I met the cognitive behavioral therapist Albert Ellis for the first time in 1993, 20 years ago now. The man impressed me with his overwhelmingly to-the-point therapy style. In his practice in New York, he met with a patients every 20 minutes and, yes, he was extremely efficient and therapeutic. When you attended one of his sessions, you first would think that he is just scolding the patient, but that is not true. Ellis was very empathetic. He unmasked the irrational thoughts of his patients in a humoristic yet confronting manner, in such a way that the patient still felt deeply respected, helped, and understood. Some of those opposing his style found him rough, but the patient did not experience it this way. I was impressed by his style and integrated pieces of his work in my work as a doctor and therapist, and later on into the online self-help program which I developed.
Love lessons by Albert Ellis
In 2005 I met his wife,DebbieJoffe Ellis, MD, for the first time and throughout the years my sympathy for her persona, her dedication, and her work grew. Her stories about 'Al' - which is what his friends call him - and how he consequently used his therapeutic principles in his own life fascinated me. That is why I asked Debbie if she would summarize these in an interview for the readers of Psyche & Brain. Our discussion took place on the 11th of December last year, and took little more than an hour.
‘Should I give an example from the life of my husband? It illustrates how another person changed surprisingly when my husband had let go of his irrational ideas and 'demands'. When he was a young man - he was about 24 years old - he was crazy about a girl named Carol. She was still very young, 18 or 19 years old I believe. They had a romantic relationship and also became very intimate. He worshipped her and wanted to share his life with her. She was very ambiguous. Sometimes she said yes, and then she said no. One evening they had shared a nice meal and he wanted to go home, when she suddenly said: "Al, I think we should keep it at this."' ‘His world collapsed. He was broken. He felt depressed and it was one of the few times in his life that he felt the tears roll down his cheeks. He went to the nearest park in New York. It was midnight and while walking he thought: "How can I be happy with her?", and he then felt even more depressed.' 'It was in that moment that he suddenly gained the insight that it was not her dismissal which caused the depression. No, it was his 'demand' that she should love him in the same way that he loved her. It was his 'demand' that they should be together for the rest of his life. And it was the fact that he convinced himself that he could not be happy without her. Suddenly, he realized that these convictions were not 'true'. Even if he - in the worst case scenario - would not be as happy with another woman, there still was a large chance that he could reach a certain level of happiness with another woman.'
‘He realized that the fact that he found that she should love him as much as he loved her, did not mean that she would. And where did this irrational thought lead him? It led him nowhere, it made him hurt instead.' ‘In that moment he realized: "Let me try not to demand that she should be with him and let me not think that I will never be happy without her."' 'He changed his attitude. Some time later, they met again and ironically this time he did not have his feeling of hopelessness. The effect? Carol's longing increased slowly. She wanted him. And then the story continues: they got married... for 18 hours. That was because her parents found out that she was married and forced them to break off the marriage because they were too young. But they always stayed good friends until she died, six years before him.' 'This example shows that someone can sometimes change when letting go of their hopelessness. But the most important reason to let go of hopelessness and to accept reality, is not to be able to manipulate the other person - it is so that we can feel good ourselves.'
‘So let us want what we want, but make sure that we do not 'demand' it. That is how Debbie ended the anecdote from the life of Albert. This goes along with the earlier article in this series 'Letting go and accepting to move forward'.
With this story, Mrs. Ellis tried to summarize the core of Rational Emotive Behaviour Therapy (REBT): ‘By becoming aware we are offered new choices. If someone does not know that they can make a choice, they will not be able to make a choice, either. When we become aware of that we are responsible ourselves for our own emotional situation and destination, we can encourage healthy feelings by thinking in healthy ways.' ‘And when we notice an unhealthy emotion (such as the depressed feelings of Albert in the beginning of the story), we can - like he did - choose to stop and ask ourselves the question: "What am I telling myself, that is causing this feeling?" Most likely you will find a 'must', 'demand', 'force', 'blowing out of proportion', or 'low frustration tolerance' in the answer. From that moment onward we can challenge our thoughts or ideas, learn to think differently and encourage healthier emotions.'
That is an important message in REBT: 'When we become aware and know we have a choice, we have the ability to influence our emotional fate. What a gift! So let us live like that, in the one life which we have got ... notice what is beautiful, even if what we are going through is not beautiful in itself.' ‘While we are reminded again and again of that life contains loss and suffering, we know that this is the nature of life, just like in the large traditions like buddhism. But if we learn to think in a healthy way, we will learn to accept that which we cannot change. And we will learn to develop the ability to enlarge that which can be experienced with joy. This way we will reduce our suffering.' 'Let us enjoy the gift of life! Let us (learn to) think in a healthy way! Let us develop and feel healthy feelings! That does not mean that we should not feel the negative things, but rather: "Let us actively feel the positive things."'
