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Misrepresentationof Behavior Therapy

by PsychoanalystsA l b e r t El l i s

Institute for Rational-EmotiveTherapyNew York, New YorkIn a we l l - f o rm u la te d a r t i c l e , Me s se rand W i n o k u r ( S e p t e m b e r 1980) dis-cuss some l imits to the integrat ionof p s y c ho ana ly t i c or p s y c h o d y n a m i cthe rap y a n d b e hav i o r the rap y . A l-tho u gh I general ly agr ee w i t h the i rthes i s , a lbe i t fo r reasons qui te d i f f e r -ent f rom the ones they present , I f e e li m p e l l e d to protes t v igorously agains tt h e i r m i s r e p r e s e n t a t i o n o f b e hav i o rthe rap y (BT)an d cogni t ive behaviorthe rap y ( C B T ) . T h e y s t a r t o f f b yf a i r ly c le a r ly d i s t i ngu i s h i ng "pure"B T , s u c h as Sk i nn e r ' s o p e ran t c o nd i -t io n in g , f r o m CBT, but then spendmost of the art ic le l umping t he t w otoge ther; and i n the process they sadlym i s re p re s e n t b o th B T a n d CBT, b u tespec ial ly the la t te r . In fac t , theym i s t a k e n l y c la i m fo r p s y c ho ana ly s i svi r tual ly all the advan tages of C B Tan d fa i l t o s ee t h a t t h e i r p a r t i c u l a rb r a n d of p s y c h o d y n a m i c t h e r a p y i sr e a l ly a f o rm o f C B T a n d a ra the ri n fe r i o r fo r m a t tha t ! L e t m e ci te someof the i r misrepresentat ions .

1 . "W he re as the b e hav i o r the rap i s tv i e ws s o r ro w as a ne ga t i v e af fe c t tob e e x t i ngu i s he d rap i d ly , the d y n a m -ica l ly o r i e n te d the rap i s t s e e s s o r ro was a na tu ra l c o nc o m i tan t o f the per-son's l i fe h i s t o r y a n d c u r r e n t c i r c u m -s tanc e s to b e f u l l y e x p e r i e nc e d , ac -cepted, and wo rk e d th ro u gh inc o nne c t i o n wi th the real an d per-ceived losses" (p. 820).A s C B T the r -apis t s hav e f re q u e nt ly go ne to g re a tl e ng t h s to m a k e c l e a r , s o r r o w a n dm o u rn i ng at the loss of a loved onear e h i g h l y ap p ro p r i a t e a f f e c t s tha t a reto b e f u l l y e x p e r i e nc e d , ac c e p te d , andwo rk e d th ro u gh , whi l e d e p re s s io n an dd e s p a i r , whi c h o f t e n c o ns i s t o f w h i n -in g about s o r ro wf u l events, are q u i t ed i f f e r e n t a f f e c t s and had b e t t e rb e t h e r a p e u t i c a l l y m i n i m i z e d ( B e c k ,1976; Burns, 1980; Ellis, 1962, 1973;L a z a r u s , 1971).2 . "Ps y c ho ana ly t i c the rap i s t s , b yco n t r a s t [ to b e hav i o r the rap i s t s ] , t u nein t o u nre c o gni z e d , u ne x p re s s e d , o r

unconscious thoughts an d feelings andare e m p a th i c i n the s e nse o f t ry i n g toc o nv e y an u nd e r s t and i ng o f the i n -dividual ' s subjec t ive experience a n di l l u m i n a t i n g the p e rs o n ' s p a r t i c u la rdilemma" (p . 821). C B T i s morepr eoccup ied wi th u nre c o gni z e d , u n -expressed, or unconsc ious thoughtsand fee l ings than psychoanalys i s o f t e nis , s ince i t express ly shows c l ients howto look for the specific i r r a t iona l an dant i e m p i r i c a l b e l i e f s the y t e l l the m -se lves to cr ea t e the i r "e m o t i o na l "p ro b le m s an d rarely rests t i l l they f indthe s e b e l i e f s ( B ard , 1980;El l i s & Gr i e -ger, 1977; K e n d a l l & H o l l o n , 1979;W e s s le r & Wessler, 1980). As for psy-choanalys ts b e ing e m p ath i c an d t r y i n gto convey an un der s t and ing o f t he in -d iv id u a l ' s s u b j e c t i v e e x p e r i e nc e andi l l u m i n a t i n g the p e r s o n ' s p a r t i c u la rd i l e m m a, wha t c o gni t i v e ly o r i e n te dthe rap i s t of an y school is not in tha ts a m e c a m p t oday?3. Ev e n b e hav i o r the rap i s t s "en-gage d i n c o gni t i v e r e s t ru c tu r i ng ( E l l i s& G ri eg er , 1977; G o l d f r i e d , 1979)l i m i t the m s e lv e s to o f f e r i n g the c l ienta somewhat res t r ic ted n u m b e r of rel-a t iv e l y s t and ard c o ns t ru c t i o ns ( e . g . ,fear of s o c i a l d i s ap p ro v a l , p e r f e c t i o n-i s m ) " (p . 821). C e r ta i n ly no t Ellis! Inone of the c hap te r s of the b o o k M e s s erand W i no k u r c i t e, we l is t n o f e w e rthan 2 7 m aj o r i r ra t i o na l p h i lo s o p h i e stha t c l i e n t s o f C B T f re q u e nt ly p re s e n tas i m p o r t a n t sources of t he i r s y m p -to m s . A n d o the r ra t i o na l - e m o t i v e an dc o gni t i v e b e hav i o r the rap i s t s i nc lu d em any m o re "s t and ard c o ns t ru c t i o ns , "whi c h fa r o u t n u m b e r t he p i t i f u l ly f e wconstructions (e.g., th e Oedipuscom-plex , p e ni s e nv y , s e p a ra t i o n a n x ie t y ,and f ixa t ion on the anal e rot ic leve l)t h a t a r e fr e q u e n t l y e m p l o y e d b y psy-choanalys t s ,

