Rational Emotive Behavioral Therapy and Jewish Thought

by Ronald Pies, MD drawing by Sarah Glidden From the Winter 2013-2014 issue of Jewish Currents “The entire purpose of our existence is to overcome our negative habits.” ­ —Rabbi Eliyahu, the Gaon of Vilna (1720-1797) I REALLY HAVE TO BLAME MY MOTHER for the way I turned out. Coming from a psychiatrist, that might sound a little odd, but it’s true. When I was still in my early teens, my mother, Frances Pies Oliver, a psychiatric social worker, was singing the praises of what was then called “RET” — Rational Emotive Therapy, in the late Dr. Albert Ellis’s original formulation. (Ellis later called it “REBT,” with “B” for “Behavioral.”) It still surprises me that in the small, western New York town where I grew up, the mental health clinic would have adopted his radical view of psychopathology, which basically said, “If you are an emotional wreck, it’s because you keep driving your car into a tree” — or, to put it in Ellis’s more positive terms, “Clear thinking... leads to sane emoting” (A Guide to Rational Living, 1961). For Albert Ellis (1913-2007), negative emotions are caused by irrational and self-defeating cognitions. The way back to “feeling good” is paved with logic, discipline, and a determination to stop belly-aching about how “unfair” life is. A typical REBT session usually involves a “Socratic” questioning of the patient’s dysfunctional attitudes and beliefs. A typical session might goes something like this: Joe: I feel so depressed today! I was expecting my best friend to call and invite me to dinner, but she never did. I’m really, really annoyed with her, and I also wonder if our friendship really means much to her! Therapist: Well, okay, Joe — anybody would be disappointed by not getting that invitation. But what do you think you are telling yourself that is leaving you so depressed and annoyed? Joe: Hm, I’m not sure. Maybe I’m telling myself that I really, really deserved to be invited to dinner? Therapist: I don’t believe that thought alone would leave you feeling depressed and annoyed, Joe. Could it be that you are telling yourself something like, “How awful that my friend didn’t invite me to dinner! She really owed me an invitation, and it’s terrible and selfish of her not to call me! She must not think very much of our friendship!” Positive change in therapy also requires more adaptive behaviors. In clinical practice, this means giving the anxious or depressed patient behavioral “homework assignments.” If the patient has crippling anxiety over being “rejected,” the therapist might give the task of asking someone out for a date. If the patient gets the date, fine; if not, he or she will see that the world did not come to an end. However, the therapeutic encounter in REBT is more than a philosophical dialectic and homework assignments. It is also a vibrant emotional experience, in the context of a supportive and empathic relationship with the therapist. Although reading books about REBT may be of some help, it is no substitute for what psychoanalyst Franz Alexander referred to as “the corrective emotional experience” of psychotherapy. Clearly, this active, confrontive, and directive approach to the patient’s thoughts and behavior is radically different from classical psychoanalysis. FAST-FORWARD TO MY PSYCHIATRY RESIDENCY, circa 1980. At Upstate Medical Center in Syracuse, our residency program was steeped in the psychoanalytic and object-relational tradition, from Freud to Mahler to Masterson and Kernberg. Yet I never left behind Albert Ellis, Aaron Beck, and other cognitive theorists who seemed to cut through all the psychoanalytic theorizing like Alexander the Great slashing through the Gordian knot. Whenever it seemed useful, I tried to integrate cognitive-behavioral approaches into a more psychodynamic approach to my patients. It was not until many years later, however, that I discovered that the cognitive therapies, especially Ellis’, have some startling affinities with views expressed in rabbinical Judaism. I can discern at least seven over-arching principles or themes that connect the two:

1. The imperative of self-awareness and self-examination.
2. The necessity of striving for self-mastery.
3. The primacy of behavior over “insight.”
4. The cultivation of self-sufficiency and equanimity.
5. The understanding and toleration of oneself and others.
6. The awareness that happiness and unhappiness are “internally caused.”
7. The emptiness of short-range hedonism and immediate gratification.

