Journal of Cognitive Psychotherapy: An International Quarterly, Volume 7, Number 2,1993

Philosophical Differences
Among Cognitive Behavioral
Therapists: Rationalism,
Constructivism, or Both ?
Raymond DiGiuseppe
St. John's University
and Institute for Rational-Emotive Therapy
Jean Linscott
St. John's University

This study attempted to validate Mahoney's classification of cognitive behav-

ioral therapists into rationalists or constructivists and to verify his hypothesis
that Rational-Emotive therapists hold more rationalist attitudes than do other
cognitive behavioral therapists. It was also hypothesized that the preference for
disputing irrational thoughts early in therapy would also serve to distinguish
between general cognitive behavioral and RE therapists. Cognitive behavioral
(CB) and RE therapists completed a questionnaire representing Mahoney's
categorization of rationalist and constructivist philosophies and the preference
for disputing irrational beliefs early in therapy. Factor analysis yielded three
distinct consistent factors named "rationalism," "constructivism," and "early
disputing." Each demonstrating adequate internal consistency. Analysis of
variance indicated that RE therapists endorsed significantly more rationalist
items than cognitive behavioral therapists. There were no significant group
differences in the endorsement of constructivist items or disputing irrational
beliefs early in therapy. General CB therapists significantly endorsed more
constructivist than rationalist philosophies. Results of the study provide empiri-
cal support for Mahoney's two-factor designation, but provide evidence indi-
cating that rationalism and constructivism are not bipolar philosophies. Thera-
pists can hold beliefs on each separately.

Cognitive behavioral therapy has evolved into a very diverse field, representing
numerous theories, which can no longer be considered a unitary or monolithic

© 1993 Springer Publishing Company

117
118 DiGiuseppe and Linscott

field. Differing theoretical perspectives ate readily apparent today, evidenced by

the estimate of at least 17 current CB therapies (Mahoney, 1990; Mahoney &
Gabriel, 1987).
Mahoney has attempted to order CB therapies by suggesting that two philo-
sophical views differentiate them: rationalism and contructivism. The rationalist
and constructivist approaches, according to Mahoney, differ chiefly in terms of
their theories of reality, knowledge, causality, primacy of cognition, and thera-
peutic technique (Mahoney, 1988a; 1988b; 1991; Mahoney & Gabriel, 1987).
As defined by Mahoney rationalism (a) argues that thought is superior to
sensation in determining experience and validating knowledge, (b) emphasizes a
distinct boundary between mental and physical processes and defends the primacy
of the higher cerebral functions of lower-brain and bodily processes, (p.45), and
(c) is by definition opposed to constructivism. Constructivism (1) asserts that
humans actively construct the realities to which they respond, (2) challenges the
idea that reality is fundamentally external and stable, (3) acclaims that human
thought cannot be meaningfully separated from feeling and action (p. 46), (4)
emphasizes life span development and change of the organism over time, and (5)
defends the systemic, complex, and reciprocal aspects of causality.
Mahoney (1988a; 1988b; 1991; Mahoney & Gabriel, 1987) also delineates
theoretical and practical differences between the rationalist and constructivistic
approaches to cognitive behavioral therapy.
Mahoney's (1991) Cognitive Developmental Therapy and the work of Guidano
(Guidano & Liotti, 1983) & Joyce-Moniz (1985) are the current cognitive
behavioral therapies thought to epitomize the constructivist approach (Mahoney,
1991; Mahoney & Gabriel, 1987). Ellis' Rational Emotive Therapy (RET) has
consistently been characterized by Mahoney (1979; Mahoney, Lyddon, & Alford,
1989) as epitomizing the rationalist approach. As Mahoney and colleagues state:
"Perhaps no single contemporary theory has done more to further advance the
rationalist approach to psychological counseling, however, than the rational-
emotive theory of Albert Ellis" (Mahoney, Lyddon, & Alford, 1989, p.72).
Ellis disagrees with Mahoney's categorization of RET as an approach based on
philosophical rationalism. Early in the development of RET, Ellis (1962) differ-
entiated his theory of psychotherapy from philosophical rationalism. Ellis pres-
ently describes RET as incorporating elements of both the rationalist and cons-
tructivist positions. Ellis claims that Mahoney's false categorization of RET
results from his ignoring modifications in the theories of RET, as well as his
incorrect understanding of the philosophies of RET (Ellis, 1989a; 1989b). Ellis
has offered numerous reasons why RET is not a rationalist approach, and he
suggests that RET maybe more constructivist than Mahoney's Cognitive Devel-
opmental Therapy (Ellis, 1989a; 1989b).
Mahoney described these philosophies as bipolar opposites. It is implied that
CB therapists will adhere to only one of these philosophies. Our hypothesis was
that the philosophies of CB therapists fall along a rationalist- constructivist
Cognitive Behavioral Philosophies 119