4. "The behavior t her ap i s t takes ano r i e n ta t i o n tha t i s r e l a t i v e ly r e a l i s t ic ,o bj ec t iv e , and e x t ra s p e c t i v e , i n con-t r a s t with the m o r e ideal i s t ic , subjec-t ive, and i n t ro s p e c t i v e o u t lo o k of thed y n a m i c psychotherapist" (p . 822).T he S k i n n e r i a n t h e r a p i s t n o d o u b td o e s, B u t no nan a ly t i c c o gni t i v e the r -apis ts l ike Beck, A d l e r , Ellis , and Laz -a r u s are e x c e p t i o na l ly i d e a l i s t i c , sub-j ec t iv e , and i n t ro s p e c t i v e i n o u t lo o k ;and p e rhap s the m o s t wi d e ly q u o te ds ta t e m e nt i n the c u r re n t C B T l i t e ra -

t u r e is the phen om en ologica l view ofthe anc i e n t p h i lo s o p he r Ep i c t e tu s :" People a r e n o t d i s t u r b e d by th eth i ngs tha t hap p e n to them but by th eview that they take of these things ."This is hardly an unideal is t ic and un-i n t ro s p e c t i v e o u t lo o k !5. "The ana ly t i c the rap i s t , o p e ra t -ing in the ro m ant i c m o d e , ho ld s ana t t i t u d e o f c u r i o s i t y , a d v e n t u r e , an dopenness t o new and un expec ted d e -v e l o p m e n t s in the cl ient . We can f i n dno c o u n t e r p a r t to t h i s d r a m a in theb e hav i o ra l d o m ai n , wi th i ts emphasison th e p ragm at i c s o f spec i f ied an dr ea l i s t i c goals d e c i d e d on at the be-gi nn i ng o f the rap y , b re v i ty and e c o n-o m y o f i n t e rv e n t i o n , m e as u rab leoutcomes, and st r ict adherence toscient if ic m e tho d " ( p . 823). Messerand W i no k u r s e e m to f o rge t tha t e v e na s t r i c t b e hav i o ra l s c i e n ti s t l i k e Sk i n-n e r s ho we d , in Walden Two, an un -u s u a l a t t i t u d e o f curios i ty , a d v e n t u r e ,and o p e nne s s to n ew an d u ne x p e c te dd e v e lo p m e nt s i n hu m ans and tha tc o gni t i v e b e hav i o r the rap i s t s l i k e E l-l i s , Laz aru s , an d M a s t e r s an d Jo hns o nhave often been accused of b e i n g toocu r io u s , to o a d v e n t u r o u s , an d to oo p e n .

6. "The i ro n i c v i s i o n , s i m i la r ly , isi nc o ngru e n t wi th th e behavioral worldv i e w . This v i s ion i s c harac te r i z e dchie f ly as a readiness to seek out in-t e rna l c o n t rad i c t i o ns , am b i gu i t i e s , andparadoxes" (p . 823). Me s s e r a n d W i -n o k u r (shal l w e s a y u nc o ns c i o u s ly ? )f a i l to r e m e m b e r tha t p a rad o x i c a l in -t e n t i o n , o ne o f the m a i n C B T m e th-o d s , w as hard ly p i o ne e re d b y F r e u do r J u n g b u t b y sever a l no t ed ant i -an-a l y t ic cogni t ive therapis ts , e spec ial lyK n i g h t D u n l a p , V i k t o r F r a n k l , J a yHaley, an d Al l e n Fay.7 . T he b e hav i o r the rap i s t ' s t e l l i nga female c l ien t " what t o do and howto d o i t c anno t hel p he r wo rk th ro u ghan d accept these gr im real i t i es . It isan e s s e n ti a l p a r t o f d y na m i c the rap yt h a t the c l ient recognize that thechoice , wi th it s at tendant r i sks , i s hero w n " (p . 823). B T a n d C B T d o n o tt e l l c l i e n t s wha t to do, though theyof ten show them h ow to do w h a t theyw o u l d l i k e to e f f e c tu a te . Ps y c ho ana-l y t i c t her apy , as a l m o s t i n n u m e r a b l ecr i t i c s hav e s ho wn, t e nd s to b e u n-u s u a l l y a u t h o r i t a r i a n a n d d e t e r m i n -

