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The Journal of Psychology:


Interdisciplinary and Applied
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The Treatment of a Psychopath


with Rational Psychotherapy
a
Albert Ellis
a
Private Practice , New York, USA
Published online: 02 Jul 2010.

To cite this article: Albert Ellis (1961) The Treatment of a Psychopath with Rational
Psychotherapy, The Journal of Psychology: Interdisciplinary and Applied, 51:1,
141-150, DOI: 10.1080/00223980.1961.9916466

To link to this article: http://dx.doi.org/10.1080/00223980.1961.9916466

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Published as a separate and in The Journal of Psychology, 1961, 61, 141-150.

T H E T R E A T M E N T OF A PSYCHOPATH WITH
RATIONAL PSYCHOTHERAPY*
Priwate Practire, N e w Yark

ALBERT
ELLIS
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Socalled psychopaths, or individuals suffering with a severe character dis-


order whose behavior is distinctly antisocial, are exceptionally difficult to treat
with psychotherapy. T h e y only rarely come for treatment on a voluntary
basis; and when they are treated involuntarily, they tend to be resistant,
surlj‘, and in search of a “cure” that will involve no real effort on their part.
Even when they come for private treatment, they are usually looking for
magical, effortless “cures,” and they tend to stay in treatment only for a short
period of time and to make relatively little improvement.
Psychoanalytic techniques of approaching psychopaths are particularly
ineffective for several reasons : These individuals are frequently non-intro-
spective and non-verbal ; they tend to be not overly-bright or well-educated;
they are impatient of long-winded procedures; and they are highly sceptical
or afraid of involved psychological analysis o r interpretation. It is therefore
only the exceptional psychopath who can be helped with analytic methods
such as those employed by Lindner (1944) in his Rebel Without a Cause.
Considerably modified techniques of interpretation, such as advocated by
Cleckley (1950) and Schmideberg (1956) are often recommended instead.
Before attempting to treat any young delinquents or older criminals in
my present private practice of psychotherapy, I had considerable experience
in examining and treating them when I was Chief Psychologist at the New
Jersey State Diagnostic Center and later Chief Psychologist of the New
Jersey Department of Institutions and Agencies. At that time I became
impressed with the fact that whether the offender was a thief, a sex deviate,
a dope addict, or a murderer, about the very worst way to try to help him
rehabilitate himself was to give him a moral lecture, appeal to his superego,
or in any way blame him for his misdeeds. For I began to see a t that time
that, in their own peculiar ways, virtually all these offenders really were
anxious and guilty underneath their facade of psychopathic bravado ; and
that, in fact, their criminal acts were frequently committed as a defensive

* Received in the Editorial Office on September 20, 1960, and published immediately
at Provincetown, Massachusetts. Copyright by The Journal Press.
141
142 JOURNAL OF PSYCHOLOGY

attempt to protect them against their own feelings of low self-esteem. I n


other words, many of them were already being compulsively driven to psy-
chopathic behavior by underlying guiIt and anxiety ; and to endeavor to make
them more guilty and anxious, as is often a t first attempted in psychoanalytic
technique, would hardly help them lose their need for their compulsive
defenses.
Instead, I found that if I temporarily showed the offender that I was not
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critical of his behavior, and if I a t first allied myself with him (if necessary)
against the authorities of the institution in which he was incarcerated (and
whom he almost invariably saw as being persecutory), a notable degree of
rapport could be established between us. T h e n , once the prisoner felt that
I was really on his side, it was often possible to show him that his pattern
of criminal behavior was not merely immoral and antisocial (which he of
course knew without my telling him so) but that, more importantly, it was
self-defeating. If I could convince him, which I often could, that however
much society might be (from his standpoint, justifiably and revengefully)
hzrmed by his crimes, he himself was invariably even more self-sabotaged
by these acts and their usual consequences, then I had a fairly good chance
of getting him to change his behavior in the future.
M y many investigatory and therapeutic relationships with criminals taught
me, then, that socalled hardened psychopaths, like other disturbed human
beings, act in an irrational and self-defeating manner because they believe,
quite falsely, that they are helping themselves thereby ; and when they are
calmly, unblamefully, and yet vigorously disabused of this belief, they are
often capable of radically changing their philosophic orientation and their
antisocial behavior which springs from that orientation. Because many or
most of the classic psychopaths are, as Cleckley points out, basically psychotic,
they are often most difficult to treat ; and one must usually be contented with
reasonably limited gains. Nonetheless, remarkable improvements in their
general living patterns, and particularly in the reduction of their antisocial
behavior, may result from proper treatment.
Partly as a result of my experience in treating youthful and older offenders,
as well as considerable experience in working with run-of-the-mill neurotics
and psychotics, I have in recent years developed a technique of psychotherapy,
called rational therapy, which is particularly applicable to the treatment of
severely neurotic and borderline psychotic individuals with whom psycho-
analytic and other treatment methods have had poor success. Rational
therapy, as I have explained in several previous publications (Ellis, 1957a,
1957b; 1958a, 1958b, 1958c), is based on the assumption that human beings
ALBERT ELLIS 143

