245 � 2003 Human Sciences Press, Inc.

Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 21, Nos. 3/4, Winter 2003 (� 2003)

REASONS WHY RATIONALEMOTIVE BEHAVIOR THERAPY

IS RELATIVELY NEGLECTEDIN THE PROFESSIONAL AND

SCIENTIFIC LITERATURE

Albert EllisAlbert Ellis Institute

ABSTRACT: Although rational emotive behavior therapy (REBT) has beenthe pioneering cognitive behavior therapy (CBT) of the twentieth century,and although its main methods are very popular among practicing cliniciansas well as members of the public, it has been relatively neglected in the pro-fessional and scientific literature. Reasons for this neglect are discussed andsome steps are suggested to make REBT more effective and more scien-tifically accepted.

KEY WORDS: cognitive therapy; cognitive behavior therapy; rational emotivebehavior therapy; psychotherapy.

There are a multitude of reasons why rational emotive behaviortherapy (REBT) is relatively neglected in the professional and scien-tific literature while at the same time it is very popular among practic-ing therapists and among members of the public. Let me see if I cancover many of them in this article.

LACK OF SOLID OUTCOME STUDIES

Although outcome studies of REBT began appearing in the early1960s, and over 250 have so far been published (Terjesen et al., 1998),

Address correspondence to Albert Ellis, 45 East 65th Street, New York, NY 10021; e-mail:info�rebt.org.

246 Journal of Rational-Emotive & Cognitive-Behavior Therapy

most of the studies have been relatively slight and have not been fea-tured in outstanding professional journals. Few of them have been ofthe caliber of the studies published on cognitive therapy (Beck, Rush,Show, & Emery, 1979) or on cognitive-behavior therapy (Barlow, Esler,& Vitali, 1998; Meichenbaum, 1977). There are many reasons for this,including these:

1. The Albert Ellis Institute for Rational Emotive Behavior Therapy,which could have been a prime instigator of solid outcome studies,has always been primarily a training institute for therapists and notan academic-research institute.

2. It attracts mental health practitioners who are devoted to helpingclients and in building their own practices to do so, but who have aquite secondary interest in psychological research. It has tried formany years to train Fellows who will be equally devoted, while at theInstitute and later in their career, to clinical practice and research,but with few exceptions has failed to do so.

3. The Institute gives certificates but no degrees to its Fellows. There-fore, it is not able to motivate them to do the kind of careful researchthat they would do in order to get a Ph.D. or a M.S.W. degree.

4. The Institute is a nonprofit organization that loses money on itstraining program every year. It only manages to stay in existencebecause of the financial support that largely comes from the incomefrom my clients, my workshops, and my book royalties—all of which Idonate to it. Good research studies are very expensive and, with itslimited income, the Institute cannot afford to sponsor them.

5. Not being an academic organization, the Institute has great difficultygetting research grants and funding from the National Institute forMental Health and other funding sources. It has applied for researchfunds a number of times but has always been turned down, except forone small grant from one of my ex-clients.

6. Published studies of psychotherapy have usually been of limited as-pects of disturbance, such as depression, anxiety, or anger, while Ihave applied the theory of REBT to most disturbances rather thanspecial ones. Thus, I have held that the basic philosophy of self-down-ing is at the core of both depression and anxiety. This has probablyled to fewer studies using REBT for specific disturbances thanstudies using other cognitive-behavior therapies.

7. REBT favors the use of a large number of cognitive, emotive, andbehavioral techniques rather than a few cognitive and a few behav-ioral methods that other cognitive-behavioral systems use. Therefore,it is quite difficult, and in some ways almost impossible, to test therelative effectiveness of the different techniques used in REBT. Thisdifficulty has discouraged researchers from solidly testing REBT.

Albert Ellis 247

8. A central theory of REBT says that people largely disturb themselvesby thinking in terms of absolute imperatives—shoulds, oughts, andmusts. But the use of paper and pencil tests to get at clients’ believ-ing and then changing their irrational beliefs, including their uncon-scious shoulds and musts, is a poor way to test them and may neverbe adequate (Bond & Dryden, 1996; Ellis, 1996; Wessler, 1996). Sinceusing other testing techniques would be much more complicated andexpensive than using paper and pencil tests, studies of some of thebasic theories of REBT have not yet been done.

