Tag Archives: REBT

The unacknowledged stigma of mental illness

By Tina C. Lott July 5, 2022

Jorm S/Shutterstock.com

There is a 900-ton elephant in the counseling room, and it is often not acknowledged by the counselor or the client. As sessions go on and therapeutic alliance builds, this elephant results in a missed opportunity for the counselor to truly know their client. This elephant is known as stigma. 

Although stigma associated with mental illness is a well-researched area, there is a paucity of the literature that teaches counselors how to 1) identify stigma and 2) process and address stigma to decrease its impact on the client. This elephant cannot continue to boast proudly from the corner of the counseling room. Counselors must call it out. But how? Now, you’re asking the right question!

Stigmas exist nearly everywhere. Sometimes stigma is associated with things we can see such as ethnicity or a set of behaviors, and other times, it is present in things that are not so obvious such as within systems or laws. Either way, stigma is harmful. 

There are two primary types of stigmas: public stigma and self-stigma. According to an article by Graham Davey published in Psychology Today in 2013, public stigma forms from negatively held beliefs that society has about a particular group of people. These beliefs often entail stereotypes, discrimination and prejudice. In a 2002 article published in World Psychiatry, Patrick Corrigan and Amy Watson postulate that self-stigma occurs when an individual internalizes the negative beliefs that society has about them. For example, it is a common belief, and myth, that people with mental illness are dangerous. Self-stigma means the individual believes this narrative even if they are not dangerous and even when there is no evidence to support this claim. Self-stigma is usually a result of public stigma. Both kinds of stigma have been documented to exacerbate symptoms. Stigma also creates an “us versus them” divide between those who have a mental illness and those who do not.

Counselors have been charged with many responsibilities within the counseling session. We attune to the client’s mood, process emotions, help to create the goal of third-order change and create a safe space for clients to explore their most vulnerable selves. One skill, however, that we are not specifically trained to do is to recognize stigma and how it impacts our client’s lives. Furthermore, most counselors are ill-equipped to know how to address stigma once its presence has been recognized. Clients come to session and talk about how their symptoms have created obstacles in their relationships, work and career, but they do not usually name stigma as one of the main culprits. Counselors who are aware of what stigma is, how it presents and how to alleviate it have a better chance at addressing those presenting issues and offering their client a more well-rounded counseling experience by acknowledging stigma’s detrimental role.

Tips for addressing stigma with clients

For the past 10 years, I’ve worked with individuals who have been diagnosed with severe and persistent mental illnesses. Specifically, I have extensive experience working with individuals diagnosed with schizophrenia. Throughout my career, I have learned a great deal about the plague of stigma and how it can often destroy a person’s will to recover. During my doctoral studies, I conducted a case study where I investigated the impact of stigma on self-stigma attitudes of an African American man diagnosed with schizophrenia. This project was profound because it allowed me to witness firsthand how detrimental stigma can be for people who have a mental illness, and most important, I learned how to recognize and address it. This study also put me on a path to share what I know about stigma. Here are three simple tips for how counselors can recognize stigma in the counseling session. 

1) Remember that counselor education and awareness are essential components of the counseling process. Stigma can form from biases, so counselors must be aware of their own prejudices. We all have them, and the sooner we can own them, the sooner we can use that information to address the elephant in the room. Ask yourself, “How do I feel about my client and their diagnosis?” Then, ask yourself how others may feel about your client. How would you feel if your partner or parent had this diagnosis? Would there be feelings of shame? Embarrassment? Denial? This process may help to reveal stigmatizing thoughts that perhaps were not as apparent. Stigma can be found in the language that the client uses to describe their mental illness, in the nonverbal communication that the client displays, or in myths and stereotypes that the client unknowingly shares with the counselor. To have the most profound impact on dismantling stigma attitudes, counselors need to have a good understanding of what stigma is and how it may present in a counseling session. Counselors should educate themselves on stigma and then listen attentively for any of these signs so that they can be addressed. 

2) Name the elephant in the counseling session. This calls for the counselor to use immediacy to recognize stigma. Calling the elephant out strips it of its power. Identifying stigma and processing how it has an impact on the client not only allows the client to tell their full story but also helps the counselor better understand the obstacles that their clients face. You understand clients in context. This force that lurks in the corner is now identifiable, and when something is identifiable, it can be addressed.

3) Create a collaborative and safe space. A collaborative, safe space is essential for good therapeutic work to happen. When the client and the counselor are working toward the same goal, the synergistic efforts become a force to be reckoned with. This partnership is necessary to effectively address negative stigma attitudes. A safe space is crucial for any therapeutic alliance to blossom, but a space cannot be safe if counselors have not done their part to identify the stigmas that make the client’s condition worse. Clients need to trust their counselor in order to be a change agent in their own recovery. Counselors who address symptoms and the stigma attached to the client’s condition create a comprehensive approach to treatment.

Addressing stigma from a theoretical framework

Some counselors may not feel equipped to try these tips. Perhaps it seems daunting to address something that the counselor only recently realized. Because counselors learn to conceptualize and treat clients using a theoretical lens, this approach might be one of the best ways for counselors to meet the responsibility of addressing negative stigma attitudes.  

My theory of choice is rational emotive behavior therapy (REBT), which was developed by Albert Ellis in the 1950s. One of the primary premises of REBT is that we are not disturbed by life events. Instead, it is our belief about the event that makes all the difference. If our beliefs are irrational, then our emotions and behaviors will be irrational as well. Counselors who use REBT aim to change faulty beliefs into beliefs that are more productive and aligned with reality. The result is less self-disturbance. 

I tested this theory in my doctoral case study that I mentioned earlier. In this study, I applied REBT techniques to the negative self-stigma attitudes of an African American male, Ike (pseudonym), diagnosed with schizophrenia. I found that many of the techniques that are unique to REBT also helped the client gain awareness of the impact of stigma. Ike learned ways to discount irrational ideas that stemmed from stigma. 

Universal acceptance 

REBT is built on the philosophy of universal acceptance, which means that we accept things for how they are. This does not mean we have to like the situation. It does not mean we agree with it. It does not mean it is fair or we condoned it. It just means that in this moment, the situation is the way it is and we have little to no control to change it. There are three primary types of universal acceptance: universal self-acceptance, universal other acceptance and universal life acceptance. 

Universal self-acceptance acknowledges that we are all a work in progress, and even with our human flaws, we are still worthy. We have to be kind and patient with ourselves as we continue to work toward self-improvement each day. Excepting one’s flaws and shortcomings without criticism but with the goal of improvement is the premise of universal self-acceptance. When clients struggle with this concept, I ask them to think of their most favorite person. Then, I have them envision telling this person the things they say to themselves in times of high criticism and negative self-talk. Most clients admit they would never say such things to the other person. So, I ask clients to think of that person every time they engage in negative self-talk. I create a rule: If they would not say these things to that loved one, they are not allowed to say it to themselves. Over time, the goal is that the client learns to talk to themselves with kindness and compassion without the need to imagine they are speaking to their loved one. Many of my clients have found this approach to be effective, and it is how I begin the process of teaching clients about universal self-acceptance. 

Universal other acceptance posits that we meet people where they are and accept them “as is.” We cannot control others, and it is not our jobs to judge them. Each person has their own way of going through life, and if we can just learn to accept this (even if we don’t necessarily like it), then we can avoid feeling overly upset when others do not behave in the ways we think they should. When clients learn to practice universal other acceptance, they can also accept other individuals who may have the same or similar mental health challenges. Practicing universal other acceptance has both indirect and direct advantages toward negating negative connotations and stigma attitudes around mental illness. 

Universal life acceptance suggests that life is going to happen whether we want it to or not. This does not mean that we should just “lie down and take it” and that our problems will be solved by inertia. Instead, universal life acceptance stresses that we have to change our thinking about the life event because being upset and angry about it will not change the circumstances. Rather than experiencing intense emotions such as rage or deep depression, we can accept the situation and strive to change it by doing so within our locus of control. We cannot control life events; we can control only our reactions to them. Essentially, we can control only ourselves, not anything or anyone else. Universal life acceptance helps clients learn to focus on what they can control (primarily themselves) and relinquish control of everything else.

Counselors can gain a comprehensive understanding of universal acceptance by practicing it themselves. Firsthand experience puts counselors in a better position to teach these concepts to clients. Additionally, understanding how universal acceptance works in their own lives gives them insight into how to apply this to a client’s presenting problems. Counselors can teach clients to apply universal acceptance to negative stigma attitudes that emerge from deep exploration into stigma’s presence and impact. 

REBT interventions for addressing stigma

As mentioned previously, REBT has the potential to be a go-to theory for addressing self-stigma attitudes. Although REBT has a plethora of interventions, I want to suggest three interventions that I personally used in my research and found to be effective in addressing Ike’s self-stigma attitudes and beliefs that caused him significant stress. 

1) The ABC situational model. The ABC situational model, which is a foundation of REBT, allows for clients to see how their irrational thinking leads to self-disturbance. If they can change their thinking, then the emotion that follows will change as well. The A in the ABC situational model stands for activating event, which is the incident or event that happened. The B stands for belief or what you tell yourself about the event. The C stands for consequence, which is how you feel as a result of the belief that you have about the event. 