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( Ju r j e v i ch , 1974), w h i l e r a t i o n a l -f o r m s o f

T es p ec ia l l y em p h a s ize c l i en t( E l l i s ,

8 . "T h e a bs en ce o f a d e v e l o p m e n -l f r a m e w o r k in the b e h a v i o r a l ap-l ea d s t o a more o p t i m i s t i c v i e wposs ible o u t c o m e ; e a r l y def ici ts andare not usual ly seen as plac-

ce i l in g o n poss ible change" (p .) . A l m o s t a l l BT a n d CB T p r a c-

f o l l o w in g l ea d e r s in the f ieldB a n d u r a , E l l i s , E y s e n c k , a n d

be l i ev e t h a t s e r io u s em o t io n a la s t rong bio logica la s s o c ia l l y l ea r n ed co m p o n e n t

change o r r e m o v a l o f e m o t i o n a li s d i s t i n c t l y l i m i t e d . If

p s y c h o a n a l y s t s a r e m o r eo p t i m i s t i c i n t h i s r e -a re b e h a v i o r t h e r a p i s t s .

9 . "T h e a n a l y t ic t h e r a p i s t a im s n o tt o h e l p c l i en t s f e e l be t t e r a n db e t t e r b u t also t o e x t e n d t h e i r

o f r e a l i t y r eco g n ize a n d a ccep t t h a t ev eni m p r o v e m e n t , l i fe i s i n e v i t a b l y

m i x t u r e o f co m ic , i r o n ic , r o m a n t ic ,n d t r a g ic elements" (p . 824). Perhapsa n d W i n o k u r a i m t o h e l p t h e i rex t en d t h e i r p e r s p ec t iv e a n d

o f r e a l i t y ; b u t i n th is theybe y o n d p s y ch o a n a l y s i s , w h ic hgive most clients an extremelyd , p a s t - o ri en t ed v ie w o f t h e m -

l i f e . CBT, on the o there x i s t e n -

therapy ( w h ich in a s en s e i s o n ei ts s u b h e a d i n g s ) , m u c h m o r e p h i l o -

a n d b r o a d e r in scope and tow i t h m a n y a s p e c t s o f h u m a n p e r-

t h a t p s y ch o a n a l y s i s l a r g e l y10. The beh a v io r t h e r a p i s t , in

v e t h i n k i n g a n d e n -in t h e d i r ec t a c t io n t h a t f o l lo wsthis v i e w p o i n t " (p . 824) . On eof CBT, s u ch a s t h a t e s p o u s ed

M a u l t s b y (1975) a n d M e i c h e n -m ( 1 97 7 ), u s es a good d e a l o f w h a tbe called p o s i t iv e t h in k in g ;

t h e h ig h l y p o p u l a r s t y l e o f Beckan d E l l i s (1973, 1979) e s c h e w st im es v ig o r o u s l y o p p o s es p o s -t h i n k i n g .

