My Philosophy of Psychotherapy
ALBERT E LLIS, P H .D. (1996)

My approach to psychotherapy is to zero in, as quickly as feasible, on the clients' basic philosophy of life, to get them to see exactly what this is and how it is often self-defeating; and to persuade them to work their heads off, cognitively, emotively, and behaviorally, to profoundly change it. My basic assumption is that virtually all "neurotic" individuals at times actually think crookedly, magically, dogmatically, and unrealistically. They do not only want, wish, or prefer; they demand. They do not merely want to achieve success, pleasure, or loving relationships; they insist on being King or Queen of the May: being noble, perfect, godlike. They want to prove themselves instead of be themselves. They stubbornly refuse to work at changing obnoxious reality, or to gracefully lump it when it is truly unchangeable. They would much rather command that it should, ought, and must be the way they want it to be; and they consequently spend a considerable part of their lives whining, crying, depressing, and angering themselves when they are not getting their particular wants fulfilled.

My psychotherapeutic philosophy holds, in other words, that the vast majority of humans, in every part of the world, are much more disturbed than they have to be because they simply will not accept themselves as fallible, incessantly error-prone humans. They often aspire to be super­humans; and because they cannot be, and because they also have inborn and acquired tendencies to denigrate themselves (and not merely their performances) when they fall short of their unrealistic ideals, they largely think of themselves as subhumans. They then feel anxious, guilty, ashamed, worthless, and self-hating. They also usually have low frustration tolerance for the inescapable foibles of others and for the hassles of living in an inexorably difficult world; and by their foolish com­mands that these others be utterly kind, considerate, loving and fair, and that the conditions of life be easy, effortless, and untroubled, they enor­mously escalate their natural and healthy feelings of sorrow, regret, annoyance and irritation into highly unhealthy feelings of anguish, self­pity, rage and depression.

Let me, at the risk of becoming boring, repeat—for this point is essential to the understanding of my philosophy of psychotherapy. Practically all individuals have strong innate and learned tendencies to act like babies all their lives: to define their wants as absolute needs (necessities); to devoutly believe that they must perform well, that others ought to treat them fairly, and that their conditions of living have to be comfortable and pleasant. To make matters still worse, they extend their antiempirical, illogical, and self-defeating demandingness into the realm of their disturbances. They consequently foolishly believe that they must not be emotionally disturbed; and that if they are, and if they go for some form of therapy, they have to get better fast, elegantly, and as beautifully as some other clients improve. They therefore frequently down themselves on three important levels: first, about their original failures; second, about their failing to be free from symptoms; and third, about their failing to improve in therapy. As a result of their arrant perfectionism—which, in a sense, is the human condition— they are often fairly deeply disturbed or self­defeating. And their resistance to therapy is continual and strong not (as psychoanalytic theory wrongly assumes) because they hate their therapists or do not want to get better, but because they almost always do have a hard time giving up their magical assumptions, accepting the often hard and harsh facts of reality, and working persistently and strongly to change their basic philosophic premises, or what Alfred Adler called their neurotic goals, aims and purposes.

Therapeutic Goals and Style

If all this is true, then it is fairly obvious what my goals and psychother­apeutic style are. I am largely determined to efficiently and effectively show my clients that: (1) They are personally responsible for their present symptoms and the past or present conditions of their lives importantly influence and affect but do not by themselves disturb them. (2) Understanding exactly what they are thinking and doing to upset themselves emotionally is usually a prelude to personality change, but only determined effort to use this understanding to make themselves think, feel, and act differently is likely to help them improve and remain improved. (3) The main attitudinal core of most of their serious states of disturbance is their reality-based tendency not merely to rate their and others' deeds, acts, and performances (which is actually good and probably necessary to survival and happiness) but their magical, devout tendency to rate themselves and others as humans: to give a report card to their essence, their being, their existence, their totality. The real purpose of this kind of self-rating and measuring of the total worth of others is not to increase their own (or others') enjoyment but to deify or devil-ify humans; and unless they give up this crazy purpose, they are virtually doomed to lifelong anxi­ety, depression, shame, and hostility. (4) By working hard against their in­nate and acquired dispositions to control the entire universe and to prove that they are better people than others, and by using a variety of cognitive, emotive, and behavioral techniques to do this, they can largely change their philosophic outlooks, stop thinking and acting like whiny children, and finally become relatively independent, very self-accepting individuals.

