Cognitive-Behavioral Therapy: One Pioneer's Contribution
He was notorious for his testy personality and loud opinions—one of which was that "neurosis is a high-class word for whining." Albert Ellis, who died last month at age 93, believed that psychotherapy should be short term, goal oriented, and efficient; his method, introduced in 1955 and now known as rational emotive behavior therapy, is one of the foundations of today's cognitive-behavioral therapy.
The theory: Irrational ways of thinking underlie most psychological conditions, and patients can get better by tackling these skewed thinking patterns, correcting them, and developing new ones. In a 2006 survey of social workers and psychologists conducted by Psychotherapy Networker in partnership with Joan Cook, an adjunct assistant professor of medical psychology at Columbia University, over 60 percent said that they employ cognitive-behavioral techniques in their work.
"What cognitive therapy does is focus on the present," says Judith Beck, director of the Beck Institute for Cognitive Therapy and Research outside Philadelphia. Beck is the daughter of Aaron Beck, who developed his own form of cognitive-behavioral therapy, simply called cognitive therapy, in the early 1960s when he was a psychiatrist at the University of Pennsylvania. Rather than exploring in depth the issues surrounding a patient's childhood, dreams, past relationships, and life experiences—essential in Freudian psychoanalysis—the short-term cognitive approach focuses on developing skills the patient can use to "have a better week." Cognitive therapists may go into those deeper issues if necessary, but "the goal is not insight alone but also practical problem solving and symptom reduction," says Beck.
Techniques used to that end may include weighing evidence to evaluate whether a patient's self-image is skewed, developing a more realistic worldview, prioritizing problems, and setting an agenda for dealing with them. According to research by Aaron Beck and others, cognitive therapy is as effective as antidepressants in initially treating mild, moderate, and severe depression, and patients who had used cognitive therapy and stopped were less likely to relapse than those who stopped medication. Cognitive therapy has also been shown to decrease the risk for repeated suicide attempts in seriously depressed patients.
REBT, on the other hand, focuses on "disputing irrational beliefs," as Ellis's disciplines put it, or directly confronting and challenging a patient's thoughts about a situation. The method is used to treat the spectrum of psychological problems, from depression and anxiety to post-traumatic stress disorder. Therapists may draw from the wider tradition of cognitive-behavioral methods, but they owe an intellectual debt to Albert Ellis whenever they dispute a patient's irrational beliefs. Though that approach has gained a reputation for confrontation and tough-mindedness, Kristene Doyle, associate executive director of the Albert Ellis Institute in New York City and a clinical psychologist specializing in REBT, says that collaboration between the therapist and patient, a patient's complete self-acceptance, and the therapist's unconditional acceptance of the patient are also essential to REBT.
Some psychotherapists see cognitive-behavioral therapies as too simplistic—approaches that ignore the complexities of a typical patient's problems. Today, many therapists use a combination approach, integrating both psychoanalytic and cognitive-behavioral techniques to suit patient needs. "Practicing therapists [are] often happy to have more than one way to think about somebody," says Nancy McWilliams, president of the division of psychoanalysis at the American Psychological Association. Adds Jonathan Slavin, who teaches psychology at Harvard Medical School and is founding president of the Massachusetts Institute for Psychoanalysis: "There's considerable evidence that all psychotherapy is effective. All versions [that] provide people with a relationship that includes any kind of empathy and understanding change the actual workings of the brain."