What is rational emotive therapy?

Introduction

Rational emotive behavior therapy (REBT), originally called rational emotive therapy, was founded in 1955 by Albert Ellis following his disappointment with traditional methods of psychoanalysis. From 1947 to 1953, Ellis had practiced classical analysis and analytically oriented psychotherapy, but he came to the conclusion that psychoanalysis was a superficial and unscientific form of treatment. Specifically, rational emotive therapy was developed as a combined humanistic, cognitive, and behavioral form of therapy. Although Ellis initially used REBT primarily in individual formats, group and workshop formats followed quickly. Ellis published approximately fifty books and more than five hundred articles on REBT, and he presented more than fifteen hundred public workshops.

According to Ellis (in 1989), the philosophical origins of rational emotive therapy include the Stoic philosophers Epictetus and Marcus Aurelius. In particular, during the first century c.e. in The Encheiridion, Epictetus wrote that “people are disturbed not by things, but by the view which they take of them.” Ellis also gives much credit for the development of rational emotive therapy to the theory of human disturbance highlighted by psychotherapist Alfred Adler. Specifically, Ellis was persuaded by Adler’s conviction that a person’s behavior originates from his or her ideas. As Ellis began writing about and describing REBT in the 1950s and 1960s, clinical behavior therapy was conceptually distinct and distant from Ellis’s ideas. The primary similarity was that Ellis employed a host of behavioral techniques in his approach.

As time passed, however, behavior therapy engaged in a controversial yet productive broadening of what was meant by behavior and started to include cognition as a form of behavior that could be learned, modified, and studied. Ellis’s REBT approach shares many similarities with other common cognitive behavior approaches to treatment. These include Donald Meichenbaum’s cognitive behavior modification (focusing on self-instructional processes and adaptive coping statements), Maxie C. Maultsby, Jr.’s, rational behavior therapy (which is essentially REBT with some adaptations, including written self-analysis techniques and rational emotive imagery), and Aaron T. Beck’s cognitive therapy.
Cognitive therapy has many similarities to REBT but was developed independently; it uses fewer “hard-headed approaches.” For example, Beck advocates the use of collaborative empiricism and a focus on automatic thoughts and underlying cognitive schemas. REBT strongly emphasizes irrational beliefs (unreasonable evaluations that sabotage an individual’s goals and lead to increased likelihood of experiencing needless pain, suffering, and displeasure), especially “unconditional shoulds” and “absolutistic musts,” as the root of emotional and behavioral disturbances.

Principal Propositions

There are six principal propositions of rational emotive therapy as Ellis described them in 1989. First, people are born with rational and irrational tendencies. That is, individuals may be either self-helping or self-defeating, short-range hedonists or long-range hedonists; they may learn by mistakes or repeat the same mistakes, and they may actualize or avoid actualizing their potentials for growth. Second, cultural and family experiences may exacerbate irrational thinking. Third, individuals may seem to think, act, and feel simultaneously. Thinking, however, appears actually to precede actions and feelings. For example, the process of “appraising” a situation usually triggers feelings.

Fourth, REBT therapists differ from person-centered therapists in that REBT practitioners do not believe that a warm interpersonal relationship between therapist and patient is a sufficient or even necessary condition for effective change. REBT therapists also do not believe that personal warmth is necessary to accept clients fully. In fact, it is important in REBT treatment to criticize and point out the deficiencies in a person’s behavior and thinking style. Moreover, Ellis argues that REBT therapists often need to use “hard-headed methods” to convince clients to employ more self-discipline.

Fifth, rational emotive therapists use a variety of strategies, including assertiveness training, desensitization, operant conditioning, support, and role-playing. The usual goal of REBT is to help rid clients of symptoms and modify underlying thinking styles that create symptoms. Ellis further identifies two basic forms of REBT: general REBT, which is similar to other forms of cognitive behavior therapy; and preferential REBT, which includes general REBT but also emphasizes philosophic restructuring and teaches clients how to dispute irrational thoughts and inappropriate behaviors via rules of logic and the scientific method. Sixth, all emotional problems are caused by people’s tendencies to interpret events unrealistically and are maintained by irrational beliefs about them.