continuum, as opposed to the either/or, bipolar philosophical distinction Mahoney

suggests. Thus therapists may espouse beliefs characterized by both the rationalist
and constructivist position.
In addition to die philosophical, theoretical, and technical issues raised by
Mahoney, another issue may separate CB and rational emotive therapists. That is,
which cognitions they target first in therapy. Both Beck and Ellis postulate the
existence of similar types of cognitions. Beck's model posits automatic thoughts
and underlying assumptions/core schema (Beck, 1976; Beck, Rush, Shaw, &
Emery, 1979; Beck & Emery, 1985). Rational-emotive therapists make a similar
distinction between inferences and irrational beliefs (Bernard & DiGiuseppe,
1989; DiGiuseppe, 1986a; 1986b; 1989; 1991; DiGiuseppe & Bernard, 1991;
Wessler & Wessler, 1980, Huber & Baruth, 1989). This literature suggests
(Bernard & DiGiuseppe, 1989; DiGiuseppe, 1986a;1986b; 1989; !991;DiGiuseppe
& Bernard, 1990) that Beck's automatic thoughts are similar to inferences in RET,
and that underlying assumptions/schema are similar to irrational beliefs.
A major difference between Cognitive Therapy and RET is the primacy of
targets. Cognitive therapy recommends that therapists challenge the automatic
thoughts first and attempts to change the underlying schema afterwards (Beck &
Emery, 1985; Beck&Freeman, 1990). RET advocates that the therapist uncover the
irrational beliefs, and challenge them as soon as possible, while actually avoiding
targeting the automatic thoughts/inferences (DiGiuseppe, 1991; DiGiuseppe &
Bernard, 1990; Dryden & DiGiuseppe, 1990; Ellis, Lockwood, & Young, 1988).
While RET has been rated as one of the most popular forms of psychotherapy
(Heesacker, Heppner, & Rogers, 1982) and Ellis has been rated as the second most
influential theorist in psychotherapy (Smith, 1982), RET has been criticized
repeatedly as lagging behind other cognitive behavioral therapies in stimulating
empirical research (Haaga & Davison, 1989a; 1989b; Mahoney, 1974,1979;
Smith, 1989). Researchers have tended to focus more on the designing of studies
concerned with the techniques of Beck and Meichenbaum. It would appear safe
to say that the opinions of present researchers in cognitive behavior therapy reflect
the work of Beck (1976) and Meichenbaum (1977), and not that of Ellis. Attempts
to evaluate the attitudes of CB therapists in general should be assessed by polling
researchers in the field. However, since RET has not greatly influenced the
research community, one would have to rely on polling practitioners trained by
Ellis to accurately assess the attitudes of RE therapists.
This study attempted to (a) assess the validity of Mahoney's bipolar categori-
zation of the rationalist vs. constructivist philosophies of CB therapy and to (b)
discover whether RE therapists were more likely to espouse the rationalist
philosophy than cognitive behavior therapists in general as Mahoney claims, and
assesses whether the distinction between the choice of targets was an important
issue among CB therapists. It was not believed that either the rationalist or
constructivist scale scores would be related to a therapists choice to target
underlying schema early in therapy.
120 DiGiuseppe and Linscott

