rational-emotive therapy and religiousness: a review

Journal of Rational-Emotive & Cognitive-Behavior Therapy Volume 10, Number 1, Spring 1992

RATIONAL-EMOTIVE T H E R A P Y AND RELIGIOUSNESS: A REVIEW

W. Brad Johnson National Naval Medical Center

ABSTRACT: Rational-emotive therapy has often been scrutinized and rejected by religious clinicians. Incompatibilities are frequently cited between rational-emotive psychology and theistic religious philisophies. Religious authors have been most notably oppossed to Ellis' ethical humanism, situational ethics and personal atheism. A review of these criticisms offers no evidence for a fundamental incompatibility between RET and religious faith. Several arguments exist for the application of cognitive-behavior therapy (RET in particular) to explicitly religious clients. The sparse empirical literature suggests that RET is effective with religious clients.

In his original paper on Rational Therapy, Albert Ellis (1957) asserted that human emotion is largely caused and controlled by thought processes. This assertion has remained foundational in the ongoing evolution of Rational-emotive theory and therapy.

Ellis has noted that the primary influences on his development of RET were the stoic philosophers, along with Kant, Spinoza and Schop- enhauer (Ellis & Dryden, 1987). RET holds that cognitions, specifi- cally, negative, unrealistic, illogical, self-defeating sentences, are the prime factor in instigating and maintaining emotional "disturbance" (Ellis, 1957, 1985). The fundamental components of rational-emotive theory have been consistently documented (Ellis, 1957, 1973; Ellis & Dryden, 1987; Walen, DiGiuseppe, & Wessler, 1980). Numerous re-

W. Brad Johnson, M.A., is a doctoral student in clinical psychology at the Graduate School of Psychology, Fuller Theological Seminary. A commissioned Lieutenant in the United States Navy, he is currently an intern at the National Naval Medical Center.

The author wishes to express thanks to Raymond N. Sampson, Albert Ellis, Charles R. Ridley and Siang-Yang Tan for their helpful comments on an earlier version of this paper.

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense nor the U.S. Government.

Address correspondence and reprint requests to Lt. W. Brad Johnson, Department of Psychol- ogy, National Naval Medical Center, Bethesda, MD. 20889-5000.

21 �9 1992 Human Sciences Press, Inc.

22 Journal of Rational-Emotive and Cognitive-Behavior Therapy

views have concluded that RET is an effective treatment for a variety of psychological difficulties (DiGiuseppe, Miller, & Trexler, 1977; Ellis, 1977a; Haaga & Davison, 1989; McGovern & Silverman, 1984). While both religious and secular critics have objected vehemently to rational-emotive philosophy and psychology, relatively few have questioned RET's therapeutic efficacy.

Rational emotive philosphy is best characterized by a logical positivist epistemology, a focus on dialectics, situational ethics, primary values of survival and enjoyment, responsible hedonism and ethical humanism (Ellis, 1973, 1980; Robb, 1986; Walen et al., 1980; Woolfolk & Sass, 1989). Ellis' ethical humanism and atheism have been among the aspects of rational-emotive theory most noted and critiqued by religious authors.

This article examines the general philosophical and uniquely religious criticisms of rational-emotive theory. It then reviews agruments for the application of cognitive-behavior and rational-emotive therapy to religious clients. Finally, it will seek to offer a summary of the sparse outcome literature.

GENERAL CRITIQUES OF RATIONAL-EMOTIVE THEORY

The philosphical basis of RET has been a frequent target of critics. (Eschenroeder, 1982; Guidano, 1988; Mahoney, 1988; Mahoney, Lyd- don & Alford, 1989; Rorer, 1989a, 1989b; Woolfolk & Sass, 1989). Ma- honey et al. (1989) noted that RET is an evolution of the "mind-cure movement" which looked to the power of optimistic thought as being the primary path toward happiness. Despite the claims of Ellis that RET is an interactionist theory, Mahoney (1989) insisted that RET advocates strict "rational Supremacy." Guidano (1988) described RET as a "surface-structure associationistic model" which holds that higher in- tellectual processes can and should direct feelings and actions. These authors have been critical of RET's failure to systematically consider the influence of environmental forces on the development and mainte- nance of irrational beliefs (Eschenroeder, 1982).

The "rationalism" underlying rational-emotive theory has been criticized for placing constraints upon the nature of knowledge and for leading axiomatically to formalistic and dichotomous thinking (Ma- honey et al., 1989). The separation of experience into the classes of rational and irrational has been viewed as a rudimentary form of

W. Brad Johnson 23

thinking. Rorer (1989a, 1989b) has asserted that logical empiricism, on which RET was originally based, is no longer a tenable epistemology.

