressed state and help one functionbetter.

Strong negative feelings can be good and bad, helpful and unhelpful. When you dopoorly, your strong feelings of disappointment and regret may push you to do betternext time. But your strong feelings of horror and self-hatred may harm you immensely.Yes, and even your feelings of horror and self-hatred may sometimes help you give updamaging behavior patterns such as compulsive smoking or drinking!

Rational ideas and behaviors are not always really rational—certainly not alwayssensible and effective. Rationally and empirically believing that the universe is senselessand uncaring will help some people to be self-reliant and energized—and help othersto be depressed and hopeless. Accurately believing that no one in the world really caresfor you will motivate some people to work at being more social and others to withdrawsocially.

Cautions and Limitations

In spite of the disadvantages of active–directive therapy, I strongly favor it over passivetherapy. But to make reasonably sure that I do not take it to extremes I try to keep inmind several safeguards. Here are some of my main—and I think postmodernisticallyoriented—cautions.

Awareness of My Technique’s Limitations

I do therapy on the basis of my sincere and strong faith in REBT—meaning, my beliefthat it most probably works well with most of my clients much of the time but that italso has its distinct limitations. I tentatively endorse and follow it but keep looking forits flaws and its shortcomings. I keep checking my own results, those of my colleaguesand trainees, and those reported in the literature. I try to keep especially aware of itsdangers and its inefficiencies. Thus, I keep looking for the limitations of my active–directiveness, pointing them out to my clients and encouraging them to be moreactive–directive in their own right (Ellis, 1996a; Ellis & Dryden, 1997).

How REBT Belongs in the Constructivist Camp 321

Awareness of Clients’ Differing Reactions

I assume that REBT methods help most of my clients much of the time—but hardlyall of them all of the time. Although I often see clients as having disturbances stemmingfrom similar dysfunctional or irrational beliefs, I also keep reminding myself that evenpeople with the same problems—for example, severe states of depression—have vastlydifferent biochemical reactions, temperaments, histories, family and cultural influences,socioeconomic conditions, therapeutic experiences, and so on. Moreover, they reactdifferently to me and my personality and preferences. Although I still start out withwhat I think are the best REBT methods for each of them—which usually means theones I have successfully used with somewhat similar clients in the past—I remain quiteready to vary my methods considerably with each individual client. I even consider,when REBT doesn’t seem to be working, using methods that REBT theory and practiceusually opposes (Ellis, 1996a). Thus I am uncharacteristically passive with a few clientswho would resist more active methods, and I am super-optimistic with some clientswho do not take well to the hard-headed realism I use with most of my clients.

Experimenting with Various Techniques

Aubrey Yates (1975), a behavior therapist, once said that each session of therapy hadbetter be an experiment—and one that leads the therapist to change tactics as the resultsof that experiment are observed. I add: I had better observe and review each series ofsessions, and the length of therapy as a whole, as an experiment. As I note the goodand bad results—or what I think are the good and bad results—of my sessions witheach individual client, I try to repeat successful REBT methods and modify unsuccessfulones with this particular client. If my REBT methods do not appear to be working, Iexperiment with some non-REBT—or even anti-REBT—methods. If these do not seemto be effective, I refer the client to another REBT or non-REBT therapist. As usual, Ikeep experimenting with a number of active–directive methods—and with some morepassive ones as well.

Using Multimodal Methods

From the start, REBT has always used a number of cognitive, emotive, and behavioralmethods with most clients, and over the years it has added a number of additionalmethods that appear to be effective (Ellis, 1957, 1962, 1988, 1994, 1996a; Kwee & Ellis,1997). All these methods have their disadvantages and limitations, particularly withsome clients some of the time. I therefore try to keep these limitations in mind and tohave available for regular or occasional use literally scores of REBT techniques—as wellas, as noted earlier, a number of non-REBT techniques. I thereby remain open-mindedand alternative-seeking in my therapy. Most methods of REBT are active–directive. Butsome—like the Socratic method of discovering and questioning irrational beliefs—aremore passive. When directiveness fails, more passive methods are borrowed frompsychoanalytic, person-centered, and other therapies.

322 Albert Ellis

Using Therapeutic Creativity

I originally used or adopted several REBT methods from other theorists and therapists,believing them to be effective implementers of REBT theory—which tentatively butstill strongly holds several major propositions. I soon found that I could better adaptmany of these methods to REBT—and to therapy in general—by slightly or considerablymodifying them. And I also devised new methods—such as REBT’s shame-attackingexercises and its very forceful and vigorous disputing of clients’ irrational beliefs—thatseem to add to and improve upon my original ones (Bernard, 1993; Dryden, 1995;Ellis, 1988, 1994; Ellis & Dryden, 1997; Walen, DiGiuseppe, & Dryden, 1992). I—andhopefully other REBT practitioners—remain open to using our therapeutic creativityto adapt and devise new methods with special clients and with regular ones. I mostlyhave created new active–directive methods. But I also designed the more passive methodof exploring clients’ early irrational beliefs, as well as the dysfunctional beliefs of others,to prime them indirectly to note and deal with their own self-defeating ideas. I havealso for many years encouraged clients to teach REBT to their friends and relatives andthereby indirectly learn it better themselves (Ellis, 1996a). I use a number of paradoxicalmethods with my clients—such as encouraging them to get at least three rejections aweek—so that they see and believe that being rejected is not horrible or shameful.

Varying Relationship Methods

REBT theory holds that the majority of therapy clients can benefit from achievingunconditional self-acceptance (USA)—that is, fully accepting themselves as good ordeserving persons whether or not they perform well and whether or not significant otherpeople approve of them (Ellis, 1972/1990b, 1988; Ellis & Harper, 1997; Hauck, 1991; Mills,1994). Consequently, I try to give all my clients what Rogers (1961) called unconditionalpositive regard; and I go beyond this and do my best to teach them how to give it tothemselves. I recognize, however, that even USA has its limitations—because some peopleonly change their self-defeating and antisocial behavior by damning themselves as wellas their actions. I especially recognize that methods of showing clients unconditionalacceptance range from warmly loving or approving them to unemotionally acceptingthem with their revealed failings and hostilities. All these methods have their advantagesand disadvantages, and all of them work well and badly with different clients. So I varythe specific ways I relate to clients and cautiously observe the results of my interactionswith them. Occasionally, I even go along with their self-damning when, oddly enough,it seems to help them. So I generally give clients unconditional acceptance and activelyteach them how to give it to themselves. But I work in many different individual andspecific ways, including indirect and passive ones.

Varying Interpersonal Methods

REBT, again on theoretical grounds, teaches clients the advantages of unconditionalother acceptance (UOA)—or the Christian philosophy of accepting the sinner but notthe sin (Ellis, 1994, 1996a; Ellis & Dryden, 1997). I do this with my clients because Ibelieve that their anger, rage, and fighting are frequently self-destructive and also ruin

How REBT Belongs in the Constructivist Camp 323

relationships with others. A good case can be made that rage and noncooperativenessseriously sabotage human survival and happiness, and that the essence of psychotherapy,therefore, is helping people achieve both USA and UOA (Gergen, 1991; Sampson, 1989).

Nonetheless, clients’ achieving unconditional self-and other-acceptance may wellhave some drawbacks—such as helping people to justify their own and other people’simmoral behavior and thereby encouraging it. So I try to realize it is not exactly apanacea.

Moreover, therapists’ ways of giving and teaching USA and UOA can easily beinterpreted wrongly by their clients. Thus, when Carl Rogers (1961) showed clientsunconditional positive regard, they often wrongly concluded that they were goodpersons because of his approval of them. But this is highly conditional self-acceptance!Similarly, if I accept my clients unconditionally when, say, they have stolen or cheated,they may wrongly conclude that I don’t really think that their behavior is evil, and maytherefore excuse their doing it.

So although I do my best to give my clients unconditional acceptance and encouragethem to give it to others, I closely watch their reception and interpretation of what Iam doing. I solicit their feedback, watch their reactions with themselves, with me, andwith others—and once again use a variety of relationship and interpersonal relatingapproaches to determine which ones actually seem to work. I actively give and teachself-acceptance and forgiveness of others. But I also actively watch and try to counterits potential dangers.

Once again, REBT has always actively used the therapeutic relationship to help clientsbecome aware of their interpersonal cognitive, emotional, and behavioral deficiencies.But I keep reminding myself that if my clients involve themselves too closely with methat may increase their neurotic neediness and interfere with their outside relationswith others. I am also skeptical of my assumption that the main ways my clients reactto me—who may be a uniquely accepting person in their life—are the same ways thatthey react to others. So I often tone down their involvement with me, encourage theirparticipation in one of my therapy groups, recommend suitable workshops, talks, andbooks, and teach them interpersonal skills specifically designed to help them in theiroutside life. I do not assume that their relationships with me are clearly transferredfrom their feelings and prejudices about their early family members—though occasion-ally that is so. I assume, rather, that they often have an idiosyncratic and personalrelationship with me and I watch closely to see if it is over- or underinvolved and howit can be constructively used despite its possible dangers. When my actively relating tomy clients seems to be iatrogenic, I try to deliberately ameliorate it with a more passivekind of interaction with them.

Skepticism About the Infallibility of the Therapist and the MainTherapeutic Methods Employed

REBT encourages clients to have two almost contradictory beliefs: First, that they areable to understand how they largely disturb themselves, how they can reduce theirdisturbances and increase their individual and social fulfillment, and how they can useseveral REBT cognitive, emotive, and behavioral methods to try to actively work atdoing what they theoretically can do. REBT thus tries to help clients have an active,

324 Albert Ellis

strong feeling of self-efficacy about changing themselves. Second, it keeps encouragingthem to see and accept their human fallibility and imperfection realistically—toacknowledge that they now are, and in all probability will continue to be, highly error-prone, inconsistent, unreasonable, inefficacious individuals. Always? Yes. To a highdegree? Yes.

Can clients, then, have confidence in their ability to grow and change—have a senseof self-efficacy in this regard—and still acknowledge and accept their quite humanfallibility? Why not? People are fallible at all sports—and also have real confidence thatthey can usually play one of them well, and actually do so. They are highly falliblestudents—but feel efficacious, say, at test taking and usually get decent marks. So it isalmost certain that they are generally fallible. But at the same time, they are highlyproficient in certain tasks, know they are proficient, and help themselves remainproficient by having a sense of self-efficacy about these tasks.

So I can safely active–directively show my clients that they are generally fallible, andeven often fallible about changing themselves. Nonetheless, if they are willing to workat changing themselves, they can have what I call achievement-confidence and whatAlbert Bandura (1986) calls self-efficacy. Believing that highly probably—not certainly—they can change, they often do.

Therapists, too, can feel confident that they are effective—in spite of their fullyacknowledging their therapeutic (and general) fallibility. This is what happens as I doactive–directive REBT. I am quite confident that I will often significantly help my clients,and usually help them more than if I used another main form of therapy. But I alsoknow full well that I am a fallible human—quite fallible. I recognize that with eachclient I can and at times easily do REBT inefficiently—yes, even though I created it,have used it with many thousands of clients, and am the world’s leading authority onit. Nonetheless, with this particular client, I may well have my prejudices, weaknesses,hostilities, frustration intolerances, ignorances, rigidities, stupidities, and so on and on.Indeed I may!

While seeing a client, I therefore often do several things:

• Acknowledge my prejudices and weaknesses.• Accept myself unconditionally with them.• Try to ameliorate and compensate for them.• Decide whether, in spite of my failings, I am still probably able to help this client.

If I decide that I am able, I push myself on with a good degree of confidence orself-efficacy.

