1 Running head: THEORETICAL COMPARISON PAPER

Theoretical Comparison Paper Aida Miloti University of Calgary CAAP 601 Shauna Thompson

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Theoretical Comparison Paper Introduction I think an effective personal theory of counselling must be grounded in a good understanding of various theories of personality and client change. I feel it is critical to examine potential theories to ensure they are meaningful, coherent, applicable, and valid. In this paper I offer a compare and contrast of rational emotive behavior therapy (REBT) and Gestalt therapy in relation to four primary elements of a good theory (taken from the CAAP 601 Instructor Commentary). After a brief description of REBT and Gestalt therapy I will use each element as a lens with which to examine each theorys meaningfulness (the philosophical element), coherency (the descriptive element), applicability (the prescriptive element), and validity (the evaluative element) in the practice of counselling today. Rational emotive behavior therapy, one of the first cognitive behavior therapies (Corey, 2008), was developed by clinical psychologist Albert Ellis in the 1950s to help clients identify and change some of their basic values in order to resolve their immediate cognitive, emotional, and behavioral problems (Ellis, 2011). Using cognitive, emotive, and behavior therapy methods REBT therapists aim to quickly, efficiently, and vigorously confront the clients faulty beliefs, teach them how to seek out and minimize these beliefs for themselves, and help them develop the skills to continue to do so outside the therapeutic environment (Ellis, 2011). Gestalt therapy is an experiential humanistic approach to therapy developed by Frederick Perls, Laura Perls, and Paul Goodman in the 1940s and 1950s. From the Gestalt therapy perspective it is important that clients be understood in the here-and-now within the context of their ever-changing relationship with their environment (Corey, 2008). Actively engaging with clients in creative experiential activities, Gestalt therapists aim to develop the clients awareness and build their store of awareness and behavioral tools (Yontef & Jacobs, 2011) to foster an integration of self (Corey, 2008). The Philosophical Element

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Underlying each theory is an anchoring philosophy, a set of working assumptions that serve as a foundation for the rest of the theory. Before incorporating principles from a theory into therapeutic practice it is necessary to identify these assumptions (which are not always explicitly stated) and decide whether or not you consider them to be meaningful. You must be able to accept the assumptions on which the theory was founded for it to be meaningful in your practice (CAAP 601). The Philosophical Element of REBT Although we learn our patterns of thinking and believing from significant others in childhood, REBT theorists dont let us blame our parents for current dysfunction; instead, they say that it is the active reinforcement of those patterns of thinking and believing in our daily lives that keep those dysfunctional attitudes operating and creating emotional disturbances (Corey, 2008). REBT therapy teaches us that by holding irrational beliefs and expectations of ourselves, others, and the universe (often defined as such by the therapist) lead to unhealthy emotional and behavioral consequences (Ellis, 2011). Ellis (1996) argues that by earnestly believing irrational and dysfunctional assumptions about themselves and others people make themselves disturbed, and that unless they are specifically taught self-acceptance people are unlikely to come to it on their own. REBT suggests that while biological and early environmental factors are important in the lead-up to personal disorganization and disorder, individuals can and often do intervene between their environmental input and their emotional output, and as such have an enormous amount of potential control over what they feel and do (Ellis, 1996). People are responsible for creating a large part of their own emotional disturbances, and they have the ability to uncreate them. Though we are born with the potential to be both selfconstructive (in that we could choose to make a change for the better) and self-defeating (in that we could choose to repeat old negative patterns) Ellis (2011) believes we are prone to make emotional disturbances worse as a result of our social conditioning. REBT maintains that in

