Journal of Cognitive Psychotherapy: An International Quarterly

Volume 19, Number 2 • 2005

Discussion of Christine A. Padesky and

Aaron T. Beck, "Science and Philosophy:
Comparison of Cognitive Therapy and
Rational Emotive Behavior Therapy"

Albert EUis, PhD

Albert Ellis Institute, New York, NY

The author largely agrees with Ghristine A. Padesky and Aaron T. Beck's (2003) article, "Science
and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy,"
disagrees with several of its statements about REBT, and particularly obiects to Padesky and
Beck's view that the fundamental difference between CT and REBT is that the former therapy
is empirically based and the latter is philosophically based.

Keywords: cognitive therapy; cognitive behavior therapy; psychotherapy; rational behavior

therapy

hristine A. Padesky and Aaron T. Beck (2003), together with myself (Ellis, 2003), have

C recently published papers in this journal on the similarities and differences between
Cognitive Therapy (CT) and Rational Emotive Behavior Therapy (REBT). I think that these
articles clarify our positions and agree with their views.
Although I agree with many of the points that Padesky and Beck (2003) make about the
essence of REBT, I disagree with some of their description of its theory and practice. In particu-
lar, they state in their first paragraph, "A fundamental difference between the two [CT and REBT]
in that REBT is a philosophically based psychotherapy and CT is an empirically based psychother-
apy." I shall discuss this point a little later.
Meanwhile, let me discuss several of my other disagreements with statements that Padesky
and Beck make about REBT.
"Research on REBT has not been as extensive [as that on CT] and only a small number of out-
come studies are published, most of them using waitlist controls rather than the active treatment
controls typically used in CT outcome research" (Padesky & Beck, 2003, p. 212). Actually, over
200 outcome studies on REBT have been published, but many of them have not been as rigor-
ously done as CT studies.
"The REBT philosophy asserts that certain types of thoughts (dysfunctional shoulds, musts,
and other imperatives) inherently lead to problems and are always present when humans are trou-
bled no matter what type of trouble is experienced" (Padesky & Beck, 2003, p. 212). No, REBT
says that this is usually the case, but by no means always. Endogenous factors are very important

' 2005 Springer Publishing Company 181

182 Discussion of Padesky and Beck

in the creation of human trouble, as well as biological tendencies to make oneself disturbed which
are emphasized even more in CT. When psychological factors are at issue, they almost always, but
not necessarily always, include overt or covert shoulds, musts, and other demands.
"Beck is more concerned with how dysfunctional a belief is than with its irrationality"
(Padesky & Beck, 2003, p. 215). REBT has always held that "irrational" basically means dysfunc-
tional and does not mean only illogical or antiempirical beliefs.
"In CT the goal is to teach clients skills that enable them to investigate their own beliefs"
(Padesky & Beck, 2003, p. 215). In REBT, a similar goal is sought; and skills and behaviors that
specifically dispute clients' irrational beliefs are also almost always sought. Clients are also specif-
ically taught several cognitive and emotional methods of investigating and changing their dys-
functional beliefs.
A depressed client "was able to recognize how her depressive thinking distorted her view of
these experiences through processes of overgeneralization, arbitrary influence, and self-blame"
(Padesky & Beck, 2003, p. 215). Yes, she would also be shown how to recognize her negative auto-
matic thoughts in REBT, but would additionally be shown that her automatic thoughts largely stem
from her underlying shoulds, oughts, and musts. CT often stops at her automatic thoughts.
"Beck advocates formulating client beliefs in the client's own words" (Padesky & Beck, 2003,
p. 216). So does REBT, but when the clients have difficulty doing so, which is often, REBT shows
them musts likely lie behind their words, helps them see that they unconsciously hold these musts,
and puts their automatic thoughts and their musts in their own words.
"This woman not only felt better in the present, she developed a better understanding of
depressive thinking process and learned skills to help reduce the high risk of depression relapse"
(Padesky & Beck, 2003, p. 216). REBT emphasizes basic understanding of thinking processes and
learned skills to reduce relapse more, probably, than does CT.
"Beck emphasizes methods of guided discovery that help clients identify' and test their own
belief through personal observations and experiments. Ellis emphasizes the direct disputation
of beliefs" (Padesky & Beck, 2003, p. 217). REBT first uses guided discovery and other means of
helping clients identify and test their own beliefs and also uses direct disputation of beliefs. Even
when irrational beliefs are quickly shown to clients and disputed by the therapist, clients are
shown other cognitive, experiential, and behavioral ways of discovering and disputing them.
"Erequently in CT, discussions of client beliefs lead to 'behavioral experiments' to test out
beliefs directly by gathering evidence on real life experiments." This is probably more often done
in REBT then in CT.
"Biology and environment... are more actively included in most cognitive therapy con-
ceptualizations" (Padesky & Beck, 2003, p. 217). Not as much as in REBT. Biology has been par-
ticularly emphasized from 1962 onward in Reason and Emotion in Psychotherapy (1962) and in
other of my writings (Ellis, 1976, 2001a).
"Ellis originally proposed a model in which thoughts precede emotions and behaviors. Beck
has always favored a more interactive model stating that thoughts, emotions, behaviors, and phys-
iological responses mutually infiuence each other as well as interacting with environmental con-
text" (Padesky & Beck, 2003, p. 217). My very first paper on REBT, given at the American
Psychologists Association Convention in 1956 (Ellis, 1958), clearly pointed out that thinking,
feeling, and behaving always interact with, mutually influence each other, and also interact with
the environment. Later REBT writings strongly emphasize that therapists should use these inter-
actions in their treatment procedures (Ellis, 2001b; Walen, DiGiuseppe, & Dryden 1992). Judith
Beck finally noted this in 1995.
"CT emphasizes the level of thought consistent with empirical findings regarding particular
problems" (Padesky & Beck, 2003, p. 217). This level of thought is often revealed, but different
depressives, for example, have several kinds of automatic thoughts, often different from other
 Ellis 183

