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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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