9. The REBT theory of irrational beliefs (IB’s) leading to emotional-be-havioral disturbances has inspired many paper and pencil tests ofdysfunctional beliefs. Most of these tests have been used in hundredsof published studies and the great majority of these studies substan-tiate the REBT hypotheses that people who hold more frequent andmore intense irrational beliefs tend to be more disturbed than thosewho hold fewer or less intense IB’s. Most of these studies, however,fail to give credit to REBT for originating this theory and, in fact,state or imply that it was originated by other cognitive-behavioraltherapists or systems.

MY PERSONAL NEGATIVE INFLUENCE

Since REBT was founded and outstandingly promoted by me, it isoften identified, by the public and the psychology profession, withme—which has distinct advantages and disadvantages. Professionalsoften slight or oppose REBT because I am quite a charismatic individ-ual, with characteristics that many of them find distasteful. This hasalso been true of some other well-known founders of therapy systems,such as Wilhelm Reich and Fritz Perls. Some of the issues in this re-spect are these:

1. My private and public manner and language, including my well-known use of four-letter words, is controversial and unconventionaland turns off many professionals. It is not exactly consonant with thescientifically respectable cognitive-behavioral therapy movement!

2. I was a noted, and widely read, sex therapist before I was known as arational emotive behavior therapist, and my sex views always were(and still are) very liberal. Many professionals are opposed to mytherapy views because of their opposition to my views on sexual liber-ation.

3. My self-help books have sold widely, have made REBT very popularwith the public, and have been often recommended by therapists totheir clients. But they are often seen, albeit wrongly, as light and

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superficial and have prejudiced many academics against me andREBT. Alfred Adler (1926), who wrote most of his main books for thepublic instead of the profession, also has been somewhat neglected by“scientific” professionals.

4. My emphasis on philosophy and my use of the word rational turns offa number of empirical-minded psychologists. I probably would havebeen wiser to use the less controversial term cognitive and calledREBT cognitive emotive behavioral therapy.

OTHER REASONS FOR THE NEGLECT OF REBT

There are a good many other reasons, in addition to those previouslystated in this article, why REBT is relatively neglected in the profes-sional literature. Here are some of them.

1. New fads and enthusiasms appear in the field of psychotherapy allthe time, some of them largely restatements of old positions under anew name, REBT is now almost 50 years old and, therefore, alongwith other older systems, often gets neglected.

2. Some of the newer systems, such as Hayes’ (Hayes, Strosahl, &Wilson, 1999) Acceptance and Commitment Therapy (ACT) are re-markably similar in many respects to REBT (Ellis, 1999b) but useterminology that seems to make them significantly different. White’s(White & Epston, 1990) narrative therapy, again, states some of thebasic principles of REBT—that people talk to themselves, make updisturbing stories, and are able to change these stories—but ignoresREBT’s priority in positing this idea. Glasser’s (1998) Choice Theoryis remarkably similar in many ways to REBT, but Glasser at leastgives credit to REBT for this similarity. On the other hand, Dyer(1977), who was trained in and practiced REBT before he wrote YourErroneous Zones, gives it no credit whatsoever, presents almost pureREBT in his book, and claims he got it from ancient philosophers.Keyes (1977) does much the same thing in A Key to Higher Con-sciousness, which is largely a rewriting of A Guide to Rational Living(Ellis & Harper, 1997) but, once again, gives no mention of REBT.

3. Many other writers copy REBT theories and practices and presentthem entirely as their own. Other writers, out of ignorance or design,use central REBT ideas but credit them to other cognitive-behavioralauthors.

4. Many authors follow the recent mystical, transcendental, New Age,and spiritual trends and either oppose REBT and significantly distortits views, as does Wilber (1989). Or, like Stanley Krippner, they useits main ideas and give little or no credit.