normally become emotionally disturbed through acquiring irrational and


illogical thoughts, philosophies, or attitudes. Emotion itself is conceived of
as largely being a certain kind-a biased, prejudiced kind-of thought; and
it is held that people can be taught to change their negative and disturbed
feelings by changing the thoughts that invariably underlie these feelings.
T h e rational therapist believes, in other words, that patients (and other
people) literally talk themselves into their neurotic or psychotic states by
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telling themselves illogical and irrational sentences, or ideas, which they have
previously learned from their parents and their culture, and have internalized
and keep ceaselessly-and senselessly-repeating. T h e main emphasis of the
therapist who employs rational technique is on analyzing the patient’s current
problems-especially his feelings of anger, depression, anxiety, and guilt-and
concretely showing him that these emotions arise not from past events or
external situations but from his present irrational attitudes toward or illogicaI
fears about these events and situations.
Thus, the patient is shown that he has one o r more basic philosophic
assumptions underlying his behavior and that if this behavior is self-defeating
these assumptions must necessarily be ill-grounded. T h e main illogical
assumptions which most patients have a t the base of their disturbances include
the following: ( a ) that it is a dire necessity for an adult human being
to be approved or loved by almost everyone for almost everything he does;
( b ) that an individual should o r must be perfectly competent, adequate,
talented, and intelligent in all possible respects and is utterly worthless if
he is incompetent in any way; ( c ) that one should severely blame oneself
and others for mistakes and wrongdoings; ( d ) that it is terrible, horrible,
and catastrophic when things are not the way one would like them to be;
and ( e ) that most human unhappiness is externally caused or forced on one
by outside people and events and that one has virtually no control over one’s
emotions and cannot help feeling badly on many occasions. These misleading
assumptions are continually revealed and attacked by the rational therapist.
Where, in psychoanalytic techniques, considerable time is spent on showing
the patient how he originally became disturbed, in rational analysis much
more emphasis is placed on how he is sustaining his disturbance by still be-
lieving the nonsense, o r illogical ideas, which first led him to feel and act
in an aberrated fashion. Rational therapy differs from psychoanalytic pro-
cedures in that ( a ) not merely the facts and pschodynamics of the client’s
behavior are revealed but, more to the point, his underlying philosophies
or ideas which lead to and flow from these historical facts; ( b ) a concerted
attack is made on the irrational beliefs that are disclosed in the course of
114 JOURNAL OF PSYCHOLOGY

the therapeutic process; ( c ) emphasis is placed far less on the disclosure of


the individual’s unconscious drives or feelings than on revealing his uncon-
scious and irrational attitudts which underlie these drives o r feelings; ( d )
the therapist literally teaches the patient how to observe his (unconscious)
illogical thinking and how, instead, to think straight; and ( e ) the patient
is usually encouraged, urged, or commanded into emotionally reeducating
actiaity.
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A case involving the rational therapeutic treatment of a psychopath will


now be described. T h e patient was a 25-year-old son of a well-to-do family
and had been engaging in antisocial behavior, including lying, stealing, sexual
irresponsibility, and physical assaults on others since the age of 14. H e had
been in trouble with the law on five different occasions, but had only been
convicted once and spent one year in a reformatory. H e displayed no guilt
about his offenses and seemed not a t all concerned about the fact that he had
once helped cripple an old man whose candy store he and his youthful
comrades had held up. H e had had two illegitimate children by different
girls, but made no effort to see them o r contribute to their financial support.
H e came for psychotherapy only a t the insistence of his lawyer, who told
him that his one chance of being put on probation, instead of being sent to
prison, for his latest offense (rifling several vending machines) was for him
to plead emotional disturbance and convince the court that he was really
trying to do something to help himself in regard to this disturbance.
For the first few sessions the patient was only moderately cooperative,
kept postponing appointments without good cause, and came 10 or 15 minutes
late to almost every interview. H e would listen fairly attentively and take
a n active part in the sessions; but as soon as he left the therapist’s office he
would, in his own words, “forget almost everything w e said,” and come in
for the next session without giving any thought to his problems or their
possible alleviation. It was not that he resentfully was resisting therapy; but
he quite frankly was doing little or nothing to “get with it.”
During the first several sessions, little attempt was made by the therapist
t o get the full details of the patient’s history. It was merely determined
that he was the only son of a doting mother, who had always given him
his way, and of a merchant father who had ostensibly been friendly and
permissive, but who actually had held up to him almost impossibly high
standards of achievement and who was severely disappointed whenever he
fell below these standards. T h e patient-whom we shall call Jim-had been
a spoiled brat with other children, over whom he was always trying to lord
it; had never lived up to his potentialities in school; had started to gain
ALBERT ELLIS 145

