Interviewed by Simona POPA
July 25, 2001, New York

"What disturbs people's minds is not events
but their judgments on events".
Epictetus, 100 A.D

Dr. Albert Ellis is one of the main initiators of the "cognitive revolution" in psychotherapy. He is known as the father of Rational Emotive Behavior Therapy (REBT) and the grandfather of cognitive behavioral therapy (CBT). He was voted the most influential living psychotherapists of the century by North American clinicians in a survey reported in the “American Psychologist”, and according to their own declarations, many other pioneers in the cognitive behavior therapy field had been influenced by him and his writings (e.g., Aaron Beck, Donald Meichenbaum). He is the president of the “Albert Ellis Institute” in New York and, at the age of 88, he still sees many clients, gives talks and workshops all over the world, and writes many new articles and books in REBT and CBT.

Simona: I would like to thank you very much for accepting this interview for the inaugural number of the “Romanian Journal of Cognitive and Behavioral Psychotherapies”. In a few words how Dr. Ellis would you describe REBT to the readers of the “Romanian Journal of Cognitive and Behavioral Psychotherapies?”
Dr. Ellis: REBT is the first of the cognitive behavioral therapies, since I started doing it in January 1955. Aaron Beck, Donald Meichenbaum, and others didn’t start their therapies till about ten years later and they used some of the main elements of REBT. And, REBT is not only the first of the cognitive behavioral therapies, but it is really the first of the cognitive behavioral emotional therapies, since it always had, unlike the other CBT therapies, very strong emotional and behavioral as well as cognitive elements. I called it Rational Therapy at the beginning to distinguish it from the other kinds of emotional and behavioral therapies. But it’s really always been multimodal, to use Arnold Lazarus’s term, and it includes strongly philosophic, cognitive and emotional, evocative and experiential, and behavioral techniques. So, some other cognitive behavioral therapies partly follow it today but it is the pioneer in that field, and is more comprehensive and integrative than most other cognitive therapies.

Simona: Briefly, what is the history of REBT, its philosophical basis, your philosophy of life? What are the steps in REBT development? It has been called Rational Therapy (RT), Rational Emotive Therapy (RET), and Rational Emotive Behavior Therapy (REBT) - why this evolution and what is the current status of REBT?
Dr. Ellis: Well, the philosophic basis originated when I was sixteen and my hobby was philosophy, especially the philosophy of happiness. I read all the major ancient philosophers and the modern ones, Immanuel Kant, John Dewey, Bertrand Russell, Ludwig Wittgenstein and I formulated my own philosophy of happiness which was somewhat close to that of Bertrand Russell who wrote a book entitled “The Conquest of Happiness”. When I read philosophy, I decided that people are constructivists and formulate all kinds of creative problem solving solutions to their goals. But they also tend to be destructivists. They imagine and create overgeneralization, as Alfred Korzybski noted, and as I saw, they invent musts, shoulds, and oughts. I recognized this when I first learned Rogersian therapy in graduate school and I saw that it was very passive and ineffective because it did not deal with clients’ irrational thinking. Then I practiced psychoanalysis from 1947-1953 and found it very passive and ineffective too. So, I took what I thought that were the best elements of psychotherapy in 1953 and described them in a monograph, “New Approaches to Psychotherapy Techniques”, that was published on 1955. But I really started writing it in 1953. So, I took the best of the therapy approaches I described and formulated REBT.

My philosophy of life has always been that humans have a great degree of choice, freedom, or agency in their life and they can choose to be very disturbed about bad things that happen to them or choose to be much less disturbed, that is, healthy, sorry, regretful, frustrated, or annoyed. REBT shows them how to feel strongly when some unfortunate event goes against their values and goals, but not to devastate themselves and not to feel depressed, horrified, terrified, and enraged. My personal philosophy has been also influenced by many adversities I experienced in my early life. I had kidney trouble and other physical aliments, my parents divorced early, my mother was neglectful, my father was even more neglectful, and we were very poor. We almost went in welfare during “The Great Depression”, in 1929, when I was sixteen years old. I decided that none of these adversities could make me feel very anxious or depressed and that I would try to improve my conditions of life, as I grew older.

