Geoffrey T. HUTCHINSON, Benjamin P. CHAPMAN
Northern Arizona VA Health Care System, Arizona, USA.
A close review of Viktor Frankl’s Logotherapy and Albert Ellis’s Rational Emotive Behavior Therapy (REBT) demonstrates remarkable similarities between these two systems of psychotherapy. An integrated Logotherapy-enhanced REBT is examined in respect to cognitions, emotions, and the reduction of rumination. Its unique contribution is to balancing discovery of meaning with the use of reason during the process of psychotherapy. Conclusions are drawn, limitations are discussed, and future recommendations are outlined.
Key words: Rational Emotive Behavior Therapy, Logotherapy, Psychotherapy, Integration
Correspondence concerning this article should be addressed to:
Geoffrey T. Hutchinson Email: firstname.lastname@example.org
This article was originally published in Springer/Kluwert Academic Publishers, in Journal of Contemporary Psychotherapy, Vol. 35, No. 2, 2005, pp. 145—155: with kind permission of Springer Science and Business Media.
Logotherapy-Enhanced REBT: An Integration of Discovery and Reason
By all conventional standards, most practitioners would consider Viktor E. Frankl’s Logotherapy and Albert Ellis’ Rational Emotive Behavior Therapy (REBT) as distinctly different, even conflicting forms of psychotherapy. Most therapists would describe Logotherapy as an existential, exploratory, and process-oriented approach to therapy. In contrast, they might view REBT as a didactic, stoic, and highly structured variant of cognitive-behavioral therapy. But beneath such distinctions, Logotherapy and REBT share some surprisingly similar philosophical principles, as well as an emphasis on pragmatism in their respective techniques. These similarities are even more noteworthy, given that Ellis developed his theory and practice before reading Frankl’s works (Ellis & Grieger, 1996). It is our contention that the technical and theoretical augmentation of REBT with Logotherapy will offer significant advantages to clients. Logotherapy-enhanced REBT provides an existential framework that balances the appeal to reason with the unique human tendency to discover individual meaning. This integration encourages clients to adopt a more effective philosophical approach to life that steers them away from self-defeating behaviors. In this paper, we strive to sketch a preliminary outline of this integration. We will begin with a brief overview of these systems of psychotherapy.
A Brief Overview of Logotherapy and REBT
Viktor Frankl’s Logotherapy
Frankl’s great contribution to psychology was his principal focus on spirituality and meaning in life (see, e.g., Frankl, 1986a, 2000a,b). An iconoclast who disagreed sharply with the mechanistic zeitgeist of his time, Frankl (1988b; 2000a) proposed that the key to human achievement and happiness entailed the discovery and fulfillment of idiographic meanings. He contended that human beings existed across three integrated yet distinct dimensions: biological, psychological, and spiritual. The spiritual dimension empowers human beings to overcome even the most overwhelming circumstances of life and acts as a doorway to unique human experiences such as joy, guilt, and creative potential (1986a, 1988a). This dimension also encourages the making of responsible, moment-by-moment decisions in order to live a meaningful life (Frankl, 1986a; 2000b; Lukas 1986). In short, Frankl’s emphasis on the spiritual dimension of life, and on the process of discovery and individual meaning-making, offered a fresh perspective on the etiology and treatment of various mental disorders and life problems.
Albert Ellis’ Rational Emotive Behavior Therapy
Ellis’ great contribution to the field was his contention that it is our interpretation of events that affects our mental health. Ellis posited that in general human beings have two basic goals: to continue living and to live in such a way to maximize happiness and minimize suffering (Ellis & Grieger, 1996). According to Ellis, dysfunctional affect and behavior are highly correlated with what he terms “irrational beliefs”. In Rational Emotive theory, the term “irrational” is used to describe any aspect of human volition that prohibits individuals from achieving subjectively desirable goals. Ellis’s solution to this problem is to teach human beings how to use rational (i.e., goal-enhancing, scientific, flexible) thinking not only to achieve goals in a more enlightened fashion, but also to change their emotions and behaviors for the better (Ellis, 1994; Ellis & Grieger, 1996; Ellis & Harper, 1997). People who use rational thinking will take proper responsibility for their lives and emotions, accept uncertainty and themselves, and practice tolerance. They will make reasonable compromises, take risks, and have higher levels of frustration tolerance, and sacrifice immediate pleasures for long-term benefits (Ellis, 1996; Froggatt, 1997).
