Thursday, September 27, 2007

Chapter 6 - REBT

My Lecture Notes
Current Psychotherapies
Chapter 6
Rational Emotive Behavior Therapy
Albert Ellis
Instructor: Jeff Garrett Ph.D.



Basic Concepts of REBT
Practical and symptom focus
Philosophically based but techniques have empirical support
Requires collaboration with client
Clients change through identification of irrational thoughts
Clients behavior and thought processes are evaluated
Stresses thinking, judging, deciding, analyzing, and doing
Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship
Is highly didactic, very directive, and concerned as much with thinking as with feeling
Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations


Basic Propositions of REBT
People have the potential to be rational, self preserving, creative, functional and to use metathought OR to be irrational, self-destructive, short-range hedonists
Culture and family can perpetuate irrational thinking
Humans perceive, think, emote and behave simultaneously
All psychotherapies are not equally effective
Ellis implies that highly cognitive, directive therapies requiring tasks and discipline are likely to be effective in a shorter time period with less sessions required
A warm therapeutic relationship may be desirable but it is not necessary or sufficient condition for change
REBT Therapists use a variety of techniques - the focus is not symptom removal but cognitive and behavioral change
Neurotic thinking is the result of unrealistic, illogical thinking
The causes of an individual’s problems are not the events that have happened but how the individual perceives them
There is an element between stimulus and response; it is thought
S -> thoughts -> R
REBT holds that beliefs mediate events and emotions
REBT provides clients with methods for changing irrational beliefs

Comparing REBT with Psychoanalysis
REBT does not focus on free association, complex history taking, dream analysis or sexual conflicts
Transference is seen in REBT as resulting from irrational thoughts
REBT employs persuasive and directive techniques
If transference occurs a REBT therapist is likely to relate it to the client's irrational beliefs
In REBT the unconscious is viewed as virtually meaningless as most elements can be brought into conscious

Comparing REBT with Adler’s Theory
The most salient similarity between REBT and Adlerian psychotherapy is the emphasis on basic mistakes
Departs from Adler regarding emphasis on past memories, social interest
REBT is more future oriented and behavioral

Comparing REBT to Jungian Therapy
Both types of therapy are holistic
REBT views the Jung’s focus on dreams, fantasies, symbols or archetypes as a "waste of time"

Comparing Cognitive Therapy with REBT
In CT thoughts are labeled dysfunctional
In REBT thoughts are labeled irrational
CT therapists are more collaborative
REBT therapists are more confrontational
CT less aggressive
REBT more aggressive
The most significant difference between REBT and Cognitive therapy (CT) therapist's forcefulness in disputing beliefs
Both CT and REBT use psychoeducation

Comparing REBT and Behavior Therapy
REBT focuses more on cognitive aspects
REBT is more similar to CT and Multimodal Therapy than BT

History
REBT – developed by Alfred Ellis
After two decades of practicing psychoanalysis he became increasingly disillusioned by the limited progress clients were making
1957 published How to live with a Neurotic
1975 published A New Guide to Rational Living which continues to be one of his most popular books
1977 published Handbook of Rational-Emotive Therapy

Current Status
Albert Ellis institute established in 1959 teaches principles of healthy living
Journal of Rational-Emotive Therapy and Cognitive Behavior Therapy reports latest findings.
Research Supports Several REBT Principles
Thoughts and feelings are not two disparate processes
Beliefs are more important than events
Metathought occurs (often captured in images)
Changing thoughts, behaviors, or emotions changes other modalities

Personality
Basic tenet of REBT is that emotional upsets, as distinguished from feelings of sorrow, regret, annoyance, and frustration, largely stem from irrational beliefs
Problematic beliefs center around words/concepts like … should, ought, awful, must, I want, I need
This is the basic personality theory of REBT … Humans largely create their own distress

Ellis agrees with Freud that … the pleasure principle drives behavior
Ellis agrees with Horney and Fromm that … cultural and family influences impact people’s irrational thinking
Ellis agrees with Adler that … fictitious goals order people’s lives
Ellis agrees with Pavlov that … cognitive conditioning occurs
Ellis agrees with Piaget that … active learning is more effective than passive
Ellis agrees with Anna Freud that … people refuse to acknowledge mistakes and resort to defenses
Ellis agrees with Maslow and Rogers that … humans have great untapped recourses