Perhaps the most important link between REBT and Judaism is the rationalistic principle itself, the view that, by means of our intellectual faculties, we can understand, modulate, and “tame” our unruly emotions. We see this principle clearly articulated by the greatest Jewish philosopher of the medieval period, Moses ben Maimon (Maimonides, ca. 1138-1205 CE): “The more mental training man has, the less affected he will be by luck or misfortune. He will not get excited over a very fortunate event and will not exaggerate its value. Likewise, if one meets disaster, he will not be disturbed and aggrieved, but will bear it valiantly.” To my knowledge, Ellis did not acknowledge Maimonides as a direct influence in the development of REBT. However, there is a striking concordance between it and Maimonides’s rationalism. “You should reject the hypothesis that human unhappiness is externally caused,” wrote Ellis, “and that you have little or no ability to control your sorrows or rid [yourself] of your negative feelings. Instead, you should realize that most of your own misery is created by your own irrational thinking, your own self-propagandization, and that you can eliminate most of your despair or anger by changing your thinking or your self-talk.” Many, if not most, patients who enter psychotherapy suffer from low self-esteem. Even those with strong narcissistic traits (as in, “I am God’s gift to humankind”) are usually covering up their self-doubts and insecurity with a sort of armor-plating of grandiosity. Low self-esteem can have many causes, of course, but from the therapeutic standpoint of REBT, it is related to the belief that one’s value as a person is a function of how well one performs. The patient begins with the premise that persons, rather than their behaviors, are to be evaluated, and that the value of people is a function of “who they are” — appearance, verbal and non-verbal behaviors, etc. — rather than “what they do.” Where this idea comes from is not particularly important from the cognitive perspective, but it is the patient’s repetitive self-propagandizing with this idea that underlies (in part) the patient’s low self-esteem and depressive world-view. REBT SEEKS TO CHALLENGE AND CHANGE THIS THINKING. Consider this passage from Albert Ellis and his colleague, Robert Harper: “If human beings have any intrinsic worth or value, they have it by virtue of their mere existence, their being... You are ‘good’ or ‘deserving’ just because you are; and if you can really believe this... you will find it virtually impossible to be desperately in need of others’ approval...” To my ear, Ellis and Harper are verging on the religious and spiritual realm in asserting that human beings have an inherent value that precedes both their “personality” and their actions. In fact, Ellis doesn’t put much stock in the whole notion of “worth” — he’d rather have us focus on what we enjoy than on how well we have performed or how much “worth” we have. Nevertheless, there are striking affinities between Ellis’s view of human worth and that of rabbinical Judaism. Rabbi Shimon exhorts us, for example, in Pirkei Avot (“Sayings of the Fathers”): “Do not judge yourself to be a wicked person” (2:18). Centuries later, commenting on this part of the Talmud, Rabbi Nakhman of Bratslov (1771-1810) explains, “Rather than falling into despair over [their] shortcomings, [people] must seek out positive elements in the totality of [their] being and judge... favorably on that basis.” How close this seems, once again, to Ellis and Harper: “If you view yourself existentially, as you are, you will almost automatically accept yourself... and you will not blame yourself or punish yourself whenever — being an imperfect human — you do something wrong or unwise. You will accept yourself with your foolish thoughts, feelings, perceptions, or actions... What greater love of self (and through love of self, potential love for other human beings) could you then have?” This doesn’t mean that we should tolerate cruel or sadistic behavior, nor would Ellis ever take that position. Nothing in REBT tells us that murder, racism or genocide should be countenanced. REBT does tend, however, to affirm the intrinsic value of human beings, even those whose behavior may be reprehensible. MAINTAINING SELF-ESTEEM ALSO DEPENDS on our ability to withstand insults, gossip, and the petty carping of others. This is a major theme in both the Talmud and Ellis’s REBT. In Sanhedrin 7a, we read, “Happy is the person who hears himself being disdained and ignores it, for a hundred evils will pass by him [without affecting him].” In Shabbat 88b, we see praise for people “who suffer insults but do not insult others; who hear someone mocking them but don’t answer; who do their duties out of love [of God] and rejoice in suffering [all humiliations that are visited on them].” Similarly, the concept of self-restraint, ignoring insults, and rising above the fray is integral to Ellis’ views: “Even when people are specifically nasty to you... it is still most important that you keep calm yourself and not condemn them severely or viciously retaliate. Whether you like it or not, they are the way they are and it is childish for you to think they shouldn’t be... if you tell yourself, instead, that ‘this situation stinks — tough! So it stinks,’ you will at least prevent yourself from being annoyed at being annoyed.” In drawing parallels between the cognitive therapies and Judaism, I am not pretending that Ellis or other modern Jewish cognitive-behavioral therapists espouse the theology of Judaism’s rabbis and philosophers, nor that Judaism played a particularly prominent role in shaping the psychological theories of Albert Ellis. While Ellis was born to Jewish parents, there is no reason to suppose that he was directly influenced by the Talmud in his formulation of REBT. Rather, the ancient influences he cited in several of his works were primarily the Stoic philosophers, in particular Epictetus (55–135 CE). There are, however, strong and interesting historical and philosophical connections between Judaism and Stoicism. The rabbis of the Talmudic period (roughly, the 1^st-6^th centuries CE) were acquainted with Stoic philosophy, and there is even a tradition claiming that the Stoic Emperor, Marcus Aurelius, was a good friend of the redactor of the Talmud, Rabbi Yehuda HaNasi. The Jewish philosopher, Philo of Alexandria (20 BCE–50 CE) also drew heavily on Stoic sources. So it’s plausible to argue that Ellis’s views were indirectly influenced by certain rationalistic Talmudic principles, transmitted via the Stoic tradition. THAT SAID, ELLIS USUALLY TOOK A DECIDEDLY NON-RELIGIOUS, if not an atheistic, position in most of his writings. In his Rational Emotive Behavior Therapy: It Works for Me — It Can Work for You (2004), he called himself a “probabilistic atheist,” meaning that although we can have no certainty, we have an “exceptionally high degree of probability” that God doesn’t exist. Nevertheless, in a paper published in 2000, Ellis acknowledged that the “constructive philosophies of REBT... are similar to those of many religion[s] in regard to unconditional self-acceptance, high frustration tolerance, unconditional acceptance of others, the desire rather than the need for achievement and approval, and other mental health goals.” For patients who wish to maintain a belief in God, Ellis even devised a “narrative” that was compatible with the core beliefs of REBT: “God gave me some degree of free will and the ability to think for myself and control myself; and I can, with God’s help, use this ability to discipline myself. God helps those who help themselves.” In any case, we need not assume that REBT and Judaic philosophy share the same underlying religious or metaphysical assumptions in order to see that, in practice, they have much in common. This is especially true of REBT and Humanistic Judaism, the movement founded in 1963 by Rabbi Sherwin Wine. Indeed, psychotherapist Dr. Robert Heller has noted some striking parallels between Rabbi Wine and Albert Ellis:

