Reading Temple Grandin Offers a New Perspective on REBT!

I have long agreed with Albert Ellis that his Rational Emotive Therapy (modernized to Rational Emotive Behavior Therapy), is a simple, elegant method for helping clients to learn how to improve their mood and live more comfortably. It is also a derivative of the ancient philosophy of Stoicism. I have worked with individuals and groups for many years, and most people to whom I have introduced REBT easily learn and use this technique for calming their unruly emotions and feeling better. It is not instant. It is not magic. But it really works. As with anything, using REBT well requires practice. 

One of my long-standing puzzles as a therapist has been how CBT (Cognitive Behavioral Therapy) has gained more popularity than REBT as the go-to therapy. There are indeed many books by many authors on each technique. Does CBT work better? Does it have better press? Are there more practitioners? is it easier to teach to therapists in training? Is it easier to teach to clients? 

My take on the above questions is  quite the opposite. I find REBT to be easier to learn, easier to teach, and more effective than CBT. I am trained in both, and, while I learned CBT in school and learned it first, when I studied REBT (Albert Ellis was one of my instructors), I was immediately stuck by how easy it was to learn, to teach, and to put into effect in my own life not to mention those of my clients. So is it the press? Perhaps.

Is Mental Illness a Myth?

Have I piqued your interest or accidentally insulted you? I did not make this question up. Thinkers and physicians for many years have wondered the same thing. Mental illness is confusing. It is not diagnosed as is physical illness via tests for microbes, probing for damaged or diseased tissue, nor compiling a list of objectively measurable symptoms. Mental illness is diagnosed via a system of symptom clusters published in one or another manual, the contents of which are agreed upon by scholars in the field. The problems arise when the contents of those manuals change over time, because mental issues are not clear-cut diseases as are physical illnesses. Things are added and subtracted over time--but we could not imagine a time when influenza would stop being called a disease!

Science tries, year after year, to isolate specific markers for mental illness. Tests come and go, but the construct remains elusive. We can objectively test for the flu or cancer or diabetes or a broken leg, but we cannot test in a way that never changes, for depression, schizophrenia, or anxiety. This does not mean that you are not suffering with your problem. It only means in this context, that your problem is mislabeled by being lumped in with physical illness. This is important for many reasons. I hope you are still with me as I elucidate why I, and others like me, believe calling mental problems "diseases" hurts those who suffer with them.

New Beginnings

Center for Conscious Living has begun its second iteration. We are now located in Oregon, seeing clients in Bend and Redmond. It has taken longer than expected to get licensed in Oregon, and while it seemed excessive, I do not at all begrudge the many hours spent reviewing ethics!

It is always good to review, and reviewing the Ethical Standards for Psychologists has given me time to review how I practice and how I want to perceive my clients. These standards cover the very basics such as, never, ever enter into personal relationships with clients, maintain high standards for privacy and confidentiality, and, most important of all, FIRST DO NO HARM, a principle that is taught to every treating professional.

How Worry is like a Hamster Wheel........

Sometimes you just have to worry, right? Wrong! Worrying about something that might go wrong, is going wrong, or has already gone wrong is not going to change things, right? Right. So all the energy you expend worrying is not being spent productively on problem-solving. What it is doing is using energy and preventing you from focusing on the real problem. If your daughter is out too late, worrying about her is not going to get her home safely. If your boss is on a tear, and you fear for you job, worrying about his erratic behavior is not going to save your job. If a tornado is bearing down on your neighborhood, worrying is not going to save it.

Worry is a distraction--we take up mental space worrying, and we feel occupied, so we are less focused on hunting for that elusive solution or doing something else productive. But the worry itself is exactly like running in a hamster wheel--you are moving, you are active, but you are still in the same place. You might expend some calories, but you will not get any closer to solving the problem.

Worry is a uniquely human activity. And as with other activities in which humans engage, we tend to defend this one. After all, if it were not important, it would not worry me, right? I ought to worry about my daughter/job/house, right? The truth is that it is not the worry that is going to help you resolve the issue. Worry represents thinking things you have already thought rather than arriving at new ideas. Worry stresses your system, causes you to lose sleep, and generally moves you away from creativity into a rut. The issue at hand may indeed be serious, but worrying is not the answer.

Take that daughter--she is late, and you are rightly concerned that something has gone awry. You can actively search for her if you have some leads; you can call the authorities if it has been a seriously long wait and she is not answering her phone, or, if it is really the usual Saturday night teenager misbehaving, you can get some sleep and let her worry all night over the consequence her well-rested parents will impose. The point is that the actual process of worrying is not what gets her safe nor you closer to a resolution.