METHOD

Subjects
Subjects were selected from two populations. The first sample, called the general
CBT sample, consisted of authors who published articles on cognitive behavioral
therapy (or related topics) between and including the years 1986-1988. The
journals sampled were: Cognitive Therapy and Research, Journal of Consulting
and Clinical Psychology, and Journal of Cognitive Psychotherapy: an Interna-
tional Quarterly. Also included in this sample were speakers scheduled to appear
at the 1989 World Congress for Cognitive Therapy. If authors from the journal
publication list were also on the referral list for the Institute for Rational Emotive
Therapy, or if the article concerned RET, they were excluded from this group.
The second sample consisted of clinicians from the referral list of the Institute
for Rational-Emotive Therapy. Only those persons on the list who had completed
the Institute for Rational-Emotive Therapy's fellowship or associate fellowship
training programs were included. Those persons who were known to the author to
no longer practice RET were eliminated.
In total, 416 questionnaires were mailed out, 161 to the general CBT sample, and
255 to the RET sample. Of the 416 questionnaires mailed, 39 were returned
unopened due to incorrect addresses, 178 were completed and returned, and the
remaining 199 questionnaires were not returned. The final sample consisted of 178
subjects, including 59 from the general CBT sample, and 119 from the RET sample.
Demographic information obtained from the general CBT sample revealed an
age range of 33-69 years, with an average age of 47 years; 83% of respondents
were male, and 15% female. The highest degree subjects obtained was a Ph.D.,
92%; M.A., 3%; ED.D., 3%; and MD, 2%. Primary employment settings in-
cluded: university academic department, 51%; private practice, 20%; hospital 0.
P. D., 9%; research setting, 5%; university service delivery department, 3%;
mental health center, 3%; hospital inpatient setting, 2%; and other, 7%. Subjects
identified themselves as either scientist/practitioners (70%), practitioners (18%),
or scientists (12%). Subjects were also asked to identify "which theoretical
position within cognitive behavior therapy would be most closely related" to their
own theoretical views. Beck's cognitive therapy (1976) was named by the
majority of the journal publication sample (49%), with the second largest
percentage of respondents naming Ellis' (1962) Rational-Emotive therapy (14%).
The RET sample consisted of respondents with an age range of 26-77, with an
average age of 45, including 72% males and 26% females. The highest degree
subjects obtained was a Ph. D., 66 %; MA, 11%; MSW, 6%; EDD, 5%; MS, 4%;
PsyD, 3%; and MD, 2%; while the year the degree was (or was to be) received
ranged from 1944-1990, with 1976 being the modal year. Primary employment
settings included: private practice, 43%; university academic department, 22%;
Cognitive Behavioral Philosophies 121

mental health center, 8%; hospital inpatient setting, 6%; university service
delivery department, hospital O.P.D., and public school, 4%, respectively, re-
search setting, 1%; and, 7% other. Subjects identified themselves as either
practitioners 55%, or scientist/practitioners 45%. In the RET sample, Ellis' RET
was named as the theoretical preference by 84% of the respondents.

Materials
The "Therapist Attitudes Questionnaire" was constructed to assess the validity of
Mahoney's bipolar categorization of CB therapists. Items were designed to
represent one pole of each of the philosophical, theoretical, and technical bipolar
dimensions derived by Mahoney to represent the rationalist and constructivist
positions, as described (see Table 1). The items were constructed by the authors
from the polarity descriptions of rationalist and constructivist philosophies from
the Mahoney and Gabriel 1987 article. Each of the 32 items represented one end
of Mahoney's descriptions of the philosophical positions. Sixteen items were
designed to represent the rationalist philosophy, and 16 items represented the
constructivist philosophy.
Six additional items of the questionnaire were included to assess differences on
their preferences for target thoughts in the initial stages of therapy. Three items
represented the therapist's choice in disputing automatic thoughts before under-
lying schema/irrational beliefs, spending more time disputing automatic thoughts
than underlying schema irrational beliefs, and the importance of helping patients
adopt new philosophies to cope with negative realities. Three items represented
the reverse order of preference.
Subjects were asked "the degree to which you endorse the following statements"
on a scale 5 point Likert scale. The questionnaire is reproduced in Table 1.
The items were sent to Mahoney asking him to verify whether or not they
accurately represented his descriptions of the rationalist and constructivist posi-
tions. He responded affirmatively.