Common Fundamental Roots
Logotherapy and REBT share fundamentally similar existential roots that render them distinctly compatible. Although these are manifested in different ways, they may be seen as complementary rather than conflicting. For Ellis, it is irrational beliefs that lead to psychological conflict, and this conflict can be relieved by a method of disputing and altering common irrational beliefs adopted by most human beings. These issues are at the root of the existential struggles of competing with other’s demands, coping with the uncertainties of life, and defending against neurotic proclivities to disturb oneself. For Frankl, individuals have a healthy, resilient core that empowers them to overcome adversity through the discovery of purpose and meaning in life. Frankl provides a method for healing a pervasive sense of meaningless, by discovering individual meaning and focusing on purposeful goals. We argue that in psychotherapy, the struggle against potentially biologically-based irrationality can be enhanced by the process of active discovery, and that likewise, the pursuit of meaning may be facilitated by rational thinking. Augmenting traditional REBT foci with the progressive development of existential awareness and unique life goals – the emphasis of Logotherapy – provides an optimal psychotherapeutic basis for addressing a wide range of human functioning.
An analysis of the similarity, complementarity and interrelation of such philosophical roots is crucial. We do not want to foster simple technical eclecticism in our theory by advocating an atheoretical application of the systems’ respective techniques. An integration of psychotherapy systems always presents theoretical challenges (Arkowitz, 1997). However, common factors evidence in recent years (see, e.g., Wampold, 2001) hints at some of the common roots of purportedly disparate systems. Parallels between existential and cognitive-behavioral therapy also have received attention elsewhere (e.g., Corrie & Milton, 2000). Here, however, we focus on the existential philosophy of REBT in order to demonstrate its partial confluence with that of Logotherapy. Unlike conventional CBT, Ellis (1994) created REBT after delving into a vast amount of classical and modern philosophy. The scope of his reading is apparent in his theories of human nature, rational thinking, emotion, and philosophical change that are existential in nature. These aspects share an abstract elegance with Logotherapy that is less visible in standard CBT. Therefore, we argue for a philosophical, existential system of psychotherapy that increases rational thinking in the context of a broader, unique purpose and philosophy of life. Construal processes, mechanisms of change, and the role of courage and responsibility represent important points of integration between discovery and reason.
REBT and Logotherapy both emphasize the importance of changing the individual, internal representations of the world at both global, more complex, and concrete, simpler levels of abstraction. Logotherapy starts with the global perspective of an existential problem plaguing the human condition: a general sense of meaninglessness (Frankl, 1988b). This concept of an “existential vacuum” affects life satisfaction and fulfillment; this condition hinders the internalization and constructive response to stressors (Frankl, 1988c; 2000b; Lukas, 1998). The vacuum acts directly upon attitudes, emotions, and behaviors, as they facilitate or detract from adaptation to the mundane, daily demands of the world. In this way, issues of construal and meaning-making do impact the immediate, microcosmic nature of everyday experience.
In fact, Logotherapy can be very psychoeducational in nature and employs pragmatic strategies, like dereflection (psychological distance and distraction), the use of humor, and paradoxical intention. Frankl also encouraged his patients to take a relaxed attitude toward their symptoms, often by having his patients deliberately provoke their own symptoms. Paradoxical intention, therefore, encourages clients to expose themselves to their own worries, similar in some respects to exposure therapies or shame-attack exercises in REBT. Although prior investigators have reported mixed results regarding the use of paradoxical intention in anxiety-related disorders (Goodwin, Guze, & Robins, 1969; Noonan, 1971), other more recent work argues that Logotherapy insights into the nature of neurosis and obsessive worrying can be clinically useful (Hutchinson, 2002).