Your job is on the line; you have a moody boss, and today is one of those days. Recognize this for what it is and get to work--the hours you spend worrying that you are next for his wrath will not help you to avoid it. In fact, there is some chance that your worry makes you flustered and ineffectual that day and indeed puts you right in the spotlight you had hoped to avoid. Yes, your job is important. The point is not that it is no cause for concern if your boss is unpredictable, just that the actual process of worrying is not what is going to resolve the issue.

A tornado is reported in your area. Batten down the hatches and find the safest place to wait it out. Worrying and fretting will not keep you safe without action. Alternatively, it is tornado weather and you sit frantically by the radio listening to the reports--you lose a day of productivity, and nothing comes of it. Better to have a preparation plan for this season and know how to implement it, then have your ducks in a row come the actual threat.

The thing about worry is that we do it all the time. We worry about our kids. We worry about our jobs, our houses, our health, the economy, our weight, and whatever else we can find to fret over. This is a bad habit. It wastes resources, stresses our immune system, and achieves nothing. Humans get attached to the thoughts that run around in our brains. We hear that subliminal chatter and assume it is meaningful and important. In reality, our minds tend to run in the same ruts they always run in, and this limits creative problem solving. The problem is that we become so accustomed to the chatter in our heads, we never question its validity.

Time to get off the hamster wheel. Learn new habits of thought and reduce your stress instantly. Yes, it sounds easy, and with practice, it is. And the new habits you learn will help you for a lifetime.

The Powerlessness of Getting Angry

"He makes me sooo mad."
"That really pisses me off."
"I can't stand it when you do that."

We often think of anger as a powerful emotion--anger makes us red in the face, we feel a surge of power, our voices get loud. What we fail to notice is that the perception of power is vastly different from the experience of power. When you are angry, you are not in control. You are powerless over what you feel, and often feel powerless over your reactions. This is not power, but its opposite, powerlessness, loss of control, and weakness. When you are not in control of your reaction to a situation, you are indeed weak. The presentation of anger may serve to decoy the person or situation about which you are angry, it presents a loud and blustery front, but it takes away your power to regain control of the most important variable: yourself.

Ah, but since it appears that people, things, and situations MAKE us angry, how do we avoid becoming angry and thus maintain control? By following the famous ABCs of Rational Emotive Therapy. A is an Activating event--it is what we complain about that has "made" us angry--a fact of experience. C is the Consequence we create--behavior(s) and/or emotion(s). Which leaves B out of its place between A and C. B is the Belief or set of beliefs, whether conscious or unconscious, that is the true cause of C. Generally the beliefs that cause anger are irrational.

To illustrate: a man tromps your toes quite hard in a crowded elevator. Your initial reaction of pain is a normal, automatic one. The next reaction (emotional C), anger, and possibly the shout (behavioral C) "hey, look where you are going", is mediated by your beliefs that "he should be more careful", "he should look where he is going", "he should have waited for the next car", etc. Then you notice the white-tipped cane--the man is blind. Your anger is replaced by compassion, perhaps a lingering annoyance that no one in front helped him enter safely, a touch of shame for being angry at a blind man, etc. Thus the anger was NOT caused by your toes having been stepped on, but by the thoughts generated by your related beliefs. The anger, thus created, can be eliminated once the belief system is altered either by new knowledge ("he is blind"), or by a conscious choice as in this next example:

Your daughter is very late getting home one Saturday evening. You are frustrated that she is missing her curfew once again. You are getting angry, and thinking about how you will discipline her when she finally shows up. You feel yourself coming to a boil, and the words "grounded for life" and "never go out with those people again" bounce around in your brain. Eventually, you realize that losing sleep, pacing the floor, and planning the expected late-night ambush will do little to solve the problem of her frequent tardiness, but will result in her becoming correspondingly angry at you and creating a stalemate on the issue of improved behavior. You create a plan to deal with her in the morning, and head off to bed, your anger having turned to disappointment, and your self-control reasserted. You even manage to get some sleep, which your worried daughter, having created her own defensive, angry stance, ("where is the expected, unreasonable parental ambush?") is not able to achieve.

Success--you have managed your irrational thoughts ("that girl must respect the house rules", "I can't stand having a child who disobeys", "what a bad daughter I have"). By changing your thoughts into calmer ones ("it is a shame she has made another poor choice", "I need a plan to help her understand that if she is living here, there are rules she must follow", "children test the patience of parents; I remember that from when I was her age, but it will make for a happier household if she learns to cooperate".), you regained control over your emotions and behaviors. Changing your thoughts from demands and name-calling into preferences and facts helped you to calm yourself and create a plan. You put yourself back in control of both you and the situation.

