A Continuation of the Dialogue on Issues in Counseling in the Postmodern Era.

This is a continuation of the dialogue among Albert Ellis, Jeffrey T. Guterman, Earl Ginter, and Sandra A. Rigazio-DiGilio, Allen E. Ivey, and Don C. Locke that has been appearing in the Journal of Mental Health Counseling on ethical issues of counseling in the postmodern era.

The discussion of the application of postmodern and social constructionism that I am about to continue began with Jeffrey T. Guterman's constructivist views (1994, 1996a, 1996b, 1996c) and my answers to these views (Ellis, 1996a, 1996b, 1997a), which appeared in the Journal of Mental Health Counseling and Counseling Today. Then, at the American Counseling Association in Pittsburgh, Earl Ginter, Sandra A. Rigazio-DiGilio, Allen Ivey, and Don C. Locke joined me and Guterman in continuing this discussion in a symposium, "Ethical Issues in the Postmodern Era" (Ginter, 1996). Ivey, Locke, and Rigazio-DiGilio (1996) and I (Ellis, 1996a) continued this discussion in Counseling Today. Finally, Ginter (1997) and Rigazio-DiGilio, Ivey, and Locke (1997) added to the discussion by responding to my 1997 paper in The Journal of Mental Health Counseling.

Is there anything more to be said on this important issue about counseling and its ethical, constructivist, multicultural, and postmodern aspects? Yes, as Ginter (1997, p. 221) stated, "The debate has flourished since Ellis' 1996 article and promises to continue for a while longer." The present article will continue this debate--or I would rather say discussion--further. It will deal largely with Ginter's (1997) and Rigazio-DiGilio et al.'s (1997) contributions.

First, Ginter (1997) agrees with one of the main points in my critique of Guterman's radical social constructionism. I said that counselors had better take an and/also approach rather than an either/or (one-sided) approach to counseling practice and criticized the extreme constructionist position as being one-sided. I stated, "Because monolithic, either/or solutions to problems have their limitations, we had better consider the range of alternative, and/also solutions and test them out to see how well--and badly--they work" (Ellis, 1997b, p.212). Although Ginter concurs with this view, he says that my article "takes on a tone that is not congruent with the `and/also' preached."

DISCUSSION OF GINTER'S CRITIQUE

Ginter is, of course, partly right. In presenting my Rational Emotive Behavior Therapy (REBT) position, I naturally favor it over the extreme constructionist position, the person-centered position (Rogers, 1961), and other therapeutic positions. How could I possibly not do so? REBT is unusually integrative and eclectic and is one of the first of what Lazarus (1989) called the multimodal therapies. Unlike many of the therapy systems, it is both/and rather than either/or; and therefore I think that it is in some ways, though not in all, more effective than most other systems. If this is my prejudice, which in some ways it is, by all means make most of it!

Ginter (1997, pp. 231-232) notes that "Although I welcome Ellis's map of an `and/also' approach, I believe this should be accomplished in such a manner which does not arrive at an unsystematic eclecticism. I do agree with Ellis that if we are unsuccessful with a client, we should not be reluctant to try techniques not usually associated with our theoretical position (and to refer the client when it is called for), but we should observe and approach the situation as the situation to add a truth to our own approach, in such a manner that it fits our own evolving theoretical position."

I quite agree. Although at first somewhat opposed to some extreme forms of experiential and religious-oriented therapy, REBT has changed its position over the years and has incorporated many encounter exercises into its practice (Ellis, 1998, 1999; Ellis & Dryden, 1997; Ellis & MacLaren, 1998). It has integrated some religious philosophies into its theory and practice (Ellis, 2000). It has also incorporated some of the "truths" of other forms of therapy in its own approach (Ellis, 1998,1999). So although I actively and enthusiastically favor REBT over other therapies, I hardly think that it is sacrosanct, as Ginter sometimes implies. If I unwittingly slip, at times, into that rigid position, I am indeed going against a fundamental REBT principle of flexibility and anti-absolutism, which it considers crucial to mental and emotional health.

DISCUSSION OF RIGAZIO-DIGILIO, IVEY, AND LOCKE'S PRESENTATION

The rest of this article will be devoted to a discussion of Rigazio-DiGilio et al.'s (1997) article, "Continuing the Postmodern Dialogue: Enhancing and Contextualizing Multiple Voices," which I consider a very important contribution to our postmodern dialogue. This article makes many trenchant points, with which I mostly agree, but with some of which I would like to offer caveats.

First, Rigazio-DiGilio et al. (1997, p.234) state one of their primary theses as follows: "Theories of counseling that primarily address the thought and action processes of individuals (e.g., REBT, psychoanalysis, CBT, Gestalt Therapy, Reality Therapy) offer unique perspectives on mental health and how to achieve it, but omit action with and reflection on the wider social systems that may have contributed to or labeled the distress. Similarly, social constructivist models listen to the client's narrative."

