| Dr.
Albert Ellis is a member of The American Academy
of Experts in Traumatic Stress and was recently
appointed to the Board of Scientific & Professional
Advisors. Dr. Ellis' contributions to the professional
practice of clinical psychology have been profound.
He was at the forefront of clinical psychology
breaking new ground in the 1940s and 1950s. In
1959, he founded the non-profit Institute for
Rational Emotive Therapy (IRET) and has been its
president. Since 1955, he has practiced individual
and group psychotherapy with more than 15,000
clients and has lectured and given workshops around
the world. He has published over 600 papers and
well over 50 books and monographs dedicated to
the practice of Rational Emotive Therapy (RET).
He is a fellow of over 15 divisions of the American
Psychological Association (APA) and is a Diplomate
in Clinical Psychology of the American Board of
Professional Psychology, a Diplomate in Clinical
Hypnosis from the American Board of Psychological
Hypnosis, and a Diplomate of the American Board
of Psychotherapy, to name a few of his vast achievements.
Many professional organizations and societies
have honored him. He has served as consulting
or associate editor of more than a dozen journals
including one dedicated to RET entitled the Journal
of Rational-Emotive & Cognitive-Behavior Therapy.
JSV: As the
creator and developer of Rational Emotive Behavior
Therapy (REBT, formerly Rational Emotive Therapy),
can you define the underlying philosophy of REBT
for me?
AE: The underlying
philosophy is that, for the most part, people
unconsciously and consciously upset themselves
about bad happenings or happenings that they view
as bad. The person then chooses to say that it
"should not" or "must not"
exist, that these things are "very bad"
and they absolutely must change them. For the
most part, people traumatize themselves by the
attitudes that they take toward traumatic events.
JSV: I know
that REBT, traditionally, has postulated that
human beings have more choice over their reactions
than they give themselves credit for. What has
been your experience when clients seem doubtful
of this notion, especially those who have been
traumatized (e.g., rape, assault victims) and
feel powerless and vulnerable?
AE: Well, I explain
to them that the whole human race is baffled by
that notion. When something very bad happens (e.g.,
rape, incest, etc.) and you immediately feel anxious
or depressed, then you falsely conclude that it
was the event that made you anxious or depressed
or angry. Individuals then fail to acknowledge
that if exactly the same thing happened to one
hundred people, they would feel somewhat differently.
Some would feel worse than you, some would feel
better than you. The human race fools itself into
believing (perhaps, because of an innate propensity)
that when you feel very upset, then something
must have caused you to feel it either in the
present or in the past. However, almost always
there is an intervening variable called your beliefs,
your attitudes, or your philosophy about the bad
thing.
JSV: What are
the "ABCs" of REBT?
AE: You start
with "G": your goals and values (e.g.,
to be happy by yourself or with other people,
vocational goals, recreational goals, familial
goals, etc.). "A" is an activating event
or adversity. "A" is some event or thing
that happens that contradicts your goals and values.
"B" is your belief about "A"
in relation to your goals and values. "C"
is the consequence, which usually is the disturbance
we talk about (e.g., trauma, despair, anxiety,
rage, etc.). So we, along with several ancient
and modern philosophers, say that "A"
contributes significantly to "C" because
rarely would you upset yourself without any bad
thing happening in your life. So "A"
doesn't by itself make you upset; it tends to
make you sorry and frustrated and annoyed which
we call healthy negative feelings about "A."
So, "A," generally leads to two feelings
- healthy negative feelings (i.e., sorrow, frustration,
annoyance, regret) and unhealthy feelings (i.e.,
horror, terror, depression, despair).
JSV: How have
you applied REBT with the treatment of survivors
of traumatic events?
AE: You show the
client that the event was really, almost always,
very bad. Occasionally they are exaggerating or
even making it up but, normally there was an accost,
there was a rape, there was incest, there was
dishonesty on the part of somebody they trusted
and that's very bad and they better feel and feel
strongly about it. But they have a choice, again,
of healthy negative feelings or unhealthy negative
feelings. They often come to therapy because they
pick the unhealthy feelings. We want to change
that to the healthy negative feelings of, again,
sorrow, regret, or disappointment about what happened.
