The philosophy and role of discomfort anxiety in a case of promoting family well being and harmony

Vol VI, No. 2, 2006 Comments (0)

Albert Ellis Institute, New York, USA
University of Oradea, Oradea, Romania

Theoretical considerations-New ideas

In this article we explore the role of philosophy and discomfort anxiety for promoting family well-being. Various important theoretical ideas are briefly presented and integrated and then a case example is discussed, based on discomfort anxiety.
Note: The editors hereby apologize for the unwitting attribution of the article named “The Pre-marital Conversation”, published in volume VI, No. 1, March 2006 of the Journal of Cognitive and Behavioral Psychotherapies to Dr. James McMahon. The above-named text was developed by Tamara Ranck for pre-marital classes at The Guidance Center, Southgate, Michigan, 2005.

Key words: discomfort anxiety, family well-being

Pages: 149-155
Correspondence concerning this article should be addressed to:


Originally delivered orally on May 20, 2005 upon reception of the Doctor Honoris Causa presented by the University of Oradea to McMahon.

In a chapter written for the text Critical Thinking About Psychology (Washington, DC: American Psychological Association, 2005, Editors Slife, Reber, and Richardson), John Chambers Christopher of Montana State University offered, “Moral Values of Developmental Psychology” (pp 207-232). Christopher’s major criticisms of developmental theory were threefold:

  1. theories such as those from Freud, Piaget, Erickson, and Bowlby, inter alia, treated the child as a bounded isomorph whose progress from birth onward could be measured in stages (i.e. a linear self);
  2. theorists read into child development from the vantage point of an adult (i.e. adult values were superimposed upon a child who was not able developmentally to engage the adult speculations);
  3. no child is an isomorph or strictly bounded organism as in Mahler-Klein’s individuation-separation since each child used language that was learned socially and since each child reflected behavior before, e.g., age 4 that worked to meet basic satisfactions encouraged by the family or group in which the child found him or herself, and who reflected more “age appropriate” behavior involving identity and abstraction to gain acceptance and progress in later years. The early behavior can be categorized as motor and cognitive reactive, while the latter can be described as sensory and cognitive active.