Let's face it: These critics of various therapies are partly accurate and make an important point. On the other hand, they almost forget and only lightly mention Adler (1926), who always stressed social interest and the contributions to mental health. They also forget that Wilhelm Reich (1960) was a propagandist for a revised social and sexual system and that Carl Rogers repeatedly campaigned for international cooperation and peace.

In my early articles and books on REBT, I emphasized that people had better change their inner musts and demands, with which they upset themselves, about the social system. But at the same time, they had better fight against that unfair and irrational system. Thus, in books like Sex Without Guilt (Ellis, 1958a), The Intelligent Woman's Guide to Dating and Mating (Ellis, 1963/1979), and Sex and the Liberated Man (Ellis, 1976), I took a firm stand against the social-sexual system that endorsed Puritanism, encouraged machismoism in men, downgraded women in many respects, and otherwise helped to cause many cultural and personal emotional evils. Along with other writers of the 1950s and 1960s such as Bertrand Russell and Alfred Kinsey, I think I can say that I was one of the main instigators of the social-sex revolution of the 1960s.

Whether counselors should preferably strive for social action along with their functions as therapeutic practitioners is a complicated and debatable question--as is the question of whether scientists, including counselors, should strive for "objective truth" as well as take a social-political stand. Much can probably be said for and against counselors assisting their clients, as Rigazio-DiGilio et al. (1997, p. 236) advocate "chang[ing] their inner thoughts and meanings to assume new behaviors that have ameliorating effect within their own personal sphere while also interrupting constraining interactions that may exist in their wider sociocultural and sociopolitical context."

Personally, I favor counselors taking this kind of sociocultural and sociopolitical stand, as my history (since I became a counselor in 1943) has shown. But while I have always been a sociopolitical "liberal"--as, it seems to me Rigazio-DiGilio et al. (1977) likewise are--what of the many counselors who are arch conservatives or reactionaries? Yes, some indeed are. As such, they may choose not to interrupt constraining interactions that may exist in their clients' wider sociocultural and sociopolitical content. Instead, these reactionary counselors may choose--yes, choose--to aid, tighten, and even aggravate their clients' contextual constraining interactions. Thus, a counselor who is quite conservative (as I think not a few are) may encourage clients to bolster the anti-female, prochauvanistic, anti-sexual, child-, woman-, and ethnic-abusing content that is still prevalent in our Western society as well as in some Asian, African, and other regions (Ivey, Ivey, & Simek-Morgan, 1997; Sue & Sue, 1990). Are we to rule that all these "reactionary" counselors are indubitably wrong? Some postmodern, relativist philosophies would especially say that neither liberal nor reactionary sociopolitical views are right or wrong in themselves. It is how you view them that constitutes their rightness (Feyerband, 1945; Gergen, 1991). Personally, I believe with Rorty (1991) that some pragmatic standards of what is "right" and "wrong" for a given society can be reasonably established. But I have a hard time--and so would Rigazio-DiGilio et al.--substantiating this view.

Let us assume that the advocacy of sociopolitical action as an integral part of therapy has dangers (especially in a democracy) but still assume that is has more advantages than disadvantages and is therefore to be implemented. Rigazio-DiGilio et al. (1997) also posit a theory of developmental counseling and therapy (DCT) and its extension, systematic cognitive-developmental theory (SCDT) that include four important points:

   In this theory four levels or orientations through which individuals,
   families, and wider social systems process information, including
   stress-inducing stimuli, are described: sensorimotor/elemental, concrete
   situational, formal/reflective, and dialectical/systemic .... These four
   informational styles ... challenge traditional theories such as
   person-centered and REBT, because these tend to give attention to only
   parts of the more inclusive information-professing paradigm.

Let me clearly define what Rigazio-DiGilio et al. seem to mean by the four informational styles of counseling they include in their DCT and SCDT systems. By the sensorimotor/elemental level they seem to mean that counselors will deal with their clients' bodily, physical, and experiential information processes; by the concrete situational level they seem to mean the practical problems of living that therapists will help their clients to handle; by the formal/reflective level they seem to mean the cognitive processes that counselors will help their clients to understand and deal with; and by the dialectic/systemic level they seem to mean the attempts of counselors to encourage and help their clients change the stressful environmental events about which they tend to upset themselves.