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general the irrational absolutist beliefs people commonly hold (and the resulting emotional disturbances) can be grouped into three main headings: 1. I must complete important tasks perfectly and be approved of by others I consider significant, or I am an inadequate and worthless person, which leads to feelings of severe anxiety, depression, demoralization, and often to serious inhibition. 2. Other people (especially my friends and family) must treat me kindly and fairly at all times or they are awful, horrible people, which leads to feelings of severe rage and anger, and often to fights, child abuse, assault, rape, and murder. 3. My life must be comfortable, hassle-free, and enjoyable at all times or its terrible and hardly worth living, which results in a low frustration tolerance that often leads to addiction, avoidance, compulsion, and phobic reactions (Ellis, 1996). REBT works to teach people how to recognize, dispute, and challenge their grandiose absolutist beliefs and how to replace them with strong, realistic preferences. Finally, Ellis proposed that human beings think, feel, and act all at the same time, and that our experiences are viewed from a framework of prior experience, memories, and conclusions. No matter how much people talk about wanting to change a bad pattern, Ellis (2011) taught that without acting against it people rarely change a profound self-defeating belief. Since our thoughts, beliefs, and behaviours are all interrelated the REBT approach uses active therapeutic methods that address cognitive, emotional, and behavioral techniques for change. To help a client make a change in one modality is to effect a change in the others. The Philosophical Element of Gestalt therapy Unlike REBT, Gestalt theory is holistic. It assumes that people are inherently selfregulating and oriented toward growth and self-improvement (Yontef & Jacobs, 2011). Therapists who use this approach believe that people do the best they can with their internal resources and the resources available in their environment at the time. Perception is not judged according to the therapists idea of rationality or validity because it is believed to be relative to

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each individuals experience in their environment. Gestalt therapy works to help clients accept themselves as they are with a good understanding what they do and how they do things in the present. Yontef and Jacobs (2011) see the Paradoxical Theory of Change as the heart of the Gestalt therapy approach. The paradox, as they explain it, is that the more a person tries to deny the true aspects of their personality and become something they are not, the more they will be stuck and unable to make changes. Gestalt theorists maintain that it is critical to understand a client in relation to their field or subjective environment. Yontef and Jacobs (2011) argue that since variables that help to shape a persons experience are part of their environment, people cannot be understood without understanding the context in which they live. In a Gestalt experience everything is relational; everything is constantly changing and in constant flux, so clients must be understood as part of that ever-changing context. As I understand the information as presented by Corey (2008), thoughts and ideas both present and past exist as part of our field. Those in the perceptual foreground have a defined form and shape in our perception and as such get our attention, like the words on this page. By contrast, ideas that remain in the perceptual background are somewhat formless and undefined until such time as we shift our attention to them, like the chair you are sitting in or the lamp on the table. By intentionally putting our awareness on something we consciously bring the object into the foreground, making it the focus of the moment, and allowing us to consider and understand it in the moment; by consciously avoiding putting our awareness on something (for example, a looming deadline) we force it into the background, potentially creating unfinished business that may resurface emotionally (involuntarily) at a later time, demanding our direct attention. In Gestalt therapy it is very important that clients have good personal awareness (Corey, 2008). Gestalt therapists pay careful attention to what is included and excluded from a clients field of conscious awareness, and teach clients to do the same for themselves. Metaawareness, or awareness of the awareness process, can empower a client to understand their

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experiences and behaviours and make changes they feel are necessary (Yontef & Jacobs, 2011). Different aspects of our environment exist in either the background or foreground of our lives. We can focus on only one aspect at a time, and our focus can change from moment to moment (Corey, 2008), impacted by our current situation. Personal awareness is necessary for clients to develop healthy self-regulation. To be able to react and respond fluidly to the events in our lives and embrace we must know and accept what we see, feel, need, want, and believe (Yontef and Jacobs, 2011). They assert that growth begins when we achieve conscious awareness of what is really happening around us, how we affect and are affected by others, and we understand and accept all aspects of ourselves and the possibilities for change. By denying or avoiding the conditions of our present reality we create a kind of unfinished business, which can be carried in present life as unexpressed feelings that make it difficult to keep our awareness centered on the present and interfere in our making connections with oneself and others (Corey, 2008). The Descriptive Element It is necessary for a good theory to provide a clear and coherent description of the therapeutic process as well as an explanation of why it works. The theory must describe human functioning and personality using core concepts that are easy to grasp and useful in explaining a range of human behavior. It is important to consider the theorys coherence across different genders, cohorts, and cultures (CAAP 601). The Descriptive Element of REBT According to Ellis (1996), REBT is collaborative and instructive, supportive and activedirective. The therapeutic relationship itself is used as a tool to teach clients how to relate to the therapist so they are better able to relate to others. Corey (2008) describes the process of therapy in REBT as educational, where the therapist functions in many ways like a teacher, teaching clients how to apply cognitive, emotive, and behavioral methods so they can better function in their intrapersonal, interpersonal, and community relationships (Ellis, 1996). Ellis

