Running head: THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT
A Theoretical Comparison of Psychoanalytic Theory and Rational Emotive Behavioural Therapy (REBT): Philosophical, Descriptive, Prescriptive, and Evaluative Considerations
Shelina Hassanali (00273150) EDPS 602 October 30 th , 2013 2 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT
Introduction In order to facilitate client change, many different theories of psychotherapy have been proposed for therapists to utilize with clients, with each having its own merits and potential drawbacks. This paper will compare and contrast two such theories, namely psychoanalysis and rational emotive behavioural therapy (REBT). As discussed in the EDPS 602 course notes (The Nature of Theory, n.d.), the four central elements of any sound theory are the philosophical, descriptive, prescriptive, and evaluative elements. This paper will compare psychoanalytic and REBT therapies in these four areas. Philosophical Element The base of any psychological theory is its philosophical element; that is, the implied assumptions which appear to be present in the theory (The Nature of Theory, n.d.). These implied assumptions are the foundation of the theory, as all other aspects depend on them. We will first consider the philosophical elements of psychoanalytic theory. Psychoanalytic Theory In the case of psychoanalytic theory, it is assumed that all humans are motivated by wishes, dreams, fantasies, or other sources of unconscious motivation (Wedding & Corsini, 2014). In other words, humans are not always conscious of the internal factors which drive their behaviours. Psychoanalytic theory also assumes that both primary and secondary processes exist, with primary processes being those unconscious dreams and fantasies which operate from birth and secondary processes being conscious, logical and reflective thinking. There is also an assumption that generally, we tend to avoid uncomfortable or threatening feelings, fantasies and thoughts, both conscious and unconscious (Wedding & Corsini, 2014). Psychoanalysts assume 3 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT that in order to avoid these uncomfortable feelings, we utilize defenses. It is assumed that people are often unaware of their defenses to these internal motivations, and that they require assistance (i.e. therapy) to recover and/or realize these (Wedding & Corsini, 2014). Rational Emotive Behavioural Therapy As compared to psychoanalytic theory, REBT seems to have many more underlying assumptions. The assumption most pertinent to the theory is the idea that people are born with the biological predisposition to be rational and irrational (Wedding & Corsini, 2014), and that irrational cognitions or beliefs lie at the centre of human disturbance (DiGiuseppe, 2009). Another assumption of the theory as proposed by Ellis (1976) is that all humans have a basic drive to stay alive and be reasonably happy and free from pain, which is a commonality with psychoanalytic theory. According to REBT, rational thinking aids in reaching goals and irrational thinking leads to blocking or sabotaging them (Ellis, 1976). While it is suggested that most individuals have a limit to their reasoning powers, proponents of the theory suggest that these powers can be increased by direction from an REBT therapist (Ellis, 1976). REBT theorists also propose that people are born constructivists, with the ability to change their own social and personal destinies. Also, it is assumed that humans perceive, think, emote, and behave simultaneously (Wedding & Corsini, 2014). In other words, an individuals actions are not separate from their perceptions, cognitions, and emotions. Instead, these processes are all occurring at the same time and having a direct and immediate effect on one another. REBT therapists also assume the humanistic principle of unconditional acceptance; that is, a person should inherently possess the ability to accept their particular situation for what it is and to examine it rationally (Wedding & Corsini, 2014). Another philosophical assumption upon which REBT rests is that of commitment to the scientific method; that is, the idea that testing 4 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT assumptions, examining functionality of beliefs, and willingness to change certain variables will result in less emotional disturbance and ineffectual behaviour (DiGiuseppe, 2009).