Rigazio-DiGilio et al. (1997, p. 237) hold that if counselors and their clients have access to all four of these orientations, they "have more options for growth, adaptation, and change." I have no quarrel with this formulation and think that it is probably more comprehensive and therapeutically more efficient than most other theories. The authors wrongly state, however, that traditional theories such as REBT "tend to give more attention to only parts of the more inclusive information-processing paradigm." That is, they omit important aspects of Rigazio-DiGilio et al.'s four-point theory. They repeat a common misconception of REBT, since it actually emphasizes the formal/reflective processing of information in the creation and maintenance of emotional disturbance, but it by no means exclusively does so. In fact, in my first paper on REBT, presented at the American Psychological Association annual convention in Chicago on August 31, 1956, I emphasized the interaction of emotion (and of emotional disturbance) with other information-processing human elements. I specifically said:

   The human being may be said to possess four basic processes--perception,
   movement, thinking, and emotion--all of which are integrally interrelated.
   Thus, thinking--aside from consisting of bioelectrical charges in the brain
   cells, and in addition to comprising remembering, learning,
   problem-solving, and similar psychological processes--also is, and to some
   extent has to be, sensory, motor, and emotional behavior. Instead, then, of
   saying, "Jones thinks about this puzzle," we should more accurately say,
   "Jones perceives-moves-feels-THINKS about this puzzle." Emotion, like
   thinking and the sensori-motor processes, we may define as an exceptionally
   complex state of human reaction that is integrally related to all the other
   perception and response processes. It is not one thing, but a combination
   and holistic integration of several seemingly diverse, yet actually closely
   related, phenomena (Ellis, 1958b., p. 35).

In addition to holistically integrating perception, cognition, emotion, and behavior and as I noted above, REBT from its start in January 1955 has been unusually multimodal in its methods of therapy. Along with several techniques of cognitive restructuring, it has advocated the use of more emotive-evocative-expressive and more action-oriented techniques than probably any other form of therapy (Ellis, 1997b, 1998,1999; Ellis & Dryden, 1997; Ellis & MacLaren, 1998; Ellis & Velten, 1998). As I also noted above, it has often encouraged the Rigazio-DiGilio et al.'s (1997) fourth therapeutic process, dialectic/systematic processing.

To be sure, REBT has not emphasized dialectic/systematic counseling or counselor's working to change the socio-political system as much as it is heavily encouraged in DCT and SCDT. Quite possibly, it and most other popular counseling procedures are relatively lax in this respect. The unique element of the Rigazio-DiGilio et al.'s article is their stress on this fourth process. REBT had better seriously consider emphasizing it more than it sometimes has done in the past and, thereby, learn from DCT and SCDT. But much can be said on the hazards as well as the advantages of stressing this aspect of counseling. It is nonetheless accurate, as Rigazio-DiGilio et al. (1997, p. 241) note: "Theories of counseling and practice that perpetuate the notion of individual and family dysfunction without giving equal attention to societal dysfunction and to the dysfunctional interactions that can occur between individuals, families, and societies (e.g., intentional and unintentional power differentials) may unwittingly reinforce the oppressive paradigm." All systems of counseling had better give serious thought to this hypothesis--as, in fact, few of them have to date done.

Rigazio-DiGilio et al. (1997, p.235) particularly emphasize Freire's (1972) insistence on action and point out that DCT and SCDT put "an emphasis on action as well as treatment within multiple layers of reality." I heartily endorse this view. As they also indicate (p. 248), "Ellis was one of the first individually oriented theorists to stress the importance of homework. He is a leader in tying counseling to environmental conditions, because he expects his clients to enact behaviors at home and in the community." Indeed so! I created REBT as the pioneering form of cognitive-behavioral therapy in 1955 because I fully realized, at that time, that human thinking promotes changes in human action; but, at the same time, human action promotes changes in human thinking. The two so-called separate processes are really quite interactional.

Moreover, therapists' actions often encourage clients' changes in cognitions and behavior. That is why I emphasized, in my paper in this series (Ellis, 1997b) to which Rigazio-DiGilio et al. (1997) responded, that unlike many counseling methods REBT is both postmodern and active-directive. Rigazio-DiGilio et al. imply that therapists using DCT and SCDT are more active-directive than other kinds of therapists; but, except for their socially-directed activity, they do not specifically indicate how they are active in the counseling processes. They certainly appear to be far from Rogerian!

REBT AND THE FOUR STYLES OF DCT AND SCDT

Rigazio-DiGilio et al. (1997, p. 246), as a primary ethical imperative, ask theorists and practitioners espousing a particular counseling perspective "to clearly specify the cells falling outside the parameters of their approaches, and the cells currently under development." Fair enough. But since they have some 225 cells in their multicultural cube, let me consider the four main styles of DCT and SCDT and see how REBT fares in regards to them:

1. Sensorimotor/elemental. REBT, with many clients (though not all) uses emotional imagery, forceful coping statements, experiential exercises, relaxation techniques, physical exercise, in vivo desensitization, shame-attacking exercise, deliberate heightening of states of feeling, and experimenting with sexual and other sensory-motor techniques of therapy. It frequently refers clients for psychotropic medication. It usually does not favor body manipulation such as Rolfing and Reichian methods, but may possibly be deficient in not experimenting with them more.