Both men believed in the power of the human spirit and did not believe in God. [They believed that] as human beings, we are all imperfect and need to accept ourselves with our flaws... [they believed in] forgiveness of ourselves and others, [and that] saying what we believe and believing what we say are but a small part of the important values that, if we learn to embrace [them], can lead to less anxiety and depression and far greater happiness in our lives. Free of psychobabble, Rational Emotive Therapy and Humanistic Judaism support the importance of following up our words with deeds and actions. The power of the present is far more important than what happened in the past. Both approaches emphasize the importance of universal human values to achieve happier and more satisfying lives.

REBT and traditional Judaism proceed from vastly different metaphysical and theological premises. They do, however, have this much in common: both assert the primacy of the intellect in its struggle with the chaos of emotion — and both insist that we must take responsibility for how we live our lives. Dr. Ronald Pies is editor emeritus of Psychiatric Times and a professor in the psychiatry departments of SUNY Upstate Medical University and Tufts University School of Medicine. He is the author of The Judaic Foundations of Cognitive Behavioral Therapy; The Three-Petalled Rose: How the Synthesis of Judaism, Buddhism, and Stoicism Can Create a Healthy, Fulfilled and Flourishing Life; a collection of short stories, Ziprin’s Ghost; and a poetry chapbook, The Heart Broken Open. Parts of this essay were published in Voices, journal of the American Academy of Psychotherapists.