Active-Directive Therapy

Because these are my goals, and because I optimistically believe that most individuals, and particularly those who are sufficiently motivated to come for therapy, can at least partially achieve them, and can frequently do so within a few months' time, I take a very active-directive role as a psychotherapist. My main activity, most of the time, consists of involved, concerned, vigorous teaching. I forcefully try to show clients, using recent examples from their own lives, that whenever they feel anxious, guilty, depressed, self-hating, or enraged, at what I call point C (which stands for emotional Consequence), they are not merely made so by A (a set of Activating Events) that occurred prior to their experiencing C. Rather they largely make themselves needlessly disturbed or symptomatic by consciously and unbconsciously choosing certain Beliefs at point B.

Moreover, the theory of Rational Emotive Behavior Therapy that I have been using for over forty years holds that whenever people upset them­selves, they tend to have both a Rational Belief (RB) which causes them to respond or emote healthy at point C, and an Irrational Belief (IB), which causes them to respond or emote unhealthy at point C. Thus, when you are rejected by someone you care for, at A, and you feel depressed and worthless, at C, you are first telling yourself something like, "Isn't it unfortunate that I was rejected; I don't like this occurrence and wish it hadn't happened; but I can stand it and still lead a relatively happy (though not as happy) existence." Consequently, you feel sad, sorrowful, frustrated, or annoyed at C.

You also, however, tend to add an Irrational Belief (IB), which says: "Isn't it awful that I was rejected! I can't stand being refused. I should have acted better and thereby got accepted; and since I didn't do what I should have done, I'm a thoroughgoing worm, who will probably always be rejected and can experience little or no joy in life!" By devoutly and superstitiously believing this nonsense, you make yourself feel inappropri­ately anxious, depressed, and valueless.

In Rational Emotive Behavior Therapy (REBT), the most important usual method of helping you give up your irrational Beliefs, and consequently feel and behave appropriately at point C, is to have you Dispute (at point D) these Beliefs, as I have shown in several books listed in the References tothis articles. Thus, I would get you to ask yourself, at D: "Why is it awful for me to be rejected? Where is the evidence that I can't stand being refused? Prove that I should or must have acted better and thereby got accepted. Even if I never act well and always get rejected (which is highly improbable) how does that make me a worthless person? damnable? a worm?"

If I persist at helping you do this Disputing, you will usually (and some­times fairly quickly) acquire a new Effect (E) or basic philosophy of life, that goes something like this: "There isn't anything awful, terrible, or horrible in the universe, including rejection by someone for whom I care; there are only serious inconveniences and frustrations, that I shall never like but that I can definitely stand. There are no absolutistic shoulds, oughts, or musts, but only it would be betters. I shall therefore keep trying until someone I care for accepts me, but if by unusual bad luck or lack of talents on my part, no one ever does, that is still only unfortunate, never the end of the world. If I fail, I fail! Tough!"

When, after a number of sessions of individual or group psychotherapy, you finally acquire this kind of value system, you become "adult" or "cured." But you always, in all probability, will be a fallible human who tends to fall back on self-defeating beliefs and who thereby sometimes foolishly makes yourself anxious or hating. Sometimes; but not very often or severely, if you make yourself basically rational.

Has my approach to therapy undergone any basic change since I first started to practice RET in 1955? Yes and no. I still, in my therapeutic ses­sions, am mainly cognitive: that is, explanatory, persuasive, and philo­sophic. But I now use many more emotive-evocative and behavioristic methods than I previously did—even though the chief reason for using them is to help people fundamentally change their thinking, and not merely to feel better (instead of get better) and not just to surrender their symp­toms (instead of changing their symptom-creating ideas).

Thus, on the emotive side, I employ, in my individual and group sessions, role playing, encounter exercises, unconditional acceptance, rational emotive imagery, shame-attacking exercises, evocation of feelings, dramatic confrontation, risk-taking procedures, and a variety of other techniques. And, on the behavioristic side, I use desensitization, assertion training, in vivo homework assignments, operant conditioning, and many other methods. REBT has led to the development of cognitive-behavior therapy; and where it used to be almost alone in this respect, it has now found respectability in the eyes of many behavior and other therapists who partly or largely employ it, Aaron Beck, Arnold Lazarus, Maxie Maultsby, Jr., and Donald Meichenbaum.