Descriptive Element The descriptive element of a theory is the way in which it explains information and phenomena and the way in which it answers the question of why something is occurring (The Nature of Theory, n.d.). This is an important element to consider because a belief regarding why something exists will inevitably have an effect on how the behaviour/situation is changed. Psychoanalytic Theory Psychoanalytic theory has a strong descriptive element, with a focus on the historical basis of why certain behaviours occur. A psychoanalyst would suggest that our behaviour can be explained by our unconscious motivations (Wedding & Corsini, 2014). They posit that individuals cut off awareness of impulses, wishes and memories because they are too threatening or because they have learned, over the years, that these motivations are unacceptable or inappropriate. Psychoanalysts also believe that behaviour is sometimes a defense which is used to avoid emotional pain. In regards to personality, proponents of this theory would argue that personality styles exist because of a compromise between our underlying wishes and our styles of defense which are used to manage these wishes (Wedding & Corsini, 2014). Psychoanalytic theory also attributes behaviour to the clients conscious or unconscious repression of undesirable negative feelings. Repression is part of the descriptive element of psychoanalytic theory because the repression of mental contents is asserted to play a causally necessary role, it is deemed crucial to the production of neuroses and psychosesand to the 5 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT generation of bungled actions by diverse hidden motives of displeasure (Grunbaum, 2001, p. 106). Another aspect of the descriptive element is the extent to which the theory explains differences across gender and culture (The Nature of Theory, n.d.). According to Wedding & Corsini (2014), psychoanalytic theory considers the role of unconscious biases and prejudices about race, culture, and class. The authors also suggest that therapists learn about racial and cultural differences and adapt treatments for their clients, which is reflective of the importance which psychoanalytic theory places on building rapport and a strong therapeutic alliance. Rational Emotive Behavioural Therapy The descriptive element of REBT seems to be simpler than that of psychoanalytic theorists. In REBT, it is suggested that disturbed emotions, maladaptive behaviours and negative consequences are caused by irrational beliefs (Wedding & Corsini, 2014). The theory states that it is not specific antecedents which cause consequences; rather, it is our beliefs related to those antecedents which cause the consequences. In other words, unfavourable behavioural and emotional consequences are a result of irrational beliefs held by individuals rather than activating events themselves (DiGiuseppe, 2009). REBT theorists also consider the role of culture and believe that irrationality and self- defeating beliefs are often exacerbated by culture and family. It has been suggested that culture and family play a large role in determining what an individual will have strong beliefs about, and subsequently, what they will become upset about (DiGiuseppe, 2009). They also state that while they challenge and dispute client beliefs, it is not the role of the therapist to dispute cultural 6 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT goals, values, and ideas. In this respect, it seems that both psychoanalytic and REBT models share an inherent respect for various aspects of culture. Prescriptive Element The prescriptive element of a theory is important in that it is the part which suggests certain actions for change (The Nature of Theory, n.d.). This element is integral because the goal of therapy is to facilitate client change in some way, and so the actions prescribed by the theory directly influence client engagement and change. The prescriptive elements of both theories are considered below. Psychoanalytic Theory In the case of psychoanalytic theory, the main goal of therapy is to make the unconscious conscious (Wedding & Corsini, 2014, pg. 41). The theory states that in order to create positive change, the client must become aware of conscious and unconscious psychological processes and actions which may be self-defeating. This realization, according to psychoanalysts, is achieved by the creation of a therapeutic alliance in which there is a collaborative relationship between therapist and client (Wedding & Corsini, 2014). The majority of work and action occurs during the therapy session itself and is a result of the positive relationship with the therapist. Through this relationship, change is facilitated by interpretation of unconscious motivations, patterns, and experiences (Wedding & Corsini, 2014). In addition, stories and experiences are historically reconstructed in order to create meaning for the client. It is the psychoanalytic theorists perspective that increasing this awareness of unconscious motivations works to increase client choice in the present and future, which then changes outcomes. Therefore, as compared to REBT, psychoanalysis focuses more on increasing 7 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT awareness of psychological processes which occur while individuals respond to internal stimuli and external events (Bornstein, 2010). To increase this introspective access and to aid in making the unconscious conscious, psychoanalysts use methods such as free association, dream analysis, and other related activities which increase the clients capacity to access previously inaccessible memories (Bornstein, 2010). This approach is quite different than that of REBT, to which we will now turn our attention.
Rational Emotive Behavioural Therapy The prescriptive element of REBT is centered on the main goal of disputing and eventually eliminating irrational beliefs (Wedding & Corsini, 2014). To do this, the therapist teaches the client to learn the ABCs of emotional disturbance (activating events, beliefs about those events, and resulting emotional consequences (DiGiuseppe, 2009). According to descriptions of the REBT model, Change is difficult, and people change only with repeated efforts to challenge their dysfunctional thoughts and rehearse new, rational, adaptive modes of thinking (DiGiuseppe, 2009, p.130). Client change and action occurs as the therapist challenges and disputes illogical and irrational beliefs, and also freely provides suggestions and advice to the client. Due to the nature of dispute itself, as well as the ability of the REBT therapist to provide advice, the relationship between therapist and client is sometimes more direct as compared to psychoanalytic theory. REBT therapists state that a warm relationship is desirable, but not necessary (Wedding & Corsini, 2014), which is different than the importance of positive, collaborative relationships which are stressed in psychoanalytic theory. However, it has been suggested that failure to address therapeutic components of the therapist-client relationship in a direct therapy such as REBT could result in dropout or therapy failure (DiGiuseppe, 2009). 8 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT The action for change which is prescribed by REBT is two-fold; first, the client must change unrealistic, self-defeating thinking and then he/she must put those changed thoughts into action by carrying out certain tasks. Therefore, as compared to psychoanalytic theory, much more action is prescribed outside of the office setting by means of concrete homework assignments (Wedding & Corsini, 2014). Examples of actions include behaviour modification, modeling, role play, psycho-educational readings, assertion training, rational emotive imagery, rehearsal, desensitization, and operant conditioning (DiGiuseppe, 2009; Ellis, 1976; Wedding & Corsini, 2014). It has been suggested that REBT provides both practical and emotional solutions, with the former focusing on problem-solving and skills development and the latter focusing on changing emotional reactions (DiGiuseppe, 2009). As compared to psychoanalytic theory, it appears that REBT has a stronger, more active prescriptive component for the client both during and outside of the therapy setting.
