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Blog post: 15th June 2020

Distinguishing Emotive-Cognitive Embodied Narrative Therapy (E-CENT) from REBT/CBT

By Dr Jim Byrne

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Preamble

The most fundamental difference between E-CENT theory and REBT/CBT theory is their models of human disturbance.

Albert Ellis, the creator of REBT, and the grandfather of general CBT, rejected the simple Stimulus-Organism-Response (SOR) model of neobehaviourism, and Freud’s It/Ego/Superego, and substituted his own simple ABC model.

The simple SOR model assumed that, every time a stimulus impacted an organism, an adaptive response, based upon prior conditioning, was emitted or produced.  If a person saw something which had previously frightened them, then they would respond with fear. But if the same stimulus had previously angered them, then they would respond with anger.

The simple ABC model dumped the role of experience, conditioning, and habit formation, and replaced those experiential psychological processes with a single concept: Beliefs! 

I have produced an extensive critique of the ABC model of REBT, in my main book on REBT, which is ‘A Major Critique of REBT’. What follows is a brief extract from Chapter 2 of that book:

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Introduction

Let us now take a look at the ABC model of REBT – which is the core model that not only determines the shape of each intervention by an REBT therapist, but which also structures the entire 45 minutes of time spent with each client.

To repeat what was said above, the ABC model is normally presented like this:

# The ‘A’ stands for an Activating event, or stimulus, which results in some kind of response from an individual.

# The ‘B’ stands for the Belief system of the individual (which includes distinctions to do with whether the individual is:

(a): Being (1) ‘demanding’; versus (2) merely ‘preferring’ something;

(b): Expressing (1) ‘awfulizing’ (which means [in REBT – but not in the Oxford English Dictionary] describing something as totally bad); versus (2) merely saying something is some small degree of badness;

(c): Implying (1) that they ‘cannot stand’ something at all; versus (2) the idea that it is merely difficult to stand it; or:

(d): Engaging in (1) condemning or damning of self, others or the world; versus (2) merely being critical of their own behaviour, the behaviour of others, and/or some features of the world/reality).

# The ‘C’ stands for the Consequent emotions (and/or behaviours) that are assumed to arise out of the interaction of the ‘A’ multiplied by the ‘B’ above.  At least, that is a form of the ABC model, which arose at some point in the evolution of the theory.  This interactional model is expressed by Windy Dryden (1999) like this: “…the C’s (consequences – JB) … follow from irrational beliefs (iB’s – JB) about negative A’s (or negative activating events – JB)…”. (Pages 7-8)^[1].

But this is a construction which is honoured more in the breach than in the observance by Albert Ellis (and perhaps many other therapists as well).  Throughout the whole of his career, as illustrated below, Albert Ellis tended to imply that no Activating event (A) could cause a client to feel anything (at point C) – unless they were hit by a brick or a baseball bat.  This is an implicit denial of the strength, power and aversive influence of all activating events (A’s), leaving the B (or irrational beliefs) to largely (or almost exclusively) account for the client’s disturbance.  And the way Ellis normally expresses this construction, when under pressure to adhere to the interactional model, is this: “Although A’s often seem to directly ‘cause’ or contribute to C’s, this is rarely true, because B’s normally serve as important mediators between A’s and C’s, and therefore (the B’s) more directly ‘cause’ or ‘create’ C’s…”^[2].  Thus Ellis hangs on to the idea that the client’s beliefs (B) are the real culprit – while seeming to accept the interaction of the A’s and B’s.  For Ellis, it is a sine qua non (or an essential condition) of human disturbance that clients, in fact, disturb themselves! (What a gift he handed to the immoral forces of the world! The exploiters, abusers and oppressors!)

In Ellis’s own words: “When I started to get disillusioned with psychoanalysis I reread philosophy and was reminded of the constructivist notion that Epictetus had proposed 2,000 years ago: ‘People are disturbed not by events that happen to them, but by their view of them’.” (Quoted in Epstein, R. [2001])^[3].

From this position, Ellis often takes the view that people upset themselves.  Nobody does it to them.  “How can anybody make you feel anything?” he will demand to know.

But he is not always consistent.  Sometimes he will say it slightly differently, like this:

“People don’t just get upset. They contribute to their upsetness”, which sounds more like the ‘interactional model’ – which says, A (or activating event) multiplied by B (or the person’s belief) equals C (or their consequent emotional response). But then he adds his escape hatch: “They always have the power to think, and to think about their thinking, and to think about thinking about their thinking, which the goddamn dolphin, as far as we know, can’t do.” (Quote from Epstein, 2001).