REBT was first called Rational Therapy because it strongly showed clients how to actively dispute their irrational beliefs. But many therapists misunderstood it because they thought it was only logical and rational and not also emotive and behavioral. In my first paper on REBT at the “American Psychological Association Convention” in Chicago in 1956, a year after I started REBT, I showed that human thinking is practically always accompanied by emotion and behavior, that emotion is accompanied by thinking and behavior, and that behavior is accompanied by emotion and thinking. All three go together, and I said, are holistically integrated. Therefore, to make a change in your thinking, you also have to work on your emotion and behavior; to change your emotion you have to work on your thinking and behavior; and to change your behavior, you have to work on your thinking and your feeling. So I called it Rational Emotive Therapy in 1961. Then Raymond Corsini kept after me to rightly call it Rational Emotive Behavior Therapy. So in 1993 I published an article in “The Behavior Therapist”, indicating that I will hereafter call it REBT. I could have called it Cognitive Emotive Behavior Therapy, which might’ve been a little better, but I still stick with REBT.

As it has always been, REBT today, is a pioneer therapy, that uses cognition, emotion, and behavior, and it has been followed and largely copied by the other cognitive behavior therapies (CBTs). But they often omit a significant part of it. CBT sometimes omits the experiential part of REBT. Thus Aaron Beck has largely omitted emotional techniques, but now he and his daughter, Judith, are finally putting a little of it into their cognitive therapy. REBT very strongly uses cognition, emotion, and behavior, all three, and it is the main integrative therapy, along with Arnold Lazarus’s Multimodal Therapy, to do so.

Simona: What is the place of REBT in the psychotherapy family? What about the place of REBT in the CBT family? What are the main differences and similarities between REBT and the other forms of cognitive behavior psychotherapies?
Dr. Ellis: Well, the place of REBT in psychotherapy is, again, its pioneering use of strong cognitive, emotive, evocative, and homework techniques. REBT always includes behavioral methods because I used behavior therapy on myself when I was very scared of public speaking and of approaching females for dates when I was only 19 years of age. I then read John B. Watson’s work with little children. He used in vivo desensitization to get them over their anxieties. So I used it on myself and made thoroughgoing change. Within several weeks, I got completely over my phobia of public speaking and my phobia of approaching young females and I was able to remain unanxious in these respects for the rest of my life. So REBT always has a very strong behavioral aspect and uses in vivo desensitization, as well as imaginal desensitization that Joseph Wolpe invented. It encompasses more cognitive, more emotive and more behavioral methods then the other cognitive behavioral therapies.

The differences between REBT and the other cognitive behavioral therapies - to mention here briefly -, one is that we unconditionally accept all clients and show them how to unconditionally accept themselves and others. REBT follows Carl Rogers in giving unconditional self-acceptance (USA). REBT practitioners, like Rogers, actively give all clients unconditional acceptance, but also actively-directively teach them how to give it to themselves and others. Like the Christian Philosophy, we show people how to accept the sinner, but not the sin. Carl Rogers showed clients how to unconditionally accept themselves by giving them and modeling unconditional acceptance. But we teach it actively and we hypothesize that humans tend to rate themselves conditionally “I am good because I do good things and I am bad when I do bad things”. Korzybski, the “general semantics” founder, called this overgeneralization. So, we teach our clients UOA - to unconditionally accept others but not their behavior and UAS - to unconditionally accept themselves in spite of their poor behaviors. Rogers modeled USA, but he was passive, we teach it actively and therefore we have the same kind of theory, in some respect, as he did, but we teach people how to actually practice it.

REBT has always said that people strongly hold their irrational, dysfunctional beliefs. Therefore, we use many strong, forceful, vigorous methods of helping them to change these beliefs for rational or functional ones. We are usually more direct than some of the others CBTs, but we are also more emotional, experiential, and evocative. Because again, if people strongly hold irrational beliefs, therapist had better use forceful, strong methods of convincing them to change those self-defeating beliefs. So we give UOA - unconditional other acceptance as well as teach USA - unconditional self-acceptance. And we always have been opposed to what is called self-esteem. Self-esteem means “I accept myself because I do well and am loved by significant others. But when I do poorly and am not approved by others, I put my whole self down and make myself anxious or depressed”. We teach you that you are able to accept yourself just because you are you, just because you are alive, just because you are human and we teach an unusual solution to the problem of unconditional self-acceptance that none of the other CBTs include. We teach you to always rate your acts, your feelings, and your beliefs according to whether they serve your purposes and the social purpose of your community. Because you are a social animal, who chooses to live with other humans. But you don’t have to rate yourself, your being, your essence, your spirit, or your soul at all. Just rate what you think, feel, and do. This is like some of the Zen Buddhist philosophy but it is not exactly the same. Because we say, you, a person exists, you have a self, an organism but you don’t have to rate yourself as a whole. You only have to evaluate and measure what you think, feel, and do, again, but not your entire self, your being. So we are quite unusual in that respect; and we also have many emotive, evocative, forceful techniques. We are stronger than most CBTs because we mostly advocate in vivo desensitization or exposure rather then Wolpe’s imaginal desensitization. So these are some of the major ways that we overlap with the other cognitive behavioral therapies but also some of which we are different. 