Procedure
After Mahoney's confirmation, the questionnaires were mailed to the journal
publication and referral list samples. In addition to the questionnaire, a cover letter
describing the intent of the study was enclosed, along with a stamped, addressed
return envelope, and a post card to request the results of the study. The purpose
of the study was described as an interest in "seeing if CB therapists actually have
similar philosophical attitudes, theoretical assumptions, and clinical interven-
tions." Subjects were requested to "fill out the questionnaire, put it in the
envelope, and return the post card separately with your name and address if you
would like us to send you the results of the study."
122 DiGiuseppe and Linscott

TABLE 1. Items in Therapist Attitudes Questionnaire

For each item, subjects were asked to "indicate the degree to which you endorse
the following statements:" with the numbers
1 through 5 representing:
1 2 3 4 5
Strongly Moderately Neither Moderately Strongly
Disagree Disagree Agree or Agree Agree
Disagree
1. Reality is singular, stable and external to human experience:
2. Knowledge is determined to be valid by logic and reason:
3. Reality is revealed to us through our senses:
4. Learning involves the contiguous or contingent chaining of discrete events:
5. The brain and the nervous system are recipients of sensority and logically
impaired information:
6. Mental representations of reality involve accurate, explicit and extensive
copies of the external world which are encoded in memory:
7. The brain is the primary and leading factor in determining human develop-
ment and somatic activity:
8. The higher intellectual processes functionally dominate and control our
feelings and behavior:
9. Negative and intense emotions should be controlled or eliminated for
healthy adjustment:
10. Psychotherapy would best derive its direction from the designation of
explicit short and long term goals, which will usually involve the control or
elimination of current symptomatology:
11. It is better for psychotherapists to focus on problems (negative behaviors
and emotions) which reflect psychological deficits or dysfunctions that need
to be redressed regulated or eradicated:
12. It is best for psychotherapists to focus treatment on clients' current prob-
lems and the elimination or control of these problems:
13. Disturbed affect comes from irrational, invalid, distorted or/and unrealistic
thinking:
14. Clients' resistance to change reflects a lack of motivation, ambivalence or
motivated avoidance and such resistance to change is an impediment to
therapy which the psychotherapist works to overcome:
15. Clients' insight into their irrational and invalid beliefs is necessary and
almost sufficient to produce therapeutic change:
16. Relapse, recidivism and/or regression of a problem after psychotherapy
suggests or reflects a failure of generalization and maintenance processes
which in turn suggests an insufficient or inconsistent use of knowlege or
cognitive structures imparted during therapy:
17. Reality is relative. Realities reflect individual or collective constructions of
order to one's experiences:
18. The validity of knowledge is less important than viability. Viability is the
best criteria for knowledge:
19. Learning involves the refinement and transformation (assimilation and
accommodation) of mental representation:
20. The primary function of the brain and nervous system is to produce the
idiosyncratic viable construction or schema to order experience:
Cognitive Behavioral Philosophies 123

TABLE 1. (continued)
21. Mental representations are tacit constructs that order our experience and
constrain perceptions but do not specify the particulars of perception:
22. Cognition, behavior and affect are interdependent expressions of holistic
systemic processes. The three are functionally and structurally inseparable:
23. The body and the mind (brain) are inseparable and interdependent:
24. Intense emotions have a disorganizing effect on behavior. This disorganiza-
tion may be functional in that it initiates a reorganization so that more viable
adaptive constructions can be formed to meet the environmental demands:
25. It is not best for psychotherapy to have a fixed goal, rather it is best to follow
the path that the client's development takes:
26. Psychotherapists should encourage emotional experience, expression, and
exploration:
27. Clinical problems are current or recurrent discrepancies between our ex-
ternal environmental challenges and internal adaptive capacities. Problems
can become powerful opportunities for learning:
28. Awareness or insight is one of many strategies for improvement, however,
emotional and/or behavioral enactments are also very important:
29. Resistance to change reflects a healthy, natural, self protecting process that
guards against changing too quickly. Therefore, resistance is adaptive and
should be worked "with" rather than "against":
30. Relapse, recidivism, and regression are natural aspects of human nature.
Change may be of nonpsychological, linear development. Regressions, and
relapse, are natural and virtually inevitable aspects:
31. Therapists' relationship with clients is best conceptualized as a professional
helping relationship which entails the service and delivery of technical,
instructional information or guidance:
32. Psychotherapists' relationship with clients can best be conceptualized as a
unique social exchange which provides the clients a safe supportive context
to explore and develop relationships with themselves and the world:
33. It is best for psychotherapists to change clients' automatic thoughts before
attempting to change core underlying schema:
34. The main task of the psychotherapist is to ferret out and change core
underlying schema as soon as possible to help the client change:
35. It is more appropriate for psychotherapists to ascertain clients' underlying
assumptions in the beginning of therapy (first sessions) than to challenge
automatic thoughts:
36. While it is important to uncover clients core schema, it is best for psy-
chotherapists to spend the first 10 to 15 sessions dealing with automatic
thoughts so that the client can become aware of their underlying schema:
37. The most important element in cognitive therapy is getting clients to empir-
ically test their notions about reality:
38. The most important aspect of psychotherapy is to help clients adopt new
viable philosophies to cope with negative realities.
 124 DiGiuseppe and Linscott