Connections with Irrationality

Thus, the basic underlying tenet of REBT is that emotional disturbances are primarily the result of irrational thinking. Specifically, REBT argues that people upset themselves with “evaluative irrational beliefs”(rather than with “nonevaluative” irrational beliefs). For example, in an essay published in 1987, Ellis described the following scenario:
If you devoutly believe that your fairy godmother looks out for you and is always ready to help you, you may live happily and undisturbedly with this highly questionable and unrealistic belief. But if you evaluate your fairy godmother’s help as extremely desirable and go even further to insist that because it is desirable, you absolutely must at all times have her help, you will almost certainly make yourself anxious (whenever you realize that her magical help that you must have may actually be absent) and you will tend to make yourself extremely depressed (when you see that in your hour of need this help does not actually materialize).

Although many forms of irrationality exist, rational emotive therapy focuses on a client’s strong “desires” and “commands.” Ellis has developed various lists of irrational beliefs that highlight the most common thinking difficulties of patients. These include such beliefs as “I must do well or very well”; “I am a bad or worthless person when I act weakly or stupidly”; “I need to be loved by someone who matters to me a lot”; “People must treat me fairly and give me what I need”; “People must live up to my expectations or it is terrible”; “My life must have few major hassles”; and “I can’t stand it when life is unfair.”

Ellis has refined his ideas about irrational thoughts to three primary beliefs. These are: “I must do well and be approved by significant others, and if I don’t do as well as I should or must, there is something really rotten about me. It is terrible that I am this way and I am a pretty worthless, rotten person”; “You (other humans with whom I relate, my original family, my later family that I may have, my friends, relatives, and people with whom I work) must, ought, and should treat me considerately and fairly and even specially (considering what a doll I am)!”; and “Conditions under which I live—my environment, social conditions, economic conditions, political conditions—must be arranged so that I easily and immediately, with no real effort, have a free lunch and get what I command.” In summary, Ellis defines the three primary irrationalities as “I must do well; you must treat me beautifully; the world must be easy.”

Origin of Irrational Beliefs and Actions

Psychological disturbances are based on irrational thinking and behaving. The origin of irrational beliefs and actions stems from childhood. Irrational beliefs are shaped in part by significant others (parents, relatives, and teachers), as well as from misperceptions on the part of children (such as superstitions and overinterpretation). Rational emotive therapy also maintains that individuals have tendencies, which are both biologically and environmentally determined, for growth and actualization of their potential. Ellis argues that people also have powerful innate tendencies to condemn themselves, others, and the world when they do not get what they “childishly need.” This pattern of self-sabotage is argued by Ellis to be both inborn and acquired during childhood. Moreover, via repetitive self-talk and self-evaluative tendencies, false beliefs are continually reindoctrinated by the individual. From the REBT perspective, self-blame and self-condemnation are the cornerstones of most emotional disturbances. By challenging self-blame and self-condemnation, via an analysis and refutation of irrational beliefs, a client can be helped.

Assessing Mental Health

Ellis defines mental health as incorporating self-interest, social interests, self-direction, tolerance, acceptance of ambiguity and uncertainty, scientific thinking, commitment, risk taking, self-acceptance, long-range hedonism (the idea that well-adjusted people seek happiness and avoid pain today, tomorrow, and in the future), nonperfectionism, and self-responsibility for one’s emotional disturbances. Three primary processes seem to be associated with mental functioning and mental disorders: self-talking, self-evaluating, and self-condemning. That is, individuals are constantly engaged in an internal dialogue (self-talk) with themselves, appraising and commenting on events that occur in their lives. Individuals also are self-evaluating in that humans seek meaning and constantly evaluate events and themselves, frequently placing blame on themselves for events. Self-evaluating is thus often associated with self-condemnation. As Ellis pointed out in an essay published in 1989, this condemnation may start in response to evaluating oneself as doing poorly at work or in school, which in turn leads to feeling guilty. This vicious cycle then leads to condemning oneself for condemning oneself, condemning oneself for not being able to stop condemning oneself, and finally condemning oneself for entering psychotherapy and not getting better.