Simona: What do you think about having so many schools, associations and different training programs in CBT? What are the consequences? Is there any danger in this fragmentation of CBT?
Dr. Ellis: I think that the integration movement in psychotherapy, which started around 1980 or so, is good and that most effective therapies will someday be integrated. Clients will have the choice and therapist will have the choice of using many aspects of cognitive behavioral therapy. All therapists will do it a little differently, but they will use many cognitive, many emotive, and many behavioral methods. REBT has always faced the fact that since some people are very disturbed, with sever personality disorders, you never know, because they are all unique individuals, which method will work best. You can say statistically that certain REBT methods may work better than others, but you cannot do it with an individual. He or she is different from all other individuals. So the more cognitive, emotive, and behavioral techniques that you have at your disposal, the more you are likely to reach the people that you see. I think that therapy will become more and more integrated and some of the techniques, which are inefficient, will be rarely used and others, which are more efficient, will be more frequently used.

Simona: Do you believe in a more homogenous CBT science and practice beyond its actual fragmentation?
Dr. Ellis: Yes, I think that CBT had better include many cognitive, many emotional, and many behavioral methods but that you cannot use them all with one, individual client. You have to selectively figure out, assess which you think will work best for this individual client, and have many at your disposal. So it will become a kind of “Cognitive Emotive Behavior Therapy” with a more homogenous theoretical framework. But, as a therapist, you do not use all CBT techniques with all your clients all the time. 

Simona: How do you see the relationship of REBT with cognitive psychology and cognitive sciences’ research?
Dr. Ellis: I formulated REBT in 1955, when cognitive science and cognitive psychology had just started and I knew very little about it. But as it kept developing, I saw that REBT overlapped a great deal with cognitive psychology and cognitive science. They both show that people largely disturb themselves with their dysfunctional cognitions. But at the beginning, cognitive science and cognitive psychology have not exactly followed the original REBT hypothesis that cognitions accompany and interact with feelings and behaviors. Therefore, cognitive science had better include many techniques and theories and merge with emotional and behavioral science. I think it is very important that we have developed cognitive science but it is inaccurate when people think in terms of three disparate human processes, cognitions, emotions, and behaviors. I think all three have to be seen as integrally related, and I think the modern cognitive science and cognitive psychology is relating them more and more.

Simona: Do you agree that REBT is mainly focused on evaluative cognition while Aaron Beck’s cognitive therapy is focused mainly on cognitive distortions?
Dr. Ellis: Yes, Beck largely considers people’s automatic thoughts and inferences and often misses the fact that behind their inferences are evaluations, especially musts, shoulds, and oughts. And Beck doesn’t see that, when people distinctly disturb themselves they almost always have explicit and implicit absolutistic musts and demands. He sees the musts as one of the major irrational beliefs. But I say that behind practically, every dysfunctional belief that leads to serious emotional disturbance, there is an implicit, tacit, unconscious or conscious, must, should, or ought. Few people only and always stick with their preferences: “I like X but I don’t need it; I hate Y but if it exists I’ll deal with it and I’ll not whine, scream, or make myself upset about it”. If they only stayed with their preferences, I think that neurotic behavior would rarely exist. So REBT puts people’s musts and the overgeneralization as primary and Beck puts them as secondary and often never discloses and disputes them at all. Using REBT, we also do what he does - show people their automatic thoughts and inferences -. But we never neglect showing disturbed people the musts that lie behind their automatic thoughts and teaching them how to change them back to preferences. REBT, therefore, is usually much deeper than Beck’s Cognitive Therapy. But Aaron Beck and his associates have done some outstanding research in Cognitive Therapy.

