| 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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