1 1 . "Where th e b e h a v i o r a l ap -p r o a c h , c o n s o n a n t w i t h t h e c o m i cv i e w , l e a d s t o a c t i o n , th e p s y c h o a n a -l y t i c a p p r o a c h , f o l l o w i n g t h e t r a g i cv i e w , l e a d s t o r e f l e c t i o n a n d i n q u i r y "(p . 8 2 4 ) . A l t h o u g h c a l l i n g C B T at r a g i c v i e w o f l i f e w o u l d b e a n a r r a n to v e r g e n e r a l i z a t i o n , i t p a r t i c u l a r l ys t resses r e f l e c t i o n a n d i n q u i r y a n du s u a l l y does so considerably moret h a n d o es t r a n s f e r e n c e - s c h m a n s f e r -e n c e - o r i e n t e d p s y c h o a n a l y s i s ( B a r d ,1980; E l l i s , 1981; Gr ieger & B o y d ,1980; W a l e n , D i G i u s e p p e , & W e s s l e r ,1980).1 2 . " B y e n c o u r a g i n g c l i e n ts to a c t ,o r b y o f f e r i n g c o p i n g t e c h n i q u e s s u c has r e l a x a t i o n o r s e l f - a s s e r t i o n , m i g h tno t the t h e r a p i s t cu r t a i l the processof p u t t i n g c l i e n t s i n t o u c h w i t h d e e p e rfe e l i ng s a n d r e s o u r ces t h a t w o u l d h e l pt h em become m o r e w h o l e , i n t e g r a t e d ,a n d g en u in e?" ( p . 8 2 6 ) . I n d eed i tw o u l d i f t h a t w e r e a l l a b e h a v i o rt h e r a p i s t d i d ! B u t u n l i k e p s y c h o a n a l -ys is , C B T does n o t e m p h a s i z e o n e o ra f ew s e l ec ted t ech n iq u es , bu t s t r o n g l ye s p o u s e s a w i d e - r a n g i n g , m u l t i m o d a la p p r o a c h i n c l u d i n g p h i lo s o p h ic a n de t h i c a l d is cu s s io n s o f cl ients ' goals ,p u r p o s es , id ea l s , a n d v a l u es ( L a za r u s ,1976). I t i s t h e r e f o r e m u ch l e s s l ik e l yt o a v o id p u t t in g c l i en t s in t o u ch w i t ht h e i r deeper f ee l in g s a n d r e s o u r c e st h a n i s a n y t h i n g r e s e m b l i n g F r e u d i a nanalysis .

In t h es e ( a n d a g o o d m a n y o t h e r )w a y s , M e s s e r a n d W i n o k u r s e t u p b e -h a v i o r t h e r a p y a n d c o g n i t i v e b e h a v -i o r t h e r a p y " s t r a w people" and t h eng l e e f u l l y proceed t o k n o ck t h em d o w n .M o s t o f w h a t t h ey c l a im t o be t h e t y p -ica l "p s y ch o a n a l y t ic" o r "psychody-namic" goals a n d a t t i t u d e s a re t o d a ycommon to m o s t n o n a n a l y t ic thera-p ies , in c l u d in g , f o r ex a m p l e , c l i en t -c e n t e r e d , ex i s t en t ia l , h u m a n i s t i c , a n dG e s t a l t t h e r a p ie s . A n d v i r t u a l l y al l the" l i m i t a t i o n s " o r "d i s a d v a n t a g es " o fB T a n d C B T t h a t t h ey p o in t to h a v en o t h i n g t o d o w it h t hes e f o r m s o f t h e r -a p y a s they a re u s u a l l y p r a c t iced to -d a y . I quite a g r e e w i t h t h e m t h a t theo u t l o o k w h ich i s i n t r i n s i c to w h a t Iw o u l d ca l l "real" p s y ch o a n a l y s i s ( a n dn o t t h e h i g h l y p e r f u m e d v e r s i o r i t h eyp r es en t in t h e i r a r t i c l e ) is la rgely in-compatible w it h m o s t e f f i c i e n t f o r m s

o f t h e r a p y s u ch a s BT a n d G E T . B u tt o g iv e m y r ea s o n s f o r t h i s w o u l d r e -q u i r e a l o n g a r t i c l e t h a t w o u l d b em u c h m o r e c r i t i c a l o f p s y ch o a n a l y s i st h a n I h a v e ch o s en t o be in t h i s s h o r tc o m m e n t a r y o n t h e i r ar t i c le .

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therapy: A skills based approach. N ewYork: V an N o s t r a n d Reinhold , 1980.Jur jev ich , R. M. The hoax of Freudism.Phi lade lph i a ; Dorrance , 1974.K e n d a l l , P. C, & Hollon, S. D. (Eds . ) .Cognit ive-behavioral -intervention:Theory, research an d procedures. N ewYork: A c a d e m i c Press, 1979.L a z a r u s , A. A. Behavior therapy and be-yond. N ew Y o r k : M c G r a w - H i l l , 1971.Lazar us , A . A . Multimodal therapy. N ewYork: Spr i nger , 1976.Maul t sby , M. C., Jr . Help yourself to hap-piness . N ew York: Ins t i tu te for RationalLiv ing , 1975.M e i c h e n b a u m , D . Cognit ive behaviormodification. N ew Y o r k : Plenum Press ,1977.Messer , S. B., & W i n o k u r , M . S o m e l im i t sto the in t egr a t ion of psychoanalyt ic andbehavi or the rapy . American Psycholo-gist, 1980, 35, 818-827.W a l e n , S. R., DiGiuseppe, R., & W essle r ,R. L. A practitioner's guide to rational-emotive therapy. N ew Y o r k : OxfordU n i v e r s i t y Press, 1980.Wessle r , R. A . , & Wessle r , R. L. Rational-emotive therapy: A cognitive behav-ioral approach. Sa n Francisco: Jossey-Bass, 1980.

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