Chambers, instead of focusing upon linear studies as found in cognitive psychology, neuroscience, or behaviorism—studies necessary to advance a science of psychology—argued for holism. Individual differences could be contained within a social system such as a family while the family functioned to help a child’s inborn talents penetrate into the environment. This argument then suggested the philosophical arguments THESES called relational ontology (relationship as the primary given or epistemology for humankind) from Martin Buber and Abraham Levinas concerning family development.
Buber, the Jewish philosopher who preferred negotiated settlements rather than force as suggested by other advocates of Zionism, argued for I-Thou (or ich und du). As you create me, I create you. Thus, strictly speaking, there is no fixed me or fixed you. A child influences his or her parents as much as the other way around. Witness Abraham Maslow’s epiphany. He had been brutalized as a child, went to Wisconsin to study behaviorism, and married there. It was after becoming a father to a female child that his life was changed. He loved her, he watched her, and he learned from her while she softened him and helped to disabuse him of the hatred he had for his mother (he has refused to attend his mother’s funeral). Maslow left a stage theory of development from physiological to self-actuation needs that could generously be referred to as “elitist”, but humanist elitist since it reflected the cream-rising effect rather than that of cooperation as argued for by Jean Bakker Miller and the Stone Center Group at Wellesly (cooperation and dependence are normative in this revisionist view of social psychoanalysis), or as argued for by the late Pope John Paul II in his encyclicals concerning family life prescinding from the Natural Law that human beings are communitarian as intended by the Creator.
Abraham Levinas left his native land after invasion by the Soviet Union to reside in France. From there, he had the opportunity to study with Heidegger. Levinas judged Heidegger’s philosophy to be humanizing but not ethically social. He argued for the face of the other for whom I as an individual am responsible (answerable to God or conscience as in the Old Testament statement, “Here I am, Lord.”). Thus, the face of the adult helps to shape the child, but the child is responsible for the well being of the other—of the adult.
This last argument for social development within contexts such as the family has been echoed in another forum by Judith Rich Harris (The Nuture Assumption: Why Children Turn Out the Way They Do, New York: Free Press, 1998). Harris was rejected from admission into the experimental program at Harvard by the then psychology chairperson George Miller. However, twenty plus years later, Harris was given the most distinguished award for research by the American Psychological Association and the person who rejected her from Harvard presented the prize! Harris argued that genetics accounted for much more than did loving environments and careful nurturing. She further argued that studies that favored nurture were biased because of study demographics that weighed against heredity. However, she did accept that nurture played a role to permit genetics to penetrate into an environment and it is this aspect of human development that currently is being investigated brilliantly by neo-Piagetians—especially in France, Switzerland and the province of Quebec in Canada.
Some theorists have conceptualized individual development from the perspective of language and genetics combined to equate to benchmarks. Lev S. Vygotsky, for example, stressed culture while he was keenly aware of heredity. William James, the American Pragmatist philosopher, psychologist, and medical doctor argued for radical empiricism, so that thought-language-development were part of a continual flow between a person and his or her culture/environment. The latter Wittgenstein’s arguments as well as those from Noam Chomsky could be conceived this way. Exceptions would be the American operant behaviorist Burrhus Frederick Skinner and to some extent the philosopher of social science Paul Watzlawick since they paid little attention to genetics.
Studies of the family have evolved from the early work of Ackerman with a psychodynamic emphasis to that of first order cybernetics theorized by von Bertalanfy wherein a system tried to keep itself in balance. In a family system a therapist either observed or became a participant observer (e.g., Harry Stack Sullivan). Bateson, Haley, Jakcson, and Papp at Mental Research Institute at Stanford in the Sixties generally followed the lead of Milton H. Erickson and his work with individuals. While Bateson could be considered the father of double-bind or circular questioning theory, Erickson often prescribed just that bind but called it paradox. The early MRI workers recognized that families developed rules or games that often led them into chaos or worse situations, yet situations that were homeostatic. The early family therapist, then, tried to shift problem conception from the individual to the interaction between individuals. Whereas Bateson recognized that any family member could be part of a double-bind, such as telling a child to become independent but not permitting that child to explore her neighborhood environment, Milton Erickson’s colleagues would prescribe the symptom to help the family members who were maintaining the bind to recognize it and to break it. In the example given of independence-dependence for the female child, the family therapist at MRI might ask the parent to keep the child even closer, to watch her every move, and to record observations in writing with voluminous detail. These so called strategic models emphasized paradoxical intention, and it was some psychiatrists in Milan—the so called Milan School—who first brought this treatment model to Europe. Conversely, and now within an era of post-Milan systemic epistemology, two of the original four members of the school, Boscolo and Cecchin, have transported their model of circular questioning throughout Europe and back to North America.
Now, Boscolo and Cecchin and their colleagues argue that the therapist {should} become part of the family system to offer advice, cause perturbations, and to influence it as a neutral party—a person who differs from a prescribing or observing expert. Change is a by-product. By doing so, Boscolo & Cecchin et al have argued (1987) that second order cybernetics have replace first order cybernetics. It will be recalled that Jackson and the MRI group at Stanford argued that the family in trouble was like a homeostatic machine. Symptoms played a part in maintaining that homeostasis. Second order cybernetics argue for the observed and the observer to become one huge mass and that it is probably better to do away with family systems arguments and to think instead of the family as a meaning system in which the opinion of the family counselor is as good as anyone else’s opinion. Here, the post-Milan group joins the thinking of Chilean biologist and philosopher of science, Humberto Maturana. Thus, the family system does not create the problem: it is the problem that creates the system. An example of this last might be statistics concerning the divorce rates in places like Bihor County, Romania. People with severe problems or lack of togetherness skills get together 50% of the time in marriage as evidenced by the divorce rate bearing that statistic to confirm it.
Albert Ellis was born in Pittsburgh in 1913, and he currently lives in New York at the Institute which bears his name. He is 92. Ellis can best be described as a rebel against dogmatism in print, a rebel against many cultural norms, and a rebel against thinking systems and epistemologies that are not open to the possibility of change. After having completed his doctorate in psychology at Columbia University in New York in 1947 he decided to work in psychotherapy. The three prevailing metaphors for human mental-emotional change at the time were Rogers’ school of nondirective therapy (Rogers also having been a Columbia graduate), behaviorism, and psychoanalysis. Ellis opted for psychoanalysis, and his own actions proved that he was less prescient about Freud and Freud’s offspring than he had been about Marx twenty years earlier. While in his late teen years, Ellis committed himself to organizing for communism or socialism as it was known in America politically. While still in his young adult years, Ellis wrote a half million word tome on why communism would fail: he judged it to be top heavy with leadership that would create bureaucracy which would doom the social movement to implosion. That is approximately what happened some sixty years later. It took Ellis much less time to revise or try to operationalize Freud’s metaphor, however. He began to challenge psychoanalysis after revisionist training in that discipline, and he quipped that if patients got better while in psychoanalysis it was in spite of it not because of it.
Ellis was working with a woman client who had been beaten by her father when she was a child. She took job interviews but failed to gain employment complaining that she was afraid of male job interviewers. She attributed her fear to her father who had beaten her, the original authority figure in her life. Ellis commented to her that her father was dead. She, in return, said, effectively, “You mean it is not my father who is disturbing me today but what I am saying today about what happened in the past?” Ellis replied in the affirmative and he added that she, the client, kept indoctrinating herself to her false belief about her father being a continuing influence in her life when it was what she was saying that day about her father’s past behavior. Those two factors gave Ellis pause and from them he developed fifty years ago last year the cognitive revolution in psychotherapy. Ellis in the late 1980s and early 1990s was quoted more often than was Freud by counseling and psychotherapy professionals and he was then the most popular living psychotherapist. He is the father of REBT—rational-emotive behavior therapy—and the grandfather of CBT or cognitive behavior therapy.
In 1957, Ellis wrote his first best seller, How to Live with a Neurotic. That initial marriage and family therapy text, aside from text about sex and sexual fulfillment, introduced Ellis’s arguments for low frustration tolerance, or discomfort anxiety (DA). Just as Boscolo and Cecchin theorized fifty years after Ellis, he argued that it was the problem that created the system. If one spouse in a couple changed, argued Ellis, the marriage or system would change. Ellis had not accepted the idea that pathology stabilized a bad situation into homeostasis since he was not interested in some thin balance line. Instead, Ellis was interested in a broad based calmness that some have mistaken for Stoicism since Ellis CLAIMED TO HAVE read Epictetus and Marcus Aurelius when he was a boy. From calmness, not flatness, Ellis judged that people more often could aim for limited hedonism or joy rather than achieve them from homeostasis. It could be argued that Ellis was mistaken in his hedonic calculus, but the mean he chose was more Aristotelian or broadly balanced than homeostatic.
Several philosophical changes have come to Ellis and his work over the years. First, in 1976 and thanks to the work of Michael Mahoney in Scientist as Subject, Ellis abandoned philosophical positivism or logical empiricism because he judged it to be non-scientific and dogmatic. Second, in 1988 at Oxford, Ellis accepted limited construction as a complement to structuralism. Thus, we humans create our own misery as well as our own limited hedonism. Both are built on heredity which penetrates into the environment. He judged that neurotic behavior was at base genetic as well as learned or constructed.

