Dr. Di Loreto’s excellent study ably demonstrates that the effectiveness of different types of psychotherapy can to some degree be measured, and I certainly hope that more studies of this kind become prevalent in the psychological literature. However, since his investigation included a limited number of clients (twenty) in each of three therapeutic groups and only two counselors from each approach or “school,” it would be interesting to see it duplicated with more clients and counselors. Otherwise, conclusions from the study (as is true of most psychological experiments) are of dubious generality.
What of the effectiveness of Rational-Emotive psychotherapy, as indicated by Dr. Di Loreto’s thesis? Naturally, I am gratified to note that in only ten group therapy sessions, led by young counselors who were hardly intensively trained in Rational-Emotive methods, this technique which I originated came off so well, particularly in regard to introverted clients— who not only reduced their interpersonal anxiety as much as they did with systematic desensitization but who also showed a significantly greater increase in interpersonal activity. As Dr. Di Loreto notes, “The benefits which accrued from the RT treatment approach did appear to be more quickly implemented into activity outside of treatment than those resulting from SD.”
Several other favorite Rational-Emotive hypotheses seem to be supported by the data of this study; namely, that Client-Centered counselors proved to be less active verbally than RT counselors : that “cognitive revamping” did prove to be an effective therapeutic method: that introverted clients definitely need prodding and were “quite inactive when left to their own devices” : that activity oriented homework assignments, to be done by the client in between the therapeutic sessions, proved to be highly workable and efficient: and that Rational-Emotive therapy actively teaches self-exploration, which was found to be most helpful in this study.
Although RT did not prove to be terribly effective in regard to extroverted clients, this is hardly the handicap it might at first appear. For one, most experienced therapists seem to acknowledge that introverts are much more common in actual therapeutic practice than are extroverts. A study by Mendelsohn and Kirk (1962), for example, shows that “compared to the nonclient subjects, the students who seek counseling score less toward the judging side, more toward the intuitive side, less toward the feeling side, and more toward the introversion side of the respective dimensions.” These investigators employed the Myers-Briggs Type Indicator to measure introversion-extroversion—the very same test that Dr. Di Loreto used in the present study. Similarly, Hammer (1968) states that, “While the extrovertive patient may look for therapy to supply little more than symptom removal, the more introspective individual hopes for more including the possibility of an inward vision.”
Even more significant to me than the fairly good results obtained with the Rational-Emotive approach used in this study is the fact that the specific technique employed was an exceptionally watered-down version of RT that is undoubtedly based on my own theory but that only modestly resembles much of the clinical practice that we teach at the Institute for Advanced Study in Rational Psychotherapy. The method that Dr. Di Loreto’s RT counselors used, as he indicates in the appendix, ( 1 ) is much too generally didactic and lecturing and does not seem to make much use of the specific clinical examples that are constantly employed in actual RT: (2) wrongly tells the client that the irrational ideas he keeps telling himself are learned when actually [as I indicate in Reason and Emotion in Psychotherapy (Ellis, 1962)], the tendency to believe them is probably inborn: (3) never seems to stress the great difficulty and the enormous amount of everyday practice that the client will probably have to undergo to overcome his severe tendencies toward irrational thinking: (4) emphasizes a warm, interested, and helpful, rather than a hard-headed, no-nonsense-about-facing-reality attitude on the part of the therapist: (5) does not, as far as I can see, specifically show the client why his basic philosophical assumptions are untenable and what he can do about constantly challenging them: (6) does not particularly stress the highly-important non-blaming aspects of RT, nor the corollary point that human beings cannot be legitimately rated and that even “ego-bolstering” or “self-esteem” are inappropriate and irrational constructs: and (7) makes relatively little use of the therapist’s active-directive, Socratic dialoguing approach.
At the same time that Dr. Di Loreto’s RT counselors kept employing a highly pale and wan Rational-Emotive approach, his Systematic Desensitization and Client-Centered counselors (ironically enough!) kept using what I would consider to be some highly effective RT-flavored methods. Thus, his SD treatment group was told, “The more you avoid people and interpersonal situations, the more anxious you get.” They were also given some time each session for verbal interchanges among clients and between clients and counselor, which “was not limited exclusively to treatment related material,” and “during the last few minutes of each session following the successful completion of an item, the Ss were aroused and reactions to images, etc. were discussed.” Also, in a typically Client-Centered manner, each SD “counselor was instructed to maintain a warm, interested, and helpful attitude.”