RESULTS

A principal components extraction with varimax rotation and listwise deletion of

missing values was performed on the items. Bartlett's test of sphericity was
significant (p < .0001), showing this matrix to be significantly different from the
identity matrix. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy
equalled .67619, signalling that the factor analysis should be fairly clean. Since
a large number of variables were significantly correlated, and since both Bartlett' s
test and the KMO measure were significant, it was concluded that this matrix was
suitable for factor analysis.
The scree test suggested a three-factor solution which accounted for 30.7% of
the variance in therapist attitudes. A principal axis factors extraction procedure
was also performed to determine the number of factors to be included in the
analysis. The results of the principal axis factors yielded a similar three-factor
solution but accounted for a smaller percentage of variance (25% vs. 30.7% in the
principal components analysis).
A conservative salience level for determining variable loadings was set at .40.
Factor loadings for 20 of the 38 items were salient at the .40 criterion level,
suggesting that 18 of the items might not be suitable for inclusion in the Factor
analysis. Inspection of the pattern loadings (see Table 2) in the rotated factor
matrix revealed 13 items with salient loadings on Factor 1,11 items with salient
loadings on Factor II, and 7 items with salient loadings on Factor III.
In examining the items with salient loadings for Factors I, II, and III, an interpre-
tation of these factors becomes apparent Of the 16 rationalist items, 10 items had
salient loadings on Factor 1; thus Factor I was labeled philosophical rationalism. Of
the 16 constructivist items, 11 items had salient loadings on Factor 11; thus Factor
11 was labeled philosophical constructivism. Of the six remaining "target thought"
items, four had salient loading on Factor in. Factor 111 was labeled as "primacy of
disputing underlying schema." In using Comrey's (1973) criterion for evaluating
variable loadings, it was judged that item 13, with a loading of .6721, was the best
measure of philosophical attitudes among the rationalist items (Factor 1), item 32
(.5240) the best measure among the constructivist items (Factor 11), and item 33
(.70543) among the primacy for disputing underlying schema items (Factor III).
Reliabilities for the rationalist and constructivist scales were high, alpha =
.8035, .7179 respectively. Correlations between the rationalist scale and the
primacy scale (r .4783 ,/> <0001), and between the constructivist and the primacy
scale (r =.2538,;? .001) were significant. The rationalist and constructivist scales,
however, were not significantly correlated (r = .0873,/> = .146), suggesting the
two scales did in fact represent distinct philosophies.
A two-factor fixed effects analysis of variance with repeated measures on the
second factor was performed, using two levels for the between-group factor —
General CB therapists and RE therapists, and three levels for the within-group
factor — rationalist scale, constructivist scale, and primacy of disputing scale.
This repeated measure factor is not a true independent variable. Due to differing
numbers of items per scale, subjects' scores on the three scales were averaged
Cognitive Behavioral Philosophies 125