In other words, although they ‘only contribute’ to their upsetness, about some Activating event; nevertheless, since they have the power to think their way out of their upsetness, they are obviously still upsetting themselves (with their ‘goddamned irrational beliefs’) if they continue to be upset!  QED!

Here is yet another Ellis formulation: “People condition themselves to feel disturbed, rather than being conditioned by external sources.” (Ellis, 1979)^[4].  (Remember, in Chapter 1 above, I mentioned that Ellis acknowledged internal and external conditioning.  Now he dumps the external conditioning completely.  Such inconsistencies are a hallmark of Albert Ellis’s reasoning!  He clearly does not have a consistent model of the human brain-mind-environment complexity in his mind, at least not available to his conscious inspection!)

And, finally, here is a summary of Ellis’s view from Corey, (2001):

“…human beings are largely responsible for creating their own emotional reactions and disturbances.  Showing people how they can change their irrational beliefs that directly ‘cause’ their disturbed emotional consequences is the heart of REBT (Ellis, 1998^[5], 1999^[6]; Ellis and Dryden, 1997^[7]; Ellis, Gordon, Neenan and Palmer, 1997^[8]; Ellis and Harper, 1997^[9])”.  (From Corey, 2001, page 300)^[10].

As I will demonstrate below, Albert Ellis has created a completely false view of human perceiving-feeling-thinking processes, by substituting an extreme Stoical philosophical proposition (which is false to facts) for any and all modern psychologies (with the possible exception of Adlerian therapy, which claims that our emotional reactions and lifestyle are ‘cognitively created’. See Corey, 2001, page 298).

This view (from Ellis and Epictetus) contradicts the modern neuroscience and interpersonal neuropsychology perspectives, which show emotion as innate, and underpinning all emotive-cognitive processes. (Siegel 2015; Panksepp, 1998; Hill 2015).

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For more of my critique of REBT, please see:

1. A Major Critique of REBT: Revealing the many errors in the foundations of Rational Emotive Behaviour Therapy

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2. Discounting Our Bodies: A brief, critical review of REBT’s flaws. (If you want to know the essence of our critique of REBT, but you don’t want to have to read 500+ pages, then this 150 page summary should appeal to you).

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3. The Amoralism of Rational Emotive Behaviour Therapy (REBT): The mishandling of self-acceptance and unfairness issues by Albert Ellis

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4. Albert Ellis and the Unhappy Golfer: A critique of the simplistic ABC model of REBT

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A more comprehensive model of human disturbance

By contrast with the simplistic ABC model of REBT/CBT, we in E-CENT counselling theory have created a much more realistic, Holistic Stimulus-Organism-Response model.

The first step in creating this model involved “adding back the body” to our models of human disturbance.  In the ABC model of REBT/CBT, there is no body.  A person is just “a belief-machine”.

But in reality, our emotions are housed in our physical bodies/ brains/ minds; and socialized into our bodies/ brains/ minds.

Over time, I refined this body-brain-mind model of human disturbance, and this is how I wrote about it in our book on Lifestyle Counselling and Coaching for the Whole Person:

8.3(b): Elucidation

There are a number of models that I use for the purpose of elucidating the client’s concerns, dilemmas, goals, etc.

Chief among them is our own holistic version of the Stimulus-Organism-Response (or Holistic-SOR) model.

The original SOR model (created by the neo-behaviourists) suggested that, when an animal (or human) notices a stimulus (S), it outputs a response (R), because of the way the organism (O) processes the stimulus.

Figure 8.1: The classic S>O>R model:

That original SOR model of neo-behaviourism was dumped by Dr Albert Ellis, the creator of Rational Emotive Behaviour Therapy (REBT), and replaced by the simple ABC model, in which the client is assumed to be always and only upset because of their ‘irrational beliefs’.  (And Freud’s ‘ABCs’ were no better, in that he implied that when something happens [let’s call it an ‘A’, or activating event], the client responds with their own phantasy [let’s call it a ‘B’, or belief], which upsets them [at point C – consequence]: though Freud did not use that ‘ABC’ lettering system)

Aaron Tim Beck (despite being a medical doctor, and theoretically aware of the importance of the human body) also adopted this simple ABC model. (Beck 1976).