Charles Huber was among the first REBT-CBT family therapists. He has been joined by others including Judith Beck and Frank Datillio. Pastoral counselors such as John Powell and Steve Johnson have adopted Ellis’s idea of discomfort anxiety to their work, while McMahon (in press) has written about some of Ellis’s ideas having predated those of John Gottman in his marriage and family programs and Sue Johnson in her theory of emotionally based marital intervention.
An example of DA used to help achieve family harmony and happiness came when the Smiths, a fictitious name, asked to see me. When I asked the family, “If you got along better, what would be happening that isn’t happening now?”, the father said that his daughter would come home when she was told to be at home on school nights (she was 15), and that the two boys (11 and 13) would quit using foul language and talking back to their parents. I saw no homeostasis or balance, and it seemed to me that the family would permit me to join them. The children even asked how I would like to have parents like the ones they had! When I ventured to disturb the meaning system in place by pointing out that problems were giving meaning to the name family, the concept of DA was invited. The teenage girl learned that she could tolerate being uncomfortable temporarily by coming home on time. That permitted her to study for a little while each night so that her school grades improved from D or below average to C or average. The two boys learned that they could be uncomfortable temporarily by using no foul language. For each day they succeeded, they were given money in a savings jar. The oldest boy wanted to use his money to join in a class trip to Washington DC, while the younger boy wanted to buy hockey equipment. The foul language was gone almost from the start. As for the parents, they went out of their way to catch their children doing something well and to praise them for it. That took effort, but they learned that by being uncomfortable temporarily they too could help build a meaning system that was not based upon problems and one that was based upon solutions.
Thus, a philosophically derived concept, DA (also called LFT or low frustration tolerance) has been used in work with families successfully to achieve goals that the family members themselves thought to be worthwhile.
Post Script: A very close family therapy fit to the philosophy of Levinas that was originally generated in Central Europe is that of Contextual Therapy featuring Relational Ethics and the Family Ledger as developed by Ivan Bosormenyi-Nagy MD. Bosormengy-Nagy, a medical doctor with some psychoanalytic training, left Hungary to settle in Philadelphia in 1948. His original work with a team was to learn about the genetic basis of schizophrenia within families. While his hypothesis eventually was supported by others, his own work with his team led to the concept that lack of trust, especially intergenerationally, was the key issue in explaining family dysfunction. The trust could best be explained in lack of loyalty, inability to express oneself within family context, and refusal to take responsibility for the other—to use Levinas’ term. One of Bosormengy-Nagy’s followers, Ulrich, provided an example of “destructive entitlement” which is paraphrased from Goldenberg and Goldenberg (Belmont, California: Brooks/Cole, 2000). A child may try to take from an innocent party what she was not able to obtain from parents. Sometimes the child may punish other people for his or her wounds. While the claims of the children in the examples may be just, their targets are not. As we saw concerning Ellis, and while the concepts of trust and loyalty from Bosormenyi-Nagy are extremely important, a core issue in each example is the inability of the children to have learned or yet to have learned high frustration tolerance or how to be uncomfortable in order to build family loyalty and trust.


  • Ellis, A. (1994). Reason and Emotion in Psychotherapy (2nd ed.). New York: Carol Publishing.
  • Ellis, A. (1996). Better, Deeper and More Enduring Brief Therapy. New York: Bruner/Mazel.
  • Sahakian, W. (1968). The History of Philosophy New York: Harper Perennial (Harper Collins Publishers)

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