depressives. Practically all of them have similar underlying shoulds and musts, and these can be
empirically discovered in individual cases when the therapists assumes, according to REBT theo-
ry, that some of them probably exist. REBT theory leads to more empirical investigation in indi-
vidual clients than CT theory probably does. In regard to personality problems, CTfinallyfollowed
REBT and now looks for core irrational beliefs or schemes, rather than automatic thoughts (Beck,
Freeman, et al., 2003).
"Although many REBT therapists are also collaborative with clients, the REBT therapist often
plays the role of arbiter of functional thoughts. In this sense, the therapist is the expert rather
than a co-discoverer of meaning with the client" (Padesky & Beck, 2003, p. 218). Yes, the therapist
had damned well better be an expert and know considerably more about disturbance and what
to do about it than most clients do. REBT honestly faces this problem, while some other theories
pretend that clients have more expertise than therapists do.
"As stated above, the client is the ultimate arbiter of which thoughts are functional" (Padesky
& Beck, 2003, p. 219). By themselves, clients often are confused and never really know. So REBT
helps them differentiate functional from dysfunctional thoughts.
"Cognitive conceptualizations for the following disorders also have received empirical sup-
port" (Padesky & Beck, 2003, p. 220). The authors list several disorders, such as depression and
PTSD. But they fail to note that hundreds of studies of REBT's irrational beliefs have been done,
showing that they are especially prevalent in a great many specific emotional-behavioral disorders.
REBT outcome studies, like many other outcome studies, often leave much to be desired. But
REBT has also inspired the study of irrational beliefs, which have been empirically investigated in
well over a thousand studies, most of which show that they are related to specific emotional and
behavioral disorders (Ellis & Whiteley, 1979). Beck's "dysfunctional beliefs," which he started to
investigate about a decade after REBT, brought "irrational beliefs" to the field of therapy, are
essentially the same as my "irrational beliefs." Many CT studies, as Padesky and Beck rightly show,
also link dysfunctional beliefs with specific psychological diagnoses.
"There are indications that CT leads to lower relapse rates than other active treatments; this
finding lends the strongest support to data for the cognitive model of treatment" (Padesky & Beck,
2003, p. 217). Yes, but REBT seems to be the pioneering therapy in showing that people's feeling
better after psychotherapy hardly means their getting better. REBT specifically defines getting bet-
ter (and staying better) as clients' not only benefiting from therapy, but also making a profound
philosophical change that will largely insure their being able to stay better, that is, refuse to upset
themselves, cognitively, emotionally, and behaviorally, if the worst possible adversities occur to
them in the future (Ellis & Whiteley, 1979). This REBT goal is stressed by REBT practitioners,
and clients are encouraged to make it one of their main therapeutic goals.
Both my paper on REBT and Padesky and Beck's paper on CT note that REBT is largely philo-
sophically based psychotherapy and that CT is an empirically based system of therapy (Ellis, 2003;
Padesky & Beck, 2003). I now see that this is only partly true because both systems are philosoph-
ically and empirically based as, in all probability, are all systems of therapy.
Let me take REBT first. I partly derived it philosophically, following the constructivist views
of several leading ancient Asian and Greek philosophers and those of some modern philosophers
(Ellis, 1962). But I first empirically noted, while I was still in graduate school, that Carl Rogers'
(1961) system and the psychoanalytic system (Freud, 1956; Horney, 1950), which I practiced
between 1947 and 1953, worked relatively poorly. I realized that something more was needed in
order to create an empirically effective form of psychological treatment. I therefore explored and
experimented with several different kinds of therapy methods (Ellis, 1956a, 1956b), found them
all empirically weak, and therefore went back to my interest in philosophy and came up with REBT.
I also heeded many experimental outcome studies that showed the questionable efficacy of the
therapies I investigated and with which I experimented.
184 Discussion of Padesky and Beck