As for the Client-Centered counselors, instead of merely giving their own feelings about their clients, confronting him, and reflecting his feelings about himself, they were instructed to use highly didactic methods that have an exceptionally strong RT quality. Thus, they were told that an individual “doesn’t have to feel guilty and thus pretend he is interested or blame himself or his friend for making him bored. He simply uncritically accepts his feeling of boredom. He is being honest with both himself and his friend by conveying his boredom to his friend, not with the intent of blaming, but with the idea of ‘Let’s make this unboring! ‘ “ And again: “But this is how you learn to listen uncritically, you focus on what, “ in fact, is coming across to you, not on classifying it as good or bad, right or wrong, etc. This holds even for feelings of anger. If they are there, then trying to decide if they are important, bad, etc. makes no sense. They’re just there. . . .If you are less blaming and less condemning, people are going to feel freer and more at ease in communicating with you about their feelings.” These so-called “Client-Centered” methods mirror, in fact almost ape, much of the material I included in Reason and Emotion in Psychotherapy and which I actively demonstrate to individual and group clients, to workshop and marathon participants, and to other RT-sponsored therapy gatherings all over the country.
It is not exactly remarkable that the philosophic cores of Rational-Emotive and Client-Centered therapy significantly overlap, in that both teach individuals how to unconditionally accept themselves and others. In fact, Harry Bone (1968) has clearly noted this overlap in an important paper on interpretation in psychotherapy. However, one of the main differences between the two systems is that RT counselors directly, actively, and concretely teach their clients non-damning philosophies of life, while CC counselors presumably do so by existential encounters and by highlighting their own personal ‘ feelings. Dr. Di Loreto’s CC counselors, however, seem to be almost as didactic and argumentative, at least in their first instructions to their clients, as are his RT counselors: and his SD counselors are not too far behind in these respects, either.
I might well contend, in other words, that while the SD and CC counselors in this study tended not to stick to their own lasts, but to use explanatory, challenging, and other approaches that are more traditionally allied with the Rational-Emotive approach, Dr. Di Loreto’s RT counselors stuck much too closely to a very narrow definition of RT and omitted some of its most powerful philosophical and confronting methods. This does not mean that the basic RT methodology was badly neglected or violated, nor that some of the results favoring the SD and CC systems would have been quite different had the counselors in each school more rigorously stuck to their own last. But, of course, one wonders.
Assuming that the results of Dr. Di Loreto’s study prove to be more broadly duplicated and hence valid, the question arises: Why did RT do relatively badly with the extroverts? Some hypotheses I might set forth here include the following: (1) The extroverts were more defensive, more complusively acting out, more disturbed, and less inclined to listen to reason than were the introverts. Consequently, they resented therapists who were more actively trying to teach them, or talk them out of, their upsetness and preferred to “listen” to therapists who were warmer to them (the CC counselors) or who didn’t bother to talk to them too much at all (the SD counselors). (2) Because of their severe disturbances and their basic unwillingness to work at changing themselves, the extroverts preferred types of therapy which helped them feel rather than get better, as Hammer (1968) intimates. They preferred to have their dire love needs catered to rather than to look at and uproot their symptom-creating, basic philosophies. (3) In order to change their basic attitudes to a significant degree, the extroverts (who tend to be more difficult clients) would have required Rational-Emotive counselors who were distinctly more effective than those who were employed in Dr. Di Loreto’s study. Actually, they had one counselor, r, who was inexperienced, and who turned out to be no more effective in reducing self-reports and behavior ratings of anxiety with extroverts than the group receiving simple attention or no treatment at all, and counselor R, who was considerably more effective. If they had had two counselors as effective (or even more effective) as counselor R, the results of Dr. Di Loreto’s study would have presumably been much different.