• Do my best to use REBT (and possibly other) methods with each client. Sometimesdiscuss my weaknesses with the client, to see if he or she is willing to continue tosee me. If so, I proceed actively, energetically with the therapy—mainly with a highdegree of confidence but also with some doubts.

• Keep checking on my doubts and often change my tactics with this (and other)clients and/or refer some to another therapist.

Postmodern philosophy, when not taken to relativist extremes, has a great deal tooffer to the field of psychotherapy, particularly in the area of psychotherapy ethics.Rational Emotive Behavior Therapy (REBT) is active–directive but is also unusually

How REBT Belongs in the Constructivist Camp 325

postmodernistic and constructivist in that it specializes in showing clients how theirconscious and unconscious absolutistic philosophies lead to much of their dysfunctionalfeelings and behaviors, and what they can do to make themselves more open-mindedand flexible in their intrapersonal and interpersonal relationships.

Active–directive therapies, however, may dangerously neglect some aspects ofconstructivist therapy, such as ignoring less intrusive and more passive ways ofcollaboration between therapists and their clients. This chapter shows how I, as anactive–directive practitioner of REBT, address some of its potential dangers and usepostmodernist ethics and safeguards to retain its efficiency and reduce its risks. Inparticular, it stresses therapists’ becoming aware of REBT’s limitations and of clients’different reactions to its techniques; experimenting with various multimodal methodsof REBT and non-REBT therapy in response to client feedback, both solicited andobserved, using therapeutic activity; varying relationship and interpersonal approaches;and remaining highly skeptical about the therapist’s and the therapeutic method’sinfallibility. These caveats and cautions will not make active–directive REBT—nor anyother form of therapy—entirely flexible and safe. But they may considerably help.

I have tried, in this chapter, to show how Rational Emotive Behavior Therapydefinitely belongs in the constructivist camp. Definitely—but not absolutistically!

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review of the outcome research. Clinical Psychology Review, 11, 357–369.Mahoney, M. (1976). Scientist as subject. Cambridge, MA: Ballinger.Mahoney, M. J. (1991). Human change processes. New York: Basic Books.Maultsby, M. C., Jr. (1984). Rational behavior therapy. Upper Saddle River, NJ: Prentice Hall.Meichenbaum, D. (1977). Cognitive-behavior modification. New York: Plenum.Mills, D. (1994). Overcoming self-esteem. New York: Institute for Rational Emotive Therapy.Neimeyer, R. A., & Mahoney, M. J. (Eds.) (1995). Constructivism in psychotherapy. Washington,

DC: American Psychological Association.

How REBT Belongs in the Constructivist Camp 327

Popper, K. R. (1985). Popper selections (D. Miller, Ed.). Princeton, NJ: Princeton University Press.Raskin, J. D. (1995). On ethics in personal construct theory. Humanistic Psychologist, 23, 97–114.Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA:

Houghton Mifflin.Sampson, E. E. (1989). The challenge of social change in psychology: Globalization and psy-

chology’s theory of the person. American Psychologist, 44, 914–921.Silverman, M. S., McCarthy, M., & McGovern, T. (1992). A review of outcome studies of rational

emotive therapy from 1982–1989. Journal of Rational Emotive and Cognitive Behavior Therapy,10, 111–186.

Simms, E. (1994). Phenomenology of child development and the postmodern self: Contrivingthe dialogue with Johnson. Humanistic Psychologist, 22, 228–235.

Tillich, P. (1953). The courage to be. New York: Oxford.Walen, S., DiGiuseppe, R., & Dryden, W. (1992). A practitioner’s guide to rational emotive therapy.

New York: Oxford University Press.Weishar, M. (1993). Aaron T. Beck. London: Sage.Yates, A. (1975). Theory and practice of behavior therapy. New York: Wiley.

328 Albert Ellis

19 An Answer to Some Objections toRational Emotive Psychotherapy

INTRODUCTION

Michael Edelstein

At 19 years old, when I met Albert Ellis, I was anxious and depressed most of the time,socially insecure, and a skilled procrastinator. I had been in psychoanalytically orientedtherapy for the past year to no avail. Then I heard Dr. Ellis speak, read one of his books,and made an appointment.

I arrived at his office (which also served as his residence) for an initial psychotherapysession. Al’s empathic, direct, sensible, wise, philosophic yet practical approach to meand my problems won me over for life. I have been a devotee and proselyte of REBT1

ever since. Consequently it’s not surprising I seem to recall having read “An Answerto Some Objections to Rational Emotive Psychotherapy” soon after its 1965 publication.In this article, Al addresses REBT philosophic and practical issues, which are raised byRobert J. Smith in his own 1964 article.2

Smith’s questions and objections include:

1. How does REBT determine a criterion for rationality?2. Are REBT values too convention-bound?3. Doesn’t REBT deny that others can affect him adversely?4. Is REBT based on a hodgepodge of pragmatic consensus and subjective idealism?5. As REBT views fears as irrationally based, it recommends ignoring rather than

facing them.6. Aren’t REBT therapists being tautological in claiming that (a) clients are disturbed

because they think irrationally and (b) clients think irrationally because they’redisturbed?

7. Are REBT therapists presumptuous in assuming that all who come for therapy canbe judged ipso facto irrational?

1 Ellis modified the label for his approach from Rational Therapy (RT) at its 1955 inception, to RationalEmotive Therapy (RET), then finally to Rational Emotive Behavior Therapy (REBT) in the 1990s. (SeeChapter 8.)

2 For a more extensive treatment of objections to REBT and its limitations, I highly recommend Ellis’seminal work, Reason and emotion in psychotherapy: A comprehensive method for treating humandisturbances, Revised and Updated (1994).

8. REBT makes untested assumptions, therefore calling for empirical validation.9. Doesn’t the REBT therapist, more directly than the Rogerian therapist, assume

certain values in the client’s worldview?10. Isn’t the REBT therapist much more authoritative than the Rogerian therapist?11. Doesn’t the existing evidence indicate that abreaction, rather than REBT strategies,

is the decisive factor in therapy?12. Does the REBT therapist fail to squarely address the client’s existential issues, while

exclusively focusing on issues related to direct physical threats in the lives of clients?

Characteristically, Dr. Ellis enthusiastically and non-defensively welcomes RobertSmith’s debates and challenges to his system. Al unsurprisingly offers comprehensive,instructive, and sometimes brilliant, fascinating responses.

When reading the article again, 45 years after its initial publication, the improvementsin the theory and practice Al had made over the subsequent 42 years captured myattention. The major revisions and additions involve how he defined “rational” and“irrational,” his conceptualizing the core philosophy underlying emotional disturbedthinking, along with the most effective ways to uproot it, and clearly distinguishingbetween self-esteem/self-confidence and self-acceptance.

Criteria for “Irrational”

In the first third of the article, Al engages in much analysis of what constitutes “rational”and “irrational” from the therapist’s and client’s perspectives. Noticeable by its absencelie the threefold criteria he highlighted in later years for determining the rationality ofa value-driven statement. These are:

1. Empirical: Are there data to support the statement? A common assertion failingthis test: “I must not get fired because then I would be unable to pay my rent.”

2. Logical: Does the conclusion follow logically from the premise? Not here: “BecauseI prefer not to fail, I therefore must not fail.”

3. Pragmatic: Does the statement help the client achieve his goals? A poor justificationfor anger: “It will force my spouse to listen to me and I’ll feel good.”

Ellis employed a fourth criteria, but never stated it formally:

4. Apodictic: This refers to synthetic a priori statements. These claims are axiomatic(a priori) truths that nevertheless apply to the real world. They are necessarily trueand logically undeniable, and yet apply to real-world phenomena.

For example, it is an apodictic truth the client does not run the universe, that he canstand what he’s standing, that rejection is not world-ending, that “musts,” “shits,” and“awfuls” do not and could not exist in reality. Consequently, we can conclude, forexample, “I run the universe therefore you must do my bidding,” “I can’t standfrustration so I must escape,” “it’s the end of the world if I’m rejected,” are apodicticallyfalse.

330 Michael Edelstein

One Versus Three Core Demands

Ellis’ comprehensive solution to emotional disturbance, presented later in REBT’sdevelopment, consisted of a threefold unconditional acceptance.

It begins with the problem, some combination one, two, or three core demands:

• ”Must” #1 (a demand on yourself): “I must do well and get approval, or else I’mworthless.” This demand causes anxiety, depression, and lack of assertiveness.

• ”Must” #2 (a demand on others): “You must treat me reasonably, considerately,and lovingly, or else you’re no good.” This “must” leads to resentment, hostility,and violence.

• ”Must” #3 (a demand on situations): “Life must be fair, easy, and hassle-free, orelse it’s awful.” This thinking is associated with hopelessness, procrastination, andaddictions.

The tripartite solution consists of:

• Preference #1: “I strongly prefer to do well and get approval, but even if I fail, I will accept myself fully” (Unconditional Self-Acceptance).

• Preference #2: “I strongly prefer that you treat me reasonably, kindly, and lovingly,but since I don’t run the universe, and it’s a part of your human nature to err, I, then, cannot control you” (Unconditional Other-Acceptance).

• Preference #3: “I strongly prefer that life be fair, easy, and hassle-free, and it’s veryfrustrating that it isn’t, but I can bear frustration and still considerably enjoy life”(Unconditional Life-Acceptance).

In the 1965 article, in contrast, Ellis emphasizes teaching the client only refusing toblame himself as the major philosophic treatment goal. He states, “[the client] is neverlikely to get the goals he desires until he unconditionally and unqualifiedly acceptshimself whether or not he fails at certain achievements and whether or not he isuniversally approved by others” (pp. 108–109). Also,

The rational emotive patient is . . . shown that he does have a concrete system ofnegative self-evaluation, that this system is sabotaging many of his own desired lifegoals, and that he’d better question and challenge it, and give it up if he wants tobecome healthier and happier.

(p. 110)

And again,

[The REBT therapist] therefore teaches his patients to accept the fact that“existential” or what Dr. Smith calls “cosmic-level” threats to man actually exist,but that they can concernedly but nonanxiously face and handle the threats if theystop defining themselves as worthless, uncopeable individuals.

(p. 111)

Objections to Rational Emotive Psychotherapy 331

As these statements from the article illustrate, Ellis does not touch on treatment byothers (must #2 and preference #2) and life circumstances (must #3 and preference #3)as arenas for initial disturbance and ultimate acceptance until later on in REBT’sdevelopment.

Self-Confidence Versus Self-Acceptance

Ellis writes: “[he] makes himself anxious when he would like to be self-confident” (p. 108). Then, on p. 109, he states: “RET contends . . . that once certain goals, suchas being unanxious and self-confident are . . . assumed to be ‘good’ and ‘rational.’”Also, “the truly self-accepting individual likes himself.”

In the early REBT years, Al did discuss self-rating, and on occasion even used theterm “unconditional self-acceptance,” as these excerpts attest. However, he had not yethoned and developed the latter notion as a mature, overarching concept in addressingthe client’s self-blaming when failing or experiencing rejection. His use of the terms“self-confident” and “likes himself” are manifestations of this, even when using theterm “self-accepting individual” in the same breath. Once he identified “self-esteem,”“self-confidence,” “self-respect,” “self-liking,” and other global evaluations asdisturbance-creating overgeneralizations, he became semantically precise andphilosophically consistent.

Enduring REBT

Despite these later refinements, the core of REBT remains intact: Only the client disturbshimself with his demandingness about adversity; the adversity itself never has thatpower. With unflagging practice and determined reinforcement, the client can identifyirrational self-talk, then question, challenge, and contradict it again and again and again, ultimately internalizing a sane perspective for coping with the difficult humancondition, creating a happy, fulfilling life. The essential achievement in REBT remainsphilosophic—unconditional acceptance of reality.