Perhaps, the most relevant and substantive critiques of RET have focused on the inconsistency and confusion prevalent in the fundamental rational-emotive theory of psychopathology and psychotherapy (Esch- enroeder, 1982; Finley, 1987; Kuiper & MacDonald, 1983; Lazarus, 1977; Roberts, 1987a; Sharkey, 1981; Smith, 1982). RET has been described as a collection of loosely related propositions, as opposed to a formal theoretical model (Eschenroeder, 1982). Similarly, Lazarus (1977) argued that: "RET has become so pliable that it incorporates nearly all methods and therefore has few meaningful boundaries and few distinctive parameters" (p. 239).

Finally, the rejection of rational-emotive psychology (REP) may be justifiable by RET itself, or so some critics would contend. Sharkey (1981) pointed out that while REP rejects the dogmatism of nonscien- tific values, it dogmatically asserts the ultimacy of science.

RELIGIOUS CRITIQUES OF RATIONAL-EMOTIVE THEORY

Few theories of psychopathology and psychotherapy have drawn such vigorous and often acrimonious responses from religious authors as has RET. This is undoubtedly due, at least in part, to Ellis' outspo- ken atheistic and openly anti-religious position. A review of the critiques of RET by religious authors indicates a universal dissatisfac- tion with REP. Notably, the therapeutic techniques of RET are seldom questioned.

The philosophical asumptions of RET have been criticized for their incompatibility with many theistic religious epistemologies. Woolfolk and Sass (1989) questioned whether or not a meaningful world view can be fashioned from the epistemological categories provided by the scientism of RET. Finley (1987) noted that while Ellis disparages religion, he clearly makes the empirical method an empiricist religion of science. Meehl (1981) has been critical of RET's implicit assumption that the therapist's rationalist-humanistic values are ultimately the correct ones. He insisted that values-clarification should exist at a rational, cognitive level without imposing the therapist's own values.

The incompatibilities of rational-emotive philosophy and Christian- ity have recently received considerable attention (Jones, 1989;


McMinn & Lebold, 1989; Watson, Morris, & Hood, 1988). McMinn and Lebold (1989) noted that Ellis' assumption that devout religious philosophies need to be altered is not consistent with a Christian therapeutic approach. Watson et al. (1988) concluded that Christ ianity and REP operate as differrent and often competing ideologies and hypothesized that reason alone is not a totally reliable guide to right belief and action.

It is not surprising that some authors have rejected altogether the possiblity of compatibility between RET and a theistic religious philosophy (Jones, 1989; Roberts, 1987b; Wessler, 1984). In place of religious faith, Ellis has advocated the substitution of scientific thinking (Wessler, 1984). In another critique, Roberts (1987b) utilized what he called a "virtues" approach to evaluating secular psychotherapies via a Christian framework and concluded that RET's conceptions of equa- nimity, self-acceptance and humor are distinctly different from the Christian versions of these virtues. Roberts concluded that the goals and ultimate values of RET and Christ ianity are mutually inconsis- tent.

Perhaps, the most significant point of contention between religious authors and those promulgating rational-emotive theory has been the question of the relationship of religiousness to mental health. From the outset, Ellis has adamantly asserted that devout religiosity, both theological and secular, is crucial to neurosis in that both are illogical forms of magical thinking (Ellis, 1960a). Further, he insisted that the concept of sin was the direct and indirect cause of virtually all neu- rotic disturbance (Ellis, 1960b; 1962), in that it leads directly to self- blame, guilt and self-hate. Ellis' earlier writings were opposed to all forms of theistic religion:

When and if humans fully accept the reality that there is no super- natural "force" in the universe that gives a damn about them or ever will, they will then be truly humanistic. Rational-emotive psychology is one of the main modern methods of helping them work toward that goal. (Ellis, 1973, p. 16)

Ellis has continued to assert that religiosity is antithetical to emotional health and rational thinking (1980, 1981, 1983, 1986, 1987). In his paper "The Case Against Religiosity" (1983), Ellis hypothesized that " . . . devout belief, dogmatism, and religiosity distinctly contrib- ute to and in some ways are equal to mental or emotional disturbance" (p. 1). He has claimed that devout or "pious" religiosity is strongly

W. Brad Johnson 25

associated with masochism, dependency, intolerance, poor self-esteem, depression, grandiosity and other disturbances (Ellis, 1983).

