02 How does it work?
This talks about the basic things that make such a difference when you receive help and upgrade your personal thinking skills to manage for yourself.
Rational Emotive Behaviour Therapy
By "Choose to be Happy" Author: Wayne Froggat
Edited for Online application.
1. What are the basics of REBT
(Rational Emotive Behaviour Therapy)
The most basic premise of REBT is that almost all human emotions and behaviours are the result of what people think, assume or believe (about themselves, other people, and the world in general). It is what people tell themselves (or think) about their situations (not the situations themselves) that determines how they feel (emote) and behave (act). A useful way to illustrate this is by using what Albert Ellis calls the ABC' model. In this framework 'A' represents an event or experience. 'B' represents what people think, believe and tell themselves about the event. 'C' represents the emotions and behaviours that follow from those thoughts and beliefs.
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Here is an example of an 'emotional episode', as experienced by a person prone to depression who tends to misinterpret the actions of other people. A. What started things off: Friend passed me in the street without acknowledging me.
B. Beliefs (or self-talk) about A:
1. S/He's ignoring me. S/He doesn't like me
2. I could end up without friends forever - and that would be terrible.
3. For me to be happy and feel worthwhile, people must like me.
4. I'm unacceptable as a friend - so I must be worthless as a person.
C. Reaction:
Feelings: unlovable, worthless, depressed.
Behaviours: avoiding people generally
Note that 'A' does not cause 'C': 'A' triggers off 'B', 'B' then causes 'C'. Also, ABC episodes do not stand alone - they run in chains, with a 'C' often becoming the 'A' of another episode. What happens is that we observe our own emotions and behaviours, and react to them.
Note, too, that most beliefs are outside conscious awareness. They are habitual or automatic, often consisting of underlying 'rules' about how the world and life should be. With practice, though, people can learn to uncover such subconscious beliefs.
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2: Practice Principles How does it work?
* The basic aim of REBT is to leave you at the completion of therapy with freedom to choose your emotions, behaviours and lifestyle (within physical, social and economic restraints); and with a method of self-observation and personal change that will help you maintain your gains.
* Not all unpleasant emotions are seen as dysfunctional. Nor are all pleasant emotions functional. REBT aims not at 'positive thinking'; but rather at realistic thoughts, emotions, and behaviours that are in proportion to the events and circumstances and individual experiences.
* There is no 'one way' to practice REBT. It is 'selectively eclectic' (chooses what works best for the situation). Though it has techniques of its own, it also borrows from other approaches and allows practitioners to use their imagination. There are some basic assumptions and principles, but otherwise it can be varied to suit oneself.
* REBT is educative and collaborative. Clients learn the therapy and how to use it on themselves (rather than have it 'done to them'). The therapist provides the training - the client carries it out. There are no hidden agendas - all procedures are clearly explained to the client. The Therapist and the client together design the homework assignments.
* The therapist - client relationship is important but is not overemphasised. The therapist may show empathy, unconditional acceptance, and encouragement; but is careful to avoid activities that create dependency or strengthen any 'needs' for approval.
* REBT is brief and time-limited. It commonly involves five to thirty sessions over one to eighteen months. The pace of therapy is brisk. A minimum of time is spent on acquiring background and historical information: it is task-oriented and focuses on problem-solving in the present.
* REBT tends to be human centred, anti-moralistic, and scientific. Human beings are seen as the arbiters of what is right and wrong for them. Behaviour is viewed as functional or dysfunctional, rather than as good or evil. REBT is based on research and the principles of logic and empiricism, and encourages scientific rather than 'magical' ways of thinking.
Note: Magical here is referring to folk making perception connections between issues, events, or actions where none can empirically be demonstrated. What it means to the client who does have a moral code, and spiritual concerns, is that your work is focused on the psyche (soul) and temporal realm, because that is where your pain is felt. One’s moral code and spiritual values are not questioned or critiqued, except for the manner in which you hold on to them.
* Finally, the emphasis is on profound and lasting change in the underlying belief system of the client, rather than simply eliminating the presenting symptoms. The client is left with self-help techniques that enable coping in the long-term future.
3: Understanding Irrational thinking
Irrational is to say that the thinking does not match the reality, or what is actually there, compared to what is perceived or interpreted in the client’s thinking.
To describe a belief as irrational is to say that:
1. It DISTORTS REALITY (It is a misinterpretation of what is happening); or it involves some illogical ways of evaluating yourself, others, and the world around you: CATASTROPHISING, DEMANDING and PEOPLE-RATING;
2. It blocks you from achieving your goals;
3. It creates extreme emotions that persist, and which distress and immobilise; and
4. It leads to behaviours that harm yourself, others, and your life in general.
3.1: The three levels of thinking
Every individual has a set of general 'rules' – usually subconscious - that determines how they react to life. When an event triggers off a train of thought, what someone consciously thinks depends on the general rules they subconsciously apply
to the event.