attention from his peers and his teachers at an early age by nasty, show-off
behavior; and had only been able to get along reasonably well with girls,
one or more of whom he usually managed to have serve him while he
sadistically exploited her masochistic tendencies.
Although the patient was quite intelligent, and could easily understand
psychodynamic explanations of his behavior-such as the possible connection
between his failing to satisfy his father’s high standards of excellence and
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his trying to prove to others, by quite opposite antisocial actions, how “great”
he was-no attempt to interpret or clarify such connections was made. For
one thing, he stoutly opposed such “psychoanalytic crap” whenever the psy-
chodynamics of his situation were even hinted a t ; for another thing, the
rational therapist frequently makes relatively little use of this kind of histor-
ical clarification, since he deems it highly interesting but not necessarily
conducive of basic personality change.
Instead, the patient’s current circumstances were first focussed upon, and
he was quickly and intensively shown that he kept defeating himself in the
present-as well as in the past. Thus, he kept discussing with the therapist
the possibility of his violating the terms of his bail and “skipping out of
town.” T h e therapist, without being in the least moralistic about this notion
or taking any offence at the implied concept that therapy was not going to
help the patient and that therefore he might as well go on living the kind
of life he had always lived, calmly and ruthlessly showed Jim that ( u ) he
had very little likelihood of being able to skip town without being caught in
short order; ( b ) he would only lead a life of desperate evasion during the
time he would remain free; and ( c ) he would most certainly know no mercy
from the court if and when he w a s recaptured. Although, at first, the
patient was most loathe to accept these grim facts, the therapist patiently
persisted in forcing him to do so.
At the same time, the therapist kept showing Jim the silly and totally
unrealistic philosophies behind his self-defeating notions of trying to skip
bail. H e was shown that he was grandiosely and idiotically telling himself
that he should be able to do what he wanted just because he wanted to do SO;
that it was totally unfair and unethical for others, including the law, to
stand in his way; and that it was utterly catastrophic when he was frustrated
in his one-sided demands. And these assumptions, the therapist kept insisting,
were thoroughly groundless and irrational.
“But why,” asked Jim at one point in the fourth session, “shouldn’t I
want things to go my way? W h y shouldn’t I try to get what I want?”
Therapist: No reason at all. T o want what you want when you want it
146 JOURNAL OF PSYCHOLOGY

is perfectly legitimate. But you, unfortunately, are doing one additional


thing-and that’s perfectly illegitimate.
Patient: What’s that? what’s the illegitimate thing?
Therapist: You’re not only wanting what you want, but demanding it.
You’re taking a perfectly sane desire-to be able to avoid standing trial for
your crimes, in this i n s t a n c e a n d asininely turning it into an absolute
necessity.
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Patient: W h y is that so crazy?


