Albert Ellis, Aaron Beck, Blayney and a Broken Down Motorbike.

"The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind!"
-- William James
 
A few months ago I set off, from Victoria, for New South Wales to visit friends who were about to move house. I had been threatening a visit for, literally, years. I wanted to get to see them before their house was gone. I was recommended not to ride a motorbike to the Blue Mountains in the middle of winter. Apparently people die in such conditions.  There was temperature to consider, and black ice, and fog. Pretty silly thing to do, really. And of course I broke down in Blayney late in a night which was forecast to drop to -4 degrees celcius. By then my fingers were already frostbitten.
 
I can be very impulsive. My closest friends know that about me, and some of them seem to treasure it. I get so bound up with my various jobs and my annoying pithy rules for every eventuality that it must be a great relief to see me set forth on an impetuous, doomed adventure.  Even as my mates' laughter is ringing in my ears, I enjoy the freedom of my impetuousness. I feel a bit like a lemming in the early part of spring. No doubt, one day I will feel a lot like a late-spring lemming. Such is life, I guess.
 
This is a post about the way people relate to logic. It will describe two of the greatest psychologists who have ever lived, Albert Ellis and Aaron Beck. Aaron isn't done yet, by the way. I saw him this year. This blog post is ultimately about the Second Wave of Cognitive Behaviour Therapy (CBT), and why we needed a Third Wave. I have been procrastinating about this entry for months. There is something immensely hubristic about judging the two co-founders of the second wave, and finding them wanting. I feel vaguely heretical.
 
I didn't feel at all heretical as I stomped through Blayney trying to get someone to answer their bloody doorbell. No-one did. I was shivering and becoming alarmed. I'd been listening to music on my phone, and the battery was low. Sometimes technology convergencge isn't worth the abacus it was calculated upon. Or whatever. At the time, I was hoping to get indoors before I froze to death, and then sort the bike out the next day. It wasn't to be. And at the back of my mind I could hear my friend saying, "Hey, Jim, I know you want the adventure, but I'm not sure of your logic in doing this trip this way..." Yeah, what a dumb idea. I am so illogical.
 
Life, of course, is not logical. Well, people aren't. Sigh. I'm not.

That is the nub of what was wrong with the second wave of cognitive behavioural therapy - but it is unfair of me to view things from that perspective, and so let's begin by praising two of the greatest people ever to walk the earth. Let us bow down before the glory of Ellis and Beck. We have time. I started by ringing RACV for help, and with my one bar of battery remaining I had to wait on hold...

So here we are at the start of the business end of my blog. This entry is about two of the four giants of late last century's psychology. This one is about Ellis and Beck. Last time we covered off Carl Rogers, and the next blog entry will be about Milton Erikson. But in Ellis and Beck, we are talking about the second wave of Cognitive Behaviour Therapy. These two are teh bomb, psychotherapeutically speaking.

In 1982 there was a professional survey of US and Canadian psychologists. Carl Rogers came in first. Freud was third. And second place belonged to Albert Ellis, the originator of Rational Emotive Behaviour Therapy. Ellis was born in 1913 and died in 2007. Until just before his death he typically worked a 16 hour day. He was one of the most respected psychologists who has ever lived.

So you'd think I'd have more respect for his ideas. I guess I am a brat psychologist, when all is said and done. I don't (and probably can't ever) appreciate fully the sacrifices made by this elder child who, when still a young child himself, bought an alarm clock with his own money and ensured he and his younger brother and sister were dressed and ready for school each day.

The RACV did finally answer, by the way, and once they heard my sad story through literally shaking teeth, they asked me to hold while they transferred me through to an operator in NRMA. First they'd explain the situation to her. My phone beeped plaintively and I huddled in the doorway of the closed hotel, staring at the railway crossing. I wondered if I would die here. I knew I wouldn't. This was just another silly chapter in an illogical life...

Albert Ellis lived a full life and a productive life. He co-authored more than 80 books and over 1200 articles. He married an Australian. He founded a new approach to counselling. If I'd ever met him in a pub, I'd have bought him a beer. Just not the friggin' Blayney one. 'Cos that door was never gonna open.

Ellis was a sickly kid and painfully shy. He seems to have innately understood the way psychology works. At age 19, Ellis once devoted a month to talking to 100 women at the local botanical garden in order to overcome his fear of rejection by women. Our old mate Wolpe would have been very proud of him, despite the complete lack of any suggestion Ellis ever tortured kittens. Ellis, I'm sure, would have been forgiven this omission.  (I also have to acknowledge of course that finding 100 women at the local botanical garden does suggest to me that there was more happening down at the park than appreciation of chlorophyll. Botanical gardens were clearly the RSVP and Match.com of an earlier era.)