Ellis offers a straight-forward model in a concrete format that permits human beings to understand their emotional and behavioral reactions to the daily demands of the world (Ellis, 1994, 1996; Ellis & Dryden, 1997; Ellis & Harper, 1997). However, Ellis also addresses a higher level of abstraction by suggesting that maladaptive ways of interacting with the world stem from some very basic, sweeping irrational beliefs (Ellis, 1994, 1996; Ellis & Dryden, 1997; Ellis & Harper, 1997). In this sense, Ellis, like Frankl, implies that there is vacuum debilitating human functioning, but it is a “rational” vacuum, or an absence of rationality. The accumulative process of irrational thinking becomes for clients an entrenched hermeneutic device responsible for continual maladaptive construals in response to activating events. In this way, irrational thinking perpetuates further disturbance by interfering at the level of basic appraisal and meaning making. This disturbance can itself interfere with the development of a healthy sense of purpose in the world.
Logotherapy-enhanced REBT addresses an “existential-rational vacuum” that acknowledges an inextricable relationship between rational thinking and purpose in life at the level of construal. Patients often suffer not only from irrational beliefs, but from a lack of meaning or life goals. Both of these deficits are likely to vitiate the appraisal process related to life, the behaviors of others, and one’s own phenomenal experience. The existential-rational vacuum drives construal processes and gives rise to many symptoms. Most importantly, the vacuum results in a restriction of present behavior, experience, and future potential. Logotherapy-enhanced REBT encourages agency and strives to engender purposeful, self-actualized behaviors. The use of techniques like rational disputation, dereflection, and paradoxical intention help accomplish these goals. Before discussing such techniques, however, we briefly note two more points of important confluence between Logotherapy and REBT: the motive or force behind change, and the role of courage and responsibility in change.
Impetus for Change
Although REBT and Logotherapy each deal with individual meaning-making, the means by which they strive to change maladaptive construal processes are only slightly different. Vis-à-vis Frankl, human beings gain greater confidence in their ability to live a purposeful life as they discover unique meanings for their existence (Frankl, 1988b). For instance, Frankl himself recounted a profoundly meaningful experience when he decided to reside in Germany with his family in spite of mounting anti-Semitism (Frankl, 1997). He understood that he needed to be available to his parents, and chose to stay in Germany after coming across a Hebrew letter engraved in a piece of marble, bearing an abbreviation of the commandment, “Honor father and mother and you will dwell in the land.” This is an example of how the Logotherapy process of discovery provides a framework in which human beings can understand their sense of self in relation to others, and use this understanding to guide life choices.
On the other hand, REBT uses rational thinking to transform the individual into an active agent in the world, able to effectively deal with life hassles and self-defined catastrophes. Because Ellis defines rational thinking as a scientific, clear, and flexible approach to life that helps people achieve their goals (Ellis & Grieger, 1996), the process of rational thinking spurs resilience, determination, and competence. In REBT terms, one might think of these things as byproducts of high frustration tolerance, a philosophy of anti-procrastination, and unconditional self, other, and life acceptance (Ellis, 1994; Ellis & Dryden, 1997; Ellis & Harper, 1997). Ellis also explained how REBT helped him as a young man. Apparently, he was able to overcome his fear of speaking to women by forcing himself repeatedly to ask them on dates (Ellis, DiGiuseppe, MacLaren, & Doyle, 2002). This self-exposure exercise enabled Ellis to promote rational thinking after choosing to intervene at a very specific cognitive and behavioral level. So, while empowerment through Logotherapy occurs during the discovery process, the impetus for change is directly related to rational thinking in REBT. It is important to note that rather than being mutually exclusive, these motives for change are complementary, and reflect the multifaceted and complex nature of change processes (see, e.g., Mahoney, 1991; 2003).
Responsibility and Courage
A strong similarity in the intent of Logotherapy and REBT is to facilitate responsibility and courage in clients. Frankl proposed that human beings are not responsible for conditions like unfair life circumstances or endogenous states (such as organic depression or psychosis), but are responsible for their attitudes toward the conditions (Frankl, 1986a, 1986b, 2000a,b). In a similar vein, Ellis encouraged clients to make rational–and hence, responsible–choices to achieve personal goals in a social world where the desires of others may conflict (i.e., the philosophy of enlightened self-interest; see Ellis, 1996; Ellis, 2001). Ellis recognized the biological proclivity to think irrationally, but still expected human beings to increase their tolerance for frustration and to decrease unhelpful negative feelings (Ellis, 1994, 1997, 2002). While Frankl directly stressed responsibility as a main cornerstone of a meaning-centered life that transcends the self, Ellis made use of many related ideas (e.g., long-range hedonism, antiprocrastination strategies) for the fulfillment of enlightened self-interest.