JSV: I know
that, for several years, you have endorsed the
notion that people tend to create a considerable
deal of their own distress through irrational
thinking (i.e., beliefs). When treating trauma
survivors, how do you approach survivors who,
so often, have had their belief system "uprooted"
through their experience?
AE: The belief
system would be something like lack of trust.
For example, a woman went out with a guy that
she knew and then he raped her. So her belief
that "he was a friend," "he was
nice," and "he treated me well"
now gets disrupted suddenly. She now believes
that even the nicest people can really abuse you,
kill you, or do anything to you. So her belief
that most people or most friends or most dates
are trustworthy is shattered. But she has two
beliefs, one is that so-called "good"
people can act badly and the other (belief) is
that "it is terrible," "I can't
stand it," "he's totally no good,"
"the world is no good," etc. That second
set of beliefs is the target for change, not the
first set of beliefs. She would be helped to see
that realistically, and acknowledge that her original
belief (that if you date a guy or he is a friend
of yours, that he would never do any harm) was
incorrect to begin with. Although, probabilistically,
it was unlikely to happen (most dates won't rape
you).
JSV: Where
do you see the greatest need for research in the
area of posttraumatic stress disorder?
AE: Well, some
research is being done to show that many people
who have severe traumatic stress, especially PTSD,
were not that healthy to begin with. That is,
they had a history of vulnerability to stress
to begin with and therefore, the stress had affected
them more than other people without severe personality
disorders or neurosis. That research is being
done and more and more probably will be. I think
it's a good idea. Of course, the main thing that
still needs to be done is the exploration of which
techniques work quickly, briefly, and effectively
and which work elegantly in the long run so that
no matter what happens in the future, he or she
won't seriously traumatize themselves again.
JSV: Could
you take me through a "mini case study."
I was wondering how you conceptualize a case and
devise a treatment plan for a trauma survivor.
Can you describe a patient that you had treated
who "stands out" in your memory and
how you were able to assist them to overcome their
difficulties?
AE: Let's see,
I have had so many that I am trying to zero in
on one in particular. (Pause). There is one that
I saw a couple of months ago. This was a woman
who went with a guy for several weeks and thought
that she knew him. They got along OK and they
had petted to orgasm. One night he got her alone
and threatened to harm her if she didn't have
sex with him - so she had it. She was quite traumatized,
particularly, again, because of her disruption
of trust. She trusted this guy and men in general
and was very shocked. Also, she experienced some
guilt because she could have screamed and yelled
and, in all probability, people in the house could
have come to her rescue; he didn't have a gun.
So she was blaming herself. So, first, as is often
in such cases, we had to go after the secondary
symptoms - the self-blame about being traumatized
and of not doing anything. We get her to what
we call USA - Unconditional Self-Acceptance. You
always accept yourself whether you hurt somebody
or stupidly act or whether you are upset about
something. So I helped her to start working on
that and then, while working on that, to accept
the reality that she was wrong in being so trustful
(maybe not terribly wrong) and that he was certainly
wrong. Moreover, bad things happen to good people
with or without their responsibility. Also, it
is important not to generalize and think that
"all men are not to be trusted" and
"any date is not to be trusted." After
about ten sessions of Rational Emotive Behavior
Therapy, she definitely started to accept herself
unconditionally and also about other things. She
was blaming herself for the rape but also for
other things (e.g., errors, mistakes she made,
etc.). Then she saw that he wasn't necessarily
a louse or a thorough bastard, even though his
act was very wrong and not overgeneralize, which
is frequently what trauma victims often do (i.e.,
they think "it will easily happen again",
etc.). Very frequently, we first work on the self-downing
about the event and how they handled it and then
the horror that could have occurred.
JSV: What symptoms
do you see as more likely to abate through the
use of REBT and which seem to be more resistant
to treatment?
