a born demander

Is there any meaningful difference between REBT and other forms of CBT? Engels, Garnefski, and Diekstra (1993) seem as though they'd like to tackle this question ("The findings of ...quantitative reviews lead to the conclusion that cognitive-behavioral therapies show the highest overall effect sizes...of all treatment modalities under study, but the degree to which RET contributed to this result is unclear" [p. 1083]) but they find themselves unable to address this question due to lack of sufficient data. Instead, Engels et al. end up comparing RET to placebo, systematic desensitization, and combination treatments--a strategy that seems to me less than useful. Comparing RET to placebo tells us little about the therapy's incremental validity, while comparing it to "combination treatments" (i.e. RET plus "behavioral therapy such as group systematic desensitization, self-control desensitization, or behaviorally oriented assertiveness training" (p. 1085)) and to systematic desensitization seems too much like comparing the same thing. Desensitization is cropping up everywhere here!

I encountered an anecdote about Albert Ellis on Wikipedia (I know, I know) relating how, as a young man, he overcame his shyness around women by approaching 100 women in the Bronx Botanical Gardens and engaging them in conversation. This desensitization procedure that he developed for himself at the age of 19 seemed like a foreshadowing of his later formation of a therapeutic strategy that he described as "unusually forceful and emotive and uniquely behavioral with its emphasis on in vivo desensitization" (p. 154). (Italics mine). Given the role of desensitization in REBT, systematic desensitization, and these combination treatments, it seems like a finding of no significant difference among these conditions tells us very little--we might have expected that methods utilizing exposure & desensitization would be similar in their effects.

What would be really interesting to know would be the answer to that first question--is there any meaningful difference between REBT and other forms of CBT? Engels et al. describe RET as "distinguished from other CBT methods especially in its therapeutic goal: the client's achievement of a new philosophical outlook" (p. 1083). But does helping clients to achieve a more existentialist worldview produce any incremental improvement over any other form of CBT? Are there clients for whom a therapist's assumption "that imperatives lead to needless disturbance" would prove unhelpful (p. 157)? Is any form of "must," too strongly adhered to, considered unhealthy, or would only certain classes of "musts" qualify? I suppose I'm thinking here of dealing with highly religious clients. Would the REBT therapist classify the "musts" of the religion as too absolutistic to be healthy? Would any orthodox client be seen as necessarily unhealthy for holding such dogmatic beliefs? I don't entirely understand the full nature of REBT--what the essential components of it are as opposed to what are simply more related to Ellis's personal therapeutic style. I'm looking forward to discussing this further in class.

P.S. Interesting excerpts from Ellis's Overcoming Resistance: A Rational Emotive Behavior Therapy Integrated Approach:

Shame-attacking exercise

(And for Jim:)
On using obscenities