Meeting Albert Ellis on that fateful day has had profound and wonderfulrepercussions for my life and, in turn, for the lives of the many individuals I have helpedsince as a therapist, author, and speaker. May his work and example continue to flourishand light up the world.

332 Michael Edelstein

AN ANSWER TO SOME OBJECTIONS TORATIONAL EMOTIVE PSYCHOTHERAPY

Albert Ellis

Dr. Robert J. Smith (1964), in a recent article, has raised some interesting objectionsto rational emotive psychotherapy (Ellis, 1962, 1965; Ellis & Harper 1961a, 1961b). Thekind of thoughtful presentation that Dr. Smith has made in his article is quite valuable,in that it vigorously challenges the originator of a theoretical view to face certaindifficulties inherent in his system and to present experimental data that would validatehis views. Let me now, thanks to Dr. Smith, put on my own thinking cap and see ifrational emotive therapy (RET) cannot meet and benefit from some of the points hemakes.

Dr. Smith first notes that RET in severing itself from historical rationalism raises thequestion: how is a criterion for rationality determined (e.g. the therapist as being rationalwhen the client or patient is not).

The answer seems to be—if we are perfectly honest—that practically all contemporarysystems of psychotherapy contend that the patient is “irrational” (that is, “neurotic,”“sick,” “disturbed”) and that this contention is largely a definitional value system, sincea nontherapist (a Nietzschean, for example) could counter that either (a) the patientis not irrational, because he should be anxious or hostile and “enjoy” these feelings, orthat (b) he is truly irrational, but that it is good for him to be so (since certain humanvalues are enhanced by irrationality). Only by somewhat arbitrary definition, therefore,is the patient held to be irrational—by the rational, Freudian, Rogerian, or other typeof therapist.

Fortunately enough, however, the patient almost invariably comes to therapy becausehe thinks he is getting poor results in living and he agrees with the therapist that he istherefore self-defeating, unreasonable, or irrational. He presumably wants to changehis ways and become less disturbed and more rational; and this is what the therapistwill presumably help him do. In rational emotive therapy therefore, rationality is notexactly, as Dr. Smith notes, “what the body of expert RT practitioners jointly accept assuch,” but also what the body of most therapists and patients accept as such.

Now this defining of irrationality in terms of the patient’s interpretation of his owndysfunctional behavior has distinct limitations and disadvantages, because, as Smithobserves, it may encourage “defining adjustment in terms of cultural and social, i.e.normative demands,” and may thereby make psychotherapy arbitrary and time-bound.True! I, myself, have criticized other therapies for being over-conventional and culturelimited (Ellis, 1964)—as have Szasz (1960) and other recent critics.

How to have your therapeutic cake and eat it?—or to define emotional disturbancein the patient’s own terms and try to help him actualize himself (Goldstein, 1954;Maslow, 1962; Rogers, 1961) and still guide him, at least at times, away from a “self”that he largely defines in regard to fairly rigid and too-limiting cultural norms? RETsolves this problem, not entirely elegantly, with what Smith calls a “naive eclecticism.”While accepting the fact that the patient is largely irrational because he defeats his ownends (e.g., makes himself anxious when he would like to be self-confident and secure),it also points out to him that he is never likely to get the goals he desires until he

unconditionally and unqualifiedly accepts himself whether or not he fails at certainachievements and whether or not he is universally approved by others.

RET contends, in other words, that once certain goals, such as being unanxious andself-confident are (by somewhat arbitrary definition) assumed to be “good” and“rational,” then a scientific and factually validatable method of reaching these goals canbe established and taught to patients; and one of its “findings” is that feelings of securityand worth, to be permanent and deepseated, can not be anchored to arbitrary, culture-centered norms, but that, instead, the truly self-accepting individual likes himself whenhe seeks his own unique satisfactions and is not too concerned (though for practicalreasons, he has to be somewhat concerned) about the conformity of pressures of hisculture.

Is this a cute but cavilling solution to the important therapeutic problem that Dr.Smith raises? We rational emotive therapists do not think so; but we would like morediscussion—and, especially, experimentation—in this connection. After queryingwhether RET is too convention-bound, Dr. Smith oppositely notes that it exhorts thepatient

to deny that others can affect him adversely. He is taught to eliminate ‘self-defeating’reasoning as seen in implicit verbalizations concerning others’ opinions abouthimself; the responses of others are treated as of little consequence. This eventuatesin virtual impregnability of the world of the self and appears to represent a shiftin the locus of values from a pragmatic consensus to that of subjective idealism asregards reality.

RET first of all defines the patient as (a) a human organism and (b) this organism’sself or ego (or what MacDougall (1924) many years ago called his self-regardingattitudes). We rational emotive therapists do not in the least try (as Smith seems tothink we do) to get the patient “to deny that others can affect adversely.” We teach thepatient, instead, that others can damned well affect him adversely as a human organism.They can easily, for example, maim him, kill him, put him in jail, fire him from hisjob, etc. Consequently, he’d better fully acknowledge this fact and act in such a waythat others, normally, will not adversely affect this aspect of him.

At the same time, we teach the patient that his other important aspect, his “self” or“ego” or self-regarding attitude, can not be adversely affected by others—unless he takesthese others too seriously and thereby gives them a power over his “self” that theyotherwise simply do not have. For as long as he is a reasonably intelligent adult, he canrefuse to have his self-regarding attitude affected by others’ positive or negative attitudestoward him. In this one respect, he is—or at least can be—master of his fate and captainof his soul.

Perhaps this dualistic view of man and his social group is a hodge podge, as Dr.Smith thinks, of pragmatic consensus and subjective idealism as regards reality. To me,it appears to be a fairly consistent pragmatic consensus, since RET is contending that(a) patients would better accept the fact that their group can adversely affect them ashuman organisms but that (b) they need not confuse this fact with the supposition thattheir group, if it views them adversely, must thereby negatively influence their self-regarding attitudes. These, I think, are both experimentally verifiable hypotheses sincethey both have factual referents. But the onus of validating these hypotheses still rests

334 Albert Ellis

on RET practitioners (as well as on Rogerian and other therapists who also seem tobelieve that though a social group can easily affect a human organism that organismhas considerable potential ability to prevent this group from affecting its self-regardingattitudes).

Dr. Smith doubts the advocacy of certain existential goals by rational emotivetherapists because we do not go along with the existential notion that “the individualshould face his fears, his ‘brushes with nonbeing,’ so to speak, as these may serve as atherapeutic value. Rather, as indicated, such anxieties are considered, irrational, henceuntenable.”

RET, however, does insist that the individual face all his anxieties, whether or notthese are irrational. It doubts whether the individual should be truly anxious (meanover-concerned or catastrophizing, rather than realistically concerned) about his“brushes with nonbeing” or about any other of the harsh realities of our terrestrialexistence; and it teaches him to accept (not to like, but to accept the facts of) humanfrailty, imperfection, and death. In this sense, it eliminates practically all of what isoften vaguely called “existential anxiety.” But it never advocates looking away from anykind of fear, rational or irrational.

Dr. Smith wonders whether rational emotive practitioners are tautological in thatthey assume that the patient is disturbed because he is telling himself nonsense abouthimself and the world and then assume that he is telling himself nonsense because heis disturbed. Dr. Smith could just as well have accused all therapists of the same kindof tautological thinking—since the Rogerian, for example, assumes that the patient isdisturbed because he does not have unconditional positive regard for himself and then assumes that because he does not have unconditional positive regard he isdisturbed. This kind of tautological thinking, as we noted above, results from eachtherapist’s somewhat arbitrary definition (to which his patients usually concur) of whatdisturbance is.

More importantly, however, most therapists seem to be saying that if disturbance isthis—irrationality, feelings of inadequacy, oedipal fixation, lack of unconditionalpositive regard, or what you will—we can help eliminate his disturbance by using certainspecial techniques. This is what the rational emotive therapists say: if disturbance iscaused by irrational thinking (which in turn leads to over-anxiety, excessive hostility,and various other symptoms which displease the patient and render him ineffective)we can help him to change his thinking, and to do so in a relatively short time, byteaching him to use our special methods of challenging his uncritically acceptedphilosophic assumptions about himself, by doing certain homework assignments, byworking to desensitize and decondition himself on specific ways, etc. Unless weempirically verify our therapeutic assumptions, we merely have an art and not a scienceof psychotherapy. Dr. Smith seems to be urging us (and, inferentially, other kinds oftherapists) to do validating studies; and he is right.

Dr. Smith asks if it is proper for the rational emotive therapist to assume that allpatients are irrational if they enlist themselves for aid, and if he thereby does notcategorically indict all applicants for therapy.

The fact that RET practitioners label practically all patients as irrational stems fromtheir theory that cognition leads to most of what we call sustained emotion, and thatwhen emotions are disordered, the perceptive–cognitive processes that cause them arealso disordered or illogical or irrational (Arnold, 1960; Ellis, 1962; Epictetus, in Hadas,

Objections to Rational Emotive Psychotherapy 335

1961). The rational emotive therapist does not assume that the patient is irrationalbecause he comes for therapy, but because he is disturbed. His coming for therapy mayactually stem from his being less disturbed, and hence less irrational, than many otherpersons who do not admit they are emotionally aberrated and who therefore do notcome for treatment.

In any event, Dr. Smith is again right in his implication that the assumption thatdisturbance equals (or stems from) irrationality is merely a hypothesis which thedevotees of RET and of various other systems of psychotherapy, such as the schools ofAdler (1931; Ansbacher & Ansbacher, 1956) and Frankl (1955), have yet to empiricallyvalidate.

Dr. Smith indicates that in Rogerian Therapy (Rogers, 1961) “there is not as directan imputation of values” as there is in RET. Quite probably true: the Rogerian patientchooses his self-evaluation out of a variety of information he is encouraged to bringout during therapy and he is allowed much freedom in choosing—or not—to changethese presumably self-defeating or disturbance-creating values. The rational emotivepatient is much more directly and didactively shown that he does have a concrete systemof negative self-evaluation, that this system is sabotaging many of his own desired lifegoals, and that he’d better question and challenge it, and give it up if he wants to becomehealthier and happier. While the Rogerian therapist (as Smith points out) is somewhatauthoritative, the Ellisonian therapist is more so. But is this bad? As long as he is notauthoritarian and dictatorial, the rational emotive school holds that it is wiser and moreefficient for the therapist to be direct and didactic, especially when he is working withseverely disturbed persons.

This, clearly, is another hypothesis which it behooves rational therapists (and otherexperimenters) to uphold or disprove.

Smith contends that the bulk of existing evidence tends to support the view thatabreaction instead of rational understanding and working through is the decisive factorin psychotherapy (Maier and Ellen, 1959). It seems to me that the bulk of what littleevidence is now available supports quite the opposing view, as many more peopleappear to have been helped to change their basic emotional outlook and to restructuretheir philosophies of living (as opposed to their being helped temporarily to feel betterwhile maintaining the same old outlooks) by hearing or reading and thinking aboutalternate ways of living than by having an abreactive experience. Here again, definitiveresearch is called for.