AE: It isn't so
much the symptom as it is the basic personality
disorder. I say and have said for quite a while
now that neurotic clients are quite different
from those with severe personality disorders (or
those) who are born with deficits (e.g., cognitive
deficits like Attention Deficit Disorder [ADD],
Obsessive-Compulsive Disorder, etc.). These are
real handicaps that are biological and neurological
in nature. Because of these problems, almost from
birth onward, they get criticized more and they
have more frustration (especially ADD). So, they
develop cognitive distortions or irrational beliefs
about these deficits and about how the world treats
them, etc. and everything gets worse. Once a person
is upset about having ADD or a learning disability,
for example, and even if you can get them to give
up their cognitive distortions (e.g., "I
am no good for having ADD"), then we still
haven't eliminated the deficit. Sometimes you
can give Ritalin or help them to read better or
give them skills training, but sometimes they
have to live with the disorder and you have to
help the person to accept themself with the disability.
This takes a longer time and can be difficult.
The whole world tends to put itself down for doing
poorly. Some people, especially those with personality
disorders, I think are innately, greater self-downers
than the rest of us. They have one hell of a time
getting unconditional self-acceptance. Also, the
two main things that get people disturbed are
the self-downing and low frustration tolerance.
Some people have abysmally low frustration tolerance
including low frustration tolerance for therapy,
etc. Consequently, the people who "beat"
themselves severely and have low frustration tolerance
are the most unlikely customers to get better
quickly and thoroughly.
JSV: How would
you manage a patient who presents with a serious
illness (e.g., terminal cancer, AIDS, etc.) who
may be "stuck" in denial and perhaps,
anger?
AE: I have a whole
book, How to Cope with a Fatal Illness. In this
book, I include several cases of people with fatal
illnesses and all kinds of other disabilities,
who handle it very well. Obviously, everybody
with a fatal illness doesn't depress themself
or get angry. I think the anger is very frequently
imagined by a psychoanalyst. Very few of my clients
get very angry. Kubler-Ross made up the stages
that one goes through when dying. They may occur.
Some people really get angry; they get angry at
God, they get angry at life, and get angry at
people who don't have illnesses. Occasionally,
this all will happen. But mostly, they are very
anxious and depressed. We show them that anxiety
comes from believing "Oh my God, this is
awful, look at what's happening." Well, if
you are dying, not much worse can happen to you
and you are going to die anyway. Depression may
come about by thinking "I will never have
the life I would have had" (which is correct)
but also "this is terrible and I can't enjoy
anything, I have to be miserable, miserable, and
miserable." So, in this book, How to Cope
with a Fatal Illness, I and Michael Abrams include
many of the elements of REBT because Rational
Emotive Behavior Therapy has always had many cognitive
techniques (e.g., disputing of irrational beliefs)
and emotional and behavioral techniques. So we
have a list of techniques that people who are
dying and their relatives can use. Thus, people
can definitely decide to be as happy as they can
be under grim conditions as, again, people have
done for centuries.
JSV: One of
the major areas that many clinicians tend to find
quite challenging when treating trauma clients
(and many other disorders, for that matter) is
the maintenance of psychotherapy treatment gains.
What do you suggest clinicians do to facilitate
and maintain the growth that a client makes in
therapy after termination from treatment?
AE: Well, I had
wrote an article in 1972 (which has been widely
cited) on how to help people get better rather
than feel better. Many psychotherapy studies show
that whatever psychotherapy was used, the person
feels better. Well, that is not so phenomenal.
I mean, you are nice to a client, you listen to
the person, and you show her/him how to cope,
so they feel better. But in REBT, a goal is to
have the client get better. That means that, one,
they rid themself of their symptoms (e.g., posttraumatic
stress symptoms such as feelings of horror, terror,
etc.). Two, they realize that they are the creator
of other kinds of symptoms that they didn't even
come to therapy for (e.g., other anxiety symptoms,
etc.). Three, they get to a point, if they really
work their ass off, where they rarely feel the
kinds of things they came for (e.g., stress, horror,
terror). Four, they work to realize that when
they fall back (because the human race easily
can fall backward), that they have to keep working
hard at it (their treatment). That is, they continue
learning how to become automatically less disturbable,
not just less disturbed. Some ways that they can
do this (besides through therapy) is by reading
books, listening to cassettes, going to workshops,
etc., and every once in awhile, going back for
some more sessions. Most of the people who benefit
from therapy do fall back to some degree, some
seriously and some not so seriously.