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believed that while the condition of warmth in the therapeutic relationship was desirable, that it was not a necessary or sufficient condition to effect personality change (2011). In the course of the therapeutic encounter, the REBT therapist may not personally like or want to befriend their client, but they always try to accept the client as a person and give them unconditional acceptance, no matter their shortcomings or poor behaviours (Ellis, 1996). Therapists in REBT use an A-B-C method of looking at human personality and emotional disturbance. An upsetting emotional consequence such as feelings of anxiety and worthlessness (C) often follows an activating experience (A) such as being rejected by someone. It is common, according to Ellis (1996) for people to incorrectly assume that (C), their feelings of anxiety and worthlessness, are caused directly by (A) (Ellis, 1996, p. 76). It is the task of the therapist to help the client learn to dispute their irrational beliefs by rationally and behaviourally challenging them, minimizing their emotional and behavioral disturbances and allowing them the chance to become happier and strive for more self-actualization and personal growth (Ellis, 2011). Like in Gestalt therapy, unconditional acceptance is a key factor in helping people come to terms with and accept the reality of difficult situations in their lives, or even just those that fall beneath our goals and expectations. Unconditional self-acceptance teaches us that we can choose to accept ourselves despite our flaws and mistakes, regardless of whether or not we do well or are approved of by others as worthy and acceptable in the world simply because we are alive, simply because we exist (Yontef & Jacobs, 2011). Unconditional other acceptance states that while we condemn others objectionable thoughts, feelings, or behaviors, we still accept them as we do ourselves, as fallible human beings. Unconditional life acceptance encourages us to accept the things in life are out of our control and we cannot change, such as natural disasters, the death of a loved one (Yontef & Jacobs, 2011). Yontef and Jacobs (2011) go on to say that since life contains both pleasurable events and inevitable sufferings we can

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achieve greater emotional stability, self-actualization, and self-fulfilment by accepting unpleasant circumstances that cant be changed. Emotions stem from our internalization of beliefs, evaluations, interpretations and personal reactions to situations in our lives. As previously mentioned, these internalizations are often faulty. Ellis (2011) explains that through the therapeutic process clients develop tools to identify and dispute irrational beliefs that have been acquired and self-constructed and are currently maintained by self-indoctrination. Clients are taught to recognize these irrational patterns, and to replace the ineffective irrational ways of thinking with effective and rational ones to promote different emotional reactions to situations in the future (Corey, 2008). With the basis of our early thought and behavior patterns linked to childhood one might think that time should be spent learning about a clients childhood events and situations to understand when and where their patterns first developed, but in REBT this is not thought to be necessary. Though it is believed that our early patterns were developed to help us navigate our life situation at the time, REBT therapy focuses mainly on the present; it is not important to spend much time connecting the present to the past or in examining the clients childhood history and relationships. With active experiences that help to dispute the clients dogmatic, irrational, or unexamined beliefs, REBT therapists teach the client to focus on the present so they can confront change those dysfunctional patterns of thinking and feeling (Corey, p.281). Ellis (2011) contends that REBT has always taken a multicultural position that encourage flexibility and open-mindedness in the therapists so they can work with clients with differing values in family, culture, or religion. Cultural and religious goals are rarely disputed; only a clients absolutists interpretations of them. The Descriptive Element of Gestalt Therapy In Gestalt therapy the focus is on the clients perceptions of reality, grounded in the idea that people are always in the process of learning, growing, and improving themselves (Corey, 200). Therapists are not expected to have all the answers, and indeed refrain from directing the