Ellis believed that this formula captures how most people get to the point of distress. People get overly distraught when their belief is faulty or illogical. For example, Ike had been at the same company for the past three years. He felt good about his work and was finally making ends meet. When he was hired, Ike self-disclosed that he had a mental health diagnosis of schizophrenia disorder. He figured it was good practice to let his employer know just in case he experienced any challenges managing symptoms. One afternoon, the executives called for an emergency meeting, and Ike learned that he and several others would be laid off from their jobs. The executives said it was due to the hardships brought on by the pandemic. Ike took in the news and had a panic attack. He was convinced that this was the worst thing that could ever happen to him and that he was chosen to be let go because of his mental illness. He was sure word would spread among future employers and he would be excluded.

If we apply Ike’s situation to the ABC situational model, the activating event in this scenario is Ike being laid off. The belief is Ike thinking that he was let go because of his illness and that things could not get any worse. Ike was convinced that there was no way he would be able to find another job. He generalized the situation and thought to himself, “This always happens to me. I’m never going to keep a job if I tell people I have this condition.” The consequence in this scenario is extreme anxiety — to the point of panic — and thoughts of hopelessness.

Ike’s self-disturbance comes from his irrational beliefs. If Ike believes he was laid off because of his mental illness but there is no real evidence, proof or situation that corroborates this idea, then his emotional response would be at the same level of severity as his thoughts. This leads to self-disturbance. Counselors can intervene at the belief level and help clients to change their irrational beliefs into thoughts that are more aligned with the reality of the situation. Challenging Ike’s unfounded thoughts about being fired because of his mental illness would be a good place to start. The clinician could help Ike realize that although the situation is not ideal and will be hard, it is not the end of the world, and it is not the most terrible thing that could ever happen. He has no concrete reason to believe he was laid off because of his illness. He was not the only person the company let go, and he did not know whether others had mental illnesses. Furthermore, there is no evidence to support that his employer will share his condition with others. This approach can help to reduce the severity of emotions and bring about a different, less traumatic, emotional experience. Ike would learn to see the layoff as an unfortunate event, but a bearable one. His distress would be more aligned and more in proportion to the actual circumstance, which would likely reduce self-disturbance. 

The ABC situation model is the cornerstone of REBT. Counselors can use this approach to gain an understanding of the origins of the clients’ faulty thinking. It is also a useful teaching tool for clients as well. The more they understand how to use this model, the more they can begin to use it outside of the counseling room, leading to third-order change. 

2) Disputation. Another technique used in REBT is disputation. Ellis believed that we must vigorously and consistently challenge irrational thoughts through disputation. Not only must we challenge them, but we must also replace them with ones that are more realistic. In my case study, Ike believed he was not capable of being loved or cared for by anyone because he had a diagnosis of schizophrenia. Although he felt this way often, I was able to get Ike to share about many instances where he experienced good relationships with others who knew about his condition. These relationships were the exception, but when there is an exception, the irrational beliefs are hard, if not impossible, to uphold. Disputation helped Ike to recognize that not all his relationships were bad and that he had experienced healthy relationships with others. Counselors who use REBT believe that the more we get into the habit of identifying and then challenging our faulty thinking, the easier it will be to replace those beliefs with thoughts that are more in proportion with reality. 

3) Reality testing. Reality testing is another fundamental intervention used in REBT, and it helps the client to use evidence to negate thoughts that are irrational. Ike, for example, often did not feel safe because of the way society had treated him in the past because of his mental illness. These negative experiences led Ike to believe that others in the community could tell he had schizophrenia just by looking at him. The stigma of what someone with a mental illness is perceived to look like was prominent in Ike’s worldview. 

Ike practiced reality testing by putting his theory into practice. I gave him a homework assignment to go for a short walk in the community and identify who had a mental illness and who did not based solely on how the person looked. After completing the assignment, Ike reported that he was not able to say for sure who had a mental illness. He said he could not tell by just looking at them and that the other person would have needed to “do something” for him to make that decision. Ike and I applied this new information to his own thoughts about how he is perceived by others. He concluded that if he were just going to the store or taking a stroll in the neighborhood, there was no way someone could pinpoint that he had schizophrenia. This exercise was repeated many times to help Ike to disprove his thoughts about this idea. 

In summary, stigma continues to wreak havoc upon those with mental illness. There is not enough focus on this issue within most counseling programs, so many counselors are not aware of stigma’s impact on symptoms and clients in general. Counselors can be change agents by gaining an understanding of the impact of stigma. And then they can educate the client by addressing stigma and its impact on the client in the counseling session. Counselors can also offer interventions to help clients learn to cope with and combat negative self-stigma attitudes. Stigma can make a condition that is already hard to manage worse, but if counselors can learn to recognize it, they can empower their clients to do the same with the added benefit of teaching clients how to cope.



Tina C. Lott is a licensed clinical professional counselor, certified alcohol and other drug counselor, national certified counselor, approved clinical supervisor, and board-certified telemental health provider. She is a core faculty member with Walden University. In addition, she is an independently contracted therapist at PATH mental health, a mother of two fantastic kids and a life partner to her fiancée. Contact her at tina.lott@mail.waldenu.edu. 


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Procrastination: An emotional struggle

By Lindsey Phillips October 24, 2019

Procrastination is a common issue — one that people often equate with simply being “lazy” or having poor time-management skills. But there is often more to the story.

William McCown, associate dean of the College of Business and Social Sciences and professor of psychology at the University of Louisiana at Monroe, cites a case example of a man in his mid-30s with a degree in chemical engineering who was procrastinating about applying to graduate school. The client reported just not being able to “get it together.” Through therapy, however, the man discovered that he had an emotional block. His parents supported his choice to get another degree, but their own lack of formal schooling often led them to make detractive comments, such as the father stating that when his children thought they were as smart as him, he would just die. The client came to realize that comments such as these sometimes incited him to self-sabotage his career.

According to Joseph Ferrari, a psychology professor at DePaul University in Chicago, “Everyone procrastinates, but not everyone is a procrastinator.” His research indicates that as many as 20% of adults worldwide are true procrastinators, meaning that they procrastinate chronically in ways that negatively affect their daily lives and produce shame or guilt.

According to McCown, a pioneer in the study of procrastination and co-author (along with Ferrari and Judith Johnson) of Procrastination and Task Avoidance: Theory, Research, and Treatment, procrastination becomes problematic when it runs counter to one’s own desires. “We all put things off,” he notes. “But when we put off things that are really in our best interest to complete and we do it habitually, then that’s more than just a bad habit or a lifestyle issue.”

McCown finds that clients with chronic procrastination often come to counseling for other presenting concerns such as marital problems, depression, work performance issues, substance use, attention-deficit/hyperactivity disorder (ADHD) and anxiety. He has noticed, however, that younger generations are starting to seek counseling explicitly to work on procrastination.

McCown says that among Gen Xers and particularly among baby boomers, tremendous stigma existed around procrastination. But that largely changed with the Great Recession, he contends, because people realized that having a procrastination problem hurt them at work — a luxury they could no longer afford.

Managing emotions, not time

A growing body of research suggests that procrastination is a problem of emotion regulation, not time management. Julia Baum, a licensed mental health counselor (LMHC) in private practice in Brooklyn, New York, agrees. “Poor time management is a symptom of the emotional problem. It’s not the problem itself,” she says.

Nathaniel Cilley, an LMHC in private practice in New York City, also finds that chronic procrastination is often a sign of an underlying, unresolved emotional problem. People’s emotional triggers influence how they feel, which in turn influences how they behave, he explains. However, clients may incorrectly assume that procrastination is their only problem and not connect it to an underlying emotional issue, he says.

People procrastinate for various reasons, including an aversion to a task, a fear of failure, frustration, self-doubt and anxiety. That is why assessment is so important, says Rachel Eddins, a licensed professional counselor and American Counseling Association member who runs a group counseling practice in Houston. “There’s not one answer to what procrastination is because [there are] so many things that lead to it,” she says.

Procrastination can also show up in conjunction with various mental health issues — ADHD, eating disorders, perfectionism, anxiety, depression — because it is an avoidance strategy, Eddins says. “Avoidance strategies create psychological pain, so then that leads to anxiety, to depression, and to all these other things that people are calling and seeking counseling for,” she explains.

Sometimes, procrastination may even mask itself initially as another mental health issue. For example, overeating in itself is a procrastination strategy, Eddins says. She points out that if certain people have a hard task they are avoiding, they may head to the refrigerator for a snack as a way of regulating the discomfort.

If a client comes to counseling because he or she is binge eating and procrastinating on tasks, then the counselor first has to determine the root cause of these actions, Eddins says. For example, perhaps the client isn’t scheduling enough breaks, and the stress and anxiety are leading to binge eating. Perhaps food acts as stimulation and provides the client with a way to focus, so counselors might need to explore possible connections to ADHD. Maybe the client is rebelling against harsh judgment, or perhaps the root cause is related to the client experiencing depression and feeling unworthy.