Assuming, again, that the results of Dr. Di Loreto’s study turn out to be duplicatable and valid, the question arises: Why was the RT approach that was used in this study so effective that “in terms of changes in target behaviors outside of the treatment setting (it) appears to have produced a greater increase in interpersonal activity” than the SD and CC approaches, while at the same time it was not similarly as effective in producing the greatest amount of anxiety reduction except in introverted clients? Aside from the reasons given in the preceding paragraph, another important possibility exists; namely, that for the length of time this study continued, increase in interpersonal activity and anxiety reduction were to some extent incompatible. That is to say, some individuals who are induced by the therapeutic process to do their homework assignments and to increase their interpersonal activity in areas where they are notably anxious (e.g., to order a cup of coffe in a restaurant and to tell the waitress they have changed their mind and now want a coke) will at first be expected to feel more anxious than if they do not carry out this assignment, although ultimately they may become less anxious about these assignments and about similar activities. Consequently, the fact that Dr. Di Loreto’s RT clients did so well in their interpersonal activity but not as concomitantly well in their anxiety reduction may be the result of their not acting in a risk-taking manner for a sufficiently long enough time to prove to themselves that it is not terrible for them to make mistakes or to be criticized. In actual Rational-Emotive therapy, it is frequently found that clients at first become more anxious as they think about taking or actually take outside risks. However, the more they actually do what they are afraid of, the more their anxiety decreases. To some degree, time is the essence of personality change in these particular clients, and Dr. Di Loreto’s study was, of course, deliberately time-limited.
In this respect, it is easy to draw an essentially false conclusion from the present study: namely, that individual clients tend to be so different that one type of therapy may well work best for a given client but not work at all well for another, and that, therefore, a therapist would better be trained to be fairly eclectic, or to employ a large variety of techniques within the framework of his fairly consistent theoretical system, so that he is able to work well with many different types of clients. I am reasonably sure, from my own quarter of a century of therapeutic practice, in the course of which I have used several different basic approaches (including Freudian, Ferenczi warmth-giving, and Rational-Emotive techniques), that there is some validity to this idea. Consequently, I have incorporated into the Rational-Emotive methodology a wide range of perceptive-cognitive, experimental-emotive, and activity-behavioristic techniques (Ellis, 1969a, 1969b). I have also pointed out (Ellis, 1968) that practically all existing schools of psychotherapy, including the Client-Centered and the Behavior Therapy schools, are really somewhat comprehensive systems, in that they include cognitive-emotive-behavioristic elements. This does not mean that they (or Rational-Emotive therapy) are eclectic, for most schools have a somewhat consistent theory of personality and of treatment, and the varied approaches they employ stem somewhat from their system, rather than from purely pragmatic considerations.
Thus, RT (in its full form, though not in the truncated manner in which Dr. Di Loreto’s counselors employed it) deliberately uses dramatic-emotive methods (such as down-to-earth language and direct and sometimes humorous assaults on a client’s irrational ideas) and uses Behavior Therapy methods [such as homework assignments and teaching the client to reinforce himself by employing Premack’s (1965) principle] in order to help him change his ideas, and it is consistently ideologically or philosophically oriented in virtually every technique that it utilizes.
The main point I would like to make here is that although clients are individually different and can sometimes be categorized (as Dr. Di Loreto categorizes them) into distinct personality types, and although one specific technique (such as persuasive discussion) may seem to work better with a certain client than another technique (such as the therapist’s revealing his own true feelings), it is still quite probable that (1) one technique will be more effective most of the time with more clients than will another, that (2) this same technique will usually help bring about more elegant or “deeper” solutions than will an alternative method, and that (3) this same technique, if practiced by competent therapists for a sufficiently long period of time, will achieve better results than an alternative method which over a shorter period seems to work better.
It will be noted, for example, that proponents of classical psychoanalysis have tended to uphold the last two of these hypotheses, and sometimes even the first, in regard to the value of their own methodology. I do not think that there is any empirical evidence to sustain their views; but as yet there isn’t very much evidence to refute them either. What I am suggesting is that after a number of studies such as Dr. Di Loreto’s pioneering experiment have been done—and the more the better, in my estimation—a group of further studies be instituted to test the above hypotheses. Meanwhile, we can only be grateful for Dr. Di Loreto’s investigation and for some of the most interesting data, conclusions, and hypotheses for future testing that it presents.
*Executive Director of the Institute for Advanced Study in Rational Psychotherapy, New York, New York.
Bone, H. Two proposed alternatives to psychoanalytic interpreting. In Hammer, E. F. (Ed.), Use of interpretation in treatment. New York: Grime & Stratton, 1968, 169–196.
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