As shown by my paper on REBT (Ellis, 2003) and by Padesky and Beck's paper (2003),
Padesky and Beck correctly show that "REBT and CT both teach that thoughts, emotions, and
behaviors interact." But they fail to note that empirically based scientific thinking and philosophi-
cally based thinking also interact.
Beck, for example, empirically studied depression, but he also conceptionally thought about
his findings and he formulated (and experimentally tried out) a theory of why people often depress
themselves and what they can do (with CT) to reduce their depressed feelings-behaviors. So in this
case, philosophizing p/«s empirical testing his theory of disturbance worked together. Padesky and
Beck imply that they greatly differ. They'd better consult Alfred Korzybski' (1933) both/and rather
than Aristotle's either/or thinking-experimenting process. Both REBT and CT are scientific-
empirical and interrelatedly, philosophical. As Padesky and Beck (2003, p. 27) state, "a major dif-
ference between them is that CT is an empirically based therapy and REBT is philosophical." This
statement is partly true, but it also partly inaccurate.
Practically all major systems of psychotherapy such as Roger's (1961) person-centered thera-
py are empirical-philosophical. They usually start with the empirical observations that prior ther-
apy systems do not work too well and had better be improved. Then they theorize and believe that
a new system would work better. They speculate about what elements this new system would
include and would omit. They experimentally try out their new theory and add new methods to
it (that they theorize will work) and subtracting some methods from it that they empirically get
evidence will not work. Finally, after much philosophically theorizing and empirical checking ofthe
therapy, they end up with a corrected system of therapy that they (for awhile) view favorably and
keep practicing. Then, for empirical and theoretical reasons, they keep revising their system.
In my own case, I began with the empirical observation that I had an emotional problem—
that is, anxiety about failing at important tasks, and being disapproved by significant others. I saw
that usual therapy techniques, such as relaxation, didn't cure it. I adopted philosophy as a hobby
and learned (especially from Epictetus) the constructivist view, that I was largely creating my own
anxiety and that I could uncreate it by changing my thinking. I got myself over my anxiety by
strongly deciding, at the age of 24, that I didn't need to be loved and didn't have to be successful. I
wrongly theorized, when I became a therapist at the age of 30, that the exploration of the early
childhood experiences of my clients was all-important and practiced liberal, non-Freudian psy-
choanalysis for a while. I saw empirically that it didn't work very well with many people and that
other therapeutic systems also didn't work. I went back to my old non-needy philosophies and to
understanding the philosophies of my clients. I started using the cognitive-behavioral theory and
practice of REBT and kept revising it as I empirically checked its results, and I developed it along
philosophical and practical behavioral lines. Although it is more philosophic than CT and most
other therapies, REBT is also, fi'om its beginnings until today, very empirical, devoted to the scien-
tific method; it checks its theories and hypothesis with empirical analysis and experimentation.
Although I cannot speak for Tim Beck and his CT followers, I again say that they have used
empirical investigation of dysfunctional beliefs and the checking of outcome studies of CT with
unusual splendid consistency. But they are also quite philosophical. They are distinctly con-
structivist, hold that people can disturb and undisturb themselves, look for core dysfunctional
beliefs in seriously self-defeating people, and have other philosophical underpinnings for their
investigatory and therapeutic practices.
AU that I have said so far adds up to my disagreements with Padesky and Beck's (2003, p. 211)
article on "cognitive therapy and rational emotive behavior therapy." They note again in their first
paragraph, a fundamental difference between the two [CT and REBT therapies] "is that REBT is a
philosophically based psychotherapy and CT an empirically based psychotherapy" (2003, p. 211).
This, I say, is inaccurate because both REBT and CBT, like practically all other therapies, are
philosophically and empirically based systems. If Padesky and Beck (2003) choose to hold that
REBT is more philosophically based than is CT, I would tend to agree. As I said in my initial pres-
 Ellis 185

entation on their similarities and differences (Ellis, 2003), I am pleased with their acknowledg-
ing the strong philosophic emphasis of REBT. That is what I do with most of my clients—urge
them to change their core irrational seli-defeating philosophies. But REBT's empirical testing of its
outcome studies had hetter follow the lead of Tim Beck and CT by becoming more empirical but
not less philosophic than it has so far been. At the same time, I would like to see CT become more
philosophical in its methods. That would be desirable but not necessary.

REFERENCES

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Offprints. Requests for ojfprints should be directed to Albert Ellis, PhD, Albert Ellis Institute, 45 East 65th Street,
New York, NY 10021. E-mail: aiellis@aol.com