Let's say that a person holds the rule: "To be worthwhile, I must succeed at everything I do." If they happen to fail an examination, this event - coupled with the underlying rule - will lead them to the conclusion: "I'm not worthwhile." Identifying underlying, general rules involves going beyond the surface INFERENCES to the client's EVALUATIONS or PERSONAL MEANINGS.
Inferences (the things we "infer")
In everyday life, events and circumstances trigger off two levels of thinking: inferring and evaluating. First, we make guesses or INFERENCES about what is 'going on' - what we think has happened, is happening, or will be happening. Inferences are statements of 'fact' (or at least what we think are the facts. They can be true or false). Inferences that are irrational usually consist of the following 'distortions of reality':
1. Black and white thinking: Seeing things in extremes, with no middle ground - good or bad, perfect versus useless, success or failure, right against wrong, moral versus immoral, and so on. Also known as ALL-OR-NOTHING THINKING.
2. Filtering: Seeing all that is wrong with oneself or the world, while ignoring any positives.
3. Over-generalisation: Building up one thing about oneself or one's circumstances and ending up thinking that it represents the whole situation. For example: "Everything's going wrong", "Because of this mistake, I'm a total failure". Or, similarly, believing that some thing which has happened once or twice is happening all the time, or that it will be a never-ending pattern: "I'll always be a failure", "No-one will ever want to love me", and the like.
4. Mind-reading: Making guesses about what other people are thinking, such as: "She ignored me on purpose", or "He's mad at me".
5. Fortune-telling: Treating beliefs about the future as though they were actual realities rather than mere predictions, or example: "I'll be depressed forever", "Things can only get worse".
6. Emotional reasoning: Thinking that because we feel a certain way, this is how it really is: "I feel like a failure, so I must be one", "If I'm angry, you must have done something to make me so", and the like.
7. Personalising: Assuming that something is directly connected with oneself, but without evidence: "Everyone is looking at me", "It must have been me that made her feel bad", and so on.
Evaluations: As well as making inferences about things that happen, we go beyond the 'facts' to EVALUATE (give a value or qualify) them in terms of what they MEAN TO US. Evaluations/meanings are sometimes conscious, though often are beneath awareness. Irrational evaluations consist of one or more of the following three types:
1. Catastrophising
There are two main forms of catastrophising. 'AWFULISING' is exaggerating the consequences of past, present or future events; seeing something as: awful; terrible; horrible; the worst that could happen. It often leads to 'CAN'T-STAND-IT-ITIS' - the idea that one can't bear (put up with; withstand; overcome) some circumstance or event. Both types serve the purpose of making people feel worse about their problems.
2. Demanding (musts and shoulds)
Also known as 'MUSTURBATING', demanding refers to the way people use unconditional shoulds and absolutistic musts - believing that certain things must or must not happen, and that certain conditions (for example success, love, or approval) are absolute necessities. Demanding implies that certain 'LAWS OF THE UNIVERSE' exist and must be adhered to. Demands can be directed either toward oneself or others. This is probably the 'core' of irrational thinking: if we kept all our wants and rule-for-living as preferences, they would cause us little trouble.
3. People-rating (putting a label, or value on others)
People-rating refers to the process of evaluating one's entire self (or someone else's). In other words, trying to determine the total value of a person or judging their worth. It represents an overgeneralization. The person evaluates a specific trait, behaviour or action according to some standard of desirability or worth. Then they apply the evaluation to their total person - eg. "I did a bad thing, therefore I am a bad person." People-rating can lead to reactions like self-downing, depression, defensiveness, grandiosity, hostility, or overconcern with approval and disapproval.
Rules [for LIVING] Rules, as we saw earlier, are the underlying beliefs that guide how we react to life. What SPECIFIC EVENTS mean to someone (how they evaluate them) depends on the underlying (subconscious or automatic thinking) GENERAL RULES (laws about how reality MUST be) they hold. Albert Ellis proposes that a small number of core beliefs underlie most unhelpful emotions and behaviours. Here is a list of such 'RULES FOR LIVING'
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1. I need love and approval from those significant to me - and I must avoid disapproval from any source.
2. To be worthwhile as a person I must achieve, succeed at whatever I do, and make no mistakes.
3. People should always do the right thing. When they behave obnoxiously, unfairly or selfishly, they must be blamed and punished.
4. Things must be the way I want them to be, otherwise life will be intolerable.
5. My unhappiness is caused by things that are outside my control, so there is little I can do to feel any better.
6. I must worry about things that could be dangerous, unpleasant or frightening, otherwise they might happen.
7. I can be happier by avoiding life's difficulties, unpleasantness, and responsibilities.
8. Everyone needs to depend on someone stronger than themselves.
9. Events in my past are the cause of my problems - and they continue to influence my feelings and behaviours now.
10. I should become upset when other people have problems, and feel unhappy when they're sad.
11. I shouldn't have to feel discomfort and pain - I can't stand them and must avoid them at all costs.
12. Every problem should have an ideal solution - and it's intolerable when one can't be found.
Bear in mind, that these rules here all represent absolutes held in the thinking. These rigid absolutes cannot be sustained or fulfilled by a fallible human being. They are a mismatch with reality and what can be delivered to them by reality. This is why when these rules, or inner thinking and beliefs are challenged by reality (what is actual rather than desired or perceived) the person who holds those beliefs is severely challenged to adjust and by holding these rules undisputed, they instead become disturbed emotionally, and in their behaviour.