Simona: In regards to evaluative cognition/irrational beliefs, do you see any relationship with the appraisal theory of Richard Lazarus?
Dr. Ellis: Yes, again. I sent him my early papers, because he and I were both interested in personality testing and he took some elements and ideas of early REBT and then did some very good research on appraisal, developing the appraisal theory of stress and emotions. But clinically speaking, he mainly shows people how to create good coping statements. We first help them to dispute and behaviorally work against their irrational uncoping self-statements. They then are shown how also to arrive at effective coping statement. So, Richard Lazarus definitively overlaps with REBT, but doesn’t include some of its important techniques of disputing irrational beliefs, changing feelings, and doing behavioral homework.

Simona: As you know, the research about the neurobiology of emotion has identified an unconscious information processing pathway (e.g., amygdala based processing) as a mediator of some of ours emotional experiences. REBT seems to be focused on the conscious or potential conscious accessible information (i.e., beliefs) as a mediator of emotional experience. How do you see the assimilation of this kind of research in REBT? Should it be incorporated in the REBT’s distinction between primary and secondary emotional problem?
Dr. Ellis: REBT is much more biological then the other cognitive behavioral therapies in that it hypothesizes that people are born constructivists but that they also innately and by social learning often think crookedly and act in a dysfunctional way. Humans quickly act against adversities, such as their being physically attacked. Therefore, we acknowledge the fact of unconscious processing and very quick and neurologically based reactions. These are based on evolution, because they help preserve the human race. But people’s quick and life-preserving reactions may also, like anger and fear, lead to dysfunctional acts. People sometimes fight against and kill others to protect themselves. But they can also enrage themselves at many things and obsessively-compulsively harm themselves. Biology helps humans to survive, but not necessary to survive happily. So, if we want to survive and survive without severe depression, severe panic, and great rage, then had better integrate, as I think REBT does, our conscious and unconscious reactions, our thoughts and feelings. I was an analyst six years before formulated REBT and in analysis we look at unconscious reactions. Freud was right about the fact that there are many unconscious, unattended aspects of our lives. But he overdid it and though that practically all disturbed thinking and feeling were unconscious. So, REBT says yes, clients unconsciously create both functional and dysfunctional thoughts, but most of them are mainly just bellow the level of conscious. Many of our unconscious irrational beliefs can be brought out with various REBT methods and they can consciously be disputed and acted against. So, REBT by no means ignores our biological and neurological tendency to perceive dangers and to almost reflexly act in order to protect ourselves. For, if you wait only for fully conscious perception of dangers, you may die. But REBT shows how you keep creating both conscious and unconscious perceptions and beliefs, and then sometimes repeat and make them habitual. It shows you how to make your dysfunctional thoughts and actions conscious and then how to think, feel, and act against them. So, the goal of REBT is not to get everybody to always think and act consciously. Instead, people will unconsciously and automatically tend to preserve themselves and to sometimes upset themselves. But then REBT shows them, when they think, feel, and act destructively, how to consciously change and control those unconscious reactions and often get to the point where they both consciously and habitually make profound philosophical, emotional and behavioral changes. Therefore REBT’s goal, which is somewhat different from the other CBT therapies, is to minimize present disturbances, to keep them away in the future, and help you get to the point where if one of the worst things happened to you, you would know how to refuse to make yourself greatly disturbed. You’d be able to cope with even extreme adversities. That is what I called the elegant solution in REBT to make yourself less disturbable as well as less disturbed.

Simona: In regards to research in REBT towards the future, what will be the most important aspect to focus on?
Dr. Ellis: Mainly, I think the primacy of the must, shoulds, and oughts. This kind of research has never been well done. Let us see if the absolutistic musts are truly the basis of much human disturbance. Another important research project had better revise the now famous tests of irrational beliefs, which I first invented in 1956 and published materials on in 1957. Many similar tests of dysfunctional beliefs have been devised and researched. Unfortunately, however, when people say that they believe or disbelieve in something in these tests they frequently prevaricate, act defensively, and don’t answer them honestly. So paper and pensile personality test are not very good for some of the basic research in REBT and I think they can be improved. I have one test - “The Ellis Emotional Efficiency Inventory” - which seems to produce more honest results. But techniques of getting at what people really, really believe when they are disturbed require much more research. As they become available, we’ll be able to test the hypothesis, which just is a hypothesis, that when people are disturbed they unconsciously and consciously take their preferences “I’d like to do well” and “I’d like to be loved by significant others”, and make them into absolutistic, dogmatic rigid shoulds and musts. Recent research tend to show that the more rigid and more forceful people hold their irrational beliefs, the more disturbed they are and the less they are helped by therapy. If REBT and CBT researchers continue their efforts, I think that hypotheses of REBT will be sustained. So let us see that it is actually done!