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client in making choices or deciding what changes (if any) need to be made in their lives. Gestalt therapists are responsible for maintaining a therapeutic atmosphere, for remaining open to the client, and actively sharing their own perceptions and experiences with the client in the moment. Along with encouraging the client to be themselves the therapists responsibility is also to be who they are and not to get lost in their role. Rather than subscribing to particular techniques and stereotypic exercises, Corey (2008) describes Laura Perls belief that the nature of the person of the therapist is more important than which techniques are used. She is quoted as saying, There are as many styles as there are therapists and clients who discover themselves and each other and together invent their relationship (Corey, 2008, p. 211). I understand this to mean that it is the unique combination of personal factors present between each client and therapist that creates the therapeutic alchemy for the development of both the client and the therapist. To assign specific techniques and limit the therapists ability to be genuine and authentic in the relationship would then restrict the creative possibilities for growth and development that are a natural part of the therapeutic alliance in this case. Gestalt practitioners believe that people are self-regulating, responsive to changing contexts, and motivated to solve their own problems (Yontef & Jacobs, 2011), so the therapist accepts the client for where they are at in the moment and does not try to force change. Gestalt therapists avoid making interpretations to explain why a client behaves in a certain way. Therapy is a two-way engagement that creates change in the therapist and the client the client is expected to be an active participant who divines their own interpretations and meanings (Corey, 2008). The therapist deeply believes that the clients subjective experiences of their reality are just as real and valid as reality as seen by the therapist. In opposition to REBT, the quality of the therapeutic relationship is of central importance for Gestalt therapists (Corey, 2008; Yontef & Jacobs, 2011), and the therapists attitudes and behaviour in therapy sessions count for more than the specific techniques that are used (Corey, 2008). What happens in the context of the therapeutic relationship is crucial, and the non-verbal

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subtext of communication (e.g. the therapists posture, tone of voice, and level of interest) conveys much to the client about the therapists attitude, what is important in therapy, and process of therapy itself (Yontef & Jacobs, 2011). The therapist does not interpret events and responses in the clients life, but helps them develop the necessary skills to interpret things for themselves. The therapist deeply cares about the clients perspectives, feelings, and thoughts, and relates to the client with an alive, excited, warm, and direct presence (Yontef & Jacobs, 2011, p.360). By regarding the client with a sense of compassion, kindness, honesty, affection, integrity, and respect it is believed the therapist can foster a safe environment that allows the client to access thoughts and feelings that were previously kept from awareness; as a result clients can experience thoughts, feelings, and emotions they were previously unwilling or unable to share (Yontef & Jacobs, 2011). Gestalt therapy is a form of exploration as opposed to being a specific intervention for behavioral change. The therapist concentrates on helping clients become aware of different ways they avoid learning from experience, how they are restricted by poor adaptations to their self-regulatory processes, and how they restrict themselves from necessary experiences by cutting themselves off from contact with others (Yontef & Jacobs, 2011). There is a dual focus in therapy on what the patient does and how they do it. Focus in therapy is always on the present. The present is considered to be the midpoint between the past and the future, and optimal functioning occurs when we are focused here in the present. Disturbances in living are often caused when a patient unsuccessfully integrates the past, present and future into their present life (Yontef and Jacobs, 2011). Yontef and Jacobs (2011) explain that some people lose contact with the present and live as if they existed in the past, unable to engage with themselves or others in the present; others live in the present as if they had no past, preventing them from learning from their past; and still others live in anticipation of the future as if the future were now, failing to engage with the present. In Gestalt therapy sessions everything takes place in the now. Exploration of past events and experiences is anchored in the present, and as much as

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possible the therapist attempts to use methods to help the client bring past experiences directly into present experience (Yontef & Jacobs, 2011). Yontef and Jacobs (2011) contend that Gestalt therapy can be used effectively with any patient population the therapist feels comfortable working with, provided the therapist recognizes the implications their own social/cultural/political situation may have on the therapeutic process and in the relationship with the client. Corey argues that clients who have been socially conditioned to be emotionally reserved might not be able to engage in the emotionally-charged experiments of Gestalt therapy (2008). I have to wonder as well about the effectiveness of the theory with patients who are looking for a directive approach, or who dont believe that increased awareness and presence in the moment will help solve their problems. The Prescriptive Element The goal of most theories of counselling is to help clients change. A good theory should provide guidance regarding specific goals for change as well as direct intervention strategies and techniques for bringing about this change. For a theory to be applicable these goals and instructions must be productive for the client and therapist (CAAP 601). The Prescriptive Element of REBT The therapists goal in therapy is to help clients seek out and minimize their faulty beliefs, to challenge clients to confront their faulty beliefs with contradictory evidence, and to help clients become aware of automatic thoughts and to change them (Corey, 2008). REBT therapy can be practiced one-on-one with a therapist, in group therapy, in intensive workshops, or marathon encounter groups. Ellis (2011) believes that specific problems can often be dealt with in a single session, provided the client does not have an abundance of problems. It is often recommended that clients attend both individual and group sessions, as participating with a group allows a client to learn REBT skills and practice them with others under the supervision of the therapist; it is also a chance for clients to interact therapeutically

