Two mental health pioneers shared the spotlight for the first time at an APA Convention as if they had been teaming up for years. In fact, the repartee between Aaron T. Beck, MD, and Albert Ellis, PhD, at the session, "On therapy--a dialogue with Aaron T. Beck and Albert Ellis," captivated an overflowing room of admirers at APA's 2000 Annual Convention in Washington, D.C., Aug. 4­8.

In a session moderated by APA Past President Frank Farley, PhD, the two living legends of therapy tackled topics such as pairing prescriptions with Beck's cognitive therapy and Ellis's rational-emotive behavior therapy, the value of Freud's theories and feelings of doubt about their life's work.

On the question of combining medications and therapy, Beck, wearing his signature bow tie, expressed some concern.

"Ideally, I think therapists are going to be able to coach and teach and educate their patients better and will work harder at therapy if they don't have drugs," he said. "The patients also will worker harder themselves if they don't feel that the drugs are responsible for whatever improvement there is."

Ellis examined both sides of the issue. "Some people we wouldn't see without medication--the psychotics, manic depressives, and others....On the other hand, the medication has lots of disabilities....It isn't that Prozac is as bad as some of the detractors of it say, but it does create a great many confusions and emotions and behaviors."

The dialogue shifted from current events to history when Farley asked Beck and Ellis whether they found any of Sigmund Freud's theories useful in their thinking. While each is well-known for departing from psychoanalysis, they admitted that certain aspects of Freud's theories might still be influencing their work.

One concept that has influenced Beck is "the whole idea of psychological determinism," he said. "That is, that psychological events can impinge on one's mental apparatus and then produce long-lasting results, and one's character can develop over time as a result of environmental influences that are interacting with biological components."

Ellis noted that most psychotherapists use some elements of unconscious thinking that Freud originally emphasized.

"One of the main things he did was point out the importance of unconscious thinking. Freud pointed out that when people are motivated to do things, that they unconsciously think, and even feel, certain things. We use that concept," Ellis said, adding, "Although Freud, as usual, ran it into the ground."

Later on, Beck playfully initiated the audience question-and-answer session by asking Ellis, "Without solid empirical evidence to support [your ideas] how can we believe any more what you have to say than what anybody else has to say?"

Above the din of the audience exploding with laughter, an unflustered Ellis replied, with a twinkle in his eye, "I heed the possibility exists that I'm wrong and they're right," he said, "but it's only a low degree of probability!"

Spurred on by the banter, audience members prompted Beck and Ellis to reveal any doubts they may have had about their work.

"I am a big self-doubter," Beck confessed. "I always doubt what I do, which is one of the reasons I do so much research and encourage research."

Ellis, as direct as his own therapy, admitted he hasn't always evaded feelings of self-doubt.

"But the one thing I don't doubt," he said, "is that if I take my general theory and my general practice--and I include [Beck's] general theory and general practice in this--and use it with a wide variety of individuals, we'll do a hell of a lot better than other kinds of therapies would."