My evaluation of the present state of the practice of psychotherapy is that it is generally superficial but at long last seems on the way to becoming deep, efficient and sane. On the superficial side, we have a seemingly endless host of "feeling," "experiential," "primal," and "new age" therapies that are highly anti-cognitive and that carry a profound and false message to their adherents: namely, that people should not use their heads too much; that they should become obsessed with getting in touch with and uninhibitedly expressing their feelings; that they should remain childish and whiny all their lives; that their natural body reactions are invariably a better guide to creative and happy living than is sensible self-discipline; and that reliance on mysticism and magic is more self-fulfilling than the use of scientific, flexible thinking.

Sifting Fiction from Fact

On the other hand, all is hardly lost, today, in the field of psychotherapy. Many younger clinicians and researchers, most of whom appear to be ori­ented toward some form of cognitive-behavior therapy, are carefully and scientifically sifting therapeutic fiction from fact and discovering why and how certain methods work and others do not. I especially recommend, in this respect, the kind of literature recently appearing in such journals as Cognitive Therapy and Research and The Journal of Rational-Emotive and Cognitive-Behavior Therapy, that has given a true shot in the arm to the cause of scientifically evaluated therapeutic studies.

What role is it suitable for psychotherapy to play in society-at-large? I would say: an exceptionally educative rather than primarily re-educative role. If psychotherapy works at all, then it has some very important things to say about the way humans behave when they are emotionally disor­dered, how they tend to get that way, and what they can do to help themselves think, feel, and act much more efficiently and enjoyingly. If it has these things to say, then it had better say them to youngsters and their teachers, preventively more than curatively, so that eventually most people, in a society such as our own, will be able to understand themselves and work hard at staving off severe emotional disturbances.

The future of psychotherapy, in my opinion, will largely be along educa­tional rather than along therapist-to-client lines. Therapists will tend to follow the educational rather than the psychodynamic, medical, or other models, and will invent and use a wide variety of pedagogical methods to reach and affect literally millions of people. Thus (as we already do in part at the Institute for Rational-Emotive Therapy in New York City), they will employ lectures, seminars, workshops, recordings, films, pamphlets, books, programmed material, and a number of other educational techniques to help people understand and change themselves.

How do I like being a therapist? Pretty well. Largely because I am exceptionally active and spend most of my time talking people out of their Irrational Beliefs instead of mainly listening to their tales of woe and supportively patting them on the head. Also, to stave off possible boredom, I am always involved in developing and redeveloping my theories of psychotherapy, and in changing my ideas and my techniques to try to bring about more effective results.

The main occupational hazard that I find in being a therapist is that I do not allow myself to become emotionally involved or very friendly with my clients. And some of them are bright, charming, warm individuals with whom I would be glad to relate if it were not against their and my therapeutic interest. Even when years have passed and I am no longer likely to see them again as clients, pressures of time and other involve­ments almost always preclude my maintaining personal friendships with them. And that is unfortunate; but not awful, horrible, or terrible!

REFERENCES

Adler, A. (1927). Understanding human nature. New York: Greenberg.

Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.

Ellis, A. (1971). Growth through reason. Institute for Rational-Emotive Therapy.

Ellis, A. (1972a). Executive leadership: A rational approach. New York: Institute for Rational-Emotive Therapy.

Ellis, A. (1972b). How to master your fear of flying. New York: Institute for Rational-Emotive Therapy.

Ellis, A. (1973). Humanistic psychotherapy: The rational-emotive approach. New York: McGraw-Hill.

Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything—yes, anything! New York: Lyle Stuart.

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. and Harper, R.A. (1971). A guide to successful marriage. Holly­wood: Wilshire Books.

Ellis, A. and Harper, R.A. (1975). A new guide to rational living. Holly­wood: Wilshire Books.

Eysenck, H.J. (Ed.). (1964). Experiments in behavior therapy. New York: MacMillan.

Lazarus, A.A. (1989). The practice of multi-modal therapy. New York: McGraw-Hill.

Maultsby, M.C., Jr. (1984). Rational behavior therapy. Englewood Cliffs, NJ: Prentice-Hall.

Meichenbaum, D.H. (1971). Cognitive behavior modification: Modifying what clients say to themselves. Waterloo, Canada: University of Waterloo.

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