Finally, Dr. Smith notes that “rational therapists dismiss responses or events in thelives of clients which are not direct physical threats, and, this writer believes, grosslyunderplay legitimate and meaningful present-day anxiety and dread (Sartre, Camus,hydrogen bomb).” I am not clear where Dr. Smith got this idea, since rational emotivetherapists do not dismiss any responses or events in the lives of patients, but insteadtry to induce them to squarely face not only these responses and events but also theconscious or unconscious interpretations and meanings they are signaling themselvesabout these responses and events. The rational emotive practitioner, moreover, oftenagrees with his patients that their concern about hydrogen bombs, air pollution, racialinjustices, etc. may be legitimate and helpful; but he doubts whether these patients’obsessive–compulsive catastrophizing, or activity-destroying states of panic, or over-concern is truly constructive or legitimate. He therefore teaches his patients to accept

336 Albert Ellis

the fact that “existential” or what Dr. Smith calls “cosmic-level” threats to man actuallyexist, but that they can concernedly but nonanxiously face and handle these threats ifthey stop defining themselves as worthless, uncopeable individuals.

In sum: Dr. Robert J. Smith is to be thanked for raising some pertinent philosophicand practical issues about the theory and practice of rational emotive (and several othermodes of) psychotherapy. Some of the points he raises may result from my and myassociates’ failure, so far, fully to clarify our position; but other of his objections canonly be met by our presenting empirical evidence that confirms our hypotheses.

References

Adler, A. (1931). What life should mean to you. New York: Blue Ribbon Books.Ansbacher, H. L., & Ansbacher, R. R. (Eds.) (1956). The individual psychology of Alfred Adler.

New York: Basic Books.Arnold, M. (1960). Emotion and personality (2 vols.). New York: Columbia University Press.Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.Ellis, A. (1964, October 30). The second-hand patient. Paper read at the New York Society of

Clinical Psychologists.Ellis, A. (1965). Homosexuality: Its causes and cure. New York: Lyle Stuart.Ellis, A., & Harper, R. A. (1961a). A guide to rational living. Englewood Cliffs, NJ: Prentice-Hall.Ellis, A., & Harper, R. A. (1961b). Creative marriage. New York: Lyle Stuart.Frankl, V. (1955). The doctor and the soul: An introduction to logotherapy. New York: Alfred A.

Knopf.Goldstein, K. (1954). The concept of health, disease, and therapy. American Journal of Psycho-

therapy, 8, 745–764.Hadas, M. (Ed.) (1961). Essential works of stoicism. New York: Bantam Books.MacDougall, W. (1924). Social psychology. New York: Century.Maier, N. R. F., & Ellen, P. (1959). The integrative value of concepts in frustration theory. Journal

of Consulting Psychology, 23, 195–206.Maslow, A. H. (1962). Toward a psychology of being. Princeton, NJ: Van Nostrand.Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton, Mifflin.Smith, R. J. (1964). A note on rational emotive psychotherapy: Some problems. Psychotherapy,

1, 151–153.Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15, 113–118.

Objections to Rational Emotive Psychotherapy 337

20 The Future of Cognitive Behaviorand Rational Emotive BehaviorTherapy

INTRODUCTION

Elliot D. Cohen

In speaking of the future of CBT/REBT, there are two distinct questions that may beraised. First, which aspects of CBT/REBT, if any, will be practiced in the future, andwhich ones, if any, should be practiced? Although these two questions are distinct, theycan easily be confused. Albert Ellis himself admits to taking a “biased view,” whichsuggests that he is probably addressing the second question. On the other hand, heconceptualizes counseling and psychotherapy of the future as largely eclectic andintegrative, with cognitive behavior therapy (CBT) and Rational Emotive BehaviorTherapy (REBT) at their core. And he says that this is “the way therapy is developing,”which suggests that he is attempting to provide an answer to the second question as well.

While neither question is easily answered, in the absence of a crystal ball, the “should”question may be less speculative, and more scientific. Notice that “should” is beingused here in an instrumental sense. It refers to a means–end or causal relationship.This question thus regards what sort of therapy would work most effectively to helpclients overcome their “psychological” problems. It is really an empirical, scientificquestion rather than one of morality or values. So, when Ellis says he is expressing a“biased view,” it appears that he is not using the term to denote an unjustified leaningor prejudice toward a particular view, but rather, a view he favors based on empirical,scientific evidence.

In this introduction, I will explore Ellis’ (instrumental) should question and try toflesh out an Ellisian perspective on where therapy should be heading in the future. Ifthe vision suggested comes to pass, then well and good. If not, then, in the noble, Stoictradition of REBT, let us not damn the universe, but instead calmly hope that eitherthis view about where therapy should be heading was misguided, or that maybe thecourse of therapy will eventually change for the better.

So, where should therapy be heading if it is to do an effective job in helping peopleconfront their “psychological” problems?

I have put “psychological” in quotes because there is not just one set of problemssubsumed under this label. Rather, there are many different types of problem. Theseproblems can range from psychotic breaches to problems of living. The latter would

include overcoming or reducing needless, self-defeating, and destructive forms ofbehavior and emotions such as anxiety, anger, depression, and guilt; improving one’scapacity to reason, creatively solving problems, setting realistic goals, and increasingone’s level of frustration tolerance in the face of challenges; becoming more self-reliant,self-affirming, and autonomous; and becoming less aggressive and more assertive.

Here, the discussion will be restricted to these latter sorts of problem. This sets aside what CBT/REBT theories, if any, would work most effectively to overcomeschizophrenia and other forms of psychosis, and so I should not be understood to beaddressing these types of “psychological” problem.

Notice also that what is true of the part is not necessarily true of the whole. Thus,whereas a particular aspect of CBT/REBT might be effective in combination with certainother theoretical components, its efficacy might be nullified when combined with others. For example, one positive aspect of CBT/REBT that Ellis highlights is its brevity. However, there can be brief ineffectual therapies and, in some contexts, brevitymight make the therapy useless, or worse. Try, for example, doing brief (classical)psychoanalysis! So, my goal will not be to provide a list of CBT/REBT components thatare alone sufficient for effective therapy, but, rather, the more modest goal of discussingjust some aspects of CBT/REBT that would, in my estimation, be necessary for effectivetherapy, that is for therapy that is effective in treating problems of living such as theaforementioned ones, and that should, therefore, be incorporated into CBT/REBT-basedtherapies of the future.

Bibliotherapy

The use of bibliotherapy in the form of self-help is a hallmark of CBT/REBT, and itshould continue to be used. As Ellis points out, millions of people have benefited fromthe books and tapes that he and his colleagues have produced.

In fact, the digital age makes possible new and innovative modes of self-help. TheInternet has the potential to make self-help resources including videos, audios, and e-books available to millions of people at the click of a mouse. Thus the REBTNetwork.org has begun to make self-help materials available on its website free of charge. Forexample, William Knaus’ How to Conquer your Frustrations is available as an e-book on this website,1 and there are other REBT-based online resources that can be obtainedfrom this website.

Further, the potential exists for development of interactive online CBT/REBTcomputer programs that can help people apply these modalities to their specificproblems and interests. For example, I have developed a reasoning-checking programcalled Belief-Scan, which scans ordinary text for faulty thinking and provides immediatefeedback on people’s thinking.2 In short, there is potential for the expansion ofbibliotherapy in the future in ways that are bounded only by the limits of one’simagination!

The Future of CBT/REBT 339

1 www.rebtnetwork.org/library/How_to_Conquer_Your_Frustrations.pdf2 For a description of this program, see for example, Elliot D. Cohen, “Teaching an Applied Critical Thinking

Course: How Applied Can We Get?” available online at www.bu.edu/wcp/Papers/Teac/TeacCohe.htm

Philosophical Analysis

What sets REBT apart from other counseling modalities is its emphasis on examiningclients’ evaluative reasoning, as distinct from their inductive reasoning. For example,some forms of CBT such as Beck’s cognitive therapy (CT) have stressed the importanceof overcoming inductive fallacies such as overgeneralization. Thus, a depressed clientmay infer that (1) everything in his life has gone wrong based on one thing having gone wrong, such as the loss of a job. The client may then conclude that (2) this mustnever have happened, and therefore life is so awful that he cannot stand to live anylonger.

Whereas CT had emphasized refuting the first level of inductive inference, REBT hasalways emphasized refuting the second level of evaluative inference. Thus the CTtherapist might try to show the depressed client that not everything has gone wrongand that there are still some positive things left. On the other hand, REBT has, fromits very inception, emphasized that correcting a client’s factual inaccuracies can amountto only a temporary fix; for bad things do indeed happen in the course of life, andfactual disputation may not always be reasonable. Rather, what is needed is a deeper,philosophical analysis that gets to the root of what sustains self-defeating and destructiveemotions such as depression. These are the fundamental evaluative fallacies ofmusturbation, awfulizing, damnation, and I-can’t-stand-it-itis. Not only will people feelbetter temporarily, they will also get better when they learn to stop telling themselveshow bad things must not happen; how awful it is when these things do happen; howthe world, or the people in it, including themselves, are no damn good; and how theyjust can’t stand it. As Ellis states,

Since the early 1970s I have stressed the fact that while most therapies try to helppeople feel better, REBT emphasizes helping them get better as well. I have becomeeven more convinced about this in recent years and have contended that even brieftherapy, when it is philosophically done can be better, deeper, and more enduringthan some of the longer therapies, such as classical psychoanalysis.

REBT’s emphasis on this deeper, more permanent type of cognitive change, what Elliscalls elegant therapy, is now a mainstay of both REBT and CBT, and it should be allowedto survive intact in future theories of counseling and psychotherapy.

The ABC Theory

REBT is philosophical because it asks people to give up self-disturbing “philosophies”such as the above ones and to replace them with constructive rational philosophies.For example, instead of demanding that things must go one’s way, one can changeone’s “musts” to preferences. (“I would prefer that I get what I want but that doesn’tmean that I must get it.”) Or, instead of telling myself that I am worthless when I messup, I can practice unconditional self-acceptance (USA).

REBT is also philosophical because it accepts classic Stoic philosophies, in particular,that of Epictetus who said that it is not the events in people’s lives that upset them butrather it is their interpretation of these events. This insight has become the basis of

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REBT’s so-called “ABC Theory.” According to this theory, it is not an Activating event(A) alone that leads to a behavioral and emotional Consequence (C). Instead, there isalways a belief system (B) that intervenes between A and C and causes C.

This theory is so essential to helping clients to pinpoint and refute their irrationalcognitions (at B) that no theory that seeks to effect cognitive change in clients canafford to overlook it. Inasmuch as all approaches to counseling and psychotherapy seeksuch change, this theory, in some shape or form, should prevail.

However, back in 1985, I began experimenting with the ABC Theory, seeking toimprove on it.3 My approach was to “logicize” the ABCs of REBT. According to thisform of Logic-Based Therapy (LBT), people sustain their self-defeating emotions bylogically deducing irrational judgments from fallacious premises. For example, I depressmyself by making the following inference:

I made a mistakeTherefore I am a worthless person

However, this argument includes a suppressed major premise, namely that, “If I makea mistake then I’m a worthless person.” This premise must be added in order for theconclusion to follow:

If I made a mistake then I’m worthlessI made a mistakeTherefore, I’m a worthless person

Once this missing premise is exposed, it can be refuted: If making a mistake meant youwere worthless, then everybody would be worthless, as everybody makes mistakes!

Further, the therapist can then look for the premises from which the exposed majorpremise has been deduced. “Why do you think you’re worthless if you made a mistake?”the therapist might ask. “Because I must be perfect or else I’m worthless,” answers theclient, thus generating the following interlocking set of inferences:

If I must be perfect and I’m not, then I’m worthlessI must be perfectTherefore, if I’m not perfect, then I’m worthlessIf I make a mistake, then I’m not perfectTherefore, if I make a mistake, then I’m worthlessI made a mistakeTherefore, I’m worthless

In this way, LBT/REBT can affect a deeper, more systematic, more logical, and morephilosophical exploration of clients’ belief systems than the causal version of the ABCtheory. It can thereby get inside the justificatory network of the client’s reasoning andhelp her make lasting philosophical changes. In my estimation, REBT should, true to

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3 Elliot D. Cohen, “The Use of Syllogism in Rational Emotive Therapy,” Journal of Counseling andDevelopment, Sept. 1987, Vol. 66, pp. 37–39.

its logical and philosophical roots, move further in the direction of a logic-basedapproach.

