The Story of Psychology (114 page)

Modeling, first used to change the behavior of children, was soon found useful in combating phobias in adults. Typically, treatment consists of having the patient watch the model in contact with the feared object in a relatively unthreatening situation, then in a series of increasingly threatening ones. In dealing with snake phobia, for instance, the model first touches the snake, then holds it, and finally allows it to crawl over his body. The therapist encourages the patient to go through the same series of activities, even guiding the patient’s hand and praising him for his efforts. Gradually, the therapist reduces the degree of demonstration, protection, and guidance until the patient, alone and without help, is able to confront the feared experience.
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Operant conditioning:
After the success of the experiment in the 1960s and 1970s in which the behavior of hospitalized psychotics was modified by the use of rewards, many mental hospitals instituted programs based on such operant conditioning. Nurses and psychiatric technicians were trained to give tokens (poker chips, cards, or imitation coins) to patients for such desirable acts as grooming themselves, keeping their rooms neat and clean, behaving normally toward other patients, and taking on job responsibilities. The tokens were exchangeable for such privileges as a movie, a special food, a private room, or a weekend pass. Positive results were widely achieved, particularly with patients who had been withdrawn and apathetic for years. “Token economy” programs, as they are called, have also been used successfully with retarded persons, delinquents, and disturbed schoolchildren.
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Nearly two thousand years ago, the Stoic philosopher Epictetus composed an apothegm that anticipated the theory behind a major form of current psychotherapy: “People are disturbed not by things but by the view which they take of them.”
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Some may find this shallow, others too pat, but its validity is shown by the effectiveness of cognitive psychotherapy. Albert Ellis, one of the originators of this form of therapy, has summed up its basic principle in what could almost be a rewording of Epictetus’s apothegm: “You largely feel the way you think, and you can change your thinking and thereby change your feeling.”
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Cognitive psychotherapy is often called “cognitive-behavior therapy,” since it incorporates elements of behavior therapy. But though the two
forms overlap, they have a somewhat different focus. Behavior therapy often treats the patient like the sheep or pig whose behavior and reactions can be shaped by desensitization and other forms of conditioning; cognitive therapy seeks to modify the patient’s feelings and behavior by modifying his or her conscious thoughts.

The cognitive approach to mental disorders emerged in the early years of the cognitive revolution in psychology. In the 1940s and early 1950s, several psychologists theorized that flawed cognitive processes, rather than unconscious conflicts, were responsible for many neurotic conditions. One of the therapists was Julian Rotter (whose work on internal and external locus of control we looked at earlier); both an academic and a therapist, he devised “social learning” therapy, a method of getting the patient to rethink his or her faulty expectations and values.
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Albert Ellis, a cognitive therapist well known to the public, has said that he was “spurred on” by Rotter’s and others’ writings but that he began practicing and promoting his own rational-emotive therapy (RET), a form of cognitive therapy, in 1955, and was therefore “the first major cognitive-behavioral therapist” and “the father of RET and the grandfather of cognitive-behavioral therapy.”
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Not exactly a modest statement, but Ellis was not a modest man. He has unblushingly written that he was “one of the most distinguished alumni of Teachers College” and “one of the best-known clinical psychologists, as well as one of the most famous sexologists, in the United States and in the world.” “My ‘old age,’ during the 1980s,” he wrote in 1991, when he was eighty-eight, “has seen my professional and public popularity, as well as that of rational-emotive therapy and cognitive-behavior therapy, steadily progress.”
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He said that “when not absorbed in something big, ongoing, and creative, [I am] easily bored,” and admitted to being a workaholic—but a healthy one—whose typical workday was seventeen hours long, running from 8:30
A.M.
to 1:15
A.M.
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Not surprisingly, at ninety-three he was lean, even skinny; his long face was often saturnine but could break into a demonic grin, and except for the lack of a pointed black beard, he looked something like the operatic conception of Mephistopheles.