After brief careers in business and as a writer, Ellis bacame a clinical psychologist. At that time, this meant psychoanalysis, complete with the mandatory analysis of Ellis himself. But by 1954 Ellis had broken with psychoanalysis and established Rational Therapy, the precursor to Cognitive Behavioural Therapy which would become the key movement of the next generation against the backdrop of behaviourism.  Theoretically, Ellis was influenced by Adler, Fromm and Harry Stack Sullivan. Sigh. I haven't told you about that lot yet. Let's just say they're a fine pedigree for a genius to cite.

Jan from NRMA wanted to know how I was. I said I was very, very cold. She asked where I was, and I said Blayney. Well, she said. You would be cold. Somehow I began to feel warmer already. She was reflecting back to me how I felt about the world. Empathy. I love it. Then she started to tell me she would get a mechanic from Orange to come and help. While I waited, I sent a text to Blackheath, to let my friends know I wouldn't be there that night.

In essence, Ellis' approach comprised a firm view that people tended to be self-defeating in what they believed, and that by challenging irrational beliefs and restructuring their cognitions (thoughts) into positive new structures, then these new beliefs would lead to healthy thoughts, emotions and action.

James might have said that by altering his attitudes of mind, a person could alter his life. Actually, he did. Sexist pronouns and all. But Ellis commercialised the notion, developing a therapy which redefined psychotherapy and aligned with the Behaviourists' predilection for logic, evidence and measurement. It was an idea whose time had come.

Within a very impressive career, Ellis also championed the humanistic revisioning of homosexuality, being at the forefront of rewriting the way homosexuality was described from 'an illness' to an aspect of human existence.  It is very easy to condemn some of what he wrote early in his career, if you're prepared to be wilfully ignorant of the courage he demonstrated in evolving his views and bringing the field with him into a more modern conception of what it means to be gay. Ellis was at the forefront of the sexual revolution.

Ok.  Enough sucking up to Ellis. Let's grovel a bit to someone who is actually still alive.  Someone I've shared an auditorium with. Someone whose daughter I have sat next to.  Aaron Beck was born in 1921, and I saw him speak this year in Boston. He was lucid and straightforward as ever. What a legend. I saw his daughter Judith speak three years ago in Barcelona - and sat next to her by mistake in Boston. I thought she looked familiar as I sat down, nodded politely to her, and listened carefully to the panel. No doubt she wrote me off as a rude Australian. Maybe she let me off on the basis I could have been one of Ellis' in-laws. If so, then never has the phrase "G'day", served me so well.

Aaron Beck developed the Beck Depression Inventory, the Beck Anxiety Inventory, and Cognitive Therapy. I use all these regularly. He formed the view that people's negative views about their world led to conclusions about themselves, their world and their future. In short, Beck, and Ellis, together pioneered an evidence-based method of approaching psychological illness and altering cognitive beliefs in order to have a positive impact on thoughts, feelings and behaviours in everyday members of society. They rock.

Ok. Take a breath. That was a lot of psychological history and the sort of blind-faith hero worship which starts to smell like people trying too hard to be persuasive. Why do we need such a cult of hero-worship in a field which claims to be based upon theory, and evidence base and logical thinking? We just do. Now shut up with your whinging.

My own whinging wasn't nearly done. It turned out that, had my bike broken down on the other side of the railway tracks, I could have had a tow truck take it to Bathurst. But because I was outside the pub, on THIS side, it would be taken to Orange. That was a long way from Blackheath, where I was headed. I felt very sad. The mechanic, a friendly guy with many injuries from a bike accident a few months before, tinkered with the spark plug. Gee, he said. It's black. When was it put in? Yesterday, I said miserably.

The truth is, the second wave wasn't completely correct. If it had been, we wouldn't have needed a third wave. And a bit of hero worship covers the cracks in the statue's foundations. But what I, and my brattish ways, need to acknowledge is what a great leap forward from Freud's approach the second wave was.

After all, I'm describing the history of modern counselling psychology as if we all knew what was happening. We didn't. There are always all kinds of crap, crackpot ideas competing for space and audience within psychotherapy and how was the average punter within the field to know if Ellis and Back were just another weird non-helpful addition? A modern day example of such stupid dangerous quackery is Thought Field Therapy. Google it and giggle, please. And an earlier example was phrenology. Google that, I dare you. It is where the idea that beady, close-set eyes were a sign of evilness originated.

So at the time of the second wave, behaviourism was still emergent. No-one called it the first or the second wave. The phrase cognitive-behavioural therapy (an amalgam of Ellis' Rational Emotive Therapy and Beck's Cognitive Therapy) hadn't been invented yet. Beck was pissed off (and remains so) that the American Psychoanalytic Institute black-balled him.

It was, in short, a mess.