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WHAT CAN BE DONE ABOUTDEMARGINALIZING REBT

Naturally, I think it would be better if REBT were fully given itsdue and publicized more as the original form of cognitive behaviortherapy (CBT) and as a form that has some unique, and possiblymore effective, characteristics. Not that this is necessary. CBT, I pre-dict, is here to stay in the psychotherapy field and will grow anddevelop in many ways. If REBT, therefore, is just a neglected part ofCBT, but its unique aspects are employed by many CBT practi-tioners, it will have well served its purpose and may be forgottenwithout too much loss.

In fact, I predict that the field of psychotherapy will become increas-ingly integrated—so that a large part of the theory and practice ofCBT will exist, say, 100 years from now. But it will partly be mergedwith other effective therapy theories and practices—as an importantpart of them. If I am correct about this, REBT will be a part of CBTand CBT will be an essential part of general psychotherapy.

So I cannot get frantic about the preservation of REBT in its ownright. Still, because I prejudicedly think it is more effective than gen-eral CBT, and especially more so than therapies that include littleREBT, I think that it would be good if its unique characteristics weregiven more professional and public notice. Here are some things thatREBTers might do to promote this notice.

1. Do much more outcome research, especially in the areas of specificemotional-behavioral problems, such as anxiety, depression, anger,addiction, and love, marriage, and family relationships.

2. Investigate the relative effectiveness of core REBT proceduresagainst that of general CBT and other therapeutic systems.

3. Rigorously test some of the unique REBT theories, especially the pri-macy of the absolutist shoulds, oughts, and musts.

4. Test several of the main cognitive, emotive, and behavioral tech-niques to see if, as hypothesized, they support each other, or whethersome of them are relatively ineffective.

5. Do a great deal of research on the effectiveness of REBT in self-helpform. I believe that REBT beautifully lends itself to self-help mate-rials that can be used by themselves or together with individual andgroup REBT. If readers, viewers, and listeners can be persuaded to dotheir homework to use these materials, REBT can be extended toliterally millions of people—and preferably should be! I am now de-veloping a REBT workbook for people afflicted with serious stress

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and anxiety. But its effectiveness had better be thoroughly re-searched.

6. The future of REBT and of CBT, I have said for many years, is inboth psychotherapy and in childhood, adolescent, and adult educa-tion. I am happy to see that Seligman and his associates (Seligman,Reivich, Jaycox, & Gillham, 1995) have recently followed up the pi-oneering use of REBT and CBT at The Living School in the 1970s(Ellis, 1972; Knaus, 1974).

7. I still hypothesize that if REBT is thoroughly practiced—that is, usedwith clients who are persuaded to employ its main cognitive, emotive,and behavioral methods vigorously and persistently—it will tend tohelp clients get better and not merely feel better (Ellis, 1979, 1992,1999a). This means that they reduce their disturbed feelings and be-haviors and consequently feel significantly less anxious, depressed,and enraged. But it means that they also make a profound change intheir cognitive-emotive-behaving philosophy so that they consciouslyand unconsciously make themselves less disturbable. If they do this, Ihypothesize, they will think, feel, and act more healthfully as therapyprogresses. But they will also have much less of a tendency to seri-ously disturb themselves even when faced with unusual adversities,such as disability, fatal illness, and war.

My concept of this kind of “elegant” change through using REBTmay be utopian, but I still maintain it. Alford and Beck (1997) have asomewhat similar claim for Beck’s Cognitive Therapy. Now it’s up toREBTers and other cognitive behavior clinicians to put this hypothesisto rigorous testing.

CONCLUSION

REBT, though the original cognitive behavior psychotherapy of mod-ern times, and although very popular with practicing therapists andmembers of the public, has been relatively neglected in the profes-sional and scientific literature. This article reviews some of the mainreasons for this neglect, including REBT’s lack of solid outcomestudies, my own personal negative influence, and other important rea-sons for the marginalizing of this comprehensive form of therapy.Some steps to rectify this situation and make REBT more effective andmore accepted in the future are presented. If these steps are taken,rational emotive behavior therapy may well revolutionize twenty-firstcentury psychotherapy as it has also tended to provoke and startletwentieth-century therapy theory and practice.

Albert Ellis 251

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