Keying Into philosophical theories and ideas

With this logic-based approach also comes the opportunity to increase the depth ofthe philosophical analysis by incorporating more philosophical ideas and theories intothe corpus of CBT/REBT. As I have shown in my book, The New Rational Therapy(Rowman & Littlefield, 2006) there is an abundant wealth of rich therapeutic ideas inclassic philosophical theories, from Plato, Aristotle, Kant, Nietzsche, William James,John Stuart Mill, Sartre, and a host of other philosophers. These philosophies can beused as antidotes for overcoming and providing constructive alternatives to the irrationalphilosophies by which people disturb themselves. For example, to the person who tellshimself that what happened was so awful that he cannot go on, Nietzsche’s theory ofsuffering can be edifying. “Profound suffering,” said Nietzsche, “makes noble” and“separates” the sufferer from the uninitiated. One’s bad experiences provide theopportunity for learning and growth. Such easily packaged and digested wisdom ofantiquity can provide an incredibly rich source of antidotes to faulty thinking, andshould therefore be incorporated into future LBT/REBT-based approaches.

Willpower

CBT/REBT has also always stressed the importance of cultivating willpower throughbehavioral training. This is an ancient Aristotelian insight. Even when people knowthat they are behaving irrationally, they fall into cognitive dissonance and continue todo so. Consequently, CBT/REBT’s emphasis on giving behavioral homework assign-ments to strengthen willpower is very important.

Cultivation of willpower means increasing frustration tolerance. People with lowfrustration tolerance (LFT) tend to give up easily when they are challenged and getangry at others, and themselves, needlessly. A hallmark of CBT/LBT has been helpingpeople to overcome LFT. To do this, it is not enough to work on cognition; behavioralchange is also necessary. CBT/LBT has surpassed other forms of therapy because itsystematically seeks to affect both cognitive and behavioral change synergistically. Thiswas and still is a revolutionary concept and should remain an indelible feature of allfuture theories of counseling and psychotherapy.

Expanding the Domain of CBT/REBT

CBT/REBT’s didactic character makes it suitable for educative contexts as well as clinicalones. Its principles and practice should be taught as a matter of course in publiceducation and at the post-secondary level. There are already REBT-based models thathave emerged for teaching REBT to children, such as William Knaus’ primer, RationalEmotive Education (REBTNetwork).

Most colleges and universities teach a popular assortment of general educationcourses known as critical thinking courses. These courses cover fallacious reasoning ineveryday life and are naturals for the incorporation of CBT/REBT. In fact, my recent

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book, Critical Thinking Unleashed (Rowman & Littlefield, 2009) has incorporated thebasics of CBT/REBT into its lessons and is presently being used in colleges anduniversities to teach critical thinking skills. However, this is only the beginning. Morework needs to be done to bring about a CBT/REBT revolution in elementary and post-secondary education. The principles and practice of this approach to rational livinghave already proven effective in helping millions of people overcome personal behavioraland emotional problems. It is therefore only fitting that CBT/REBT is systematicallywoven into the fabric of contemporary education.

Conclusion

The revolution that Albert Ellis started in the mid 1950s with the invention ofCBT/REBT now offers great promise in helping to shape the therapeutic and educativelandscape of the twenty-first century, and beyond. CBT/REBT’s concept of bibliotherapycan blossom into a dynamic, interactive, and cost-effective mode of delivery with theaid of advancing digital and online technologies. Its capacity to provide elegant philo-sophical antidotes to a wide range of human problems can be expanded to embracethe corpus of constructive philosophies pooled from the wisdom of antiquity. Therigors of formal logic can be injected into the ABCs of REBT to support even deeper,more profound levels of philosophical analysis. Emphasis on cultivation of willpowerand promotion of high frustration tolerance should remain the power pack drivingconstructive change. The dynamic CBT/REBT engine to emerge from the aforemen-tioned developments should continue to cross disciplinary lines and become part ofthe fabric of general education throughout the world. This was Albert Ellis’ vision: adidactic, cost-effective, highly philosophical and logical, brief form of therapy, instantlyaccessible to all, universally embraced in thought and deed. It should come to fruition.

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THE FUTURE OF COGNITIVE BEHAVIOR ANDRATIONAL EMOTIVE BEHAVIOR THERAPY

Albert Ellis

In writing about the future of counseling and psychotherapy, I shall naturally take abiased view and hold that its future will largely be eclectic and integrative, as that isthe way therapy is developing. At the core of this eclecticism and integrationism,however, will be cognitive behavior therapy (CBT) in general and my own form ofCBT, now called rational emotive behavior therapy (REBT).

Cognitive behavior therapy (CBT) is one of the youngest of today’s popularpsychotherapies, and I think I can immodestly say that I seem to have originated it inJanuary 1955, under the names of rational therapy (RT) and rational emotive therapy(RET) (Ellis, 1957/1975, 1958, 1962). Psychoanalysis had previously existed for over ahalf century, and client-centered, existential–humanistic, and behavior therapy wereabout a decade old at that time. Cognitive therapy, without the emotive and behavioralaspects included in REBT, originally became popular in the latter part of the 20thcentury (Dubois, 1907; Ellenberger, 1970) and was particularly developed by AlfredAdler (1927, 1931). Eclectic and integrative therapy also was becoming fairly well knownin the 1950s (Thorne, 1950) but grew enormously in the 1980s (Beutler, 1983; Goldfried,1980).

Cognitive behavior therapy, in general, and rational emotive behavior therapy inparticular significantly overlap with early cognitive therapy as well as with existential–humanistic and behavior therapy; and REBT is exceptionally eclectic and integrative,as is Arnold Lazarus’s multimodal therapy (Ellis, 1988, 1994, 1996; Ellis and Dryden,1991; Ellis and Grieger, 1977, 1986; Ellis and Harper, 1975; Lazarus, 1989; Yankura andDryden, 1994). Together CBT and REBT have been tested in over 500 outcome studies,the great majority of which have shown them to be more effective than other forms of therapy or of waiting list groups (Beck, 1991; Ellis, 1979a; Hajzler and Bernard, 1991;Hollon and Beck, 1994; Lyons and Woods, 1991; McGovern and Silverman, 1984;Meichenbaum, 1977; Silverman, McCarthy, & McGovern, 1992; Smith and Glass, 1977).

Because of their clinical effectiveness, CBT and REBT have recently become verypopular forms of therapy and even therapists who ostensibly practice other forms ofpsychological treatment, such as psychoanalysis, transactional analysis, and existential–humanistic therapy include, and one might say, sneak in CBT methods. Therapy thatis called eclectic or integrative also often mainly consists of cognitive behavioral practice.

I predict that the future of cognitive behavior therapy will be exceptionally promisingand that it will consciously or unconsciously, overtly or covertly, continue to influenceand be used by most therapists in individual psychotherapy, and is already becomingthe rule. In group therapy it is still not the main modality employed by most therapistsbut, once again, many of its best procedures, such as cognitive homework assignments,are creeping into experiential and analytic therapies (Ellis, 1992). In marital and familytherapy it is also becoming much more popular and will, I prognosticate, continue togrow (Baucom and Epstein, 1990; Beck, 1988; Ellis, 1986, 1993; Huber and Baruth,1989).

In the field of sex therapy, CBT has practically taken over and is easily the mostpopular form of treatment (Ellis, 1976; Kaplan, 1974; Leiblum and Rosen, 1989;LoPiccolo and LoPiccolo, 1978; Masters and Johnson, 1970). It certainly looks as thoughits preeminence in this important area of psychological treatment will continue andwill expand.

So the future of CBT in regular fields of therapy seems quite bright. But in severalrelated fields it appears to be even brighter. For unlike several other forms of therapythat insist on an intimate intense relationship between the clients and their therapists especially psychoanalysis and humanistic existentialist psychotherapy, CBTcan be effectively taught in a number of psychoeducational and mass media ways. Letme mention a few important areas in which it is already quite popular and seems wellon its way to becoming even more influential.

Self-help Materials

Both REBT and CBT include many psychoeducational approaches that can easily beexplained in written and audio-visual materials and thereby set up to teach literallymillions of readers, listeners, and viewers. The last two decades have spawned a myriadof self-help, best-selling books such as—Your Erroneous Zones (Dyer, 1976), A NewGuide to Rational Living (Ellis and Harper, 1975), and The Road Less Traveled (Peck,1978)—that are heavily cognitive behavioral. Millions of CBT oriented audio and videotapes have also been sold and used. An increasing number of self-help materials byreputable CBT therapists have also been widely employed (Barlow and Craske, 1989;Ellis, 1988; Lewinsohn, Antonuccio, Breckenridge, & Teri, 1984).

The future of CBT oriented self-help materials looks bright; it is probable that theywill be increasingly used by themselves and as adjuncts to individual, family, and grouptherapy in the next decade and beyond. At our psychological clinic at the Albert EllisInstitute in New York, we have found that clients who use the self-help materials thatwe recommend often improve quicker and more intensively than those who make littleuse of these materials; and several studies have shown that cognitive behavioral writingsand cassettes are effective when used by themselves (Barlow and Craske, 1989;Craighead, McNamara, and Moran, 1984; Foa and Wilson, 1991; Goleman, 1989; Forest,1987; Pardeck and Pardeck, 1984; Scoggin, Jamison, & Gochneaur, 1989). Other studieshave shown that nearly 90% of psychologists use bibliotherapy in their practice andthat only 4% found this unhelpful. Considerable evidence for the widespread use ofself-help materials by different kinds of therapists has also been found (Atwater andSmith, 1982; Pardeck and Pardeck, 1984). It would be most surprising if the present-day effective use of cognitive behavioral materials by therapists and by users who arenot undergoing therapy does not continue and expand.

Self-help Groups

Ever since Alcoholics Anonymous and Recovery groups started in the 1930s, self-helpgroups have become very popular and have literally millions of active members today.Most of the groups, like AA, Recovery Inc., Over-eaters Anonymous, and GamblersAnonymous, have a clearcut cognitive behavioral orientation; and one of the newer

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groups, Self Management and Recovery Training (SMART), specifically follows andteaches REBT and CBT in its regular weekly meetings (Knaus, 1995). Virtually all theother self-help groups, too, use rational coping statements, behavioral procedures, CBT-oriented self-help literature, and other cognitive behavioral materials. The anti-addictionpamphlets, books, and audio-visual cassettes now used in this large-scale movementsell millions of copies every year and seem to be growing in popularity. The future ofcognitive behavioral self-help groups and paraphernalia appears to be quite assured.

Stress Management Training

Stress management training today is actually a very popular form of psychotherapy butone that is mostly done by trainers, educators, employment assistance personnel, andother non-therapists. It reaches great numbers of people, many of whom reduce theirstress and anxiety with no other forms of treatment; and it mainly consists of cognitivebehavioral techniques and includes the kind of self-help materials mentioned above.More and more organizations, such as business, educational, non-profit, political,professional, athletic, and religious organizations are teaching their employees andmembers stress management procedures and are using REBT and CBT materials andmethods. At the Albert Ellis Institute in New York, for example, we have a very activeCorporate Services Division, directed by Dr. Dominic DiMattia, that works withbusiness and other organizations to teach their members rational effectiveness training,which is done through workshops, courses, written and audio-visual materials, andother cognitive behavioral methods (Abrams and Ellis, 1994; DiMattia, 1987; DiMattiaand Long, 1990; Ellis, 1972a, 1988; Ellis, Gordon, Neenan, & Palmer, 1997; Gschwanderand DiMattia, 1991; Klarreich, 1990; Wolfe, 1974; Wolfe and Brand et al., 1977).