2. Concrete/situational. REBT has pioneered in homework assignments, assertion training, role modeling, conflict-management strategies, practical problem solving, cost-benefit analysis of behaviors, exposure to phobic situations, relapse prevention, and many other concrete/situational methods of therapy. I am not sure where Rigazio-DiGilio et al. (1997) would find it deficient in this respect.

3. Formal/reflective. REBT is famous for its cognitive restructuring, reframing, empirical and logical questioning, Socratic dialogues, use of stories and metaphors, doing cost-benefit analysis of feelings and behaviors, and many other reflective techniques. It is often accused of over-emphasizing these aspects of therapy, but actually combines and integrates them with affective and behavioral methods.

4. Dialectic/systemic. REBT, along with showing clients how to achieve unconditional self-acceptance (USA), reminds them that they choose to live in a social group and had better heed the rules and mores of this group, and work for unconditional other-acceptance (UOA). It particularly interrupts and overcomes feelings of anger and rage and fosters peaceful cooperation (Ellis, 1992; Ellis & Tafrate, 1987). It also stresses feminist therapy (Ellis, 1963/1979; Wolfe, 1980; Wolfe & Naimark, 1991) and anti-homophobia and sex-liberationist therapy (Ellis, 1963/1979,1976; Ellis & Blau, 1998). It has also stressed marriage and family therapy since the 1950s (Ellis, 1957, 1991). It is not as active in urging clients to improve the social context in which they live as Rigazio-DiGilio et al. (1997) might like it to be, but it is not exactly a slouch in this respect.

From what I have said so far, I hope it can be seen that I and REBT definitely favor the Rigazio-DiGilio et al. (1997) development in counseling theory. Of all the many systems of counseling that have been used, theirs seems to be the most comprehensive and potentially most effective. In some ways, I am definitely prejudiced in its favor since I believe that in many respects it overlaps with, and has often been preceded by, REBT theory and practice. But the authors describe it in unusual detail; that makes it a valuable addition to the counseling movement. I also agree with them that it has many postmodern aspects but that it warns against some of the extreme aspects of postmodernism and social constructionism that I have previously criticized in my discussion with Guterman (Ellis, 1996b, 1997a). Development Counseling Theory is therefore not radical constructionism or postmodernism, but takes a more sensible middle-of-the-road postmodernist position.

THE TIME CONSTRAINTS OF DCT, SCDT, AND REBT

This present article is already long, but let me briefly mention one important point that may seriously interfere with the actual practice of comprehensive systems of counseling like DCT, SCDT, and also with REBT, as I have usually presented it. Both these systems take immense time and energy for counselors to learn and practice. If they are adequately shown to clients, as they preferably should be, these clients would also have to take a considerable number of therapy hours and an even greater number of homework time to thoroughly learn and follow their methods.

Thus, even if the main aspects of DCT and SCDT were actively-directly taught to clients (as REBT is usually taught) they would have to devote much thinking, emoting, and behaving time to following their therapeutic procedures. This may be especially true of clients' implementing, in thought and in action, the dialectic/systemic aspect of using DCT and SCDT, as Rigazio-DiGilio et al. (1997, p. 238) advocate, "to seek solutions that incorporate resources form the self, the other, and the wider environment."

Now, of course there is nothing wrong with this. Clients energetically using what REBT calls PYA (push your ass) to really help themselves and others significantly change may well be what is required in practically all effective counseling. The fact remains, however--as almost all studies of therapy show (Koss & Shiang, 1994)--that the average client remains in counseling only a few sessions, usually no more than six. Moreover, today's socio-economic forces, and particularly the influence of HMOs, seem destined to continue this paucity of treatment session. If so, how will the therapist's using DCT and SCDT, as well as those using the many-faceted methods of REBT, have the time to encourage their clients to effectively learn and practice the methods of these comprehensive systems of counseling?

REBT, like some other forms of individual and group counseling, has developed brief therapy and self-help procedures that seem to be effective (Ellis, 1996c; 1998; Ellis & Harper, 1997; Ellis & Velten, 1998). Rigazio-DiGilio, Ivey, and Locke had better consider this important problem. Otherwise, counselors who are trained to use DCT and SCDT properly may have a hard time holding their clients long enough to make these systems of counseling effective. But, again, this paper is long enough already, so I leave this important aspect of counseling for further discussion.

DISCUSSION

This ongoing discussion of issues in the postmodern era and how they are related to counseling theories and practices has by no means settled the complicated issues involved. By all means let us hear some more views on these important matters.

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Albert Ellis, Ph.D., is the president of the Albert Ellis Institute for Rational Emotive Behavior Therapy in New York, where he practices individual and group therapy and trains counselors. Correspondence should be sent to Albert Ellis, 45 East 65th St., New York, NY, 10021. Email into@rebt, org.