In response to these claims by Ellis and others, religious authors have suggested that religion can serve as a socializing agent, a sup- presser of pathology, a perceived source of refuge and a frequently utilized form of self-therapy via religious expression and activity (Johnson & Ridley, in-press; Propst, 1982; Spilka, 1986).

A review of the empirical literature offers no evidence for the positive correlation between religiousness and pathology postulated by Ellis. Stark (1971), in a review of the literature, concluded that psychopathology is negatively related to conventional forms of religious commitment. King (1978), in a study of evangelical Christians, found that the percentage of emotional disorders within this group was the same as that found in the general population. Sharkey and Malony (1986), in a study of clients in Ellis' own counseling center, found that highly religious clients reported fewer symptoms of emotional distress than nonreligious clients. Finally, Bergin (1983) conducted a meta- analysis of 24 studies relevant to the religiousness-emotional adjust- ment debate and concluded that no support exists for the preconcep- tion that religiousness is necessarily correlated with psychopathology. In fact, more recent evaluations of the literature (Bergin, 1991; Gart- ner, Larson, & Allen, 1991) have concluded that the preponderance of evidence suggests that religion is associated with mental health bene- fits.

With the introduction of the Religious Orientation Scale (Allport & Ross, 1967) and it's intrinsic-extrinsic scales, the correlation between religiousness and pathology, as postulated by Ellis, has been further called into question. While the intrinsic person relates religion to all of life and is tolerant and mature, the extrinsic person tends to com- partmentalize religion and is prejudiced, immature and self-serving. In a comprehensive review of I-E research, Donahue (1985) concluded that extrinsicness tends to be positively correlated with negatively evaluated psychological characteristics and uncorrelated with measures of religiousness. Intrinsicness tends to be uncorrelated with negatively evaluated characteristics and positively correlated with other measures of religiousness (Bergin, 1983; Bergin, Masters, & Richards, 1987; Bergin, Stinchfield, Gaskin, Masters, & Sullivan, 1988; Watson, Morris, & Hood, 1988). Most recently, Johnson, Ridley, DeVries and Pettorini (1990) found that extrinsicness was associated with irrational thinking (as measured by the Rational Beliefs Inventory) and less frequent religious behavior. There was no evidence for a correla-


tion between religious behavior and psychopathology (as measured by the SCL-90-R).

In summary, empirical research on the relationship between religiousness and mental health suggests no greater incidence of psychopathology among religious persons than among those in the general population. In fact, evidence suggests that an intrinsic religious orientation is an asset and that it may be used therapeutically to provide leverage in favor of growth (Bergin et al., 1987; Propst, 1981; Spilka, 1986). It appears that the religiousness-pathology connection hypothesized by Ellis (1983) is relevant only to the extrinsically religious person who is characterized as less committed, less mature, dogmatic, rigid and prejudiced (Allport & Ross, 1967; Donahue, 1985; Feagin, 1964). It seems likely that Ellis' critique of the rigid "believerism" (Ellis, 1980) among "devout religionists" (Ellis, 1983) is most applicable to extrinsically oriented and indiscriminately pro-religious persons.

To his credit, Ellis has emphasized "probalistic atheism" which suggests that the less dogmatically religious persons are, the healthier they are likely to be (Ellis, 1980, 1981). He has also drawn a clearer distinction between healthy and unhealthy types of religiousness, based on the emotional and behavioral consequences of each (Ellis, 1984, 1986). People who have a devout belief in dogmatic and damn- ing religions tend to be emotionally disturbed, while people who ad- here to liberal or even orthodox religions, but who do so moderately and who strongly prefer but do not insist on following its dictates, normally do not get into serious emotional or behavioral trouble (Ellis, 1986).

ACCOMODATION OF COGNITIVE-BEHAVIOR THERAPIES TO RELIGIOUS CLIENTS

Accommodation theory (Johnson & Ridley, in-press) holds that the accommodation of established psychotherapeutic interventions to a client's existing belief system is itself a unique ingredient of change in therapy with religious clients. The accommodated intervention is somewhat modified to be more palatable to the religious client.

Several authors have offered theoretical accommodations of Cogni- tive-Behavior Therapy (CBT) and Christian theology (Edwards, 1976; McMinn & Lebold, 1989; Pecheur, 1978; Propst, 1982, 1988; Tan, 1987). Both Edwards (1976) and Propst (1982) have suggested that

w. Brad Johnson 27

there are striking parallels between theology, Scripture, prayer and the techniques of cognitive behavior modification. Pecheur (1978) wrote that:

Cognitive therapy appears to make explicit the process of growth indicated in Scripture. Consequently, it should be the most effective means of obtaining cognitive change and, concomitantly, emotional and behavioral change in clients. (p. 251)

McMinn and Lebold (1989) believe that by carefully using Beck's technique of collaborative empiricism or Meichenbaum's collaborative therapeutic style, religious clients can be motivated to evaluate their beliefs in a supportive manner.