Applications of REBT and CBT in the workplace or in other organizations are verylikely to have an increasingly active and popular future.

School Programs

Both REBT and CBT are ideally, and perhaps most importantly, suited for schoolprograms from nursery school through graduate school. They are, of course, one ofthe most didactic forms of therapy and many studies and reports have shown that theirmain methods can be taught in large and small groups in the form of classes, lectures,workshops, and audio visual presentations (Bernard and Joyce, 1984; Ellis and Bernard,1983, 1985; Gerald and Eyman, 1981; Knaus, 1974; Seligman, Revich, Jaycox, andGilljam, 1995; Vernon, 1989).

Considering that the vast majority of children, adolescents, and adults all over theworld receive schooling of some sort, and that relatively few of them receive any amountof emotional education, and considering that cognitive behavioral methods of enhancingemotional health are unusually didactic and homework-assigning, the potential use ofREBT and CBT in the school system is enormous. Significant beginnings in this directionhave already been made and numerous regular education and continuing educationprograms on personal growth and development are now being offered, almost all ofwhich are heavily cognitive behavioral. My conviction is that these programs willcontinue to expand greatly, so that within the next decade or two few high school and

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college graduates will fail to acquire considerable emotional education along with theiracademic and vocational learning.

Brief Therapy

Brief therapy has been pushed into unusual prominence in the 1990s, largely becauseof the insistence of health maintenance organizations (HMOs) and other insuranceagencies. However, REBT and CBT have always been intrinsically brief procedures andmost of the studies showing their effectiveness have been with subjects who have hadfrom ten to twenty sessions (Hollon and Beck, 1994; Lyons and Woods, 1991; McGovernand Silverman, 1984; Silverman et al., 1992).

This is hardly surprising; I originated REBT in 1955, after I had practiced psycho-analysis, because I found psychoanalytic, person centered, and most other therapies tobe too long-winded and inefficient.

One of the main theories of REBT is that disturbed people usually have an underlyingand core belief system that includes powerful absolutistic musts and demands. Theynot only get influenced and affected by negative life events but also create and maintaindysfunctional philosophies, that are integrated with their self-defeating feelings andbehaviors; and they also have innate and acquired constructivist thoughts, feelings, andbehaviors that help them change themselves and become more functional (Ellis, 1991a,1994, 1996; Kelly, 1955; Mahoney, 1991).

In particular, REBT is a highly active–directive, philosophical form of therapy thatshows clients how they specifically upset themselves and how to use a number ofcognitive, emotive, and behavioral methods to reduce their disturbances and helpthemselves be happier, more self-actualized individuals. It assumes that effective REBTcan often be done in relatively few sessions though hardly with all clients all of the time(Broder, 1995a, 1995b; Dryden, 1994, 1995a, 1995b; Ellis, 1991c, 1992, 1996; Warrenand Zgourides, 1991). Cognitive behavior therapy also specializes in relatively brieftherapy and has shown some remarkable successes in this regard (Barlow, 1989; Beck,Rush, Shaw, & Emery, 1979; Foa and Wilson, 1991; Shapiro, 1995).

Because REBT and CBT are experimental procedures that stress efficiency as well asphilosophical depth (Ellis, 1985; Ellis and Dryden, 1991, 1997) they are likely to remainin the vanguard of brief therapies well into the twenty-first century.

Elegant Therapy to Help Clients Feel Better and Get Better

Since the early 1970s I have stressed the fact that while most therapies try to help peoplefeel better, REBT emphasizes helping them get better as well (Ellis, 1972b, 1979b). Ihave become even more convinced about this in recent years and have contended thateven brief therapy, when it is philosophically done can be better, deeper, and moreenduring than some of the longer therapies, such as classical psychoanalysis (Ellis, 1985,1991a, 1994, 1996). Elegant therapy that is designed to help people get better in additionto feeling better includes several goals: (1) reducing their presenting symptoms, suchas performance anxiety or depression over a serious loss; (2) discovering and reducingtheir related and more general symptoms, such as anxiety and/or depression in otheraspects of their lives; (3) helping them reach a point where they rarely disturb themselves

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about unfortunate life situations and therefore make themselves less disturbable; (4)showing them how, if and when they do fall back to emotional and behavioral upsetness,they can use their previously learned therapy methods to quickly undisturb themselvesagain and make themselves even less disturbable.

Although several methods of therapy vaguely try to achieve this elegant goal, REBTis especially oriented in this direction. It hypothesizes that a prime factor in disturbanceis cognitive emotional musturbation—the dogmatic, rigid, and forceful holding ofabsolutistic should, oughts, and demands on oneself, on other, and on externalconditions; and it focuses on showing people how to become aware of and change theircore dysfunctional philosophies, including their innate tendencies to overgeneralize,reify, and absolutize, which Korzybski (1933) and others have pointed out (Ellis, 1994,1996; Piatelli-Palmarini, 1994).

Some other cognitive behavior therapists have followed REBT in this respect (A.Beck, 1995; J. Beck, 1995; Mahoney, 1991; Meichenbaum, 1992), while many solution-focused and social constructionist therapists have not (deShazer, 1985; Guterman, 1994).My prediction is that the future of effective psychotherapy lies in this direction andwill be much more concerned than it now is with helping clients feel better and getbetter, and thereby make themselves significantly less disturbable.

Helping Clients Achieve Unconditional Self-acceptance (USA)

Existentialist thinkers, such as Paul Tillich (1953), emphasized helping people achieveunconditional self-acceptance (USA)—that is, to accept themselves as ‘worthy’ personsjust because they are alive and human (Bordin, 1979; Ellis and Harper, 1961; Rogers,1961). Many other therapists have endorsed this philosophy, as opposed to that ofconditional self-esteem, as advocated by Branden (1970) and others.

Rational emotive behavior therapy especially teaches clients how to achieve USA,first by the therapist’s accepting them (Beck, 1976; J. Beck, 1995; Bordin, 1979; Ellis,1972a; Meichenbaum, 1992; Rogers, 1961); but also by actively–directively teachingthem how to give it to themselves and achieve it whether or not their therapist or anyoneelse gives it (Ellis, 1972a, 1973, 1985, 1988, 1994, 1996; Ellis and Harper, 1975; Hauck,1991; Mills, 1993). Like Korzybski, REBT holds that people have a strong innate (aswell as acquired) tendency to rate their goals and purposes and also to overgeneralizedlyevaluate their self, their totality, their essence, and their being. Therefore, therapistshad better help their clients to stop forcefully and persistently upholding the is ofidentity—‘I am what I do’.

This aspect of therapy is particularly emphasized by REBT. It not only, as mentionedabove, encourages people to accept themselves unconditionally, whether or not theyperform well and whether or not other people (including therapists!) accept them. Italso offers them a unique solution to the pernicious self-rating game: ‘Don’t rate,measure, or evaluate your highly complex self, essence, or being at all. Only rate yourthoughts, feelings, and actions. No self-rating!’ (Ellis, 1973, 1994, 1996).

According to REBT, this ‘ideal’ solution to the problem of unconditional self-acceptance (USA) is difficult to achieve and easy to fall back from. So it also offerspeople the less elegant solution: ‘I’m ok just because I, exist, because I’m human, becauseI choose to view myself as okay.’ Its concept of and methods of teaching USA are

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somewhat unique. If they prevail and become influential they will, I predict, importantlyenhance the future of counseling and psychotherapy.

Enhancing High Frustration Tolerance

Both REBT and CBT have always pointed out that people largely needlessly disturbthemselves by, first, self-downing (SD) and, second, indulging in low frustrationtolerance (LFT) or by demanding that their life absolutely must be easier and moregratifying than it is and by awfulizing (AWF) and whining when it is not (Ellis,1957/1975, 1962, 1985, 1988, 1994, 1996). Particularly REBT has stressed, in this respect,dis comfort disturbance along with ego disturbance, and has shown how the twocommonly interact and reinforce each other (Ellis, 1979, 1985).

Most other popular psychotherapies especially psychodynamic ones have playeddown low frustration tolerance and its powerful tendency, first, to lead to emotionaldysfunctioning and, second, to maintain it by blocking people who ‘see’ what is wrongwith them from changing and continuing to change their dysfunctional ways. Even thepoor results that accompany self-downing (SD) are usually maintained and augmentedby people’s ‘easily’ indulging in it and stubbornly refusing to give it up. Similarly,people’s LFT and awfulizing about how their life difficulties of course, absolutely shouldnot exist is often exacerbated by their self-downing (SD) about their laziness andresistance to change.

I predict, therefore, that the future of effective counseling and psychotherapy willsee more attention being paid to clients’ LFT including their rage, and how to helpthem overcome it as well as a strong emphasis on their achieving unconditional self-acceptance.

Low frustration tolerance can be said to have two main subheadings: (1) peopledemanding that their life conditions be easier and more enjoyable; (2) their insistingthat other people absolutely must treat them more kindly, considerately, justly, andlovingly than they often do, and consequently making themselves intensely angry,enraged, violent, and homicidal against these ‘inconsiderate bastards’! This major formof LET is obviously rampant around the world and leads to much social as well asindividual harm.

The Future of Other Forms of Counseling and Psychotherapy

Assuming that general cognitive behavior therapy (CBT) and specific rational emotivebehavioral therapy (REBT) will flourish in the twenty-first century, what will be thefuture of the other therapies that are popular today? I predict that certain aspects ofthem will flourish and be integrated with CBT and REBT but that some of them willdie out as schools.

To be more specific, person-centered therapy (Rogers, 1961) will continue in theform of unconditional positive regard. But this will be taught to clients more activelydirectively and, as is presently the case in REBT, few counselors and therapists will beas nondirective and passive as many person-centered practitioners now are.

Classical psychoanalysis, as practiced by Freud (1965) and his orthodox followers,will rarely be used. But some of the psychodynamic explorations such as using the

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relationship between the therapist/counselor and the client and investigating theconnection between early experiences and present disturbances will be briefly employed.Free association and dream analysis will largely be dropped.

Jungian therapy (Jung, 1954) with its emphasis on exploring archetypes and thecollective unconscious will rarely be practiced. But Jung’s emphasis on individuation,self-actualization, and creativity will often be incorporated into general counseling andpsychotherapy.

Adler’s individual psychology (Adler, 1927, 1931) will be more popular than everbut its highly cognitive practice will have many of the effective emotive and behavioralmethods of CBT and REBT added and routinely incorporated into it. Its pioneeringadvocacy of social interest will be increasingly incorporated into other therapies.

Existential therapy (May, 1969; Yalom, 1990) will not be too popular in its own rightbut some of its main values will be incorporated into general counseling andpsychotherapy as they have already been incorporated into REBT. These values includehelping clients to choose their own pathways, live in dialogue with other humans, bemore present in the immediacy of the moment, and learn to accept certain limits inlife.

Religious, transpersonal, shamanistic, and mystical therapies will continue to existin the twenty-first century just as they have existed for thousands of years. However,they will be studied more scientifically and some of their coltish and iatrogenic aspectswill slowly be dropped. ‘Spiritual’ therapies will also remain popular but professionalcounselors and therapists will tend to use more of their purposive and meaningfulphilosophies instead of their supernatural-oriented aspects (Ellis, 1991b, 1994; Ellis andYeager, 1989; Frankl, 1959).