Even if one discounts the hyperbole, Ellis’s achievements and energy were extraordinary, considering the poor start he had.
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He has described his father as a spendthrift and runaround who gave him no fathering and his mother as given over to bridge, mah-jongg, and other
diversions. Young Ellis, who grew up in the Bronx, was hospitalized eight times for nephritis between the ages of five and eight, and was forbidden to play active sports, developed into “something of a sissy” where such activities were concerned, and was shy, introverted, and phobic about speaking in public. All this, he has said, helped him become a “stubborn and pronounced problem solver”:

In his teens and twenties, Ellis’s ambition was to become a writer; he produced many unsuccessful manuscripts, but, being practical, took a degree in accounting and another in business and, despite the Depression, was able to get decent jobs. Among his unpublished manuscripts was a vast tome on sexuality, and friends often asked him for sexual advice. He liked counseling them so much that he decided to become a clinical psychologist, and, while holding down a job managing a gift-and-novelty firm, went to graduate school at Teachers College, Columbia University, and received his doctorate in 1947, at thirty-four.

For any normal man, so late an entry into the field would have meant a minor career, but not for Ellis. While working in the New Jersey mental health system for some years, he took four years of psychoanalytic training, began seeing patients of his own in 1948, and by 1952 had a full-time practice in Manhattan. He also began the abundant production of both professional and popular books on sexuality and allied matters; his radical views and frequent penchant for vulgar language made him something of a scalawag in psychotherapy, a role he seems to have delighted in all his life.

Between 1953 and 1955, Ellis began to rebel against psychoanalysis; he found it too slow, too passive (on the part of the analyst), and not suited to his personality. As he explained to Claire Warga, a psychologist who wrote about him in
Psychology Today
a few years ago:

After experimenting for two years with techniques more to his taste, he worked out rational-emotive therapy, and in 1955 began practicing it and writing about it. Its essence, he wrote in an early paper, is that the emotions associated with neurosis are “the result of illogical, unrealistic, irrational, inflexible, and childish thinking,” and that the cure lies in the therapist’s “unmasking” the client’s illogical and self-defeating thinking and teaching him how to think “in a more logical, self-helping way.”
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The overall tone of the therapist’s—or at least Ellis’s—approach is indicated by certain key words. The therapist should “make a forthright, unequivocal
attack
on the client’s general and specific irrational ideas,” “try to induce him to adopt more rational ones in their place,” and “keep pounding away, time and again, at the illogical ideas which underlie the client’s fears.”

It is not easy to convey on the printed page the essence of RET, as practiced by Ellis; his provocative and challenging manner has to be imagined. The following sample (abridged here) does however capture something of the flavor and process of his method. It is part of an early session with a twenty-six-year-old commercial artist who has a steady girlfriend and has sex with her regularly but is afraid of becoming a homosexual.

Some of this may seem hard on the patient, but Ellis has always said that confrontational RET works better than nonconfrontational RET. Warmth, on the other hand, can be harmful, in Ellis’s opinion. When still in his psychoanalytic phase, he tried being warm over a ten-month period and found that it pleased his clients and made them feel good but made them sicker—more dependent and needy—than they had been, and he gave it up.
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Ellis formalized his ideas as “the ABC theory of RET.” Activating Events (A’s) in people’s lives are intermingled with their Beliefs (B’s) about those A’s, and largely because of the B’s the result is Consequences (C’s)—emotional and behavioral disturbances. Later on, he spelled out in detail the multiple interactions and feedbacks among the A’s, B’s, and C’s. For instance, a bad C—emotional reaction—feeds back into the belief system and strengthens the B (belief about an experience, and that in turn influences how the sensory system actually evaluates an experience (A).
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The goal of RET is to get the client to make a “profound Basic Philosophic change…to see, to surrender, and to stop reconstructing their core musts that are at the bottom of their dysfunctional Basic Philosophic Assumptions.” In sum: Rational thinking is the source of mental and emotional health.