Dr. Ellis Helped Change Our Field for the Better

Clinical Psychiatry News - Volume 35, Issue 10, Page 23 (October 2007)

Three years ago, at the age of 90, Albert Ellis, Ph.D., told a reporter that he planned to continue working and teaching as long as he could. “While I'm alive, I want to keep doing what I want to do,” he said. “See people. Give workshops. Write, and preach the gospel according to St. Albert” (New York Times, May 4, 2004).

Dr. Ellis died in July, but his gospel remains alive and well in the form of rational emotive behavior therapy (REBT). Dr. Ellis' basic theories, founded in 1955, became one of the first challenges to the long, drawn-out psychoanalytic therapy that had dominated much of outpatient talk therapy. REBT offered a new and refreshing set of approaches to talk psychotherapy using human thinking capacity to begin to challenge inaccurate thoughts about self and situations.

The idea was to replace faulty perceptions with more appropriate thinking, leading to a better level of adjustment and higher functioning.

Much has been written and discussed about the way in which Dr. Ellis related to patients, his breaking with tradition, and his occasional vulgar use of the language. Getting caught up in the comedy and drama of his style would be easy, but we must not forget the substance of his work: He helped break the chains of psychoanalysis that not only had dominated therapy but had marginalized other techniques.

Even today, much of the analytic model is defended in far too many quarters as the “real” way to understand and treat patients. I can't imagine the resistance that Dr. Ellis must have faced in the 1950s.

Dr. Ellis clearly showed that a shorter-term and action-oriented method of treatment worked, and, furthermore, brought lasting results. I mention the idea of lasting results because many psychoanalytic practitioners would give some credence to rapid change but would remind colleagues that such change “wasn't lasting.”

To understand Dr. Ellis, it helps to put his work into context. The origins of behavior therapy developed from behavior modification techniques to several very organized and reliable cognitive-behavioral therapies that exist today.

It is helpful to look at the concept of relearning through a series of rewards developed by Edward L. Thorndike, Ph.D., in the early 20th century. Then we look to the work of Dr. Ivan Pavlov and his study of classical conditioning, and, of course, that of John B. Watson, Ph.D.—who moved some of the Pavlovian thinking into approaches aimed at understanding and treating human behaviors therapeutically.

I believe that those developments in behavior therapy, to name a few, helped to lay the groundwork for Dr. Ellis' development of his cognitive-behavioral techniques, probably as much as his rebellion against classical psychoanalysis. For example, the behaviorists would treat an elevator fear as just that—by treating and curing the fear with a known technique, such as systematic desensitization. Often, this works, and it is one-dimensional. The analytic people would see the fear rooted in unconscious conflict with repressed thinking and the need to work on many issues of fear—not necessarily the elevator fear. Sometimes, that approach works, but it's very time consuming and has limited, if any, support from outcome studies.

Against this backdrop, I see Dr. Ellis' thinking as a giant step forward in applying behavioral techniques to irrational thinking and faulty thought patterns beyond the one-dimensional behavior modification techniques and in teaching us that we can connect with present psychological problems through our verbalizations, challenging the faulty and irrational learning in the here and now arena.

A decade after Dr. Ellis first began developing REBT, Dr. Aaron T. Beck developed his own cognitive-behavioral therapy, which has many similarities to REBT. Dr. Beck codified and tested his results more thoroughly (“Cognitive Therapy Reaches a Milestone,” The Psychiatrist's Toolbox, November 2006, p. 21). Dr. Ellis and Dr. Beck focused more on short-term treatments. They emphasized addressing patients' current situations that needed to be evaluated and treated with relearning techniques.

Dr. Ellis wrote or edited more than 75 books and became one of the original masters of thought challenging and relearning, which is now called cognitive therapy.

Historically, for the most part, mental health professionals in the first part of the 20th century were medical doctors and psychologists who appear to have been mainly academics and experimentalists. So for a learning theorist to offer a competitive set of ideas and treatments to this psychoanalytic set of theories, with its intellectualism extending not only into treatment but to literature, art, and culture, must have been an arduous task for Dr. Ellis.

He did succeed, though, and he needs to be honored for his work and resistance to some wonderfully developed intellectual theories that the early analysts developed—theories that, to this day, have not been evaluated by scientific standards and have not proven their efficacy in clinical care.

When you think of psychoanalytic psychotherapy—which in the past often continued for years with sessions of four to five times per week (I guess for the wealthy or for trainees)—and you juxtapose that to the mainly shorter-term cognitive therapies, it is difficult to understand why this century-old system continues to be used in treatment and even taught as a viable first-line method of therapy. Analysts I speak to today, although sticking to their analytic beliefs, appear to be very directive and thought-challenging in their treatments. I tend not to tell them what they're doing for fear they may stop this good kind of cognitive treatment.

However, classical psychoanalysis appears to be on the wane, as an article about the New York Psychoanalytic Society and Institute—the first psychoanalytic program in America—pointed out (“Patching Up the Frayed Couch,” New York Times, Sept. 9, 2007). According to the article, the institute still has a small but hardy band of disciples, including artists and writers, who strive to broaden their appeal in an “ever more skeptical age.”

As for Dr. Ellis, I never met him but have heard about off-the-cuff remarks he made to those in pain. For example, he referred to people as “whining” and told them to simply get “get over it.” I certainly don't condone relating to patients in that way. Whatever the therapeutic approach, there is a way to frame material so that learning and insight are offered in the therapeutic process. In fact, this focus on reframing is a foundation of my learning, philosophizing, and action (LPA) technique, which integrates three important aspects of the way in which I believe we acquire, process, and reprocess information therapeutically. For me, the shorter and more learning theory/cognitive oriented, the better. Certainly, time has shown that these shorter cognitive approaches work well, are therapeutic, and are long lasting.

In the evolution of philosophies and treatments in mental health, we are only in the first few chapters of a very large book on how to integrate learning, memory, emotions, and behaviors into our lives and daily functions and to use talk therapy treatment to effect change. Our talk therapy strategies are ever changing and need to be updated as our knowledge grows.

Patients should be told about which therapies are available so they are able to make informed decisions on what they can expect from treatment.

Let me know your thoughts about Dr. Ellis' pioneering work and changes you've made to make cognitive therapy better, and I'll try to pass your thoughts along to my readers.

PII: S0270-6644(07)70664-1

doi:10.1016/S0270-6644(07)70664-1