Eclectic, multimodal, and integrative counseling and therapy, as I noted above, willbecome more acknowledged and more popular than it is now. I still think that it willusually be heavily cognitive behavioral but will include important aspects of othertherapies (Ellis, 1994; Lazarus, 1989; Norcross and Goldfried, 1992).

The Use of Biological Methods

Rational emotive behavior therapy (REBT) pioneered a biosocial approach to counselingand psychotherapy in the early 1960s, when I faced the fact that many seriously disturbedpeople have strong biological as well as learned tendencies to become dysfunctional.Indeed, REBT is still one of the few therapies to hypothesize that all humans are bornand reared with the tendencies to defeat and to constructively change themselves andthat, with hard work and practice, they can use the latter proclivities to minimize (butnot entirely remove) the former (Ellis, 1962, 1965b, 1973, 1985, 1987, 1994, 1996).

Consequently, REBT has always favored integrating biological and medical withpsychological methods (Ellis, 1994, 1996). It still does. I predict that future counselorsand psychotherapists will increasingly refer many of their clients for medication,exercise, diet, and other health procedures and will often integrate psychological andbiological methods of increasing emotional function, and happiness.

350 Albert Ellis

Individuality and Sociality

Although the enhancement of human individuality, self-direction, and self-actualizationhas been a prime goal of most counselors and therapists in western countries up tonow (Freud, 1965; Jung, 1954; Maslow, 1954), individuals practically always live insocial groups; their ‘personality’ is enormously influenced by their social upbringing;and their survival may well depend on a higher degree of social interest than counselingand psychotherapy often promote (Adler, 1927, 1931; Ellis, 1965a, 1973, 1994; Lasch,1978; Sampson, 1989). Twenty-first century psychological practice had better, andprobably will, effectively abet human individuality and sociality. Not either/or butboth/and!

Conclusion

The future of counseling and psychotherapy looks good to me for several reasons.

1. Therapy is being experimentally studied and will continue to be investigated, muchmore than before. This will tend to make it briefer and more effective for morepeople more of the time.

2. It is becoming more open-minded and integrative—which again will probablyincrease its efficiency.

3. It is dealing more fully with people’s core disturbances and with the thoughts,feelings, and behaviors that go with them. It is on the way to helping them becomeless disturbed and less disturbable.

4. It is increasingly helping people to achieve both unconditional self-acceptance(USA) and higher frustration tolerance (HFT).

5. It is increasingly emphasizing the dual goals of helping people enhance their humanindividuality and their sociality.

All this looks optimistic. But what we don’t know about effective counseling andpsychotherapy far outweighs what we do know. If we have high frustration toleranceand scientific flexibility, our future as counselors and therapists looks bright!

References

Abrams, M., & Ellis, A. (1994). Rational emotive behavior therapy in the treatment of stress.British Journal of Guidance and Counseling, 22, 39–50.

Adler, A. (1927). Understanding human nature. New York: Greenberg.Adler, A. (1931). What life should mean to you. New York: Blue Ribbon Books.Atwater, J. O., & Smith, D. (1982). Christian therapists utilization of bibliotherapeutic resources.

Journal of Psychology and Theology, 10, 230–235.Barlow, D. H. (1989). Anxiety and its disorders: The nature and treatment of anxiety and panic.

New York: Guilford.Barlow, D. H., & Craske, M. G. (1989). Mastery of your anxiety and panic. Albany, NY: Center

for Stress and Anxiety Disorders.Baucom, D. H., & Epstein, N. (1990). Cognitive-behavioral marital therapy. New York:

Brunner/Mazel.

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1960s, psychotherapy systems 5

AA see Alcoholics AnonymousABCDE model 22ABC model 26, 73–85, 340–342aberrant individuals 294, 299–302; see also

anger; anxiety; depressionacceptance: conditional self-acceptance 64,

314; Ellis-Branden debate 39–42;Hartman’s value theory 46–48; of reality23; self-acceptance 38–61; self-esteemcontrast 45; unconditional positive regardversus acceptance 45–46; unconditionalself-acceptance 33, 64, 314, 331–332,348–349; of unreality 110; versus self-confidence 332; viability of Ellis’s views42–43

activating events 26, 74, 75, 78, 79–84, 236,263

active-directive approach, REBT 319–321activity homework 33–34, 78, 87, 88, 91, 94,

96–98; failure training 141; Flora casestudy 233–234; Martha case study 215,220; school programs 346; willpower 342

addiction 109, 253–266Adler, A. 350agoraphobia 147–148Alcoholics Anonymous (AA) 255, 259alcoholism 16–17, 254, 255, 256, 258–266;

disease theories 259–263; genetic causes264–266

American Personnel and GuidanceAssociation 20

anger: case studies 50–53; as irrationalbehavior 23

anxiety 137–156; anxiety about anxiety143–144, 147–151; anxiety about

psychotherapy 144; biosocial elements144–145; case study 27–35; compulsions143; discomfort anxiety 137–139, 143, 146,150–151; ego anxiety 142–143, 145–147,150–151; obsessions 143; perfectionism167–168; phobias 119, 143, 147, 149;reduction techniques 137–139

Aristotle 342attribution irrationalities 114Ausubel, D. P. 299, 304avoidance irrationalities 111Axtelle, George 55

Beck, Aaron T. 235, 311, 340behavior, activating events 79, 82–84behavioural assignments see activity

homeworkbeliefs about activating events 79–84; see also

irrational belief systems; rationalbeliefs/ideas

bibliotherapy 339, 345bigotry 55biological basis, definition 106Biological Basis of Human Irrationality, The

(Ellis) 106–123biological factors: anxiety 144–145; irrational

beliefs/ideas 103–123; self-defeatingbehaviors 129–130

biological proclivities 28, 269, 315, 350biosocial approach 144–145, 350blame 9–10, 13, 15, 17, 54, 261–266, 265, 331;

alcoholism 259–263; Flora case study 223;Jane case study 28; Martha case study 175,193, 194, 197, 200, 212, 213, 216; self-esteem 63

Boulder Conference (1949) 4Bourland, D. D. 58

Index

Branden, Nathaniel 39–42Brett, Hyman 297brief therapy 347Brown, Helen Gurley 285Buchman, Frank 259Buddha 142

Can Rational Emotive Behavior Therapy(REBT) Be Effectively Used With PeopleWho Have Devout Beliefs In God AndReligion? (Ellis) 272–277

case studies: depression 15–17, 222–238;Flora 222–238; Jane 27–35; John and Sally169–170; Martha 174–221; perfectionism169–170, 174–221; Richard Roe 50–53

castration fears 15CBT see cognitive behavioral therapychallenging irrational belief systems 78, 89Chartham, Robert 287, 289Clay, Rebecca A. 272–273clients: differing reactions to REBT 322;

difficult group therapy members 97–99client-therapist relationships 140cognitive behavioral therapy (CBT): brief

therapy 347; educative contexts 342–343;future of 338–355; group therapy 86–102;history 90–92; ineffectiveness for someclients 131–132; theory 90–92; willpower342

cognitive processes: anxiety 144–145,147–151; ego anxiety 145–147;perfectionism 158–160; phobias 147;psychoneurosis 151–153; see alsothinking

command statements see must-statementscommunity, reinforcement and family

training (CRAFT) 254compulsions 143conditional self-acceptance 64, 314conformism 55, 107consequences (cognitive, emotional and

behavioral), activating events 79, 82–84constructivist approach 310–328coping self-statements 29–30, 231–232counseling see cognitive behavioral therapy;

group rational emotive therapy;psychotherapy; rational emotive behaviortherapy; rational emotive therapy; rationaltherapy

countertransference, group therapy 93–94

couples, perfectionism and irrational beliefs168–170

CRAFT (community, reinforcement andfamily training) 254

critical thinking 310criticisms of REBT 313–314, 329–337; see also

limitations of REBTcustoms, irrational beliefs/ideas 107

Danielsson, B. 49–50defensive irrationalities 113–114demandingness 22, 114, 138, 165, 166, 168,

234; see also must-statements;musturbation

denial 253–266dependency irrationalities 111depression: case studies 15–17, 27–35, 50–53,

222–238; causes 62–63; empiricalcontributions 234–238; “mental illness”label 306; symptoms 227; treatment222–238; understanding of 234–235

DIBS see disputing irrational belief systemsdifficult group members 97–99disability, coping with 239–252disapproval, fear of 15discomfort anxiety 137–139, 143, 146,

150–151disease theories, alcoholism 259–263disputations 256, 270disputing irrational belief systems (DIBS) 78,

89drug-dependency 254, 255, 256, 258–266dysfunctional behavior, skill training lack

131

economic irrationalities 110–111education 30, 88, 141, 241, 342–343,

346–347ego: anxiety 142–143, 145–147, 150–151;

illegitimate aspects 66–67; irrationalbeliefs 107; legitimate aspects 65–66;rational emotive therapy 62–72; self-individuation 65–66; self-rating aspects66–67, 70; solutions to 71; surrender of 49

elegant therapy 347–348Ellis, Albert: contribution to psychotherapy 5;

criticisms of 20, 313; disability coping242–252; down-to-earth manner 19;leadership of group therapy 86–87;therapeutic style 174

358 Index

Ellis, Albert, papers: An Answer To SomeObjections To Rational EmotivePsychotherapy 333–337; A Twenty-Three-Year-Old Girl, Guilty About Not FollowingHer Parents’ Rules 178–221; Can RationalEmotive Behavior Therapy (REBT) BeEffectively Used With People Who HaveDevout Beliefs In God And Religion?272–277; Denial 258–266; Expanding theABCs of Rational Emotive Therapy 78–85;Flora: A Case of Severe Depression andTreatment with Rational Emotive BehaviorTherapy 227–238; Group Rational Emotiveand Cognitive Behavioral Therapy 90–102;How Rational Emotive Behavior TherapyBelongs in the Constructivist Camp315–328; Psychoneurosis and AnxietyProblems 142–156; Psychotherapy and theValue of a Human Being 43–61; RationalEmotive Therapy 25–37; RationalPsychotherapy 7–18; REBT Abolishes Mostof the Human Ego 65–72; Should SomePeople Be Labeled Mentally Ill? 294–309;The Biological Basis of Human Irrationality106–123; The Future Of Cognitive-BehaviorAnd Rational Emotive Behavior Therapy344–355; The Role of Irrational Beliefs inPerfectionism 162–173; Using RationalEmotive Behavior Therapy Techniques toCope with Disability 242–252; WhyRational Emotive Therapy to RationalEmotive Behavior Therapy? 127–134; WillThe Real Sensuous Person Please Stand Up?284–290

Ellis, Havelock 284emotion: activating events 79, 82–84;

definition 7; thinking interrelationship7–9

emotional upset: causes 25–26; irrationalbeliefs 10–17; “mental illness” label302–304; musturbation 73; see alsoneuroses

empathetic listening 55–56enjoyment 56enlightened self-interest 22environmental factors, self-defeating

behaviors 129–130Epictetus 23, 142, 162, 202, 318, 340excitement-seeking irrationalities 112existential therapy 350

Expanding the ABCs of Rational EmotiveTherapy (Ellis) 78–85

experiential challenges 140–141experiential irrationalities 108expressive-emotive techniques 14–15