In recent years there have been numerous offerings of "Christian" therapies which fundamentally accommodate established CBT techniques (Backus, 1985; Backus & Chapian, 1980; Collins, 1980; Crabb, 1977; Propst, 1981, 1982, 1988; Worthington, 1982; Wright, 1986). Col- lins (1980) focused on behavior change via rewards, coping techniques, homework assignments and challenging irrational beliefs. Crabb (1977) identified problem feelings, behaviors and thinking in clients. He then helped them develop "spirit-controlled" feelings, plan and carry out "Biblical behavior," and clarify more "biblical thinking." Backus (1985), Backus and Chapian (1980), Worthington (1982) and Wright (1986) very explicitly integrated the techniques of rational restructuring, including self-talk, imagery, refraining, modeling and dis- putation, into a Christian counseling approach. Finally, Rebecca Propst has carefully utilized cognitive restructuring (1982), religious imagery (1981) and a global cognitive-behavior modification approach (1988) with religious populations.

ACCOMMODATION OF RET TO RELIGIOUS CLIENTS

In spite of the previously detailed concerns of religious authors that RET is theoretically and philsophically incompatible with religious faith, several authors, including Ellis himself, have found RET to be highly applicable to therapy with religious clients (Beaman, 1978; Carter, 1986; Dire, 1984; Ellis, 1981, 1984; Jones, 1989; Law- rence & Huber, 1982; Sharkey, 1981; Walen et al., 1980; Wessler, 1984; Young, 1986). In the most important theoretical work among


these, Sharkey (1981) concluded that RET does not follow from or de- pend upon REP and that one may therefore adopt and practice RET while rejecting REP. Sharkey wrote:

Despite the problems with REP, the techniques of RET seem to be among the simplest, sanest and most philosophically neutral prac- ticed today. As a philosophically neutral therapy, RET need not wed itself to any theoretical dogma, including the "ethically humanistic" philosophy of RET. (1981, p. 153)

Several authors have insisted that RET suffers from a negative halo effect - the result of the often unorthodox statements of Ellis, as well as his obscene language, mili tant atheism, extreme liberal views and his equating of religion with neurosis (Lawrence & Huber, 1982; Walen et al., 1980; Wessler, 1984). Walen et al. (1980) found it un- ecessary to have clients give up all forms of religious belief but only the most extreme forms of religious orthodoxy which seem to decrease their enjoyment, self-acceptance and toleration of others. Wessler (1984) recommended an alternative to RET, which he called "Cogni- tive Appraisal Therapy" (CAT). CAT shares with RET an emphasis on the role of evaluative thinking in emotional disturbance, but rejects atheistic humanism and the dogmatic stance of Ellis on must statements. Further, several theoretical papers have found "remarkable" similarity between the premises of RET and Christian theology (Beaman, 1978; Carter, 1986; Dire, 1984; Jones, 1989; Lawrence & Huber, 1982; Young, 1986). Carter concluded that both Scripture (c.f. Pro'v. 23:7; Mark 7:18-23) and applied psychology support the tenet that thought processes precede and influence our emotions and actions. Ellis (1981) has written:

I soon help most of my clients to see that however "immoral" or "unethical" they are, it is still only desirable and never necessary that they act morally and ethically. Consequently, although their behavior is bad, they are never worms, lice, or bad people. In this way, as a rational-emotive therapist, I accept the Christian doc- trine of accepting the sinner but not the sin; and I can still firmly hold that client's acts, deeds and performances are often highly "wrong" or "unethical" but that they are not "bad" or "immoral" people. (p. 11)

There have been several recent attempts to practically integrate RET with Christian psychotherapy or counseling (Backus, 1985; Dire,1984; Hauck, 1972; Johnson, 1991; Johnson & Ridley, 1989; Pow-

w. Brad Johnson 29

ell, 1976; Robb, 1988; Stoop, 1982; Thurman, 1989). These approaches have been given various names such as "misbelief therapy" (Backus & Chapian, 1980), "vision therapy" (Powell, 1976) and the "self-talk approach" (Stoop, 1982), however, each of them essentially accommo- dates the techniques of RET to Christian values and scriptural truth.