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and socially with group members, to engage in role-playing and take risks in a safer, supervised environment before taking their new skills out into the world (Corey, 2008). REBT therapists help clients minimize their absolutist ways of thinking using cognitive, behavioristic, and emotive techniques. There is a long and varied collection of techniques in REBT, so a sampling is included here to provide the general flavour of the REBT experience. As in Gestalt therapy, REBT therapists are creative in their use of techniques, tailoring their methods to the needs of each client. Corey (2008) suggests that REBT practitioners may introduce their client to psychoeducational materials like books and videos, or have them listen to and evaluate recordings of their own therapy sessions. Unlike Gestalt therapy, REBT cognitive techniques are often quite forceful and confrontational, relying on methods such as debating, disputing, and challenging irrational belief patterns, explaining and interpreting the meaning behind a clients choices and behaviors, and teaching improved alternative ways of thinking, feeling, and behaving (Corey, 2008). REBT therapists assign homework to help clients locate their internalized absolutist beliefs, and encourage clients to put themselves in risk-taking situations that will allow them to challenge those beliefs (Ellis, 2011). REBT therapists might use role playing and rehearse behaviours or bring out their feelings, or they might create shameattacking exercises that allow clients to confront faulty beliefs about acceptance and personal responsibility. They might also use humour to show a client the absurdity of their beliefs and encourage the client to take themselves less seriously. The therapist might insist that clients change their self-limiting vocabulary, replacing their absolutes (like should, must, and ought) with preferences (it would be nice if...) to help them think, feel, and behave differently. They also employ the use of visualization to have clients imagine themselves thinking, feeling, or behaving they way they would like to in real life (Corey, 2008). The Prescriptive Element of Gestalt Therapy The true goal of Gestalt therapy is awareness. The goal in therapy is for the therapist to assist clients in becoming consciously aware of in-the-moment experiencing, to foster an

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integration of the self, and to expand their knowledge of and capacity to make choices (Corey, 2008). Gestalt therapy uses a lively and active relationship with active methods to show patients different ways they block their awareness and help them integrate the developing regulation of their own awareness (Yontef & Jacobs, 2011). Unlike REBT, Gestalt theory sees increased and enriched awareness as curative in and of itself, as it gives clients the capacity to face and accept parts of themselves they previously denied, to assume ownership of their experiences, and responsibility for what they do and how they do it. In Gestalt therapy, psychotherapy is believed useful when a persons development process becomes impaired, they fail to learn from their mistakes and past experiences, and their own self-regulatory abilities no longer help them to move past outdated, maladaptive patterns. Additionally, psychotherapy is also warranted when people do not deal well with crises in their lives, when they feel poorly-equipped to deal with other people in their lives, or they need guidance for personal or spiritual growth (Yontef & Jacobs, 2011, p.359). Like REBT therapy, Gestalt therapy has an exceptionally diverse range of styles and modalities for therapy (Yontef & Jacobs, 2011). Gestalt methods all share an emphasis on experimenting, direct experience, presence, and awareness of the here-and-now. Sessions may take place one-on-one with a therapist or in larger groups up to and including large systems. In assisting the client to develop self-awareness the counsellor uses Gestalt experiments that are created specifically for the client for a specific purpose. The attitude in experimentation from the therapist is a try it and see outlook. A wide range of experiments are designed to intensify emotional experiencing and to help the client understand and integrate conflicting feelings (Corey, 2008), and though there are many available techniques none are required or dictated for specific situations. Ideally the client and therapist co-create experiments, and therapists are expected to tailor the experiments to suit what the client needs to experience in the moment without holding to an agenda for what outcome the experiment must lead to for the client (Ramey, 1998).