Ellis and Frankl both also focused intensely on the importance of courage. Ellis proposed that it is unethical to allow human beings to wallow in their irrational beliefs (Ellis, 1994; Nielsen, Johnson, & Ellis, 2001). Clients gain courage to pursue the kind of life they want as they learn to challenge ingrained irrational processes that have historically blocked their goals. For Frankl, courage is born through the process of discovery in the face of tragedy, and developed through the choice to transcend suffering in the pursuit of higher goals (Frankl, 1986a; 2000a). Both perspectives require bravery and perseverance. For Frankl, the fulfillment of higher purposes outside of the self (the will to meaning) paradoxically increases happiness as a byproduct (1988d). For Ellis, the vigorous, relentless pursuit of personal goals (with appropriate consideration for the desires of others) increases happiness (Ellis, 1996, 2001). In both systems, courage and responsibility are emphasized in order to achieve these ends.
Therapeutic Goals and Technique
Working with Cognitions
Logotherapy-enhanced REBT involves a deeper commitment to changing negative cognitive sets than either form of therapy in isolation. The goal of Logotherapy is to help create a “modulation of attitudes” for clients so they can construct a “ … stronger, improved, ethically more valuable, more helpful … attitude” (Lukas, 1998, p. 116). Logotherapy empowers clients by connecting them with strong inner resources in the face of adversity; this involves a considerable cognitive shift for clients, who may perceive themselves as powerless, ineffectual, or victims. Logotherapeutic cognitive strategies often involve Socratic technique – much like REBT – but are designed to prompt the discovery of life purpose and meaning at a spiritual level. Traditional REBT is executed with a methodical and strategic focus on cognitive and behavioral techniques (i.e., logical and practical disputation, empirically testing assumptions, behavioral exposure). The goal of these methods is to challenge the inflexible shoulds and musts, absolutistic demands, self-downing, and catastrophic beliefs to which clients often cling (Ellis, 1994, 2001; Ellis & Grieger, 1996; Ellis & Harper, 1997).
When such REBT techniques are augmented by Logotherapy, the result encourages clients to cultivate hope, faith, and optimism in addition to reason. Thus, a comprehensive range of cognitive adaptations may be effected, including 1) an appreciation for the value of the human spirit and its ability to endure tremendous stress; 2) the discovery of meaning, and how meaning may be interwoven in the experience of the suffering itself; 3) a new understanding of intact aspects of life that have not been affected negatively by crisis or tragedy; and 4) an exploration of alternative perspectives of life’s proverbial slings and arrows (see, e.g., Lukas, 1998). Most importantly, changes in such existential meaning structures can be galvanized by the use of REBT techniques. Conversely, more adaptive rational thinking may be brought about by Logotherapeutic exploration and discovery. Rather than opposing one another, the cognitive shifts occurring in REBT and Logotherapy complement one another. Thus, Logotherapy-enhanced REBT can facilitate reciprocal and comprehensive alterations of both rational processes and core existential schema.
Working with Emotions
Because of its focus on discovery and individual meanings, Logotherapy-enhanced REBT may be better suited to increase positive affect in the lives of clients than either therapy in isolation. Ellis notes that clients can find a vitally absorbing interest in life, live life more fully, and enrich themselves through their experiences (Ellis, 2001; Ellis & Harper, 1997). However, an approach specifically aimed at the idiosyncratic discovery of purpose can help therapists tailor their interventions to clients’ individual experiential values. Frankl argues that human beings cannot only “enrich the world by our actions” alone, but can also “enrich ourselves by our experience” (Frankl, 1986a, p. 45). Such experience may involve cultivating an aesthetic appreciation for things like music and nature, or simply feeling at peace with other human beings through social gatherings.
This actualization of experiential values, and the positive affect that follows, can also be used as a cognitive and affective REBT disputation technique. This technique can target and alter irrational beliefs and behaviors. In other words, the client becomes armed with individual, meaningful experiences that combat irrational thoughts like “I am always anxious and am never calm,” “I will never feel undepressed,” and “My negative feelings will never go away.” Positive experiences can lead to more rational conclusions like “I can create happiness in my life,” “My life can be enjoyable,” and “I know how to help myself feel better next time I happen to make myself depressed.” The expansion of emotional and phenomenal experience permits a greater appreciation for what one is capable of doing. It becomes a tool to increase confidence in one’s ability to achieve goals and contend with the demands of others.