One approach Eddins recommends for finding the root cause is the downward arrow technique, which involves taking the questioning deeper and deeper until the counselor uncovers the client’s underlying emotion. For example, if a client is avoiding cleaning his or her house, the counselor could ask, “What does it mean to have a messy house?” The client might respond, “It means I can’t invite people over.” The counselor would follow up by asking, “What does that mean?” These questions continue until the client and counselor get to the issue’s root cause — such as the client not feeling worthy.

Eddins and Cilley both find imaginal exposure helpful for accessing clients’ actual memories and experiences and discovering the underlying cause of procrastination. For instance, if a client is procrastinating over writing an article, Cilley may have the client imagine sitting at his or her desk and staring at the blank computer screen. Cilley would ask, “What’s going on in this moment? Where are we? What is around you? How are you feeling emotionally at the thought of writing this article?” The client might respond that he or she feels anxious about it, which means the underlying cause is emotional.

“Imagination is really great with drumming up emotions,” Cilley notes. “The emotion starts to come into the session when [clients visualize what they are avoiding].”

Addressing irrational thoughts

“You can do all the time-management skills in the world with someone, but if you haven’t addressed the underlying irrational beliefs fueling the anxiety, which is why they’re procrastinating, they’re not going to do [the task they are avoiding],” notes Cilley, an ACA member who specializes in anxiety disorders.

As described by Cilley, the four core irrational beliefs of rational emotive behavior therapy (REBT) are:

  • Demands (“should” and “must” statements such as “I should go to the gym four times a week”)
  • Awfulizing (imagining a situation as bad as it can be)
  • Low frustration tolerance, which is sometimes referred to as “I-can’t-stand-it-itis” (belief that the struggle is unbearable)
  • Self-downing (defining oneself on the basis of a single aspect or outcome, such as thinking, “If I mess up one work project, then I am a failure”)

“When we’re having procrastination problems, a lot of times we awfulize about the task and have abysmally low frustration tolerance about the energy required to do it,” observes Cilley, a certified REBT therapist and supervisor and an associate fellow at the Albert Ellis Institute. “And we disproportionately access how bad it would be to do it or to be put through it and minimize our ability to withstand or cope with it.” Put simply, sometimes when people think something will be too difficult, they don’t do it.

Another common reason people procrastinate is a fear that they could fail, and they interpret failure to mean that something is inherently wrong with them, Cilley says.

For example, imagine a client who comes to counseling because he procrastinates responding to work emails out of fear that he will answer it incorrectly and his co-workers will realize he is a failure. To first identify the root cause, Cilley would ask a series of open-ended questions to the client’s statements regarding procrastination: I am avoiding responding to emails at work. What would it mean if you responded to the emails? I’m afraid I would do it incorrectly. What if you did respond incorrectly? My boss would think I’m an idiot. What would that mean to you? That I’m no good at my job. I’m a bad employee.

A self-label of “bad employee” causes the client to filter everything through that lens, including minimizing the good that he does, Cilley points out. In addition, the man will act as if he is a “bad employee,” which reinforces this label and makes him more prone to procrastination, Cilley says.

One technique that Cilley uses with clients to challenge unhealthy thinking and break the vicious cycle is the circle exercise. He draws a big circle, and at the top he writes the client’s name. At the bottom, he writes the negative thought in quotes — “I’m a bad employee.” Then, he places six plus signs and six minus signs inside the circle and asks the client to think of six things that he or she does poorly at work. The client might respond, “I procrastinate on tasks, I show up late, I make mistakes when I respond to emails” and so on. Next, Cilley has the client name six things that he or she does well. For example, the client could say, “I care about the work I do, I stay late if needed, and my co-workers can depend on me.”

If clients respond by saying that they don’t have any positive qualities at work, then Cilley will ask them to think about what positive things another co-worker would say about them (even if the clients don’t believe the statements themselves).

Next, Cilley circles one of the statements in the minus category and asks the client if this one negative statement erases the other six positive statements. To emphasize the flawed logic, he may also ask if one positive trait causes all of the negative ones to go away and makes someone a “perfect” employee.

This exercise challenges black-and-white thinking and helps clients separate their identities from their actions or the task they messed up on, such as sending an incorrect email, Cilley explains.

Even after clients identify their irrational beliefs and create rational coping statements (positive beliefs used to replace the negative and irrational ones), they still may not believe the rational ones. When this happens, Cilley uses an emotiveness exercise he refers to as “fake it till you make it.” He asks clients to read the rational beliefs out loud 10 times with conviction — as if they were Academy Award-winning actors and actresses who wholeheartedly endorse and embrace the beliefs.

If clients are going to rebut thoughts such as “I am a failure” and “I can’t do anything right,” then a monotone voice won’t help them change their thoughts or calm down, Cilley notes. “Anyone can go up on stage and read a speech,” he says. “The emotion and conviction behind your voice is what moves the audience, and that’s what we have to do to ourselves when we’re trying to convince ourselves of the rational beliefs.”

Even though clients may not initially believe what they are saying, by the eighth or ninth time they repeat it, they are finally internalizing the beliefs, Cilley says. On the 10th time — when clients are starting to actually believe what they are saying — he records them repeating the rational beliefs. Clients are then instructed to listen to this recording three times per day throughout the week as a way of talking themselves into doing whatever they have been procrastinating over, he says.

Cilley has also used role-play to help clients put stock in more rational thoughts. He does this by adopting the client’s irrational belief (e.g., “I am a failure” or “I am unworthy”) and then asks the client to try to convince him of more rational thoughts. By doing this, the clients start to convince themselves. Even though clients often laugh at this exercise, Cilley has found it to be one of the quickest ways to change clients’ irrational thoughts.

REBT and other short-term therapy techniques are not just effective but also efficient for clients who procrastinate, notes Baum, a rational emotive and cognitive behavior therapist and supervisor, as well as an associate fellow at the Albert Ellis Institute. With procrastination, clients often want to see results quickly, she says. They want to finish the work project, clean their house or get to the gym next week, not next year. REBT helps clients quickly “take responsibility for their behavior and recognize that they have agency to change it,” Baum emphasizes.

Learning to tolerate discomfort

Often, people procrastinate to avoid discomfort, Eddins notes. This discomfort comes in many forms. Maybe it’s procrastinating on beginning a complex task at work out of fear of failure, or avoiding having a difficult conversation with a friend.

The first step is helping clients become aware of the discomfort they are avoiding, Eddins says. “When we suppress our feelings, that’s when the procrastination and avoidance habits emerge,” she adds.

Eddins often uses the “name it to tame it” technique. She will first ask clients what they are feeling when thinking about the task they are avoiding. Clients may not have a word for this discomfort, so she will ask them to identify what they are feeling physically, such as a tightness in their chests.

Baum, a member of the New York Mental Health Counselors Association who specializes in helping creative professionals and entrepreneurs overcome procrastination, helps clients learn to cope with feelings of discomfort through imaginal exposure. First, Baum teaches clients coping skills such as breathing exercises to use when they experience discomfort. She also helps them identify, challenge and replace irrational thoughts that contribute to emotional distress and self-defeating behaviors. Then, she asks them to imagine walking through the scenario they have been avoiding.

For example, a man procrastinates about going to the gym because he feels ashamed of being out of shape. The client thinks to himself, “I’m out of shape. I won’t fit in at the gym. I’m no good because I let myself go.” These thoughts and his fear of others judging him prevent him from going to the gym despite the health benefits.

To address this emotional problem, Baum would have the client imagine walking into the gym and getting on the treadmill as others stare at him. During this exercise, she would guide the client to breathe slowly to keep his body calm and have him practice rational thinking, such as accepting himself unconditionally regardless of the shape he is in or what others may think. This will help him overcome his shame and productively work toward a healthy fitness routine.

Eddins also uses a mindfulness-based technique called “surfing the urge” to help clients. She instructs clients to stop when they feel the urge to procrastinate and ask themselves what the urge feels like in their bodies and what thoughts are going through their heads. For instance, clients may notice having an urge to get up and grab a snack rather than work on their task. This technique helps them learn to sit with their discomfort and face the urge rather than distracting themselves from it or trying to change it, she explains.

The power of rewards and consequences

Cilley finds rewards and consequences a useful motivational tool for those clients who are good at identifying irrational beliefs and who already possess coping and emotion-regulation skills yet are still procrastinating when faced with certain tasks (or even their therapy homework). For example, clients could reward themselves by watching their favorite show on Netflix after they complete the task. The ability to watch the show could also become a consequence — they would withhold watching the show until they complete the task.

Counselors may need to help clients determine appropriate rewards. McCown, a clinical psychologist at the Family Solutions Counseling Center in Monroe, Louisiana, finds that clients sometimes want to use grandiose rewards that really aren’t helpful motivators. For example, a client may decide that he or she will take a trip to Europe after finishing writing a novel. McCown notes that the likelihood of this motivating the client to make progress on the novel isn’t as strong as if the client used smaller rewards, such as going out with a friend or taking a walk to celebrate completing 300 words of their novel.