Personality View of Human Nature
We are born with a potential for both rational and irrational thinking
Ellis suggests humans have an innate nature to want, need and condemn when needs aren't met
If an individual's needs aren't met they display a tendency to childishly condemn themselves, others and the world
Ellis contends that we are self-talking, self-evaluating, and self-sustaining.
We have an inborn tendency toward growth and actualization
We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk
We have the capacity to change our cognitive, emotive, and behavioral processes

View of Emotional Disturbance
REBT views emotional disturbances as the result of irrational thinking and behaving.
We learn irrational belief from significant other during childhood
REBT therapist teach clients to feel "undepressed" even when they are unaccepted and unloved by significant others.
Blame is at the core of most emotional disturbances
Irrational idea (e.g., I must be loved by everyone)à internalize à self-defeating
We have a tendency to make ourselves emotionally disturbed by internalizing self-defeating beliefs
REBT hypothesizes that we keep ourselves emotionally disturbed by the process of self-indoctrination
REBT holds that neurotic problems directly stem from magical, "unvalidated" thinking

The solution for dealing with an individual's demandingness most strongly supported by REBT is decreasing demandingness

The ABCs (and D) of Emotion
REBT refers to the ABCD. ABCD stands for, activating events, beliefs, consequences (or consequent emotion), and dispute
In challenging an individual's thought processes, REBT would use persuasion and directive
The A-B-C Theory of Personality



A does not equal C

A + B = C

D = Dispute

Is this statement/idea/belief true?
Is it healthy?
Is it helpful?
Is it realistic?
Is it logical?
Is it rational?

Case Discussion 1
Tom, a college sophomore, want to overcomes his shyness around women. He does not date and even does his best to keep away from women because he is afraid they will reject him. But he want to change this pattern.
Using the ABCs of Emotion analyze and help Tom

Case Discussion 2
Mary would like to take a course in creative writing, but she fears that she has no talent. She is afraid of failing, afraid of being told that she is dumb, and afraid of follow through with taking the course.
Using ABCs of Emotion to analyze and help Mary

Case discussion 3
Brent feels that he must win everyone’s approval. He has become a "super nice guy" who goes out of his way to please everyone. Rarely does he assert himself, for fear that he might displease someone who then would not like him.
What are the possible irrational beliefs?
How do you help Brent?
If Brent is Asian American, what cultural components you might take into account?

Irrational Ideas
Irrational ideas lead to self-defeating behavior
Some examples:
"I must have love or approval from all the significant people in my life."
"I must perform important tasks competently and perfectly."
"If I don’t get what I want, it’s terrible, and I can’t stand it."


Ten Common Irrational Ideas
I should be loved and approved by significant others and live up to their expectations.
I must be highly competent, adequate, intelligent and achieving before I can me happy.
When people act unfairly I should blame them and view them as bad people.
It is a terrible catastrophe when I am rejected, treated unfairly, and things aren’t as I would like them.
Since my feelings are caused by external factors, I have little or no ability to control or change them.
I should be greatly concerned about dangerous and fearful things and must center my attention on them until the danger has past.
I can handle difficulties and responsibilities better by avoiding them than by facing them.
People and things SHOULD turn out better than they do, and when they don’t I should see them as awful, terrible, etc.
My past remains all-important, and must influence my feelings and behavior now because it once did.
I can achieve maximum happiness by inaction or by passively enjoying myself.


The Therapeutic Process
Therapy is seen as an educational process
Clients learn
To identify and dispute irrational beliefs
To replace ineffective ways of thinking with effective and rational cognitions
To stop absolutistic thinking, blaming, and repeating false beliefs


Therapeutic Goals
A basic goal is to teach clients how to change their dysfunctional emotions and behaviors via cognitive and behavioral methods - into healthy ones.
Two main goals of REBT are to assist clients to achieving unconditional self-acceptance and unconditional other acceptance.
As clients become more able to accept themselves, they are more likely to unconditionally accept others.