TABLE 2. Rotated Factor Matrix,

PC Factor Analysis
Factor 1 Factor 2 Factor 3
Ql .25522 -.34310 .22422
Q2 .48959* -.09172 .37322
Q3 .32354 .05970 .44263*
Q4 .28902 .15184 .45567*
Q5 .20981 .20907 .39040
Q6 .25065 -.04823 .42981*
Q7 45382* .01127 .37525
Q8 .56877* -.22093 .26878
Q9 .42857* -.19930 .19161
Q10 .49735* .13922 .24814
Qll .52282* -.06958 -.09111
Q12 .62823* .01510 -.01339
Q13 .66382* .05626 .06443
Q14 .42437* .08211 .00222
Q15 .31276 -.00296 .20572
Q16 .47945* -.18575 .24785
Q17 -.07371 .56310* .00642
Q18 -.13937 .55749* .17155
Q19 .18866 .44839* .15581
Q20 .17867 .38734 .19571
Q21 .01211 .36014 .35262
Q22 .37509 44705* -.01098
Q23 .23759 .38017 .04752
Q24 .02309 .51456* -.08399
Q25 -.06059 .36940 -.18762
Q26 -.08187 .49977* .13194
Q27 .15805 .46455* -.03024
Q28 .03759 .42199* -.03404
Q29 -.17372 .45105* .07925
Q30 .07341 .43848* -.34925
Q31 .50242* .04299 .15041
Q32 -.12153 .57945* .01548
Q33 -.14139 .00648 .70543*
Q34 .60465* .02872 -.20664
Q35 .26477 .18731 -.47168*
Q36 -.10820 .07786 .65064*
Q37 .26835 .02627 .53079*
Q38 .60329* .16873 -.17078
*Salience level = .40

(total item responses/number of items) producing a mean score for each subject
on the rationalist, constructivist, and primacy of disputing scales.
The means and standard deviations of the General CB and RE therapists
attitudes are presented below in Table 3, followed by the summary of the ANOVA
results in Table 4.
A conservative alpha level of .01 was set for both the main effects and simple
effects analyses. Results of the ANOVA indicate that both main effects, thera-
126 DiGiuseppe and Linscott

TABLE 3. Means and Standard Deviations of

Therapist Attitudes for General Cognitive
Behavioral and RET Therapists on Rationalist,
Constructivist, and Primacy of Disputing Scales
Scale R Scale C Scale P
Groups X SD X SD X SD
Genrl CB 3.203 .548 3.778 .368 3.287 .465
RET 3.544 .559 3.739 .483 3.452 .484

pists' group [F(l 145) = 6.06, p =.015], and scale type [F(2,290) = 35.72, p
<.0001] demonstrate significance as well as significant interaction of group by
scale [F(2,290) = 6.48, p- .002]. Since the groups were not randomly assigned
and the independence of the error term could not be guaranteed, the epsilon-
corrected degrees of freedom was used. This did not change the significance of the
main effects, or of the interaction effect.
Simple effects analysis on the between-group factor showed subjects in the
RET sample scored significantly higher on the rationalist scale than did subjects
in the General CB sample, F(.9225,133) = 16.24, p< .01. No significant group
differences were seen on the constructivist and primacy scales. Analysis of the
within group factor (scale type) showed significant differences for both the
General CB andRET groups within scales, F(1.845,267) 25.61,p < .01; F(I.845,267)
= 14.26, p <.01, respectively (see Table 5).
Post-hoc comparisons on the within-groups factor using the Tukey Kramer
modification for unequal Ns showed the General CB sample's mean scale scores
were significantly higher on the constructivist scale than on both the rationalist
and primacy scales (HSD = .224). The RET sample's mean scale scores were
significantly higher on the constructivist scale than on the primacy scale (HSD =
.224). There were no significant differences between the rationalist vs. constructivist
scores, or the rationalist vs. primacy scores.

TABLE 4. Summary of the Analysis of Variance of

General CB and RET Therapist Attitudes on Rationalist,
Constructivist, and Primacy of Disputing Scales
Source SS df MS F p w2
Groups 2.32 1(.9225) 2.32 6.06 .015 .018
SSwgps 55.43 145(133) .38 — — —
Scales 12.75 2(1.845) 6.37 35.72 .000 .103
GroupsxScales 2.31 2(1.845) 1.16 6.48 .002 .017
ScalesxSSwgps 51.75 290(267) .18 — — —
Alpha - .01
*Geiser Greenhouse Epsilon = .9225, Corrected elf's in parentheses.
Cognitive Behavioral Philosophies 127

TABLE 5. Simple Effects of the Interaction of Groups

by Scales
Source SS df MS F P
Groups on:
Scale R 4 .9225 4.336 16.2 < .01
Scale C .05 .9225 .052 .194 NS
Scale P .8 .9225 .943 3.53 NS
Error term:
MSwcells 133 .267 — — —