Emotional and behavioral difficulties often occur when simple preferences are chosen above thoughtful decisions. Ellis believes that individuals have inborn growth and actualization tendencies, although they may become sabotaged through self-defeating and self-condemning patterns. Based on the REBT model, clients benefit from exposure to three primary insights. Insight number one is that a person’s self-defeating behavior is related to antecedent and understandable causes. Specifically, an individual’s beliefs are more important in understanding emotional upset than are past or present activating events. Insight number two is that individuals make themselves emotionally disturbed by reindoctrinating themselves with irrational and unproductive kinds of beliefs. Insight number three is that through hard work and practice, irrational beliefs can be corrected.

Treatment Steps

As detailed by Gerald Corey in 1986, practitioners of rational emotive therapy actively teach, persuade, and direct clients to alter irrational styles of thinking and behaving. REBT can be defined as a process of reeducation in which clients learn to think differently and solve problems. The first step in treatment often focuses on distinguishing rational (or reasonable) thoughts from irrational (or unreasonable) beliefs. Educational approaches are employed to highlight for the client that he or she has acquired many irrational “shoulds, oughts, and musts.” The second step in treatment emphasizes an awareness of how psychological disturbances are maintained through a client’s repeated reindoctrination of illogical and unreasonable beliefs. During the third phase of treatment, therapists assist clients in modifying maladaptive thinking styles and abandoning irrational beliefs. Via a variety of cognitive, emotive, and behavioral approaches, self-condemnation and self-blame are replaced with more rational and logical views. Finally, the fourth step in REBT involves developing a rational lifestyle and philosophy. Specifically, from internalizing rules of logic and scientific thinking, individuals may prevent future psychological disturbances and live more productive lives.

A-B-C Theories

The A-B-C theory of personality and the A-B-C (D-E) theory of emotional change are also central to REBT approaches. “A” refers to an activating event. Activating events can include facts, events, behaviors, or perceived stimuli. “B” refers to beliefs triggered by the event or beliefs about the event. “C” refers to the consequential emotional (behavioral or cognitive) outcomes that proceed directly from beliefs. “D” is the application of methods to dispute or challenge irrational beliefs, and “E” refers to the effect of disputing beliefs on the emotional (behavioral or cognitive) reaction of the client.

Activating events are generally regarded as inherently neutral, and they have no particular emotional meaning in and of themselves. Thus, activating events do not directly cause emotions. Instead, beliefs about events primarily cause emotional reactions. For example, a woman who had been depressed for more than twelve months following the death of her husband from terminal cancer was participating in a hospice therapy group and had demonstrated little or no improvement over the last year. She reasoned that because her husband was dead, she would never feel happy again (nor “should” she feel happy again, since he was dead and she was “not entitled” to experience pleasure without him). She added, “He was the center of my life and I can never expect to feel happiness without him.” Her resulting emotional reaction was severe depression, which accompanied her complicated grief and underlying anger.

In an effort to uncover and dispute her unreasonable beliefs, several strategies were employed. First, group members provided feedback about her reasonable and unreasonable ideas following (and during) her husband’s death. In particular, group members pointed out that she could expect to experience happiness again in her life since she had experienced pleasure on many occasions before she met her husband, while her husband was away during military service, and while they were married and she enjoyed activities in which he did not share. Next, her emotional reaction was examined and viewed as being caused not by her husband’s death, but instead by the manner in which she interpreted his death (as awful), her own ability to cope and change (as limited), and her future (as hopeless). A variety of behavioral and cognitive strategies were employed to challenge her irrational and self-condemning assumptions. Behavioral homework assignments included increasing activity levels and engaging in pleasurable activities to challenge the notion that she could never experience happiness again. Self-confidence and hope were fostered via strategies that highlighted her ability to cope with stress. This client also found cognitive homework assignments, wherein she listed her irrational beliefs on a daily log and then disputed those beliefs or replaced or modified them with more reasonable statements, to be helpful.

