The Triumvirate of Modern-Day Psychological Therapy

Source: Photo by Clifford Lazarus 1996

Do you recognize any of these three men? That laypeople might not is totally understandable. They are not readily recognizable, nor are any common household names.

A great many practicing mental health professionals may not recognize any of them.

The glaring gap in knowledge is akin to a modern-day theoretical physicist not recognizing Niels Bohr, Werner Heisenberg, and Robert Oppenheimer.

Naturally, almost everyone recognizes Albert Einstein, hence his deliberate omission despite his unparalleled, seismic contributions to modern physics.

Just as Bohr, Heisenberg, and Oppenheimer shaped our current understanding of the atomic structure, quantum mechanics, and nuclear physics, the men in the photo—Albert Ellis, Arnold Lazarus, and Aaron Beck—shaped the landscape of current-day psychological therapy; especially evidence-based and empirically supported ones like CBT (cognitive behavioral therapy).

Indeed the photo introducing this post shows the triumvirate who laid the foundation of modern-day professional psychology and behavioral health treatment. And just like almost everyone recognizes Einstein, similarly Sigmund Freud is also highly recognizable, hence his omission from the gallery.

But unlike Einstein who practically single-handedly built the theoretical framework of modern physics on actually testable, verifiable, and disprovable scientific hypotheses, Freud single-handedly built the scaffolding of early psychological therapy on his own unscientific introspection, intuition, and imagination. That is one reason why his ideas of psychoanalysis are, astoundingly, still embraced by many mental health practitioners because psychoanalysis is based on essentially untestable, unverifiable, and unfalsifiable concepts. Hence psychoanalysis is more of a religion than a scientifically driven approach to psychological therapy. Perhaps that is why it persists despite its demonstrable ineffectuality.

Indeed, that is why in the early 1950s Dr. Albert Ellis (September 27, 1913 – July 24, 2007) broke rank with the prevailing field of psychodynamic psychotherapy and founded rational psychotherapy that he ultimately evolved into rational emotive behavior therapy (REBT). Unlike psychoanalytic and psychodynamic therapies, which posit the cause of psychological distress is unresolved, unconscious, psychosexual conflicts based on early childhood experiences, Ellis proposed that people are innately irrational and acquire all sorts of faulty beliefs that lead to their emotional suffering.

While the aim of psychoanalysis is to relieve “neurotic suffering” by making the unconscious conscious (mostly through free association and dream interpretation) thereby resolving the distress producing intrapsychic conflicts, the goal of REBT it’s to help people identify, challenge and replace their irrational and maladaptive ideas thus relieving their psychological distress.

Like Albert Ellis, Aaron “Tim“ Beck (July 18, 1921 – November 1, 2021) was also trained in psychoanalytic psychotherapy but, also like Ellis, quickly realized his patients experienced streams of distorted and negative automatic thoughts arising from dysfunctional core beliefs about themselves, the world, and the future.

Moreover, Beck understood peoples’ distorted thinking had profound effects on their emotions and behaviors. By helping patients identify and evaluate their automatic negative thoughts Beck discovered they were able to think more realistically and thereby feel better emotionally and behave more adaptively. In this way Beck is credited as being the father of cognitive therapy (CT).

Unlike Ellis, however, Beck was strongly influenced by scientific thinking and engaged in extensive research to evolve and validate his therapeutic approach. In addition, he created what is perhaps the most widely used assessment instrument for clinical depression, the eponymous Beck Depression Inventory. Over time, Beck increasingly appreciated the importance of direct behavioral change as a powerful amplifier for his cognitive therapy and is thus also credited as being the chief architect of CBT.

An honor that, in my opinion, is actually deserved by Arnold Lazarus (January 27, 1932 – October 1, 2013).

Indeed, the science of psychological therapy has its roots in the soil of the work that Arnold Lazarus and Joseph Wolpe did in Johannesburg, South Africa during the late 1950s. Wolpe and Lazarus took the lessons from conditioning research (e.g., Pavlov) and applied them to the practice of therapy. Thus, “systematic desensitization” (a scientifically based treatment for anxiety) was introduced into the clinical repertoire and the marriage of psychological science and clinical practice began.

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In addition to contributing to the genesis of behavior therapy (BT) Lazarus was the first person to use the terms “behavior therapy” and “behavior therapist“ in the professional literature (i.e., Lazarus, 1958).

Nevertheless, Lazarus quickly found that focusing on behavioral techniques alone was too limiting which lead him to incorporate cognitive factors into his method. Indeed, in 1971 he published his seminal book Behavior Therapy and Beyond which remains a groundbreaking text of what would later become known as CBT. Lazarus went on to further differentiate and expand his clinical approach leading to “broad-spectrum” behavior therapy and ultimately to multimodal therapy (MMT) which is arguably one of the most elegant and comprehensive approaches to psychological therapy ever conceived of.

MMT arose out of Lazarus’s realization that there were significant treatment omissions in BT, CT, REBT, and even CBT, which he all found too limited and narrow. Hence, in addition to focusing on behavior, cognition, and affect, MMT also thoroughly assesses imagery, sensations, interpersonal relationships, and biological/drug factors, resulting in a seven-point assessment framework termed the BASIC I.D.

In addition to its uses in therapy, the BASIC I.D. concept stands alone as a model of human personality and phenomenology. As importantly, the BASIC I.D. reflects the uniqueness of individuals; it can represent a person's "basic identity." And while all people have a BASIC I.D., no two people will have identical psychological experiences and, therefore, will require individually tailored psychological therapy.

Also, because of its breadth and emphasis on technical eclecticism (using proven methods without subscribing to the theory or school of thought that spawned them) MMT can subsume most other therapeutic approaches (e.g., traditional CBT, DBT, ACT, EMDR, mindfulness, etc.) while the converse is not possible.

One of MMT's most powerful features, however, is that it transcends simple diagnostic labels and facilitates highly individualized therapy (C. Lazarus, 1991). This is because many people with the same diagnosis can experience very different symptoms, and thus require very different treatment plans.

Individually, Ellis, Beck, and Lazarus each made enormous contributions to modern, evidence-based psychological treatment methods. Collectively they are the triumvirate of pioneering, twentieth-century mental health treatment visionaries and innovators. True giants in the pantheon of what is simplistically referred to as CBT. Giants upon whose shoulders the vast majority of present-day mental health practitioners stand.

Remember: Think well, Act well, Feel well, Be well!

Copyright 2022 Clifford N. Lazarus, Ph.D.