Scales for:
CB Ther. 9 1.845 4.878 25.67 < .01
RET Ther. 5 1.845 2.71 14.26 < .01
Error term:
MS scalesxSSwgps 51.75 267 .19 — —

A discriminant function analysis was performed to analyze group differences

on specific items. The alpha level was set at .01. Item analysis revealed that the
RET sample scored significantly higher than the General CB sample on the
rationalist items 8,9, and 13, on the constructivist item 31, and on the primacy of
disputing items 34 and 38. No significant group differences were seen on the
remaining 12 rationalist items, 15 constructivist items, or4 primacy items. Group
membership, based on therapists' responses to the 38 items of the rationalist,
constructivist, and primacy of disputing scales correctly predicted 83% of the
General CB sample, and 84% of the RET sample.

Discussion
The results from the present study suggest that Mahoney is correct in hypothesiz-
ing two broad philosophical positions in CB therapy. The categories of rational-
ism and constructivism, as based upon the high alpha coefficients for both scales,
the non-significant correlation between scales, and on the interpretation of the
factor analysis were shown to represent consistent positions on philosophical,
theoretical, and practical interventions among CB therapists. In addition, thera-
pists scores on the Therapist Attitudes Questionnaire were shown to correctly
discriminate group membership for a large majority of cases in both the General
CB and RE therapist groups (83% and 84% respectively).
The results do not, however, support Mahoney's hypothesis that the rationalist
vs. constructivist philosophies are bipolar opposites which serve to distinguish
between cognitive behavioral therapists. If Mahoney's hypothesis that these
philosophies are bipolar opposites were correct, a high negative correlation would
have resulted between the rationalist and constructivist scales. The result of a
nonsignificant positive correlation obtained in this study shows, however, that
this was not the case.
 128 DiGiuseppe and Linscott

In support of Mahoney's categorization of RET, rational emotive therapists

trained by Albert Ellis were shown to support more rationalist attitudes than CB
therapists in general. However, rational emotive therapists showed as much
support for constructivist attitudes as did other cognitive behavioral therapists.
Thus Mahoney's either/or distinction of the rationalist and constructivist beliefs
is not supported. In separating the groups, it was shown that General CB therapists
showed more agreement with constructivist scale items than with either rationalist
or primacy of disputing items, while the RE therapists showed more agreement
with constructivist over primacy of disputing items, and equal amounts of
agreement with both rationalist and constructivist items.
Therapist groups showed no difference in preference for disputing automatic
thoughts early in the initial stages of therapy (as measured on the "primacy scale").
Significant correlations shown between rationalist and primacy scales, and cons-
tructivist and primacy scales suggest that the preference for disputing underlying
schema/irrational beliefs early in therapy may represent a strategy found within
both the rationalist and constructivist philosophies, and thus may
not be a distinguishing feature of the two therapist groups. This finding
eontradictsboth Ellis' (1989b) and Beck's (Beck &DeRubis, 1987)accountof their
therapies. An alternative explanation is that the relatively small number of items on
the primacy scale may account for the scale's failure to distinguish between
therapist groups. An additional explanation for this finding may be the recent focus
in Beck's Cognitive Therapy on underlying schema. As Beck's Cognitive Therapy
has evolved there has been more emphasis on the role of underlying schema being
the mediating factor in emotional disturbance (see Beck & Freeman, 1990), and thus
the Beck and Ellis positions may be evolving in similar directions.
While this study lends support for Mahoney's notion of philosophical distinc-
tions within cognitive behavior therapy, there is yet no evidence that these
philosophical difference reflect actual differences in they way therapists conduct
therapy. In this study there was a relationship between the philosophical scale and
the primacy of disputing scale. Perhaps future research could investigate whether
these various philosophical attitudes reflect any other differences in therapists
self-report or in-session activities. In addition, it would be interesting to examine
whether any of these philosophical attitudes are related to therapy outcomes.

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Cognitive-Behavioral Therapies, pp. New York: Guilford.
Beck, A., & Freeman, A. (1990). Cognitive Therapy ofPersonality Disorders. New York:
Guilford.
Beck, A., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective,
New York: Basic Books.
Cognitive Behavioral Philosophies 129

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Psychology, St. John's University, Jamaica, NY, 11439.
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