Farson, Richard 55–56feeling irrationalities 108Flora, case study 222–238forceful self-dialogue 33forceful self-statements 33, 232forensic psychiatry 292Freedman, D. X. 301–302free will 56Freud, Sigmund 59, 253frustration 23, 51, 63, 82, 88, 141, 146, 223;

see also low frustration tolerance

Garrity, Terry 289Gazzaniga, Michael 104global ratings 56–59“good” people 54, 58Group Rational Emotive and Cognitive

Behavioral Therapy (Ellis) 90–102group rational emotive therapy 86–102;

activity level of therapist and groupmembers 99; content orientation versusprocess 94–95; countertransference 93–94;difficult group members 97–99; Ellis asleader 86–87; group members’ activitylevel 99; group structure 87; here-and-nowactivation 97; history 90–92; interventionlevels 94; norms 87; process 92–101;techniques 89; theory 90–92; therapistactivity level 99; transference 92–93;underlying process theme identification 96

group socializing 33guilt, Martha case study 174–221

habit-making irrationalities 109Hartman, Robert, value theory 42, 46–48health, irrational beliefs/ideas 110hedonism, irrational beliefs/ideas 113Hemingway, Ernest 302Henry, Jules 54here-and-now activation 97here and now focus 21homework see activity homeworkHorney, Karen 159

Index 359

hostility irrationalities 111–112Hotchner, A. E. 302How to Live With a Neurotic (Ellis) 3, 162human value: global ratings 56–59; self-

evaluation 38–61humour, use in RET 31hypercompetitiveness 170

illogical thinking 108; see also irrationalbeliefs/ideas

immorality irrationalities 112–113impulsiveness, Martha case study 174–221inactivity 62individuality and sociality 351Institute for Rational Emotive Therapy 4Institute for Rational Living 21interpersonal methods, REBT 323–324intolerant behaviour 169–170irrational belief systems: attribution 114;

avoidance 111; biological factors 103–123;in couples 168–170; criteria 330; debating29; defensive 113–114; definition 78, 106;demandingness 22, 114, 138, 165, 166,168, 234; dependency 111; detecting28–29; economic 110–111; emotional10–17; excitement-seeking 112;experiential 108; habit-making 109;hostility 111–112; immorality 112–113;magic-related 112; major illogicalideas/perceptions 11–12; memory-related114; origins 10; perfectionism 158–173;persistence of 117–118; political 110;rational belief discrimination 29; scientific115; sources 3; types 107–115; ubiquity of117–118; unmasking 10, 15–17, 26–27; see also beliefs

Islam 225

James, William 342Jane, case study 27–35John, case study 169–170Jungian therapy 350

Kant, Immanuel 342Kinsey, Alfred 285Korzybski, A. 58, 59

label of “mentally illness” see “mental illness”label

LFT see low frustration tolerance

limitations of REBT 321; see also criticisms ofREBT

listening 55–56logical positivism 310, 317logical thinking see rational beliefs/ideaslove 120low frustration tolerance (LFT) 23, 81, 91,

113, 118, 121, 342, 349; see also frustrationLucretius 23

magic-related irrationalities 112Male Continence (Noyes) 284Marcus Aurelius 142, 202Martha, case study 174–221memory-related irrationalities 114Menninger, K. 300, 304“mental illness” label 291–309; aberrant

individuals, treatment of 299–302; moralresponsibility 298–299; scientificadvancement 304–306; self-denigration297–298; social discrimination 295–297

mid-life crises 62Mill, John Stuart 342moral responsibility, “mental illness” label

298–299Morgenstern, F. V. 296, 299must-statements 26, 311, 313, 314, 331musturbation 73, 145, 166, 222, 223, 228, 340,

348mutual respect 55

name change, RET to REBT 124–134NCR (Not Criminally Responsible) 292need vs. want 22neuroses: anxiety problems 137–156; causes

9; cognitive processes 151–153; definition19; irrational beliefs/ideas 109;perpetuation 13; primary neuroses 9–10;research 151–153; secondary neuroses9–10; see also anxiety; emotional upset

NGRI (Not Guilty by Reason of Insanity) 292

Nietzsche, Friedrich 44, 342non sequiturs 52, 81, 121, 167Not Criminally Responsible (NCR) 292Not Guilty by Reason of Insanity (NGRI) 292Noyes, John Humphrey 284

obesity 62obsessions 143

360 Index

Oedipus complex 12–13over-generalizations 121

Pakistan 224, 226panic 143, 149passivity 62penalties 34perfectionism: anxiety sensitivity 167–168;

case studies 169–170, 174–221; cognitiveprocesses 158–160; in couples 168–170;hypercompetitiveness 170; irrationalbeliefs and 158–173; Martha case study174–221; stress 170–171

personal worth 22–23person-centered therapy 349philosophy 23, 142, 162, 278–279, 318, 336;

Stoics 202, 249, 313, 340phobias 10, 119, 143, 149; agoraphobia

147–148; cognitive processes 147Plato 342political irrationalities 110Polynesia 49–50praise 54, 55prejudice 55, 108present-focus 21; see also here-and-now

activationprimary neuroses 9–10problem solving 7, 21–22, 30–31, 53, 88, 92,

139proclivities, biological 28, 269, 315, 350procrastination 23psychiatric terminology 295–296psychoanalysis 349–350psychoeducational methods 30; see also

educationpsychoneuroses see neurosespsychotherapists see therapistspsychotherapy: 1960s 5; acceptability criteria

4; anxiety about 144; future of 338–355;human value 38–61; rational therapy3–18; see also specific therapies

Psychotherapy and the Value of a HumanBeing (Ellis) 43–61

psychotic symptoms, types 109

questioning irrational belief systems 78, 89

rating of self see self-evaluationrational beliefs/ideas 13, 26, 78; see also

beliefs; irrational belief systems

rational emotive behavior therapy (REBT):ABC model 340–342; active-directiveapproach 319–321; addiction therapy253–266; bibliotherapy 339, 345; brieftherapy 347; clients’ differing reactions322; constructivist approach 310–328;criticisms of 313–314, 329–337; denial253–266; depression treatment 222–238;disability counseling 239–252; educativecontexts 342–343, 346–347; eleganttherapy 347–348; Flora case study222–238; future of 338–355; God-oriented/REBT philosophy comparison278–279; group models 87–88; grouptechniques 89; group therapy 86–102;holistic approach 128; ineffectiveness forsome clients 131–132; interpersonalmethods 323–324; Islam 225; limitationsof 131–132, 321; Martha, sessiontranscript 174–221; multimodal methods322; name change from RET 124–134; inPakistan 224, 226; perfectionism 160–173;philosophical analysis 278–279, 340;process, Martha case study 175–221;relationship methods 323; religiosity269–279; resistant clients 131–132; schoolprograms 5–6, 346–347; self-help books339, 345; session transcript, Martha casestudy 174–221; SMART Recovery groups87–88; therapeutic creativity 323; therapistinfallibility 324–326; transcript of sessionwith Martha 174–221; willpower 342

rational emotive education (REE) 88, 241rational emotive imagery (REI) 32, 89, 232rational emotive therapy (RET) 19–37; ABC

model 26, 73–85; behavioral methods33–35; cognitive methods 28–33; ego62–72; emotive methods 32–33; namechange to REBT 124–134; Richard Roecase study 50–53; teaching to others 30

rational therapy (RT) 3–18, 73reality, acceptance of 23REBT see rational emotive behavior therapyREBT Abolishes Most of the Human Ego (Ellis)

65–72Redlich, F. C. 301–302REE see rational emotive educationreferentiating 30REI see rational emotive imageryreinforcements 34

Index 361

rejection fears, Martha case study 174–221relationship methods 14–15, 323religious beliefs 109–110, 269–279respect 55RET see rational emotive therapyReuben, David 287–288, 289rewards 121Robertiello, Richard 56Roe, Richard 50–53Rogers, Carl 45–46Role of Irrational Beliefs in Perfectionism, The

(Ellis) 162–173roleplaying 32RT see rational therapy

Sade, Marquis de 286Sally, case study 169–170Sarbin, T. 291–292Sartre, Jean-Paul 336, 342school programs 5–6, 346–347science-related irrationalities 115SD see self-downingsecondary neuroses 9–10self-acceptance 38–61; conditional self-

acceptance 64, 314; Ellis-Branden debate39–42; Hartman’s value theory 46–48;self-esteem contrast 45; unconditionalself-acceptance 33, 64, 314, 331–332,348–349; versus self-confidence 332;viability of Ellis’s views 42–43

self-appraisal see self-evaluationself-awareness 50self-confidence 332self-consciousness 50, 54self-defeating behaviors:

biological/environmental factors 129–130;learning 121; types 109

self-dialogue, forceful 33self-downing (SD) 349; mentally ill people

297–298self-esteem: advantages 67–68; disadvantages

38–61, 62–72; Ellis-Branden debate 39–42;self-acceptance contrast 45

self-evaluation: advantages 53, 67–68;disadvantages of 38–72; elements of41–42; Ellis-Branden debate 41; globalratings 56–59; Hartman’s value theory46–48; problems resulting from 53–56; see also self-rating

self-help books 339, 345

self-help groups 345–346self-individuation 65–66; see also egoself-interest, enlightened 22self-punishment, Martha case study 174–221self-rating: disadvantages 68–69; magical

thinking 70; solutions to 71; see also self-evaluation

self-sabotage see self-defeating behaviorsself-statements: coping 231–232; forceful 33self-verbalizations 8, 10self-worth 314Sensuous Couple, The (Chartham) 287, 289Sensuous Woman, The (Garrity) 287, 289session transcript, Martha case study

174–221sexperts 280sexuality 12, 49, 114–115, 280–290shame-attacking exercises 32, 232, 323Should Some People Be Labeled Mentally Ill?

(Ellis) 294–309Six Pillars of Self-Esteem (Branden) 40skill training 34, 131Skinner, B. F. 130SMART Recovery groups 87–88Smith, Robert J., criticisms of REBT

329–337social anxiety, case study 27–35social discrimination against mentally ill

295–297sociality and individuality 351social progress and emotional disturbance

302–304‘spiritual’ therapies 350Stoic philosophy 202, 249, 313, 340stress, perfectionism and 170–171stress management training 346suicide 296Szasz, T. S. 305, 306

tabus, Polynesia 49Tahiti 49techniques: disputing irrational belief systems

78, 89; rational emotive education 88, 241;rational emotive imagery 32, 89, 232;shame attacking exercises 32, 232, 323;skill training 34, 131; what is going on78–79; see also specific therapies

television-viewing 62terminology, psychiatric 295–296therapeutic creativity 323

362 Index

therapeutic techniques, transcript of sessionwith Martha 174–221

therapists: client resistance to therapy 132;infallibility skepticism 324–326; irrationalbeliefs/ideas 116

therapy see psychotherapy; specific therapiesthinking 7, 7–9; see also cognitive processestransference, group therapy 92–93A Twenty-Three-Year-Old Girl, Guilty About

Not Following Her Parents’ Rules (Ellis)178–221

unconditional positive regard 45–46unconditional self-acceptance (USA) 33, 64,

314, 331–332, 348–349uncontrollable events 139unreality, acceptance of 110USA see unconditional self-acceptance

Using Rational Emotive Behavior TherapyTechniques to Cope with Disability (Ellis)242–252

values: Hartman’s theory 42, 46–48; self-evaluation 38–61

Van de Velde, Dr. 285–286

what is going on (WIGO) 78–79Whitman, Charles 301WIGO (what is going on) 78–79Wile, Ira S. 285willpower 342, 343Will The Real Sensuous Person Please Stand

Up? (Ellis) 284–290Women’s Liberation movement 286work anxiety, case study 27–35worth/worthlessness 70–71

Index 363

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