The most comprehensive of these approaches (Backus, 1985; Thur- man, 1989) have insisted that the goal for Christ ian clients is the substitution of t ruth for error and correct belief for wrong belief. The t ruth of the Bible is considered to be the t ruth by which all other t ruth should be measured. "The Christian criterion for the contents of the black box is the t ruth of God. This is, of course, the criterion Jesus himself recommended" (Backus, 1985, p. 22). These approaches are no- table in that they openly recognize the value of rational-emotive psychotherapeutic techniques and yet are careful to provide them with a philosophical basis consistent with Christian faith.

EMPIRICAL LITERATURE

To date, only four controlled outcome studies have compared religious and secular approaches to therapy with religious clients (John- son, 1991; Johnson & Ridley, 1989; Pecheur & Edwards, 1984; Propst, 1980). In each of these studies, an established cognitive intervention was modified to incorporate the religious values of clients. Johnson & Ridley (in-press) have recently discussed this approach and have la- bled it "accommodation" of secular technique to religious values.

Of these studies, only Propst (1980) found a religious approach to be more effective than a non-religious one. In her study, a religious imagery treatment reduced evidenced of mild depression on both self-report and behavioral measures significantly more than did a nonreligious imagery or self-monitoring treatment. Pecheur and Edwards (1984), using a Christian form of Beck's cogntive treatment for depression, reported no significant differences between secular and Christian versions of the treatment in reducing depression.

More recently, Johnson (1991) and Johnson and Ridley (1989) have accomodated a Christ ian version of RET to intrinsically religious client samples. Johnson and Ridley (1989) operationalized a brief (six session) Christian form of RET and compared the therapeutic efficacy of this t reatment with a standard version of brief RET with 10 depressed Christian clients. Results indicated that both treatments were effective in reducing depression and automatic negative thoughts,


while only the Christian RET treatment reduced client's irrational beliefs. Johnson (1991), in a second study, employed a similar comparative outcome design with 32 depressed Christian clients. Clients were seen for eight sessions of RET or Christian RET (CRET). While CRET followed the same general format as RET, it used the Bible (rather than human reason) as a guide to truth. Clients were encouraged to dispute or "rebuke" irrational/unbiblical thinking and to use the ultimate source of truth, Scripture, to dispute such thoughts. Homework assignments incorporated biblical evidence and example in disputa- tion, imagery, relaxation, and bibliotherapy. Results showed that both treatments significantly reduced depression, automatic negative thinking, irrational thinking and general psychopathology. These differences were maintained at a three month follow-up. There were no differential t reatment effects.

The principal finding from the these studies is that RET and a Christian version of RET have equivalent beneficial effects on depression in intrinsically religious Christian clients. Preliminary empirical evidence suggests that RET can be accommodated to the religious belief system of Christian clients without impairing the therapeutic value of the intervention (Johnson, 1991). Thus in spite of Ellis' anti- religious position (Ellis, 1980, 1983, 1987), there is currently no evidence for a fundamental incongruence between the practice of RET and a Christian belief system.

CONCLUSIONS

A review of the empirical l i terature offers no support for the axi- omatic link between religiousness and mental health postulated by Albert Ellis. Evidence indicates that an intrinsic religious orientation is associated with greater overall mental health and that it may be utilized as a powerful source of strength in psychotherapy. The extrinsically religious person, however, is likely to be less mature and more dogmatic and thus vulnerable to a greater frequency of irrational thinking and general pathology. The relationship between religiousness and mental health is neither linear nor orthogonal as Ellis once claimed (Ellis, 1960a).

The fundamental philosophical components of REP are incompata- ble with theistic religious philosophies. While REP advocates atheism, a logical positivist epistemology, situational ethics and responsible hedonism, Judeo-Christian theologies advocate theism, a theistic epis-

W. Brad Johnson 31

temology, universal (scripture-based) ethics and responsible self-con- trol.

In spite of these incompatabilites, empirical evidence suggests that RET can be effectively accommodated to the religious values of intrinsically religious clients. It remains to be seen whether these results will hold true with extrinsically oriented clients. Future research should examine the efficacy of preferential or "elegant" RET (Ellis & Dryden, 1987) with religious populations. It is hypothesized that reli- giously accommodated RET will prove particularly helpful in the pro- vision of mental health services to those religious clients who will only seek treatment from a therapist operating within an explicitly religious framework.

Finally, Albert Ellis has recently demonstrated a willingness to consider the possibility of non-pathological religiousness. This trend is seen as positive and consistent with available empirical data. This trend further contradicts claims that RET is formalistic, dichotomous and dogmatic (Mahoney et al., 1989).

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