Therapist: For the simple reason that, first of all, any demand or necessity
is crazy. Wanting a thing, wanting any damned thing you happen to crave,
is fine-as long as you admit the possibility of your not being able to get it.
But as soon as you demand something, turn it into a necessity, you simply
won’t be able to stand your not getting it. I n that event, either you’ll do
something desperate to get it-as you usually have done in your long history
of antisocial behavior-r else you’ll keep making yourself angry, excep-
tionally frustrated, or anxious about not getting it. Either way, you lose.
Patient: But suppose I can get what I want?
Therapist: Fine-as long as you don’t subsequently defeat your own ends
by getting it. As in this case. Even assuming that you could skip bail
successfully-which is very doubtful, except for a short while-would you
cwentually gain by having to live in terror of arrest for the remainder of
your life or by having to give up everything and everyone you love here to
run, let us say, to South America?
Patient : Perhaps not.
Therapist: Perhaps? Besides, let’s assume, for a moment, that you really
could get away with it-you really could skip bail and that you wouldn’t get
caught and wouldn’t live in perpetual fear. Even then, would you be doing
yourself such a great favor?
Patient: I t seems to me I would! W h a t more could I ask?
Therapist: A lot more. And it is just your not asking for a lot more that
proves, to me at least, that you are a pretty sick guy.
Patient: I n what way? W h a t king of crap are you giving me? Bullshit!
Therapist: Well, I could get highly “ethical” and say that if you get away
with things like that, with rifling vending machines, jumping bail, and such
things, that you are then helping to create the kind of a world that you
yourself would not want to live in, or certainly wouldn’t want your friends
or relatives to live in. For if you can get away with such acts: of course,
others can too; and in such a pilfering, bail-jumping world, who would want
to live?
ALBERT ELLIS 147
Patient: But suppose I said that I didn’t mind living in that kind of
world-kind of liked it, in fact?
Therapist: Right. You might very well say that. And even mean
it-though I wonder whether, if you really gave the matter careful thought,
you would. But let us suppose you would. So I won’t use that “ethical”
argument with a presumably “unethical” and guiltless person like you. But
there is still another, and better argument, and one that you and people like
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you, generally overlook.


Patient: And that is?
Therapist: T h a t is-your own skin.
Patient: M y own skin?
Therapist: Yes, your own thick and impenetrable skin. Your guiltless,
ever so guiltless skin.
P a t i e n t : I don’t get it. W h a t the hell are you talking about?
Therapist: Simply this. Suppose, as we have been saying, you are truly
guiltless. Suppose you, like Lucky Lucian0 and a few other guys who really
seem to have got away scot-free with a life of crime, really do have a thick
skin, and don’t give a good goddam what happens to others who may suffer
from your deeds, don’t care what kind of a world you are helping to create.
How, may I ask, can you-you personally, that icmanufacture and main-
tain that lovely, rugged, impenetrahle skin ?
Patient: W h a t difference does it make how I got it, as long as it’s there?
Therapist: Ah, but it does!-it does make a difference.
Patient: How the hell does i t ?
Therapist: Simply like this. T h e only practical way that you can get
guiltless, can maintain an impenetrable skin under conditions such as we
are describing, where you keep getting away with doing in others and reaping
criminal rewards, is by hostility-by resenting, hating, loathing the world
against which you are criminally behaving.
Patient: Can’t I get away with these things without hating others? Why
can’t I ?
Therapist: Not very likely. For why would a person do in others without
hating them in some manner? And how could he not be at least somewhat
concerned about the kind of dog-eat-dog social order he was creating unless
he downed his potential concern with defensive resentment against others?
Patient: I don’t know-. W h y couldn’t he?
Therapist: Have you?
Patient: Have I, you mean, managed not to-?
Therapist: Exactly! W i t h your long history of lying to others. Leading
148 JOURNAL OF PSYCHOLOGY

them on to do all kinds of things they didn’t want to do, really, by your
misleading them as to your feelings for them. T h e girls you got pregnant
and deserted, for instance. T h e partners in crime you double-crossed. T h e
parents whose help you’ve always run back for after breaking promise after
promise to them? Would you call that lowe you felt for these people?
Affection? Kindliness?
Patient : Well-uh-no, not exactly.
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Therapist: And the hostility, the resentment, the bitterness you felt for
these people-and must keep perpetually feeling, mind you, as you keep
“getting away” with crime after crime-did these emotions make YOU feel
good, feel happy?
Patient: Well-at times, I must admit, they did.
Therapist: Yes, at times. But really, deep down, in your inmost heart,
does it make you feel good, happy, buoyant, joyous to do people in, to hate
them, to think that they are no damned good, to plot and scheme against
them?
Patient: No, I guess not. Not always.
Therapist: Even most of the time?
Patient: No-uh-no. Very rarely, I must admit.
Therapist: Well, there’s your answer.
Patient: You mean to the thick skin business? You mean that I thicken my
skin by hating others-and only really hurt myself in the process.
Therapist: Isn’t that the way it is? really is? Isn’t your thick skin-like
the lamps made of human skin by the Nazis, incidentally-built of, nourished
on little but your own corrosive hatred for others? And doesn’t that hatred
mainly, in the long run, corrode you?
Patient: Hm. I-. You’ve given me something to think about there.
Therapist: By all means think about it. Give it some real, hard thought.
I n a similar manner, the therapist, in session after session with this intel-
ligent psychopath, kept directly bringing up, ruthlessly examining, and
forthrightly attacking some of his basic philosophies of living, and showing
him that these philosophies underlay his antisocial thoughts and behavior.
No criticism of o r attack on the patient himself was made; but merely on
his ideas, his thoughts, his assumptions which (consciously and unconsciously)
served as the foundation stones for his disordered feelings and actions.
After 22 sessions of this type of rational therapy, the patient finally was
able to admit that for quite a long time he had vaguely sensed the self-
defeatism and wrongness of his criminal behavior, but that he had been
unable to make any concerted attack on it largely because he was afraid
ALBERT ELLIS 149
that he couldn’t change it-that ( a ) he had no ability to control his antisocial
tendencies; and ( b ) he felt that he would not be able to get along satisfac-
torily in life if he attempted to live more honestly. T h e therapist then
started to make a frontal assault on the philosophies behind these defeatist
feelings of the patient. H e showed Jim that an individual’s inability to
control his behavior mainly sterns from the idea that he cannot do s-that
long-standing feelings are innate and unmanageable and that one simply has
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to be ruled by them. Instead, the therapist insisted, human feelings are


