Help that Works: Rational Emotive Therapy and Cognitive Therapies
So, you are thinking about getting some help with a personal problem and you have no idea how to choose a therapist. A good way to narrow the field is to investigate the types of therapy offered by a given individual. Whether you are seeking help with depression, weight loss, substance use, chronic pain, or anxiety, selecting a therapist trained to use one of the types of cognitive, or rational-emotive therapy offers promise for the most efficient and effective change.
Historical BackgroundThe history of psychotherapy is full of innovation. From the early days of Sigmund Freud, who developed what is now called "psychoanalytic" psychotherapy through the days of the strictly behavioral approach pioneered by B.F. Skinner to today, our knowledge about what works in psychotherapy has changed drastically. The development of psychotherapy has made a path from one extreme to another--do we need to explore every detail of the individual's past to heal him or can we simply create a system of behavioral controls and ignore his thoughts and feelings to attain long-term change? Not surprisingly, the answer is neither of those two extremes. While a basic understanding of one's past helps the therapist to comprehend how and why a current disturbance is in place, exploring it in detail is most often not necessary for the individual to achieve the desired improvement in psychological health. And, conversely, while changing negative behaviors and reinforcing positive ones is part of most good therapeutic programs, by itself, behavioral change is inadequate in the creation of a stable, long-term life change.
Evidence-Based TherapyWhat's needed, logically, is a more sophisticated and scientific approach. Several schools of psychotherapeutic change have evolved to offer such approaches: Rational-Emotive Behavior Therapy, the first of this sort, and Cognitive-Behavioral Therapy, a series of offshoots or REBT, are two of the better known. The best-known names in the development of these schools of psychotherapy are Albert Ellis, Aaron Beck, and David Burns, a bibliography of whose writings are below.
A new term has recently arisen in managed care circles: "evidence-based psychotherapy". What this means is that your insurance company wishes you to choose a form of psychotherapy that is demonstrated (not "proven" as that is impossible, given the many variables in human behavior) to work most effectively and efficiently. Cognitive forms of therapy meet this criterion. In fact, the first therapeutic modalities to undertake the challenge of demonstrating efficacy in controlled studies rather than anecdotal case reports, are the cognitive therapies. And the results bear out choosing such a method when seeking therapeutic change(1).
Relationship and HomeworkIn addition to showing support for cognitive therapy as the treatment of choice for many psychological stressors and life problems, research can demonstrate which factors, or aspects, of the therapeutic process are most likely to encourage and support change in the therapy client. The factors that win this lottery are homework--does the therapist give and does the client do--follow-up assignments? therapeutic alliance--does the client experience acceptance from the therapist? and only then, experience and technique--is the therapist experienced and is he selecting a technique demonstrated to be effective in handling this problem? Interestingly, client variables other than whether you do your homework are insignificant. Most people can benefit from cognitive therapy regardless of age or intelligence or presenting problem (2).
Cognitve Therapy DefinedSo, having established that this represents a better way to do therapy than many, what exactly does cognitive therapy entail? Cognitions are thoughts. Thoughts are the basis for our perception of self--we are what we think. Thoughts cause feelngs--repeat--thoughts cause feelngs!!! You may not be aware of having a thought at the time a feeling arises, but indeed some thought, belief, or perception, whether conscious or unconscious, instantaneous or slowly developed, has caused that feeling. You are walking in the woods. A large beast hurtles toward you. If you know the beast to be your very own large dog, you feel joy or excitement or, if he was lost, relief. If, on the other hand, the beast is unfamiliar, you may freeze in terror or run like the wind. Thus your belief about the identity or nature of the beast running at you, as well as your thoughts about the potential nature of the encounter, influenced your feelngs and your behavior.
The ABCsWithin the province of cognitive approaches to psychotherapy, we identify:
terms of a more common daily occcurence, your boss yells at you due to an error you made (A). You find yourself feeling upset, anxious, angry (C). You may or may not be aware of some sequence of thoughts and beliefs (B: it is terrible that the boss is angry; I am no good anyway; I should not have made that error; I can't stand working for him). Now, some of your thoughts are simply inferences or facts about the situation--the boss, indeed, is angry, and you might, indeed, be fired. You really do hate working for this guy. The rest are irrational beliefs--ideas with some level of what is termed "cognitive distortion". For instance, the fact that you made an error and might be fired in no way affirms that you are no good. The fact that the boss is angry is a fact; why is it terrible? In fact, you can stand working here, as you seem to have been doing so for some period of time. The fact that you made an error demonstrates your fallibility but does not answer to the "should"--why should people not make errors?--indeed they do so with some regularity.
Cognitive DistortionsCognitive distortions come in many varieties: shoulds, ought-tos, musts; magnification, minimization; personalization, blaming; fortune-telling; all-or-nothing thinking (Burns) are examples as detailed in the process labeled cognitive therapy, while the rational-emotive behavior school of thought identifies four specific categories: Demandingness (that "should" or "ought"), blaming or labeling ("I am/He is stupid"), low frustration tolerance ("I can't stand it"), and awfulizing ("How awful that I made that error"). Your distorted thoughts relate to your beliefs about yourself ("I should not have done that"), others ("He is a total jerk") or the world ("It is awful that I can't find a job")(Ellis).
Disputing and Effective New PhilosophyAt the heart of the process of rational-emotive or cognitive therapy, you learn to
and thus change the uncomfortable feelings. While most of us would prefer that we not be fired, we will survive the experience and it in no way proves anything about our value as human beings. Preferences and feelings based upon rational thought are not the target of cognitive therapy. Rather, when a feeling becomes huge (rage rather than dismay; guilt rather than remorse) and counter-productive in terms of helping us to achieve adaptive behavioral responses to difficulties we encounter, then it is time to ferret out the underlying irrational beliefs. Cognitive therapies are not about becoming unfeeling machines, but rather about using our feelings adaptively as they are meant to be used--to identify good and bad events and alter what we can in our behavior to have more good than bad events occur to us.
Learn Rational-Emotive Therapy NowThe Center for Conscious Living offers Rational Emotive Behavior Therapy and Cognitive Therapy in addition to other therapeutic modalities in helping you to achieve a happier life and a better synthesis of reason, emotion, and behavior. Dr. Low has completed her primary and advanced certifications in REBT from the Albert Ellis Institute and looks forward to guiding you in the process of learning how to avoid upsetting yourself.
References1 Beck, A.T. (1970).Depression: Causes and Treatment, Philadelphia: University of Pennsylvania.
2 Burns, D.D., Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model. Journal of Consulting and Clinical Psychology, 60(3), 441-9.
Edelstein, Michael R. & Steele, David R. (1997) Three Minute Therapy: Change Your Thinking, Change Your Life
Ellis, Albert (1975) A Guide to Rational Living