Getting from anger to calm is a process. It begins, in the language of RET, with D, a Dispute: "Is it really true that she must respect the rules, or is that just my unreasonable demand of a teenager?", "It is not true that I cannot stand her behavior", "She can be unruly, but she is not all bad"). Following your dispute, you arrive at a new approach, the reasonable beliefs that will allow you to sleep, as in the example above. E is that Effective new belief or philosophy. And F is your new behavior and emotions: getting a night of good sleep and dealing calmly with the teen in the morning ("Honey, we need to talk about your curfew"). You win and so does she. Having a calm parent helps her to remain open to learning and improving.

Whenever you find yourself thinking "(he/she/that)makes me sooo mad", you have given away your personal power. To maintain power and control, change your thoughts so that you can be understandably upset, disappointed, concerned, confused, etc., without losing control over your reactions and thus, the situation. Rational Emotive Behavior Therapy, developed by Albert Ellis, can help you learn to prevent anger and maintain control. Empower yourself!

Anti?-Depressants Again

One can never overstate the danger of relying heavily upon anti-depressant medication as the first line of defense for every psychological complaint and a goodly number of physical complaints as well. Anxious? take Zoloft. Can't sleep? Try Paxil. Stressed? Take Effexor. Pain? Take Celexa. Smoking? Take Wellbutrin. IBS? Take more Wellbutrin.
The way I learned it in school, non-psychiatric MDs should NEVER prescribe psychotropic medications, because 1) they are not trained to diagnose psychiatric issues and 2) they are not versed in any other approach to such problems. I also learned how to do psychotherapy in school, which MDs do not. And it turns out that study after study demonstrates that psychiatric problems are responsive to good psychotherapy, but rarely to drugs. It also turns out that a good number of medical problems are more responsive to good psychotherapy than to drugs. Hypnosis works better for IBS and WARTS (yes, you read right) than anything else out there!
The following references will help you get over the drug-company driven belief that anti-depressants are so great we should put them in our drinking water!
Oh, and it is important to note that the side effects as well as the withdrawal effects from various antidepressants include anxiety and insomnia!
Be a skeptical consumer.

Efficacy and Effectiveness of Antidepressants: Current Status of Research.
H. Edmund Pigott, Allan M. Leventhal, Gregory S. Alter, John J. Boren,
NeuroAdvantage, LLC, Clarksville, Md. , Department of Psychology, American University,
Washington, D.C. , USA
"Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy."

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=318293&Ausgabe=254424&ProduktNr=223864&filename=318293.pdf

STAR*D Wars:
The Corruption of the National Institute of Mental Health and the Failure of Antidepressants

Friday, 30 June 2006, 12:33 pm
Opinion: Bruce E. Levine
"While the FDA’s trust of flawed and fraudulent pharmaceutical company data has long been a problem, NIMH’s STAR*D study is a kind of “boot on the face” for Americans. In STAR*D, U.S. taxpayers paid for a methodologically substandard study done by drug-company connected researchers, who drew unjustifiably positive conclusions about antidepressants. "

http://www.scoop.co.nz/stories/HL0606/S00351.htm#a

Holistic Psychology?

The practice of clinical psychology can involve many types of therapy as well as advice-giving and counseling. When I talk about holistic psychology, I do not mean a type of therapy, but a philosophical approach that informs my approach to therapy.

Many approaches to mental health rely upon what we call reductionism--the idea that the mind and the body are separate and can be treated separately. The whole idea that mental distress is cured by a pill falls into this category. In contrast, the holistic approach says that each individual is an indivisible whole and must be treated as such. Thus, a mental health issue such as depression is not a "mental illness", but an adaptation of some sort to the individual's current reality, and a whole picture needs to be formed of the individual in order to adequately treat the problem.

In the same way, physical ills are influenced by a variety of factors we call stressors. stressors can be internal or external, mental or physical. temporary or permanent. Even a cold is influenced by the weather and the state of your immune system, not just the exposure to a virus. Some illnesses are more multi-determined that others. Irritable bowel is more a disease of response to stressors than the flu, for example.

The holistic approach requires individual treatment planning and a collaborative relationship between professional and client, rather than a traditional doctor-patient relationship. In this regard, I often refer to myself as a teacher or even a tour guide. The client cures him- or herself--I lead the way. With this approach, you have a sense of control over your fate and gain mastery over the problem that was vexing you.