So one of the main contributions of E-CENT counselling has been ‘adding back the body’ to the client; and accepting that the client’s body-mind-environment-whole is implicated in all of their emotional and behavioural states.

In the process we developed a more holistic version of the Stimulus-Organism- Response model. (See Figure 8.2 below)

In the simple, classical SOR model, an incoming stimulus (S) – (which is a sensed experience) – impacts upon the nervous system of the organism (O) – (or person, in our case) – causing a reactive response (R) to be outputted (or generated), to cope with the stimulus (or incoming experience).

In the early stages of our explorations, after looking at Freud and Ellis – on the ABC model and the Experience-Phantasy-Neurosis model – we turned our attention to the Parent-Adult-Child (PAC) model of TA, plus this simple, classic SOR model.

But then we began to ask ourselves what factors are most likely to affect the capacity for a human organism to be able to handle difficult incoming stimuli, or activating events.  We came up with an extensive list, which includes:

Diet: (meaning balanced, healthy, or otherwise).  (Does the individual/ organism have enough blood-glucose to be able to process the incoming stimulus, physically and mentally?)

Exercise: (meaning regular physical exercise designed to reduce stress, versus a sedentary lifestyle)^[11]

Self-talk, scripts, frames and schemas: (Including conscious and/or non-conscious stories and narratives/ thinking-feeling states/ self-signalling/ attitudinizing / framing, etc.  Plus other culturally shaped beliefs and attitudes, expectations, prophesies, etc.  Plus non-narrativized experiences stored in the form of schemas and frames, etc.)

Relaxation: (or release from muscle tension and anxiety, versus tension and anxiety);

Family history: (including attachment styles [secure or insecure]; childhood trauma; and personality adaptations, etc.);

Emotional needs: (including deficits and/or satisfactions);

Character and temperament: (as in Myers-Briggs or Keirsey-Bates)^[12];

Environmental stressors: (including home environment, work situation, economic circumstances, and so on);

Sleep pattern; and the balance between work, rest and play.

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By keeping our focus on the fact that the client is a complex, socialized body-brain-mind; steeped in storied- (or narrativized-) experiences (plus non-storied experiences) of concrete experiences in a concrete world; and living in a complex relationship to an external social environment – which is often hostile and unsupportive, resulting in stress-induced over-arousal of the entire body-brain-mind – we never fall into the trap of foolishly asking the client: “What do you think you are telling yourself in order to cause your own problem?” 

And we do not foolishly tell the client that the thoughts which (in reality, very often) follow on from their emotional experiences are causing those emotional experiences!

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We focus on the client’s story and the client’s physical existence, both with roughly equal, but variable, emphasis.  Sometimes the story needs most attention, and sometimes the state of the body-brain-mind, in terms of diet, exercise, etc., is more important.

Traditional medical doctors were guilty of separating the body from the mind, and trying to treat the body as a ‘faulty machine’ – which was in line with Newtonian mechanics of the nineteenth century, which lasted well into the twentieth century and beyond.

Sigmund Freud, as a trained neurologist and MD, came out of that tradition and began the process of moving towards some kind of appreciation of the mind.

However, many generations of counsellors and psychotherapists have gone too far in this direction, and forgot all about the body.

Some modern medical doctors are beginning to realize their original error.

Here’s how Dr Ron Anderson, Chairman of the Board of the Texas Department of Health, describes his aim for all the doctors he influences:

 

“I try to have people understand wholeness if I can, because if you don’t understand the mind/body connection, you start off on the wrong premise. 

You also have to understand the person within their family and community because this is where people live”.^[13] 

 

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Using the Holistic SOR model

Figure 8.2 below shows how we present the holistic SOR model for our clients.

Figure 8.2: The E-CENT holistic SOR model

As indicated in Figure 8.2, E-CENT theory takes a holistic view of the client as a social-body-mind, with a habit-based character and temperament, living in a particular social and physical environment, with stressors and supports.

The client has a personal history which is unique to them; plus some social shaping that extends to their family, and some to their community; some to their nation/ race/ gender, etc.

This illustration should be read as follows: Column 1 – ‘S’ = (or equals) a stimulus, which, when experienced by an O = Organism (in our case a human), may activate or interact with any of the factors listed in column 2; and this will produce an R = Response, as shown in column 3.