If clients are having trouble enforcing rewards or consequences themselves, counselors can become the enforcers — but only as a last resort, Cilley says. For example, Cilley had a client who was procrastinating when it came to taking steps toward starting a side business because he feared he would do it imperfectly, and that would make him a “failure.” After learning how to identify his irrational thoughts and how to regulate his emotions, the client still needed one final push to start his business. The client was a gamer, so both he and Cilley agreed that if he didn’t start his business that week, Cilley would change the client’s PlayStation 4 password so that he couldn’t play video games until after the business was launched.

“You want to make sure you have a good working alliance with the client and that they feel safe to be vulnerable and that [you] can laugh about this [with them] because it’s kind of unorthodox. But sometimes that’s what works for some people. They need that accountability,” Cilley says. “Just laughing about how silly the consequence is in therapy can make it more of a fun challenge.”

Giving yourself permission

Eddins finds that shame is a big factor with people who procrastinate. “Somehow we learned that shame [is] a way of motivating — ‘If I’m just hard on myself, then maybe I’ll get it done’ — and that for sure backfires and leads to procrastination,” she says.

For some people, their inner critic is shaming them constantly with “should” statements (e.g., “I should work out four times a week”). Procrastination is their way of rebelling against this harsh judgment, Eddins explains.

Self-compassion is one way to address critical thoughts and shaming, Eddins says. For example, the critical inner voice that declares a client lazy if he or she doesn’t go to the gym could be changed to use more motivating statements such as “It feels good when I go outside and move my body.”

In addition, if critical thoughts start to surface when clients are trying to complete a task, they can use a self-compassionate voice to remind themselves that they will feel better after they take a break, Eddins advises. In fact, the act of giving oneself permission to take a break, practice some self-care, and rest and relax can sometimes break the cycle of procrastination, Eddins says.

A 2010 study found that students who forgave themselves for procrastinating when studying for a first exam were less likely to procrastinate when studying for the next one. The researchers concluded that self-forgiveness allows people to move past the maladaptive behavior and not be burdened by the guilt of their past actions.

At the same time, Eddins advises counselors to be careful with the technique of giving permission. Clients with black-and-white thinking may interpret that as the counselor telling them it is OK to be “lazy.” Instead, she recommends that counselors use this strategy within a context that the client will accept.

Eddins had a client who put off meal planning each week because it was stressful. When Eddins asked why it was stressful, she discovered the client was preparing up to three different meals each night to accommodate each family member’s personal preferences. Eddins knew that if she told this client to give herself permission to cook only one meal each night, the client would engage in black-and-white thinking: “Well, that would make me a bad mom.”

So, instead, Eddins said, “No wonder you are exhausted. You are trying to do everything for everyone else but not for yourself. This doesn’t work for you. You have permission to take care of yourself and do what works for you. And that does not make you a bad mother.”

Strategies for success

Procrastination does offer momentary relief and reward, which only reinforces the behavior and continues the cycle of avoidance, Eddins notes. So, the more times that an individual avoids a task, the more difficult it becomes to stop the cycle of procrastination.

In counseling, clients can learn strategies that are more effective than avoidance. One therapeutic technique that Eddins likes involves breaking tasks into smaller ones that are realistic and obtainable. For instance, an individual who hasn’t formally engaged in exercise in the past year might be tempted to set a goal of working out four times a week. This person has created an ideal “should,” but because the goal is overwhelming, he or she is likely to continue avoiding exercising, Eddins points out.

Should this happen, Eddins might explore why the client is procrastinating on the goal: “Tell me about the last time you worked out. When was that?”

When the client responds that it was a year ago, Eddins would suggest establishing a smaller goal to ensure success and build motivation. For example, the client could start by exercising one day a week for 10 minutes and build from there.

“I want [clients] to take the smallest possible step because I want to [help them] build success,” Eddins says. “That is actually reinforcing in the brain because … it gives you that sort of reward and that success, and then that allows people to achieve the goal.”

McCown points out that “the rehabilitation of a severe procrastinator is almost like working with a severely depressed person: Once they are able to … do anything, they will feel better about themselves, and they’ll have more self-efficacy.” That’s why it is important to get these clients to succeed at some task, even if it is a small and relatively meaningless one such as going to the grocery store or getting the car washed, he says.

Counselors can also help clients who procrastinate to create specific — rather than generic — goals, Eddins says. For example, a goal of “meal planning” would become “planning four meals for dinner on Sunday afternoon.” The counselor can then collaborate with these clients to identify the specific actions they will need to take to meet that goal: What typically happens on Sunday afternoons? What could get in the way of this task? How can you make time on Sunday afternoons? What do you need to prepare in advance? What steps will you take to complete this task?

Some clients, especially those with perfectionist tendencies, may resist setting a small goal or task because they don’t see it as “good enough” or as an effective way of achieving their larger goal, Eddins says. In these cases, counselors may need to address the client’s black-and-white thinking and the role it can play in procrastination, she adds.

Counselors can also help clients identify optimal times to complete tasks that they have been procrastinating on, Eddins says. For instance, clients might tell themselves they will complete an unpleasant task right after getting home from work. But if the counselor knows the client doesn’t like his or her job and will likely need some time to decompress after getting home, the counselor can point that fact out and note that it increases the likelihood of the client avoiding the task, she says.

Shifting clients’ focus to what they will do — rather than what they won’t do — is another way to motivate clients, Eddins says. For example, counselors can encourage clients to think along the lines of “I’m going to come home, get a glass of water, put on my tennis shoes, go out for a 10-minute walk, and then come home and fix dinner” rather than “I’m not going to sit on the couch this evening and watch television.” Trying to avoid procrastination or its underlying emotional root makes procrastination more active and powerful in one’s mind, Eddins points out.

All of these strategies can aid clients in addressing the deeper emotional problems connected to their procrastination. McCown stresses that procrastination won’t go away by itself. “Joe Ferrari phrases it quite beautifully: ‘It’s not about time.’ It’s often something deeper,” McCown says, “and I think counselors are in a great role to figure out whether it’s just simply a bad habit or whether it’s something a little more serious.”




Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Singalong with Richard Watts: Teaching REBT through song

By Bethany Bray February 16, 2016

When Richard Watts’ counseling graduate students arrive to class for a unit on Albert Ellis and rational emotive behavior therapy (REBT), they’re in for something a little different.

Watts, a professor at Sam Houston State University in Huntsville, Texas, pulls out his guitar and sings songs he’s written to illustrate the irrational beliefs that Ellis in part developed REBT to combat.

Set to familiar tunes such as “Mary Had a Little Lamb” and “Oh Suzanna,” Watts’ song lyrics paint a picture of some of the self-sabotaging feelings and behaviors that REBT addresses, such as perfectionism, obsessive relationships, defeatism, victimhood and so on.

Ellis referred to such beliefs as “stinking thinking,” Watts says. REBT works to reverse negative, often paralyzing thoughts into rational beliefs, such as an acceptance that we are not perfect and that life won’t always go our way, but that is OK.

Through the years, Watts has written a slate of songs to highlight the self-defeating beliefs with which many people struggle. In most causes, the songs feature a good dose of humor. For example, the “Rejected Lover’s Refrain,” sung to the tune of “On Top of Old Smokey,” ends with the lines: “Oh

Richard Watts with his guitar.

Richard Watts with his guitar.

why did you leave me? What’s that all about? I guess that I’m worthless and you figured it out. I really deserve this, I know that it’s true. If I only could dear, why, I’d leave me too!”

Watts distributes the lyrics in class and encourages his students to sing along. He’s been singing about REBT in his classroom — as well as in group therapy settings and, occasionally, at professional conferences and events — for two decades.

“We sing the songs and they make us laugh, but many times humor also makes us think,” says Watts, a professor of counseling and director of Sam Houston State University’s Ph.D. program in counselor education. “[As] I’m teaching students, I’m trying to get them to think about their own irrational beliefs as well as their clients’.”

Watts is following in the tradition of Ellis, who wrote songs to illustrate irrational beliefs decades ago. Ellis led workshops every Friday night at his New York City institute for many years. Known for his big personality, wit and sometimes-irreverent style, Ellis would pull members of the audience on stage for live therapy sessions. He used the songs as a therapy tool, often encouraging the audience to sing along. In 1987, Ellis penned a chapter “The use of rational humorous songs in psychotherapy” in ‪William Fry and Waleed Salameh’s book ‪Handbook of Humor and Psychotherapy: Advances in the Clinical Use of Humor.

Watts decided to write songs of his own after discovering that today’s college students aren’t as familiar with many of the older tunes that Ellis’ songs are set to. At first, Watts says, his students are a little startled by seeing their professor in a new context — similar to seeing your teacher in the grocery store as a kid. But they soon warm up, he says, even laughing and singing along.

“I’m not [Eric] Clapton, but I can play pretty well,” Watts says with a chuckle. “I thought it’d be a clever way of introducing the material.”

When used in group therapy, especially in groups with men, the songs often get clients to open up, he says.