invariably controllable-if one seeks out the self-propagandizing sentences
(e.g., “I must do this,” “I have no power to stop myself from doing
this,” etc.) which one unconsciously uses to create and maintain these
“feelings.”
Jim’s severe feelings of inadequacy-his original feelings that he never
could gain the attention of others unless he was a problem child and his later
feelings that he could not compete in a civilized economy unless he resorted
to lying or thieving behavior-were also traced to the self-propagated beliefs
behind them (to the sentences, “I am utterly worthless unless I am always
the center of attention, even though I gain this attention by unsocial
behavior”; “If I competed with others in an honest manner, I would fall
on my face, and that would be utterly disgraceful and unforgivable”; etc.).
These self-sabotaging beliefs, and the internalized sentences continually main-
taining them, were then not merely traced t o their source (in Jim’s early
relations with his parents, teachers, and peers) but were logically analyzed,
questioned, challenged, and counter-attacked by the therapist, until Jim
learned to do a similar kind of self-analyzing, questioning, and challenging
for himself.
After 31 sessions (mainly on a once-a-week basis) of this type of highly
active rational psychotherapy, Jim (who by that time had been placed on
probation) voluntarily gave up the fairly easy, well-paying, and unchallenging
job which his family, because of their financial standing, had been able to
secure for him, and decided to return to college to study to be an accountant.
“All my life,” he said during the closing session of therapy, “I have tried
to avoid doing things the hard way-for fear, of course, of failing and
thereby ‘proving’ to myself and others that I was no damned good. N o
more of that crap any more! I’m going to make a darned good try a t the
hard way, from now on; and if I fail, I fail. Better I fail that way than
‘succeed’ the stupid way I was ‘succeeding’ before. Not that I think I will
fail now. But in case I do-so what?”
Jim is now (two years later) finishing up college and doing quite well
150 JOURNAL OF PSYCHOLOGY

at his school work. T h e r e is every reason to believe that he will continue


to do so at his chosen field of endeavor. A self-defeating psychopath has
finally turned into a forward-looking citizen. I n this case, the patient’s
high intelligence and good family background unquestionably contributed to
making him a more suitable prospect for psychotherapy than the average
psychopath would usually be. T h e same technique of rational psychotherapy,
however, has recently been used with several other individuals with severe
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character disorders and symptoms of acute antisocial behavior and it appears


to work far better than the classical psychoanalytic and psychoanalytically
oriented methods which I formerly employed with these same kind of patients.
While rational therapy is no quick panacea for all human ills, it can be a
remarkably effective technique when adequately and forcefully used with
a wide variety of severely and moderately disturbed patients.
Summary. A summary is given of the main aspects of the technique of
rational psychotherapy; and a case illustration is presented showing how this
technique has been applied to a 25-year-old male with a long history of
psychopathic behavior. It is held that individuals with severe character
disorders, including symptoms of extreme antisocial behavior, can often be
successfully treated if the therapist is not moralistic but he directly and
actively institutes a rational-persuasive attack on the basic illogical beliefs
and unrealistic ideologies which invariably underlie psychopathy.

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3. -. Outcome of employing three techniques of psychotherapy. 1. Clin.
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4. .- Neurotic interaction between marital partners. J . Counsel. Psychol.,
1958, 6, 24-28. ( a )
5. .- Rational psychotherapy. J . Grn. Psychol., 1958, 69, 35-49. ( b )
6. -. Hypnotherapy with borderline schizophrenics. J . Gen. Psycho/., 1958,
69, 245-253. (c)
7. LINDNER,R. Rebel Without a Cause. New York: Grune & Stratton, 1944.
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