JSV: As you
look back on your illustrious career, what do
you believe has had the greatest impact on you,
personally, as a healer and helper of, literally,
thousands of clients?
AE: The main thing
goes back to when I was nineteen before I was
a therapist. I read a lot of philosophy articles
by John B. Watson (who desensitized children to
mice, etc.). I first forced myself to speak and
speak and speak in public because I had a phobia
for public speaking. I deliberately made myself
uncomfortable. I am completely over that now and
enjoy speaking in public. I then forced myself
to approach young women, which was more difficult,
in the Bronx Botanical Gardens and get rejected
and rejected and rejected and not run away from
it until I got over the fear of rejection. I started
doing much better. I could see that Watson was
really right regarding in vivo desensitization
as were several other therapists around that time.
Also, the philosophers were right by postulating
that we mainly upset ourselves and I was upsetting
myself about the "horror" of speaking
badly in public or getting rejected. So, using
those things, I was later able to see that Psychoanalysis,
Gestalt Therapy, and Rogerian Therapy really don't
work well because they ignore in vivo desensitization
and they really don't lead to a profound philosophical
change. They fail to show clients that no matter
what they do, they are still O.K.
JSV: How did
you become involved in the field of Psychology?
AE: I became involved
by accident. I got my Bachelors in Business Administration
but I didn't like accounting. I was good at it
but it was a bore. Then, I was going to be a writer
and write the "great American novel."
I wrote twenty complete manuscripts in my twenties
including plays, novels, etc. and none of them
got accepted. Then I decided to write non-fiction,
especially on sex, love, and marriage which I
was interested in and I thought would sell. My
friends and relatives found out that I was reading
hundreds of books and articles in those areas
and I was becoming an authority, so they came
to me with their personal sex, love, and marriage
problems. To my surprise, I found out that I could
help them in a few conversations and then I went
for training in graduate school and became a psychologist.
But I didn't realize at first that I knew that
much. I was able to counsel people about their
problems in a short period of time.
JSV: As you
are aware, The American Academy of Experts in
Traumatic Stress recognizes that traumatic events
are an unfortunate part of the human experience
that professionals and workers from many fields
work with on a regular basis. What do you see
as the major advantage of an organization that
is dedicated to increasing awareness and ultimately,
improving the treatment for survivors of such
events across over a hundred different professions?
AE: Well, it has
a great advantage and one of those advantages
you have just said. That is, the Academy recognizes
that trauma is part of the human condition. Actually,
as I have told my clients for many years, life
is spelled H-A-S-S-L-E for all of us. We all have
hassles, problems, difficulties, etc., especially
when we get married and have children. You then
may get more hassles. But also, there are real
traumatic things that can happen (e.g., accidents,
rape, incest, war, etc.). These things happen
all over the place. There are many kinds of trauma.
If we can finally educate the public, not just
in therapy, then I say (although no one has done
a great study on it yet), that people are much
less likely to make themselves traumatized even
with very stressful events in the first place.
And once trauma occurs, they can be shown how
to deal with it and not permanently upset themselves
about it.
JSV: I understand
that you elected to become a member of the Academy.
What is it that appealed to you about this organization
and, perhaps, influenced, your decision to join?
AE: Well, the
fact is, it has a good cause. This is a good forum
for a variety of professionals to show people
(i.e., survivors of traumatic events) that they
can cope with the worst kind of adversity or trauma
and not upset themselves about it. I think that
people in the field who have some "know how"
in working with trauma should be available in
some source (i.e., the National Registry of the
Academy). People should be able to look up and
find professionals who specifically have the "know-how"
about severe traumatic stress. I think that is
a good idea.
©1997
by The American Academy of Experts in Traumatic
Stress, Inc.
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