“Many times [in group settings], clients are reticent to share ideas that might be inhibiting their progress,” says Watts, a licensed professional counselor supervisor, American Counseling Association fellow and immediate past president of the North American Society for Adlerian Psychology. “But we’ll sing these songs, and I’ll see them laugh and whisper to their neighbor, ‘This is so me!’ … After they’ve sung and laughed together using those songs, they feel more at liberty to talk about and unpack the meaning that they saw in those songs for themselves.”

Similarly, the songs serve as an icebreaker in the classroom. They are also an effective, if nontraditional, way of helping students learn and remember Ellis’ points. The lessons stick with students much more so than if they were to simply read about the concepts in a textbook, Watts says.

In one case, a student who struggled with perfectionism printed out Watts’ song about the issue (the “Perfectionist’s Refrain”) and attached it to the visor of her car as a reminder. Other students have asked for recordings of the songs to use in sessions with their own clients.

“They sing about it, they laugh about it and then we talk about it,” he says. “It’s an application exercise. They’re not merely reading about the different [cognitive] distortions. In a sense, the songs are fun case studies. They learn to listen for the irrational belief theme underpinning [each] song. It sets them up for having an ear and an eye for the mistaken beliefs.”

After singing his songs, Watts urges students to start looking for irrational beliefs elsewhere, including in popular culture. Students are often surprised to discover how often irrational beliefs – from love lost to feelings of worthlessness – are embedded in their favorite music, he says.

Given Watts’ penchant for using clever lyrics as both a teaching and therapy tool, it perhaps comes as no surprise that he has a musical background. He came to the counseling profession after earning an undergraduate degree in music (choral conducting) and working as a church choir director. As an undergrad, he put himself through college by singing in piano bars.

Watts’ irrational belief songs proved so popular that some of his colleagues encouraged him to submit the songs for publication in the Texas Counseling Association’s academic journal. They were published in academic journals several times in the 1990s, including in the Journal of Humanistic Counseling.

Watts sent a copy of his song lyrics to Ellis prior to the influential psychotherapist’s death in 2007. Ellis responded with a letter, written on the letterhead of his Institute for Rational-Emotive Therapy, and said that Watts’ songs were “right on the ball and can be very useful.”





Richard Watts’ REBT song lyrics and recordings are available online at bit.ly/1PwpziW.

Contact Watts at rew003@shsu.edu





Albert Ellis

Albert Ellis

Interested in learning more about Albert Ellis and REBT? See “Getting to know (and love) Albert Ellis and his theory,” Allen Ivey’s recent Q+A with Ellis’ widow, Debbie Joffe Ellis, that appeared in Counseling Today.








Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Getting to know (and love) Albert Ellis and his theory

Interview by Allen Ivey December 23, 2015

As 2015 came to a close, so too did the 60th anniversary of Albert Ellis first presenting his widely influential approach to psychotherapy in 1955. Initially, his approach was severely challenged by many, and when he presented it to his peers at the annual American Psychological Association (APA) convention in Chicago in 1956, he was booed and jeered. But, ultimately, he won the respect Branding-Images_Ellishe deserved. Today, Ellis is considered the originator of cognitive behavior therapy, although he used the term rational emotive therapy, later changing it to rational emotive behavior therapy (REBT).

This interview summarizes the life and work of Albert Ellis, but it also offers insights into another emerging legend who is carrying on his legacy: Debbie Joffe Ellis, Albert’s spouse, co-author and co-presenter.


Allen Ivey: Debbie, we first met in Borneo in 2013 when Mary [Bradford Ivey] and I keynoted on neuroscience and counseling and you presented on REBT. Mary and I then attended your workshop where you presented REBT and did live demonstrations. We were vastly impressed and felt that Albert Ellis was alive in you, but at the same time that you had also added some important new dimensions, clarifying his work.

Thank you for taking time to review your life with Albert and the importance of REBT today. Perhaps the way to start is for you to tell about how you and Albert met and your developing relationship.

Debbie Joffe Ellis: My pleasure. It brings me deep satisfaction to share about my incredible husband and our rare and remarkable connection and relationship. I first heard of Al when I was a child and saw some of his books in my psychologist aunt’s library. I read parts of those books, and what I read made good sense. I could understand it — even though I was young, somewhere between the ages of 10 and 12. Little did I know then, or when I was studying REBT some years later, that I would end up adoring and marrying its founder and creator.

Whilst studying psychology at the University of Melbourne (Australia), I attended lectures and workshops Al gave whilst on a teaching visit there. I felt deeply moved, both by him and his dynamic, yet deeply compassionate, approach.

During that time of his visit, we chatted briefly. I noticed that many people, including students and professors, felt intimidated by Al’s direct and full-on manner. I did not feel that way at all. Whilst in awe of his brilliant work, I felt fully at ease in his company, and I felt that I had known him for a very long time. Behind his public and, at times, confrontational manner and no-nonsense style, I felt the truly kind, caring and good-hearted man that he was. His outer manner did not fool me.

Following the completion of my studies and my licensing as a psychologist, I practiced REBT in my private practice and taught the approach in Melbourne. Al and I did not meet again until 15 years later at an APA conference. Our remarkably close friendship began at that time. We were in regular contact through mail and phone calls, and I would visit him in New York each year. Our love relationship began a few years later.

I recognized his warmth, authenticity, trustworthiness, no-nonsense attitude, brilliance, magnificent wit and wisdom, as well as his kindness and genuine caring about the well-being of others. He had a reputation among some for being loud, using colorful language and appearing abrasive, curmudgeonly and provocative. He simply chose that way of expression to help get his points across in a memorable way so that people would think about their thinking, learn and remember aspects of his approach, apply it and benefit. The abrasiveness was not representative of his authentically caring and humble character. In our personal lives, he was most gentle, sweet and considerate in his manner, with his oft-outrageous humor and wit a source of great enjoyment and laughter.

Some may be surprised to know that in his younger years, Al loved going to performances of classical music, Broadway shows and movies. He said that if he had not become a psychologist, he would have loved to have written music and lyrics in addition to writing fiction, including the Great American Novel.

AI: Albert maintained a rigorous and demanding schedule late into his life and in the face of some serious health problems. What do you think gave him such a strong passion and drive to help others?

DJE: He cherished life, despite the health and other adversities he faced from childhood until the end of his life, including managing his diabetes. His hope was that through adopting his philosophy and approach, others would choose to enjoy and live their lives intensely, despite and including their challenges — as he had succeeded in doing. He was aware of how quickly life passes and of the importance of living life to the full. Al reminded us that life inevitably contains loss and suffering but that by thinking in healthy ways, unchangeable adversities can be endured in healthier ways.

Throughout childhood, he experienced illness, was often hospitalized for lengthy periods and rarely was visited by his family. He chose to occupy his mind with things that prevented him from dwelling on thoughts that led to his feeling sad and depressed. He read books from the hospital library, spoke with children in his ward and their visitors, and fell in love with the pretty nurses. He used his imagination to create vivid scenarios of what he would do when he grew up. This “cognitive distraction” action became one of the oft-used methods in REBT.

As a teen and young man, he suffered from intense shyness. He was too afraid to speak to girls. In college he was voted president of his political group but felt very anxious when it came to speaking in public. He then forced himself to speak more often, with the understanding that deliberately and repeatedly pushing himself to do what was uncomfortable would result in his feeling more comfortable and capable at it. As he forced himself to give talks, he reminded himself that the worst that could happen would be far from tragic or the end of his life. In a short time, not only was he over his fear of speaking in public, but he discovered that he was good at doing so and enjoyed it too.

Another well-known example of Al applying his “just do it” approach was his giving himself the task of talking to 100 girls during the month of August. He made one date, and she didn’t show up, but he overcame his fear of talking with females. This practice of “in vivo desensitization” and the practice of vigorous, encouraging, positive and realistic self-talk became a core part
of REBT.

When Al was about 24, he fell madly in love with a young woman, Karyl, who gave him the on-again, off-again treatment. One evening after she told him she wanted a break, he felt deeply depressed. He went for a midnight walk and had a major epiphany. He realized that it was not the rejection by Karyl that caused his depression but rather his demands and insistence that she should love him as much as he loved her, that she should not reject him and his belief that he could never be happy without her in his life. He realized that it was his attitude, irrational beliefs and absolutistic thinking — not the circumstance of being rejected and without Karyl — that created his despair. Searching for demands — the “shoulds” and “musts” — and strongly disputing them with precision to create healthy rather than debilitating emotional responses to disappointing events, and doing one’s best to eliminate absolutistic thinking are core parts of REBT.

AI: Given that, could we explore how REBT became important over time and some of the key issues and findings in that process? And talk about Albert’s foundational work in cultural difference.

DJE: In the early years of REBT, peers and colleagues harshly condemned Al, calling him and his theory superficial, simplistic and worse. But he persisted in talking, teaching and writing about it. He succeeded in changing the world of counseling and psychology. REBT ideas have influenced and been incorporated into many types of cognitive therapy, including cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), positive psychology, coaching and more. Al’s qualities of persistence, applying high tolerance for frustration and not needing the approval of others contributed to getting his goals accomplished and his approach being increasingly accepted and embraced. They are attitudes that REBT encourages and recommends to one and all.