To be more precise: The holistic SOR model states that a client (a person) responds at point ‘R’, to a (negative or positive) stimulus at point ‘S’, on the basis of the current state of their social-body-mind.

How well rested are they?

How high or low is their blood-sugar level (which is related to diet)?

How well connected are they to significant others (which is a measure of social support)?

How much conflict do they have at home or at work?

What other pressures are bearing down upon them (e.g. from their socio-economic circumstances; physical health; home/ housing; work/ income; security/ insecurity; etc.)

And how emotionally intelligent are they? (Emotional intelligence is, of course, learned, and can be re-learned!)

Within the Holistic-SOR model (in Figure 8.2 above), in the middle column, what we are aiming to do is to construct a balance sheet (in our heads) of the pressures bearing down on the client (person), and the coping resources that they have for dealing with those pressures.

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So this is a historical-social-stress model. It is not a purely ‘cognitive distortion’ model; nor a purely ‘biological/ sexual urges’ model; nor a purely ‘prizing and listening’ model.

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For more insights into this whole body-brain-mind approach to emotive-cognitive- embodied therapy, please take a look at the page of information about Lifestyle Counselling and Coaching for the whole Person.***

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That’s all for now.

Best wishes.

Jim

Dr Jim Byrne

Doctor of Counselling

Fellow of the International Society of Professional Counsellors (FISPC)

ABC Coaching and Counselling Services

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The Institute for E-CENT Counselling

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ABC Bookstore Online

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Endnotes

[1] Dryden, W. (1999) Rational Emotive Behavioural Counselling in Action.  Second edition.  London: Sage Publications.

[2] Ellis, A. and Dryden, W. (1999) The Practice of REBT.  Second edition.  London: Free Association Books. Page 9.

[3] Epstein, R. (2001) The Prince of Reason: An interview with Albert Ellis, developer of rational emotive behaviour therapy. Online blog article and interview. Psychology Today online blog article https://www.psychologytoday.com/articles/200101/the-prince-reason

[4] Ellis, A. (1979). Rejoinder: Elegant and inelegant RET. In A. Ellis & J.M. Whiteley (eds.). Theoretical and empirical foundations of rational-emotive therapy (pp. 240–271). Monterey, CA: Brooks/Cole.

[5] Ellis, A. (1998) How to Control your Anxiety before it Controls You.  Secaucus, NJ: Carol Publishing Group.

[6] Ellis, A. (1999) How to make yourself happy and remarkably less disturbable.  San Luis Obispo, CA: Impact.

[7] Ellis, A. and Dryden, W. (1997) The Practice of Rational Emotive Therapy (Revised edition).  New York: Springer.

[8] Ellis, A., Gordon, J., Neenan, M., and Palmer, S. (1997) Stress Counselling.  London: Cassell.

[9] Ellis, A. and Harper, R. (1997) A Guide to Rational Living.  Third Edition. Hollywood, CA: Wilshire.

[10] Corey, G. (2001) Theory and Practice of Counselling and Psychotherapy. Sixth Edition.  Belmont, CA: Brooks/Cole.

[11] The British National Health Service (NHS) supports the view that exercise is good for mood disorders, like anxiety and depression.  Here’s their comment specifically on depression:

“Exercise for depression

“Being depressed can leave you feeling low in energy, which might put you off being more active.

“Regular exercise can boost your mood if you have depression, and it’s especially useful for people with mild to moderate depression.

‘Any type of exercise is useful, as long as it suits you and you do enough of it,’ says Dr Alan Cohen, a GP with a special interest in mental health. ‘Exercise should be something you enjoy; otherwise, it will be hard to find the motivation to do it regularly.’

“How often do you need to exercise?

“To stay healthy, adults should do 150 minutes of moderate-intensity activity every week.”  In E-CENT we recommend 30 minutes of brisk walking every day, minimum. Source:   http://www.nhs.uk/conditions/stress-anxiety-depression/pages/ exercise- for- depression.aspx) Accessed: 23^rd February 2016.

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[12] Keirsey, D. and Bates, M. (1984) Please Understand Me: Character and temperament types. Fifth edition. Del Mar, CA: Prometheus Nemesis Book Company.

[13] ‘The healing environment’: An interview with Dr Ron Anderson, in Bill Moyers’ (1995) book: Healing and The Mind.  New York: Doubleday. Page 25.

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