Trauma Response Profile: An Afternoon with Dr. Albert Ellis Esteemed Member of the Academy's Board of Scientific and Professional Advisors

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.