Al was also a controversial trailblazer because of his significant contributions to changing long-held archaic and uncivil societal attitudes toward sex, sexuality, diversity, racial prejudice and more. He loudly championed equal rights for women and gays back in the 1940s and onward; supported interracial relationships and marriage (banned in some states in the country at that time); testified in the Supreme Court against censorship; wrote his groundbreaking book Sex Without Guilt, helping many people develop acceptance of premarital sex, masturbation, practices considered “abnormal” and other nonharmful activities labeled “evil” by conservatives of the time — to name just a few of the causes he put effort and energy into.

AI: Yes, Albert became a hero to me early in my career for his forward thinking about human rights. Most people, including many CBT followers, still have much to learn from this early pioneering work. At the end of his life, Albert experienced a serious loss when he was removed from his role as president of the board of directors of the Albert Ellis Institute. Furthermore, he was banned from teaching and working in his own institute. How did he experience this? How did Albert — the professional helper — behave in this challenging situation?

DJE: In his final years, strange and unanticipated conflicts arose. There were some changes in his institute which he did not approve of, in addition to other circumstances which shocked him. He was removed from his role as president of the board there and was not permitted to participate in teaching or to conduct his famous Friday night live therapy demonstrations there, after nearly five decades of giving them. The Albert Ellis Institute was founded and mostly paid for through his teaching, writing and outside speaking earnings. He lived incredibly simply, received a most modest annual salary, and his commitment to the work and his institute was such that most of his earnings went into the institute. He rejected luxuries that were offered to him, saving money on what he considered unnecessary spending. For example, he refused to fly business/first class when offered.

In response to actions being carried out by some in the institute against his goals, he felt the deepest sadness he had ever experienced. He worked hard to change what was happening and fought to regain his roles and to bring about justice. He and I continued to see clients and give workshops in a large space that we rented in the building next door. Unfortunately, he did not achieve his goals, although a Supreme Court judge did reinstate him to the board. Unfortunately, this happened too late and, weeks later, he succumbed to pneumonia — the beginning of his most serious health decline, culminating in his death 15 months later. Doctors agreed that his illness was most probably a result of his exhaustion and fatigue from his strenuous efforts to regain his place and influence in his own institute.

Al hated what had been done, but he did not hate the people who carried out the actions. He felt compassion for them, truly practicing what REBT teaches: unconditional other acceptance. The “master” was put to the test and passed with honors. Up until his final weeks, he continued to help people who would visit him in the hospital, including groups of students. Al also showed compassion and gave help to various medical staff in the hospital, all while he himself was a patient in great physical pain, fighting hard to recover. He not only helped people through his words to them but also by modeling his principles. I often say that he practiced what he preached and preached what he practiced.

So, Al was passionate about and driven to help as many people as possible. He had faced and overcome many hardships and had experienced firsthand the fruit of stubbornly refusing to create or dwell in unhealthy emotions. He experienced the consequential joy of minimizing emotional suffering, which liberated energy to enhance effectiveness and enjoyment of life. He wanted others to know and experience that they too could create more productive, colorful and enjoyable lives by applying his philosophy. He was a remarkable, one-of-a-kind individual — a visionary.

AI: I’d like you to focus on the “E” in REBT. Cognitive psychologists all too often miss out on that. To me, backed by neuroscience research, it is clear that unless a client is emotionally satisfied, the decision or action will never be sufficient. Albert was also ahead of the game with his inclusion of homework in the therapeutic process.

DJE: One of the misconceptions that some people hold about REBT is that it is about feeling less emotion, or less unpleasant emotion, or that it mainly focuses on the cognition and behavior
of an individual and less on the emotions. These ideas and any like them are truly false.

One of the gifts that REBT offers is clearly distinguishing between healthy emotions felt in response to adverse circumstances — such as grief, sadness and concern — and the unhealthy emotions in response to adversity which we create when we think in irrational ways — such as depression, anxiety and rage. REBT encourages us to experience and accept those healthy emotions as enriching parts of this tapestry of life and its variety of events, disappointments and losses. REBT reminds us that we can choose to prevent changing healthy emotions into debilitating, unhealthy emotions. We encourage and embrace the experiencing of all healthy emotions in REBT, not only the “happy” ones. REBT teaches the difference between irrational and rational thinking, and its methods and techniques present the how-tos of doing so in clear and simple ways.

Al was likely one of the first, if not the first, to strongly emphasize the benefit of ongoing effort and homework for helping individuals maintain therapeutic and other gains. Even if a person feels comforted by empathy from another and regains hope, he or she will only maintain that comfort and hope and maintain lasting changes by persistently remembering the wise tenets of REBT and continuing to take appropriate actions after sessions to create the healthy emotions. That involves doing homework using REBT tools and techniques.

AI: How has REBT continued to evolve since Albert’s passing in 2007? I have attended your presentations and even participated in a workshop. It is clear that you understand REBT fully as well as he did — perhaps even better. It is exciting to see you continuing and expanding his work.

DJE: Al liked my way of communicating and wanted me to continue his work in my style and way, which I love to do. It is a part of me, in my blood.

In Al’s final years, we worked together in every aspect of his work. We were presenting and writing more on REBT and Buddhism than he had in earlier decades. I look forward to completing a manuscript on that topic that he and I started working on prior to his passing. As more people experience greater stress in these challenging times, many suffer from increasing anxiety and depression. Many people seeking relief turn to one form or another of spirituality. I talk and write about the commonalities and differences of Buddhism, other spiritual approaches and REBT. The “spiritual” components of adopting compassion, acceptance and kindness are actually not new parts of REBT, but as time goes on, I give stronger emphasis to such REBT aspects as unconditional acceptance, compassion and kindness, mindfulness, awareness and gratitude. In addition to their life-enhancing potential, these aspects can be basic to the therapeutic relationship and working alliance. Encouraging and emphasizing the benefits of practicing greater mindfulness, compassion and gratitude has become ever more important as the theory continues to develop.

In my work, I do my best to set the historical record straight in terms of Al’s place in the evolution of psychology, counseling and psychotherapy. I feel dismayed that since his passing, fewer of the main teachers of psychology and counseling practice are acknowledging Al and REBT’s pioneering place and role in their own work. I have met a number of students who think REBT came after CBT instead of realizing that cognitive therapy and CBT were first presented around 14 years following Al’s early works. A few letters of correspondence between Aaron T. Beck and Al can be read in Al’s autobiography, and Beck often respectfully acknowledges that Al’s work was significant as he developed his approach.

Aspects of Al’s work were also very influential in the development of positive psychology — a fact which Martin P. Seligman has respectfully acknowledged — and yet I have met people who embrace positive psychology who have no idea of that fact. Elements of REBT can be recognized in ACT, DBT, coaching and even heard in the preaching of certain popular television evangelists. Al would continually acknowledge in his talks and writings the works of Adler, Horney, Korzybski, ancient and contemporary philosophers and others who had influenced or contributed to
his work.

I do my best when I present, teach and write to keep REBT relevant to current times and issues — and to give credit where credit is due.

AI: I am aware that Albert’s influence lives on, as cognitive therapy rests on his shoulders. At the same time, I see you as a solid innovator, continuing and taking his ideas further. Mary and I have heard you talk and have participated in your excellent workshop. We love your energy and appreciate your scholarship. Let’s turn the topic to you, your accomplishments and what you visualize for the future.

DJE: I make a point of including live demonstrations of the application of REBT with volunteers whenever possible when I teach and in my many presentations. These live demonstrations are unrehearsed, authentic and in no way role-playing. Al entrusted me to carry on his ideas and work further, and it is my joy, my passion, my mission. I love presenting both to helping professionals and to members of the general public. There is a real need to present a full picture of REBT and its promise when it is applied for continuing to change and improve our work and daily lives.

As part of this, I present and conduct live workshops in New York, my home-base city, and in other places throughout the United States and the world. I am an adjunct professor at Columbia University. In the past 18 months, I have presented in India, Mexico, Hawaii, Australia, Jerusalem, Chicago, Washington, D.C., Toronto and San Francisco. I love these opportunities to share REBT and its continually expanding dimensions and to witness its relevance to people of the variety of cultures and religions to whom I present.

I trust that more research will be done to add to that which already exists on REBT. The excellent and voluminous published CBT research by Aaron T. Beck and colleagues supports REBT principles. However, there is need for more research that focuses on specific and unique REBT tenets, especially on the impact of the “musts,” the importance of the “E,” REBT’s philosophical assertions and the benefits of REBT’s vigorous mode of disputation of irrational ideas. I look forward very much to seeing findings from the ever-growing field of neuropsychology and neurophysiology incorporated and applied as appropriate to the existing REBT theory.

APA produced a DVD as part of its “Systems of Psychotherapy” DVD series in which I demonstrate the REBT approach with a client. APA also published the book Al and I wrote about REBT. Transcripts of 12 real sessions with a client that show the therapeutic progress have been made available by Alexander Street Press (2015), which also filmed three DVDs of me talking about various aspects of REBT. I continue to attend and present at major conferences on psychology/therapy and to write books, chapters, articles and reviews for various books and journals.