So was my bike. Owen from NRMA and I had no idea that the choke cable was stuck on due to a broken spring in the carburettor. That was making the engine run 'rich', and turning the spark plugs black. I'd learn that several days, and several hundred dollars, later. For now, he was looking sadly at me and deciding to break the rules and get some poor bloke out of bed in Bathurst to come pick up my bike. Empathy. Sympathy. Whatever. Owen, I love you.

Ok so what faults do I, as a third-wave psychotherapist, find with Beck and Ellis? Not too damned many, if I know what is good for me. It is worth me considering that a substantial government rebate within Medicare is based upon the assumption that 2nd wave CBT is a fundamentally valid option for treating the psychologically ill. In order to get paid, a psychologist must generally describe themselves as cognitive-behavioural therapists. And there is an entire industry of 2nd-wave manuals for treating various specific issues, from social phobia to schizophrenia, which pretty much hold sway in the market place as established wisdom and THE way to treat clients. CBT rules. And there's a line in our code of ethics which specifically forbids a psychologist from denigrating the profession. It is all very neatly tied up, really.

But sometimes it is important to break the rules. Owen saw the broader picture and he helped me. I try to see the broader picture within psychotherapy and I try to help my clients. Ultimately that is the real requirement of our code of ethics. So what is my problem, from a treatment perspective, with Ellis and Beck?

To be incredibly unfair to them (and please be aware, this is a 'straw man' argument), the rational therapists see thinking as logical. By challenging false assumptions, they think that my behaviour will change. But my friends all told me I was mad to ride a 250 cc motorbike, in the middle of winter, to Blackheath. I agreed with them. But it is an adventure, I said, pulling on my lemming suit. My lemming suit  is very warm. Shame the gloves were so thin. Every 10k of speed is one degree colder. Riding through Blayney at 60k the air hitting my gloves was perhaps at -10. (I doubt it though. Only felt like -5).

So my point is this: arguing with my cognitions is not enough. Even if you persuade me that my ideas won't hold water, it is only when I gain insight that those are truly MY ideas that I will begin to change. I actually think Ellis and Beck understood that, perhaps intuitively. But it was only later technology which has made that point explicit, and so many of the 2nd wave technicians have not understood a key aspect of delivering effective therapy. They're knocking out their own copies of David, I guess.

The rest of my Blayney story turns out pretty well. I talked to Owen and waited for the tow truck.  I forget what time it was, but my friend Renae arrived first. She'd driven from Blackheath to Blayney to collect me. Just under a two hour trip. Renae rocks. The tow truck rocked along soon after. By five a.m. I had put everyone to way too much trouble and was running numb fingers through my hair in the hottest of showers in Blackheath. It would take two months for my fingers to return to normal. I guess I was lucky. After the shower, I slept. My decisions had inconvenienced a lot of people, but ultimately they enabled me to have a very special experience with no serious consequences. In the wider scope, my logic was, perhaps,  weird - but not completely flawed.

We don't just have a mind. We have a brain, and it makes decisions based, not just on logic, but on chemicals and history and phobias and traumas. Not enough of sleep, water, exercise or folate can all affect our decisionmaking. Peer groups, cultural assumptions, alcohol and sugar all can also distort our decisions. Examining our thoughts can expose the gaps in our logic - but old-style cbt was sometimes equal in effectiveness to being on a waiting list. And sometimes our thoughts can't be successfully challenged because we're arguing with biology.  Beck and Ellis weren't the first to argue that our thoughts determine our behaviour. Not even William James was. I can show you loads of works by Plato where Socrates tries to challenge the cognitive frameworks of his fellow Athenians. But we're more than minds. That is where 2nd wave CBT fails.

I am impulsive, in part, because I am habitually impulsive. I have been accused of having a death wish. I am also impulsive because I like being impulsive. I think I feel vaguely like a pirate when I say damn the torpedoes. Not that there were torpedoes in the 17th century. But hell, lemmings don't actually commit mass suicide either. I guess sometimes we can't rely upon our assumptions. My impulsiveness comes from my neural pathways, and my schooling in boys-own adventure stories. Ultimately, my own actions are more complex than answering the question:  what makes the most sense to do next?

Ultimately, the second wave of CBT was impressive technology. And it was superseded later. And we're over the hump, reader! From here on in, the posts relate to the newer technology. We're up to current best practice.

The RACV paid for all kinds of stuff that weekend. They were brilliant. The NRMA road crew were excellent, too. Renae and her household were wonderful friends and fine company. By Monday afternoon I was headed back through Blayney on my way home. I was relishing the adventure, and my bike was running well. I stopped for fuel, and I looked at the pub. It was a nice little bustling town on a sunny day. Only my numb fingers remained to reassure me how much I had hated the place. Hated myself, more like. But somehow, didn't hate my impetuous spirit.


I like the way I take risks. It is one of the finest attitudes of my mind. And, some days, that alters my life's experience.