In addition, REBT is one of the few systems of psychotherapy (unlike conventional cognitive-behavioral therapy) that emphasizes a distinction between unhelpful and adaptive emotions. It strongly advocates the avoidance of strong, sustained negative emotions that are unproductive; these include rage, depression, severe anxiety, and irrational jealousy (Ellis, 1994; Ellis and Harper, 1997). Furthermore, it differentiates the latter emotions from the less intense negative feelings that are simply the normal part of the human condition (e.g., sadness, frustration, disappointment, concern). A Logotherapy-enhanced REBT can further improve the balance of positive experience and reasonable tolerance of normal, negative feelings. It achieves this goal by addressing the meaning that inheres in normal, negative emotions. The result is that clients not only learn to distinguish between unhealthy and healthy (or normal) negative affect, but are able to explore what such everyday negative affect may signify for them.
Logotherapy-enhanced REBT can be used to decrease maladaptive metacognitive processes, the foremost of which may be obsessive self-interpretation. Excessive reflection on the rationality of one’s thinking and the constant self-evaluation that often follow represent a human phenomenon that is generally unhelpful (Frankl, 2000b). REBT also notes that individuals can disturb themselves through self-deprecation for being irrational (Ellis & Harper, 1997; Ellis et al., 2002). Thus, the constant evaluation of the self, and the irrational demand that “I must always be rational or else…” can be an iatrogenic effect which REBT commonly refers to as a secondary disturbance (Ellis et al., 2002). In particular, individuals who have high standards of perfection can engage in excessive, perpetual disputation of their irrational beliefs. As a result, their energy for coping may be depleted, and they can experience an increase in life hassles.
The constant disputation of irrational beliefs may develop into a compulsion, designed to rigidly control the process of normal thoughts. Some research on obsessions and metacognitive processes suggests that people often disturb themselves needlessly by evaluating thoughts in a harmful manner, instead of appraising them as fleeting and unimportant (e.g., Baer, 2001; Hutchinson, 2002). Logotherapy-enhanced REBT can deter such obsessive scrutiny of one’s rationality through techniques like dereflection (psychological distance and distraction) Dereflection might involve tasks such as increasing focus on others, becoming more in tune with sensory experience, or engaging in absorbing and fulfilling activities. Thus, secondary disturbances that arise from the irrational belief “I must not be irrational” can be counteracted with a healthy, positive emphasis on the here-and-now and simple life experiences.
These areas alone represent an advantage in scope and versatility over either form of psychotherapy in isolation. There are, however, a variety of other areas in which such an integration promises to exceed the sum of its parts. These include greater latitude in the degree of directiveness or therapist activity considered appropriate; the availability of techniques to work with less insightful clients on existential issues; the ability to explore spirituality/religiosity in treatment when they arise; and (depending on client and situational characteristics) the choice to tap rational, philosophical and/or aesthetic processes as vehicles of change.
Logotherapy-enhanced REBT ultimately views humans as existential, potentially rational beings engaged in the process of active, individual discovery. It serves to empower clients by facilitating greater personal agency and encouraging personal responsibility. This Logotherapy-enhanced REBT approach is also applicable to a variety of different types of clients, presenting concerns, and therapeutic situations. This broad application is an important strength given that most therapists value versatility (e.g., Norcross, 1995). Much more than mere technical eclecticism, this approach is theoretically integrative and assists clients in the development of self-enhancing, rational codes. Simultaneously, it is addressing fundamental issues of life meaning, purpose, and spirituality, through the process of discovery.
Consistent with the principles of Logotherapy (e.g., Lukas, 1998), Logotherapy-enhanced REBT’s commitment is to honor the individual discovery of clients’ beliefs and overall purpose in life, rather than to attempt to modulate the client’s attitude to that of the therapist’s or to some external reality. REBT also strives to avoid dogmatism by suggesting (rather than insisting) that clients use reason, rather than the therapist’s worldview, to think more adaptively. Thus, Logotherapy-enhanced REBT does not as a system advocate the imposition of therapist values on clients. Discovery and reason are considered complementary therapeutic processes, rather than static values with which errant clients must be brought into line.
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