Finally, and perhaps most importantly, I do my best to live my life incorporating the REBT philosophy. I make effort to not only teach, talk and write about REBT and use it with clients and others I care about, but also to contribute in positive ways to as many other people as I can. I feel immense joy when doing so.

I do my best to remember to apply the tenets of compassion, acceptance and kindness. And I feel most fortunate and grateful each day as I do so.




Allen Ivey, distinguished university professor (emeritus), University of Massachusetts, Amherst, is a diplomate of the American Board of Professional Psychology and a life member of the American Counseling Association. He is the author or co-author of more than 45 books and 200 articles, translated into 25 languages. Many of these publications have been co-authored with Mary Bradford Ivey. The couple present around the nation and world on original work in microcounseling, developmental counseling and therapy, multicultural and social justice issues, and how to implement neuroscience into daily counseling practice.

Letters to the editor: ct@counseling.org

Remembering Albert Ellis

August 6, 2007

Branding-Images_EllisIn 2004, a little more than a month before the American Counseling Association honored him as one of the profession’s five “living legends” at its convention, Albert Ellis spoke with Counseling Today about the greatest challenge of his career.

Ellis recalled the intense criticism he initially received in the 1950s upon developing rational emotive behavior therapy (REBT), an action-oriented therapy that challenged the prevalent psychoanalytic approach of the day. Today, many mental health professionals consider REBT the foundation of cognitive behavior therapy.

“I was very severely criticized when I first did it because it was not emotional, evocative or psychoanalytic,” Ellis said. “(The REBT approach) was supposedly superficial, not at all deep, or so it was thought by many others in the profession. They called me all kinds of names for using it, so I used REBT on myself and didn’t take the criticism too seriously. I told myself that they may have something to them, but they are not that crucial or important. I went ahead despite opposition.”

As a matter of course, Ellis never seemed to let opposition — or any other obstacle for that matter, including advancing age, profound hearing loss or poor health — slow him down. Variously labeled a maverick, an eccentric, controversial, confrontational, provocative, irreverent, more showman than serious lecturer, Ellis nevertheless emerged as one of the most indisputably influential and innovative figures in the history of psychology and counseling. In 2003, the American Psychological Association named him the second most influential psychologist of the 20th century, behind only Carl Rogers.

Ellis, 93, died shortly after midnight on July 24 of kidney and heart failure in his apartment on the top floor of Manhattan’s Albert Ellis Institute, which he originally established as the Institute for Rational Living in 1959. Until falling seriously ill at age 92, Ellis was still famously known for putting in exceptionally long days — writing books in longhand, seeing clients and teaching at every opportunity. Until the last four months of his life, he continued to meet with students even while in a hospital and nursing home.

Ellis was born in Pittsburgh in 1913 and raised in New York City. He earned a degree in business from the City University of New York and briefly tried to make his way first as a businessman and then as a fiction writer. He eventually began writing nonfiction, gradually focusing on the topic of human sexuality. Individuals began seeking him out for advice, and this lay counseling convinced Ellis that he should enter the field of clinical psychology. He went on to earn his master’s and doctorate degrees in clinical psychology from Columbia University in 1943 and 1947, respectively.

After serving as the chief psychologist for the state of New Jersey, Ellis moved into full-time private practice in 1952. According to the article “A Brief Biography of Dr. Albert Ellis 1913-2007,” available at www.rebt.ws, “His task of building a full-time practice (was) aided by his growing reputation as a sexologist, especially from his books The Folklore of Sex (1951), The American Sexual Tragedy (1954) and Sex Without Guilt (1958). … He also wrote the introduction to Donald Webster Cory’s controversial book, The Homosexual in America, and thereby became the first prominent psychologist to advocate gay liberation.”

During the early days of his private practice, Ellis also began seriously questioning the passivity, efficiency and effectiveness of Freudian psychoanalysis, concluding that “talk” alone wouldn’t truly help clients. He grew to believe that clients would change only if they took direct action to modify their self-defeating behaviors and thoughts. Making a clean break from psychoanalysis in January 1953, he began referring to himself as a “rational therapist” and introduced his REBT approach (then known as rational emotive therapy) two years later.

A prolific writer and accomplished public speaker in addition to being a tireless worker, Ellis spread the gospel of REBT, causing a dynamic shift in the field of psychology. His weekly public therapy workshops at the Albert Ellis Institute became famous, regularly drawing crowds of 100 or more every Friday night for several decades. Attendees were often treated to displays of Ellis’ trademark style, which included exhorting his volunteer participants — sometimes in no uncertain terms — to stop feeling sorry for themselves and move on with their lives by taking action. It was not unusual for his blunt guidance to be accompanied by liberal doses of colorful language.

Ellis also liked to infuse humor into his speeches and therapy sessions. In 2004, he told Counseling Today that he was especially proud of penning rational humorous songs. He spent much of his free time, he said, listening to music, which inspired his own lyrics to counseling tunes. “I’ve been making up songs for many years and having people sing them in group and individual therapy,” he said. Ellis also noted that if he hadn’t become a psychologist, he would have enjoyed being a composer.

In 2005, Ellis sued the Albert Ellis Institute after its trustees voted to remove him from the board of directors and suspended his Friday night workshops (see “The legend versus the legacy,” Counseling Today, February 2006). The board contended it had received negative feedback pertaining to Ellis’ presentations and lectures, saying he could no longer hear and was sometimes lashing out during therapy sessions. The board also said it took action because Ellis’ medical expenses were putting the institute’s tax-exempt status in jeopardy.

Ellis and his supporters countered that the board was leading the institute in a direction that veered away from REBT and didn’t want to contend with Ellis. In December 2005, Ellis and his third wife, Debbie Joffe Ellis, a psychologist he had married when he was 90, resumed the Friday night workshops in rented office space next door to the Albert Ellis Institute. In January 2006, a New York state Supreme Court judge reinstated Ellis to the board, saying that he had been removed without proper notice.

A memorial service for Albert Ellis is scheduled for Friday, Sept. 28 at 7:30 p.m. at St. Paul’s Chapel at Columbia University.


Thoughts on Albert Ellis

Debbie Joffe Ellis, widow of Albert Ellis

Al — brilliant genius, unique personality, witty, compassionate, wise, bold and unconditionally loving.

Throughout his life he fully practiced what he preached. He was a solid model for healthy being and a compass for truth.

In his last three years, faced with situations that could have devastated many, Al endured with supreme courage and dignity, determined to continue to fight for justice, whilst maintaining a compassion for those who acted against him.

The world has lost an irreplaceable force for good. I have lost my most beloved husband and partner. I am now, and for the rest of my life will be, fully and wholeheartedly dedicated to teaching and sharing the wisdom and gift of Albert Ellis and rational emotive behavior therapy.

Jeffrey T. Guterman, assistant professor, Barry University; author, Mastering the Art of Solution-Focused Counseling

Ellis was a revolutionary figure. He is most well known for leading the cognitive revolution and developing REBT, one of the most effective and widely practiced models in the field. But he was also a pioneering sexologist who was an instigator of the sexual revolution in the 1950s and 1960s. As a result of his writings — for example, his 1958 book Sex Without Guilt — Ellis contributed to significant changes in attitudes about sexuality.

We have lost one of the most influential figures in the history of psychotherapy. Ellis takes his place with the likes of Freud, Rogers, Jung and Adler as among the most important psychotherapists in the field.

Ellis had legal struggles at the end of his life, ironically, against members of the board of his own Albert Ellis Institute, who tried to remove him because they claimed he was becoming increasingly eccentric and was incurring inordinately high medical bills for his deteriorating physical condition. The Supreme Court of the State of New York eventually ruled in favor of Ellis, and he remained at the institute, where he had been working and residing since 1964. Only when he died could it be said that Ellis finally left the building.

Albert Ellis’ relationship to me evolved through the years from therapist to supervisor to colleague, but I have always considered him to be my friend. I first met Ellis in 1986. I was his client then and was seeking help to overcome my problem of shyness with women. In that very first session, Ellis forcefully disputed my irrational belief — “I must not be rejected or I will be a worthless person!” — and he suggested that I practice getting rejected many times “until I stop giving a crap.” When I reported in a follow-up session that indeed I had approached a woman and got rejected, Ellis replied: “Good! You don’t have to marry the broad!”

Ellis was my first and most influential mentor. Like many counselors, his REBT profoundly informed my own practice — and my life! Although I eventually shifted away from REBT to a solution-focused approach, I still use many of its techniques from time to time.

In the 1990s, Ellis and I participated in an ongoing debate in publications and ACA workshops about counseling in the postmodern era along with other leaders in the field, including Michael D’Andrea, Earl Ginter, Don C. Locke, Allen E. Ivey and Sandra A. Rigazio-DiGilio. At the workshop, “Counseling in the Postmodern Era” held at the ACA 1999 Annual Convention in San Diego, Ivey acknowledged that Ellis had made seminal contributions in the area of social advocacy through his long career. Ivey then asked if Ellis would add an “S” to REBT to put a name to the emphasis that he placed on social context. Ellis said that as a result of participating in this workshop, he would put more thought to the role of social reform in counseling and agreed to consider revising his theory of REBT accordingly. It was impressive to observe Ellis’ willingness to accommodate an alternative view live on stage. At the end of the workshop, Ivey stated, “Let’s remember the moment when we saw a great man become even greater.” The audience gave Ellis a standing ovation.