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Though the list of techniques is too rich and varied to detail in full in this paper, but a sampling is included to provide an overview of what a client might expect in Gestalt Therapy. The therapist may simply help the client to focus their attention and awareness on what is being experienced in the here and now. When the client reports a feeling the therapist might ask them to stay with it and work through the feeling, deepening their capacity to work through emotions. The client might be asked to experiment with putting thoughts or feelings into action through role playing, dramatization, or creative expression through poetry, art, journaling, or movement (Yontef & Jacobs, 2011). Unresolved feelings with another person may be dealt with using the empty-chair technique: imagining the other person in the empty chair and carrying out the unspoken dialogue as if they were there, at times also playing the part of the other person in completing the dialogue. At other times a client might be asked to simply visualize and mentally walk through a past experience in the present in order to effectively increase awareness (Corey, 2008). Corey (2008) also details the techniques for paying particular attention to the clients physical experience in therapy, including their breathing and physical sensations; they might ask a client to exaggerate their physical movements and gestures, or to speak for a numb limb or interpret the meaning behind their rapid, unsupported breathing. The client might be asked to try on behaviours with the reversal exercise, allowing the client to make contact with parts of themselves that had been denied, or act out each part of their dream and live them as if they were happening in the present (Corey, 2008). The Evaluative Element Finally it is important to consider whether or not the theory lends itself to research that can test its precepts to see if they actually work. A good theory can be subjected to objective or subjective confirmatory research to show that its intervention strategies and working assumptions lead to valid, tangible client outcomes (CAAP 601). The Evaluative Element of REBT

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Ellis (2011) credits REBT as having inspired scores of objective experiments to test its theories, and references hundreds of research studies that generally validate its major theoretical principles (p. 225). Ellis (2011) also references more than 200 published subjective outcome studies that show REBT to be effective in changing the thoughts, feelings, and behaviours or groups and individuals with different types of problems, particularly with religious clients, school children, and individuals with anger disorders. The Evaluative Element of Gestalt Therapy It is difficult to subject Gestalt therapy to objective research (experimentation) because it has no real prescribed measurable methods that are suitable for use with each client, and experiments do not typically account for the importance of the therapeutic relationship, which is difficult to quantify. However, Corey (2008) references several process and outcome studies that demonstrate the effectiveness of Gestalt therapy based on outcome research. Gestalt therapy was found to be useful in treating a variety of psychological disorders, particularly personality disturbances, psychosomatic problems, and substance addictions. The effects of Gestalt therapy tend to be stable in follow-up studies one to three years post-treatment. Conclusion After completing this review I have found that REBT and Gestalt therapy have many more similarities than I first believed. Although the REBT approach (especially if observing Ellis) is quite abrupt and lacking in the warmth and positivity of Gestalt therapy they both share an active focus on the present, a desire to help clients understand their way of thinking and behaving in the world, and an unconditional positive regard for the client as a fallible human being. For clients who require a more in-your-face directive approach to counselling perhaps REBT is the better choice as it is time-limited, thorough, inquisitive, and demands active participation. For those who prefer more of an exploratory, experimental, fun and creative approach to therapy I would suggest the Gestalt approach.

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References

Corey, G. (2008). Theory and Practice of Counseling and Psychotherapy, Eight Edition. Belmont, CA: Brooks/Cole. Ellis, A. (1996) The humanism of rational emotive behavior therapy and other cognitive behavior therapies. Journal of Humnistic Education & Development, 35(2), 69-88. Ellis, A. (2011). Rational Emotive Behavior Therapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 196-234). Belmont, CA: Brooks/Cole. Ramey, L. (1998). The use of Gestalt interventions in the treatment of the resistant alcoholdependent client. Journal of Mental Health Counseling, 20(3), 202-215. Yontef, G. & Jacobs, L. (2011). Gestalt Therapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (pp. 342-382). Belmont, CA: Brooks/Cole.