Evaluative Element The evaluative element of theories, which is often overlooked, is as important as the other elements because this is what tells us if what we are doing actually works. The main question addressed by this component is whether or not the therapy approach is successful in helping clients to meet their goals (The Nature of Theory, n.d.). Psychoanalytic Theory As one of the main assumptions of this theory is that unconscious processes motivate behaviour, any evaluation of the theory would need to examine this argument. That is, we would need to evaluate whether or not an approach which claims to improve client outcomes by increasing client choice due to examination of unconscious motivation, defenses and recreation 9 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT of meaning actually works. According to Wedding & Corsini (2014), psychoanalytic theory has been the subject of some criticism due to its lack of receptiveness to empirical research and criticism. That said, there have been many randomized control trials which have found substantial effect sizes for the efficacy of psychoanalytic approaches to therapy (Wedding & Corsini, 2014). In terms of evaluating long-term psychoanalysis, it has been suggested that this is more easily evaluated using naturalistic studies as opposed to randomized control trials used to evaluate short-term psychoanalysis (Wedding & Corsini, 2014). Rational Emotive Behavioural Therapy Evaluations of REBT focus on the role of irrational and rational beliefs on behaviour. If replacing irrational beliefs with rational ones has a positive impact on behaviour and outcomes, it would mean that the theory has merit. It has been reported that several scales have been created to assess irrational beliefs, and many studies have found that REBT has high effectiveness and efficacy (DiGiuseppe, 2009). Of these studies, hundreds have found positive results linking irrational beliefs with negative outcomes, including depression (Macavei, 2005). The effectiveness of REBT for other issues such as anxiety, public speaking and anger has also been shown (DiGiuseppe, 2009). REBT may be more easily evaluated due to the concrete homework tasks and tracking of behaviours which occurs during treatment. For example, if a client is working on anxiety reduction for public speaking, tracking forms which provide data related to public speaking attempts and associated anxiety levels may then be used for evaluation of therapy. In the case of psychoanalysis, it may be more difficult to evaluate exactly which mechanism of therapy was 10 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT most effective as there is no exact way to measure how much more conscious (or less repressed) a clients motivations are. Conclusion As evidenced by the above discussion, psychoanalytic and rational emotive behavioural therapies are quite distinct in their philosophical, descriptive, prescriptive, and evaluative elements. Psychoanalytic theory proposes that it is our unconscious dreams, fantasies, and desires which motivate behaviour, and that these are mediated by the meaning we create and the defenses which we consciously or unconsciously use (Wedding & Corsini, 2014). REBT, on the other hand, states that behaviour and outcomes are caused by rational or irrational beliefs and thoughts about certain antecedents. Psychoanalysts believe that by exploring, interpreting, and recreating meaning of unconscious motivations, we increase client choice and therefore improve outcomes. In contrast, REBT therapists state that change is created by disputing irrational beliefs and illogical thinking (Wedding & Corsini, 2014). Therefore, it appears that for psychoanalysis, there is more of a focus on the past, while REBT has more of a focus on the present. It seems to be the case that there are more prescriptive ideas presented in REBT as compared to psychoanalytic theory, where clients are required to be much more active in therapy as well as between therapy sessions. In terms of the evaluative component, it appears that both theories can be tested to see if they work and there is strong supporting evidence in the literature for the efficacy of both treatments. Overall, it would appear that psychoanalysis and rational emotive behavioural therapy are both sound theories for facilitating client change. The choice between the two would ultimately depend on therapist preference and style as well as the clients presenting situation. 11 THEORETICAL COMPARISON OF PSYCHOANALYSIS & REBT References Bornstein, R.F. (2010). Psychoanalytic theory as a unifying framework for 21 st century personality assessment. Psychoanalytic Psychology, 27(2), 133-152. Ellis, A. (1976). Answering a critique of rational-emotive therapy. Canadian Journal of Counselling and Psychotherapy, 10(2). Retrieved from http://cjc.synergiesprairies.ca/cjc/index.php/rcc/article/view/1721 DiGiuseppe, R. A. (2009). Rational-emotive behavior therapy. In Kazantzis, N., Reinecke, M.A., & Freeman, A. (Eds.), Cognitive and behavioral theories in clinical practice (pp. 115-147). Guilford Press. Grunbaum, A. (2001). A century of critical analysis: critical retrospect and prospect. International Forum of Psychoanalysis, 10(2), 105-112. doi:10.1080/080370601300177188 Macavei, B. (2005). The role of irrational beliefs in the rational emotive behavior theory of depression. Journal of Cognitive and Behavioral Psychotherapies, 5(1), 7381. Sperling, M. B., Sack, A., & Field, C. L. (2000). Psychodynamic practice in a managed care environment. New York: Guilford Press. The Nature of Theory [Course Handout]. (n.d.). Retrieved from https://blackboard.ucalgary.ca/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fb lackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_155723_1%26url%3d Wedding, D., & Corsini, R.J. (2014). Current psychotherapies (10 th ed.). Belmont, CA: Brooks/Cole.
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