Although Ellis remained strongly aligned to REBT right to the end of his life, he demonstrated the importance of being flexible and open to new developments in the field. For example, in some of his later writings, he acknowledged that he would use so-called “irrational” techniques with some clients if his bread-and-butter REBT methods were ineffective.

Ellis also frequently wrote about the limitations of REBT and counseling in general. He read up on many of the latest cutting-edge developments in the field in a continual effort to find new and effective ways of helping clients change.

Ellis was also an active participant on the Internet. On August 21, 1996, I hosted ACA’s first text-based chat, with Albert Ellis as the special guest. Ellis went on to participate in several Internet events with me.

Ann Vernon, vice president, Albert Ellis Institute Board of Trustees; professor emeritus, University of Northern Iowa

The field of psychotherapy has benefited tremendously from Dr. Albert Ellis’ contributions. He was ahead of his time in championing a theory that helps people help themselves, which in this age of managed care, is very significant. This comprehensive approach can be applied equally successfully with children as well as adults.

The applicability with children is what drew me to REBT, because as a school counselor, I was in search of a theory that would be practical for school-aged children. I went to my first training in New York in 1976 and then proceeded through all levels of training, opening the Midwest Center for REBT in Iowa in the late 1980s. Al encouraged me to do this and also served as a mentor, giving me feedback on my first REE (rational-emotive education) curriculum, Thinking, Feeling, Behaving, and urging me to promote applications in schools, which I have done over the years.

Dr. Ellis was totally dedicated to his work, working from early in the morning until 11 p.m. until his late 80s. I know this firsthand because, for several years, I stayed in the apartment he and Janet Wolfe shared on the sixth floor of the institute when I would go to New York to attend board meetings. Al had no interest in leaving the institute unless he had appointments or speaking engagements; he would rather be writing, seeing clients or listening to classical music than doing things most people enjoy, such as socializing with friends, going out to dinner or to the theater, sightseeing if in a new environment and so forth. In his words, “If you’ve seen one ****ing mountain, you’ve seen them all!”

Just prior to his 90th birthday, I arranged with ACA President Mark Pope for Al to be part of a keynote panel at the ACA Convention in Kansas City, where (Ellis) was honored. Because of his extreme hearing loss, he was quite anxious about being able to hear the questions, but Jon Carlson did a marvelous job of moderating the panel, giving Al the questions ahead of time and in writing so he could respond. He displayed his typical sense of humor and brought the huge crowd to a standing ovation as he closed the session by singing several of his humorous songs for which he is famous.

In the next presentation, a panel on specific applications of REBT with Drs. Allen Ivey, Kristene Doyle and myself, he spoke eloquently, delighting the audience with some typical “Al” behavior, swearing a bit profoundly as he emphasized several points.

Years ago at an REBT conference in Keystone, Colo., Al and a select group of invited colleagues participated in a think tank to address the topic of how REBT would “live on” after Al. As I recall, Al was adamant about the future of the theory being in rational emotive education and self-help and the importance of empowering clients of all ages to use the theory. Although he jokingly said that he would probably outlive us all, his message was that REBT “must” live on.

In my mind, there is no doubt that the theory will live on because, through the Albert Ellis Institute and its affiliates all over the world, countless numbers of individuals have been trained in this theory and have used it successfully, personally and professionally. The institute is dedicated to continuing his mission even though he is no longer with us.

Brian S. Canfield, ACA president, 2007-2008

A true innovator in the mental health field, Dr. Albert Ellis provided counselors and other helping professionals with a conceptual framework and set of clinical interventions for addressing a wide range of client issues. His theory and treatment approach of rational emotive behavior therapy provides a concise model for addressing aspects of human cognition, affect and behavior and has provided the foundation for all solution-focused approaches to counseling and psychotherapy. His contributions have influenced a generation of counselors and therapists and will undoubtedly continue to do so in the future.

I was first exposed to the theories and concepts of Dr. Ellis as a counseling graduate student in the seventies. I was very attracted to his notion that thoughts influence emotions and, subsequently, our behaviors. This concept helped me integrate an understanding of how cognitions and affect are interconnected and result in the behavioral choices we all make. Feelings, while important, are to a large extent an outcome of our beliefs. I continue to use aspects of his theory and treatment concepts in my work with clients.

Mark Pope, ACA president, 2003-2004; professor and chair, Division of Counseling & Family Therapy, University of Missouri-Saint Louis College of Education

When I began my master’s degree in counseling and personnel services at the University of Missouri-Columbia in 1973, I said I would never be a behaviorist. The book 1984 had just come out, and I was an anti-establishment political activist who wanted to change the world, to never be controlled by “group-think.”

We learned in our theories of counseling course about the new cognitive behavioral techniques and about the guru of that revolution, Dr. Albert Ellis and rational emotive therapy (as it was then called). We watched the “Gloria” tapes and saw this strange, wild-eyed and –haired professor talking about changing the way that people thought. It sounded like 1984 all over again, but then I realized that it was about the individual client “choosing” to change, not having change forced upon them from this outside, impersonal, governmental entity. I was hooked.

To me, a gay man coming out in the 1970s, Dr. Ellis’ work on human sexuality was a breath of fresh air. He questioned the basic beliefs of his psychoanalytic colleagues (who were dominant at that time) about homosexuality, and he gave those of us who were gay hope for our new profession — hope that it would come around and realize our struggle for acceptance and our humanity. Dr. Ellis opened the door for me as a gay man to become a counselor, to enter into our profession. I would not be here without his work, and any contributions I have made to our profession are a direct result of Albert Ellis.

In 2004, I finally got to meet Albert Ellis when I invited him to speak on a keynote panel of “living legends” at my ACA Convention (as president) in Kansas City. Rogers and Perls had already died, and Ellis was the last of the “Gloria” triumvirate. He was very ill, and the ACA staff was not sure he would make it, but Jon Carlson, who moderated that panel, said, “Al is tough and really wants to come.”

As one of my final acts as ACA president, I got to share the stage with Albert Ellis while he regaled the overflow crowd of conventioners with songs and colorful language. It was also his birthday, and I led the audience in singing “Happy Birthday” to him. We even had a birthday cake with candles — a lot of candles — which was eaten by those in attendance both at the keynote and at my presidential reception later that night. Very memorable. It was the last time he would be able to attend an ACA Convention.

Our profession, the mental health professions in general and, really, the world are richer, more interesting and hopeful places because of him and the gifts that he gave to us.

Brooke B. Collison, ACA president, 1987-1988

From the time I was a grad student in the sixties to the time I retired and beyond, Albert Ellis has always been a “bigger-than-life” figure in the counseling world. His early work had a huge impact on the grad students who would discuss his latest diatribe and wonder if he, Rogers and the other giants in the field were actually talking about the same profession and the same processes. As students, we hung on every word and replayed every film.

Ellis has always been a guaranteed draw at any convention, much to the chagrin of a group of University of Missouri folks who, in the early sixties, were excited to find their convention program room packed to

standing-room only with people ready, they thought, to hear a presentation on “Use of the D-Square Statistic in Profile Analysis.” Imagine their surprise when no one asked a single question and no one left the room at the close of their exciting statistical presentation. Only after the program had concluded and the presenters had stepped into the hallway did they discover that the room full of people were actually there to hear the presenter scheduled for the next session — Ellis. They had decided to sit through any program scheduled ahead of his in order to have a seat for Albert’s presentation.

In my 30 years as a counselor educator, the student response to Ellis has always, predictably, been the same: “I love the theory, but I can’t stand the theorist.” The degree to which counseling students needed to like the theorist in order to accept the theory produced some fascinating maneuverings in class discussions.

One photo in my ACA album shows me with Albert at the Chicago convention. At the black-tie dinner that year, I was pleased to present Ellis with a nice check and an award from ACA. In his acceptance speech, Ellis, distinguished in his tux and with a boutonniere in his lapel, acknowledged the importance of ACA (then the American Association for Counseling and Development) with the remark, “Nothing else would get me to put on this goddamned tie.”

It is sad to think of Ellis’ death. He was, and is, a giant in our profession — regardless of how one thinks about the theoretical, personal and practical aspects of what he promoted. I don’t see any figure on the horizon who is likely to achieve such prominence. His death truly represents the passing of an era.

Jon Carlson, distinguished professor of psychology and counseling, Governors State University; named one of ACA’s “living legends of counseling” in 2004

Albert Ellis was unique. Wherever counselors and psychologists gather, it is only a matter of minutes before “Ellis stories” are shared. Al was eccentric and left so many memories for all of us.

No one worked harder than Al — seven days per week, 20 hours plus each day. He was always available to help patients or colleagues. I frequently asked Al to create articles, write endorsements or just share some thoughts on a difficult case. He never said no and managed to respond within a day or two.