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BRIEF THERAPY: A RATIONAL EMOTIVE BEHAVIOUR APPROACH: DR. STEPHEN PALMER INTERVIEWS DR. ALBERT ELLIS
First published in The Rational Emotive Behaviour Therapist, 3, 2, 68-71, 1995. Published with the permission of the Editors.
Copyright, 1999, Palmer and Ellis.
BRIEF THERAPY: STEPHEN PALMER INTERVIEWS ALBERT ELLIS
YOU'VE JUST RECENTLY COMPLETED WRITING A BOOK ON BRIEF THERAPY. COMPARED TO SOME THERAPIES, SUCH AS ANALYSIS, REBT IS INTRINSICALLY BRIEF. WHAT DO YOU MEAN BY BRIEF THERAPY?
I mean, first of all, what you have just said! One of the main reasons I originated REBT in 1955 was because the psychoanalysis that I'd previously done, including psychoanalytically oriented therapy, is intrinsically long. It takes a fairly long time to get people to free-associate, analyze their dreams, and go over and over their childhood and later historical material. It is almost impossible to do classical analysis in less than a year, and frequently several years. Psychoanalytically-oriented psychotherapy is a lot briefer; and I found out, to my surprise when I did it, that it was better, got better results than classical analysis. When you do analytically-oriented therapy, you sit face to face with your client, whereas in classical analysis you let them lie on the sofa and you sit behind them, not directly looking at them. In analytically-oriented therapy you see each other and you quite quickly get their basic history. Your interpretations start much sooner. In classical analysis you may hardly interpret at all for a whole year or so, whereas in psychoanalytically-oriented psychotherapy, after a few sessions you may start giving them interpretations - e.g. that the reason why they fight with their mate today is because they still hate their mother or father and they're transferring that hatred to their mate even though he or she is quite a different person. Even analytically-oriented therapy takes a considerable length of time. You see clients once or twice a week for a year or two or three before you expect really good results.
REBT is intrinsically more efficient and briefer. Often during the very first session I can show people the ABCs of distress. Something bad is probably happening in their life at point A, and they're too distressed about A largely because of what they're telling themselves, their belief system, at point B. I show them how to dispute their self-defeating beliefs (Bs) and acquire a different, more effective philosophy. So REBT is sometimes successfully done in a few sessions.
Also, of course, REBT can be done by self-help material - by books, cassettes that teach REBT principles. People can briefly learn and use this material and other REBT methods. In my new book on Brief Therapy I go through a good many of the REBT methods - cognitive, behavioural, and emotive methods - and also other kinds of therapy and what they do in their brief therapy. I show how people, by using REBT and various other methods, can make themselves feel better and act better, but how they can easily fall back to their self-defeating, demanding ideas. In the final chapters of the book I show certain more elegant REBT techniques, such as anti-awfulising, where we teach people that nothing is awful because awful really means totally bad. Many stressors in life are plainly inconvenient and bad but none of them is really awful, horrible or terrible. I describe a number of other REBT methods that will lead to what I call the elegant solution to distress. This includes helping people to not only feel much better and get over some of their behavioural symptoms but also make themselves less disturbable. By this I mean that after therapy has ended they rarely seriously distress themselves about anything.
To make themselves distinctly less disturbable, people can use some of the highly philosophical REBT techniques, such as USA (unconditional self-acceptance). With USA they fully accept themselves, though not some of their acts, no matter how badly they perform, and who loves or doesn't love them. They also can acheive unconditional acceptance of other humans (UAO), even when those others are acting immorally or badly. If they can get to these profound philosophical solutions, there is a good chance that they will really become significantly less disturbable, and rarely in the future will upset themselves about anything.
They can also teach themselves to cope with any kind of very bad situation - including having AIDS or cancer. If they strongly and persistently use REBT people won't be happy about very bad stressors but they won't be utterly depressed and miserable about them. Then, if they do fall back to seriously distressing themselves, they will be able to quickly go back to some of the ABCs of REBT and un-upset themselves again.
My book on brief REBT therapy is one of the few books which aims to show therapists how to teach their clients how to get to this elegant kind of solution - not just to improve their current anxiety, depression, and rage but to ward off future disturbances that they are to create. The book, Better, Deeper and More Enduring Brief Therapy, shows therapists how to educate their clients to be both less distressed and less distressable - yes, even when some of the worst stressors occur in their lives.
IN HIS BOOK ON BRIEF THERAPY, WINDY DRYDEN ACTUALLY RECOMMENDS AN ELEVEN-SESSION COUNSELLING PROGRAMME. WHAT ARE YOUR VIEWS ON THIS FORMAT?
I rarely recommend any specific number of sessions. I just assume that individuals are different, especially in how they react to the therapy, apart from the differences in their disturbances. I have had some clients who in a very few sessions - say five - have made a profound philosophical change, or at least a good part of it. I have also found other people who do the same thing just by reading my books or by listening to my cassettes. I had a woman, 'L', come to see me about a year ago who was severely disturbed for years when she lived in New York. She had OCD (obsessive-compulsive disorder) in addition to panic and very low frustration tolerance. She had a rough time in New York, so she left and settled in the West where she eliminated some of the stressors in her life because she couldn't take the stressors that existed in New York, she said, including the problems in her social relationships. She got some coginitve behaviour therapy on the West Coast and that helped her but not that much. Then, about half a year before coming to New York to thank me, she bought A New Guide to Rational Living, read it thoroughly several times, and was convinced that she had achieved unconditional self-acceptance. She felt she had remarkably changed, and was able to come to New York to visit friends, particularly an old friend whom she previously couldn't tolerate. She reported on her progress and showed me how after being in New York several days she was able to live with and tolerate her friend. She was also able to take the hassles of the West Coast and to do remarkably well. I had had no sessions with 'L'. She had just read A New Guide to Rational Living and listened to some of my tapes.
So I'd say that eleven sessions may well be too much for some people! On the other hand, I see others for brief therapy who have 20 or 30 sessions (which I still regard as brief).
So I rarely set any specific number of sessions. Some clients have a time limit because they come to New York specially to see me and can only stay a few weeks, so we have a limited number of sessions. But even then they always have the option of continuing afterwards by phone. I do a lot of phone therapy with people. Some of them I've never seen. They've just read my books or heard about me and they call for an appointment.
So I don't limit sessions to 10, 11, or whatever but try with every client to make therapy as short as feasible and to see whether REBT works well with this particular client in 5, 10, 15, sessions or more. We only have a limited number of sessions when clients decide that they only want a certain number, for whatever reason.
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