Limitations

Rational emotive therapy and its various techniques have been evaluated in at least two hundred studies. Although many of these studies have been associated with various methodological flaws, the effectiveness of REBT with a broad range of psychological disturbances is impressive. At the Evolution of Psychotherapy Conference in Phoenix, Arizona, in 1985, Ellis identified several limitations of REBT (and other therapies). These included several key “irrationalities.” Because individuals falsely believe that they are unchangeable, they fail to work to change themselves. Because individuals falsely believe that activating events cause emotional reactions, they blame the activating events and fail to change their beliefs about them. Individuals falsely believe that unpleasant emotional reactions must be good or useful and should be cherished instead of minimized. Individuals are often confused about emotional reactions (for example, concern and caution versus anxiety and panic) and experience difficulty surrendering the inappropriate negative feelings. Because some REBT techniques require subtle and discriminative styles of thinking by clients, some clients are not capable of succeeding in therapy. REBT is not particularly useful for young children or developmentally delayed individuals (typically REBT requires a chronological age of at least eight years and average intelligence).

Criticisms

Ellis is regarded by many psychologists as the most prominent theorist in the cognitive behavioral school of psychotherapy. His insight and conceptualizations are evident in many of the various cognitive behavioral psychotherapeutic approaches. Specifically, the A-B-C theory of personality is well regarded among cognitive behavioral therapists, and many of Ellis’s treatment strategies are frequently used by clinicians across other schools of psychotherapy. Ellis’s interpersonal style in treatment has been criticized by many authors. Specifically, a warm, confiding relationship between therapist and client is often deemphasized in Ellis’s writings, and confrontational interactions may be commonly observed in videotapes of rational emotive therapy. It also appears, however, that more attention is being paid to the quality of the interpersonal relationship between REBT practitioner and client. Moreover, the strengths of the REBT approach are not based on the style of any particular therapist but instead are evident in its underlying theory and therapeutic strategies.

Undoubtedly, the influence of rational emotive therapy in the field of psychotherapy will continue to be prominent. Ellis has written extensively on the application of REBT principles to diverse psychological disturbances. The Institute for Rational Emotive Therapy in New York continues to train hundreds of therapists and serves as a distribution center for most of the books and pamphlets developed by REBT therapists.

Bibliography

Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. 8th ed. Belmont: Thomson, 2009. Print.

Dryden, Windy. Rational Emotive Behavior Therapy: Distinctive Features. London: Routledge, 2009. Print.

Dryden, Windy, Daniel David, and Albert Ellis. "Rational Emotive Behavior Therapy." Handbook of Cognitive-Behavioral Therapies. Ed. Keith S. Dobson. 3rd ed. New York: Guilford, 2010. 226–76. Print.

Dryden, Windy, and Raymond Digiuseppe. A Primer on Rational-Emotive Behavior Therapy. Champaign: Research, 2003. Print.

Ellis, Albert. Better, Deeper, and More Enduring Brief Therapy: The Rational Emotive Behavior Therapy Approach. New York: Brunner, 1996. Print.

Ellis, Albert. Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy. Buffalo: Prometheus, 2001. Print.

Ellis, Albert, and Robert A. Harper. A New Guide to Rational Living. 3d rev. ed. North Hollywood: Wilshire, 1998. Print.

Robertson, Donald. The Philosophy of Cognitive-Behavioral Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy. London: Karnac, 2010. Print.