Simona: As far as I know, you had a program of teaching kids to think rationally. What were the reasons that you started it? What were the reasons for stopping it?
Dr. Ellis: The reasons for starting it in 1971 were to see if REBT could be effectively taught to children by their regular teachers. We definitely found that it could be learned by normal children of 6 and 7. Since 1971 about 30 experiments have been done by REBT-ers and recently by Martin Seligman. These researches show that REBT and CBT can be taught to children in their classrooms. We had some practical problems with our school because it was a small school and most of the children only stayed in it a few years and then were moved by their parents to a larger school. We wanted them to stay from the first grade to eight grade to see how REBT would work with younger and older children. So for practical reasons we ended our school project but we still push rational emotive education. At our recent “Forty-fifth Anniversary Conference” in Colorado, I recommended that teaching certificates be given to teachers, because we think that if therapists can do REBT quite effectively, other people can learn it in various kinds of settings and courses. I said many years ago that the future of REBT and CBT rests in teaching it to practically all children, as well as adolescents and adults, in the school system, so they learn that they largely upset themselves and that they can do a great deal to refuse to upset themselves. So, REBT is not a medical model but an educational model and we hope that it and CBT will be thoroughly introduced in educational systems.

Simona: Can you please comment about the training program in REBT from the Institute and from the affiliate centers? What do you think about the evolution and the status of REBT in Europe?
Dr. Ellis: We always had REBT affiliates, especially in England, Holland, Germany, Israel, Australia, Canada, and Mexico. Now therapists are being trained in REBT in many other countries, and we hope soon will be in Romania. Eventually we will have affiliate-training centers in all part of Europe, Latin America, and the rest of the world. So we hope that REBT will be taught and trained internationally much more than it is today. But our widespread affiliated training centers are already doing a great job of spreading the theory and practice of REBT.

Simona: As one of the most influential therapists today can you tell us very briefly who was the most difficult client? How did you deal with?
Dr. Ellis: I cannot say who was my most difficult client, because one can easily be more difficult and different from others. In particular, I saw a woman who was very, very angry and who, ironically enough, was one of the trainers of Recovery Inc., founded by Abraham Low. Low was a pioneering psychiatrist who practiced cognitive therapy. My client was one of the main leaders in Recovery, but she was very angry, including raging at me very often. She knew REBT and she even taught it to others. But I had a very rough time and never completely helped her overcome her rage. Unfortunately, she had cancer and died after a year. By the time of her death, I succeeded in helping her get over her extreme low frustration tolerance and her enormous self-downing. But, though benefited considerably by REBT, she suffered from severe personality disorder and she distinctly improved but hardly was cured by my therapeutical effort.

Simona: Supposing that REBT would not exist and you have a friend that needs psychotherapy urgently. Which kind of psychotherapy would you suggest to him?
Dr. Ellis: I would suggest other forms of CBT, of course, if CBT existed, because it overlaps most with REBT, even though it doesn’t include all the strong elements, which I think REBT has. But CBT is quite effective, as many studies show, and I would recommend it. If both REBT and CBT no longer existed, it would be hard for me to recommend any form of therapy because practically all of them are limited. They stress emotion or behavior or thinking and not all three and many of them do more harm then good. A lot of therapies do harm because they stop people from getting to an elegant solution and working, working, working for the rest of their lives against their innate destructive tendencies as well as against their destructive thinking, feeling, and behavior learned from their parents and their environment.

Simona: What does the future hold for REBT?
Dr. Ellis: As I said before, therapy will be much more integrated in the future than it is in present and REBT will be a main element included in the integrated therapy. It will not exactly be REBT but it will include a great deal of it. Also, as I said before, REBT and CBT will not only be used with clients, who are disturbed, but also used prophylactically and educationally taught in school systems. If so, some of the main elements of REBT will be communicated to children as they are growing up.

Simona: A few words for Romanian and Eastern European new generation of psychotherapists would be…
Dr. Ellis: I’m very happy to see that in Romania and in other countries in Europe people are using a great deal of REBT and CBT instead of their former emphasis on Rogersian or psychoanalytic therapy. So I’m glad to see that REBT and CBT are advancing, advancing, advancing and that countries in Eastern Europe are getting on to the cognitive, emotional, and behavior bandwagon. Great!