I saw Albert Ellis for the last time fifteen months before his passing. He has written 75 books during his career and had hundreds of publications. His entire capital which he gathered from a life full of savings, the rights on his books and the intellectual property is what he donated to a foundation, so that it could continue with his work and his mission. He kept nothing himself and assumed that the foundation would support him at old age. Now the 92-year old Albert Ellis fell ill, very ill, and the medical costs for survival got very high. Some employees had organized a juridical move to put him out of his foundation. He was not even allowed to enter the building anymore. He did not have money to survive. Some colleagues appealed to the international psychologists' community to support him and to help him to survive financially, to be able to continue to pay his medical treatments. It was in this context that I met Debbie for the first time. How did Ellis deal with it? How did he useREBT on himself? Accepting that which is, is the basis ofREBT. This is what we saw in Al's first love story. Did he do this, too, 68 years later in the face of shocking injustice?
‘Unconditional acceptance means: you accept the person unconditionally as a worthy being, but that does not mean that you need to accept the behavior of this person', Debbie explains. 'You may fight for justice when someone misuses you. But for your inner balance, peace, and stability, and your emotional wellbeing, you realize that the person who misuses you is an imperfect human being who acted wrongfully. But in essence this imperfect person is a valuable human. That is very difficult for people to understand.'
‘Do we choose - in the one life which we have - to enjoy life, or do we choose to suffer it? We can (learn to) choose how we think and how we feel.' ‘There is a large chance that we meet people in our lives that act in such a way that we get hurt. We can choose in such moments to think: "They should not be allowed to do so." But that does not change them and it does not help us, either. We could also work to adopt the attitude that they, just like me, can make mistakes. We can see that many things influence our choices and actions. If someone does something in a certain way, then there is a reason for this. It can even be so that they have a chemical imbalance in their brain.' ‘So we can take action to protect ourselves from their actions, without judging them as a person. Maybe we even need to call the police or take judicial steps.'
But while REBT recommends to take suitable actions (regarding their actions), it is smart to constantly remind ourselves of the following two insights: 1. I can overcome that which I do not like 2. If I had been in the same situation they are in and had their brain chemistry, I might have done the same thing which they did. Holding onto bitterness is something which Ellis sometimes described with the following image: 'Taking poison oneself and meanwhile hoping that the other person dies of it'. Albert Ellis preached compassion rather than bitterness. ‘We are getting to the end of Albert's life. Paul, you were there when Al held a seminar in which he told people about the fate that had struck him.. I remember that. He had been treated brutally by people in his professional environment. And he did what I describe here: he hated what they did. We had a lawyer and we tried to get justice. But still, he did not hate the people.' ‘And did he manage to do so?', I asked her. ‘Yes 100 percent. You are talking to the person who was with him day and night, except for when I took a shower or used the bathroom.' ‘There was one specific afternoon which i remember well. There was yet another case of distasteful behavior and it had been like this for a while. I could not hide my tears. He saw my unhappiness, took my hand and kindly said: "Debbie, Debbie, you are such a good REBT-teacher, you are a great therapist, but you are not applying it to yourself!"' ‘He said: "Accept, accept! They need to act like they are actin right now, if they are thinking the way they are thinking. Debbie, they have a disorder in their thoughts and in their brains. He said this in a non-sarcastic tone of voice. If they are thinking as they are thinking - partially because they learned to do so, partially due to their biology - they will act like they are acting right now. He did not say that as an excuse for their poor behavior."'
The most important differences when comparing REBT to other cognitive behavioral therapist, are that REBT focuses more on acceptance and compassion, and at the other hand on de-bunking negative thoughts or ideas. Albert Ellis found it important to make these lose their power rather than just replacing them with new ideas, like many people often do. Making them lose their power is done by reasoning about every detail until the irrational thought loses all of its value.
Friends and colleagues often told Ellis to let go of the concept of acceptance, because this seems like something many people cannot overcome. He refused. For him, acceptance and compassion are essential. The last few years, the concept of acceptance can be found in several types of therapy. The clearest example is ACT, 'Acceptance and Commitment Therapy' by Steven C. Hayes, who made it attractive. Apparently Ellis was ahead of his time. From the long video-interview with his widow, I selected mainly personal experiences from the life of Albert Ellis, MD, for this article. Would you like to see the entire video-interview? That is possible. Go to the videos on www.15minutes4me.com/video/albert-ellis-rebt. There, Debbie Joffe Ellis also gives a detailed explanation fo the REBT theory, with the use of personal anecdotes. I was enchanted by her story and now understand REBT better than I did before.
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Paul Koeck, MD