Therapist’s function and Role
1. Encouraging clients to discover their irrational beliefs and ideas
2. Making connection of how these irrational beliefs lead to emotional disturbances
3. Challenging clients to modify or abandon their irrational beliefs.
4. Dispute the irrational beliefs and substitute rational beliefs and behaviors.
5. Displaying warmth toward clients may be desirable but it is not necessary.


Client’s Experience in Therapy
Client is a student and learner--- the client learns how to apply logical thoughts, experiential exercises, and behavioral homework to problem solving and emotional change.
Focus on here-and-now experiences
Does not spend much time to exploring clients’ early history and connecting present and past
Expect to actively work outside the therapy sessions.


Relationship Between Therapist and Client
The role of the client in rational emotive behavior therapy is like that of a student and a learner
Relationship Between Therapist and Client
Intensive therapeutic relationship is not required. But, REBT therapist unconditionally accept all clients and teach them to unconditionally accept others and themselves. (therapists accepts them as persons but confront their faulty thinking and self-destructive behaviors)
Ellis believes that too much warmth and understanding can be counter-productive, fostering dependence for approval.


Relationship Between Therapist and Client
Therapists shows great faith in their clients’ ability to change themselves.
Open and direct in disclosing their own beliefs and values
Transference is not encouraged, when it occur, the therapist is likely to confront it (e.g., clients believe that they must be liked and loved by their therapists.)
Therapeutic techniques and procedures


Cognitive methods
Disputing irrational beliefs
If I don’t get what I want, it is not at the end of the world
Doing cognitive homework
Applying ABC theory in daily life’s problems
Put themselves in risk-taking situations to challenge their self-limiting beliefs.
Replace negative self-statement to positive message
Changing one’s language
It would be absolutely awful..à It would be inconvenient
Using humor


Emotive Techniques
Rational-emotional imagery
Imagine the worst things that could happen to them
Role playing
Shame-attacking exercises
Take a risk to do something that they are afraid to do because of what others might think…until they realize that their feelings of shame are self-created.
Use of force and vigor
From intellectual to emotional insight
Reverse role playing


Behavioral Therapy
Use most of the standard behavioral therapy approaches.
PersonalityWays Individuals Alleviate Pain
Distraction
Shame Attacking Exercises

Demandingness

Leads to less demands of others
Individual becomes less anxious
Palliative (soothing)
Satisfying Demands
If demands are catered to, the individual feels better but does not get better
Therapist can give love and approval; provide pleasurable sensations
Ultimate impact is demandingness is reinforced.
Magic and Mysticism
Magical solutions are often offered to children and even to adolescents and adults
Generally magical solutions only temporarily placate the individual


Main Goals of REBT
The primary goal of REBT is the alteration of basic values and beliefs
REBT’s goal is to achieve minimal demandingness and maximal tolerance
Although temporary, palliative techniques may be used in REBT but the main goal is for more permanent solutions
Goal is minimization of musturbation, perfectionism, grandiosity, and low frustration tolerance
In therapy, REBT teaches patients to differentiate between those items they want or desire and musts
REBT assist client in seeing how giving up perfectionism improves their lives
REBT aims at changing habits as well as cognition through cognitive and behavior techniques


Psychotherapy
REBT helps clients acquire a more realistic, tolerant philosophy of life
REBT practitioners often employ a rapid-fire active-directive-persuasive-philosophical methodology
The solution for dealing with an individual's demandingness most strongly supported by REBT is decreasing demandingness


Psychotherapy
REBT Therapist Stress
only hard work and practice will correct irrational beliefs
self defeating behavior is past related but maintained by present beliefs
current distress results from self continuation of irrational beliefs


Mechanisms of Psychotherapy
The focus is on the clients irrational beliefs
REBT therapists do not hesitate to contradict the client’s beliefs and is often one step ahead while showing acceptance
REBT therapist teaches the client to think and act differently - sometimes therapist may do more talking than the client
Therapists do not merely tell clients that their thoughts are irrational but attempts to encourage clients to see this for themselves


Application of REBT
Depression
Anxiety
Psychosis
Bipolar
Autistic
Anger management
Stress managment
Children
Problems with love, sex, and marriage
Couples and marriage and family counseling
Prevention
Research from CT supports the basic premise of REBT

2 comments:

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grevyturty said...

It's Albert Ellis, not Alfred Ellis.