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4: Putting it all together
Here is an example (using the ABC model) to show how it all works:
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A. Your neighbour phones and asks if you will babysit for the rest of the day. You had already planned to catch up with some gardening.
B. You INFER what will happen: "If I say no, she will THINK badly of me."
You EVALUATE you inference: "I couldn't stand to have her disapprove of me and see me as selfish." Your EVALUATION comes from the UNDERLYING RULE: "I need love and approval from those significant to me - and I must avoid disapproval from any source."
C. You say, "YES!"
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In summary, people view themselves and the world around them at three levels:
1. Inferences,
2. Evaluations/personal meanings, and
3. Underlying rules. The therapist's main aim is to get at the underlying, semi-permanent, general 'rules' that are the continuing cause of the client's unwanted reactions.
5: HELPING PEOPLE CHANGE The steps involved in helping clients change can be broadly summarised as follows:
5.1: STEPS
1. B-C connection
(The connection between the belief and the consequence or outcome in terms of emotions and behaving)
This is where the CLIENT is helped to understand that EMOTIONS and BEHAVIOURS are caused by BELIEFS and THINKING. This can take place by reading material that demonstrates that, or by discussion.
2. Relevant beliefs uncovered
This is where the CLIENT is shown HOW THE RELEVANT BELIEFS MAY BE UNCOVERED. The ABC format is invaluable here. Using an episode from the client's own recent experience, note the 'C', then the 'A'.
Then the client is invited to ask (at 'B'): "What was I telling myself about 'A', to feel and behave the way I did at 'C'? As the client develops understanding of the nature of irrational thinking, this process of 'filing in the gap' will become easier. Such education may be achieved by reading, direct explanation, and by self-analysis with the therapist's help and as homework between sessions.
3. Teach disputation of beliefs
The CLIENT is then taught HOW TO DISPUTE and CHANGE THE IRRATIONAL BELIEFS. Replacing them with more rational alternatives. Again, education will aid the client. The ABC format is extended to include 'D' (DISPUTING irrational beliefs), 'E' (the new EFFECT- new ways of feeling and behaving - which is desired), and 'F' (FURTHER ACTION for the client to take).
4. Help to get into action
HELP THE CLIENT TO GET INTO ACTION. Acting against irrational beliefs - for example, disputing the belief that disapproval is intolerable by deliberately doing something to attract it, then discovering that one survives - is an essential component of REBT. Its emphasis on both rethinking and action makes it powerful tool for change.
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Techniques used in REBT
There are no techniques that are essential to REBT - one uses whatever works, assuming that the strategy is compatible with REBT theory. However, the following are examples of procedures in common use:
* Online session analyses of specific episodes to teach client how to uncover and dispute irrational beliefs (as described above).
* Discussion.
* Imagery. (Using the imagination to learn how to be in control of thinking and emotions)
* Reading (self-re-education).
* Written self-analysis exercises as homework, using online forms and resources emailed out.
Probably the most important techniques is to do the HOMEWORK. This includes reading, self-help exercises, and experiential activities. Online sessions are really 'training sessions', between which the client tries out and uses what they have learned and then gives feedback. You will be helped through links given to you to learn how to analyse specific episodes where you feel or behave in the ways you are trying to change.
SOME UNIQUE FEATURES OF REBT
Absence of self-evaluation
First, let us view the REBT approach to a common therapeutic problem: that of low self-esteem.
Possibly most counsellors would try to help people with low self-esteem by encouraging them to regard themselves as 'worthy' human beings. The REBT therapist takes a radically different approach - encouraging the client to throw out the idea of self-esteem entirely! This involves giving up the practice of trying to judge human beings as 'worthy' (a notion, incidentally, that implies it is possible for them to be 'unworthy'!); and getting rid of the idea that people somehow need 'value' or 'esteem'.
The client is, instead, urged to
1. Aim for unconditional SELF-ACCEPTANCE - irrespective of their traits and behaviours or how other people see them;
2. Acknowledge that they simply exist - and choose to stay alive, seek joy, and avoid pain; and …
3. Instead of rating their SELF, to concentrate on rating their ACTIONS OR TRAITS (and the effects of these) in terms of how they help achieve the client's goals.
Secondary Problems
REBT postulates that human beings frequently develop problems about their problems. By creating these 'secondary' problems, they complicate their emotional and behavioural difficulties. Guilt is a common secondary problem: for instance, people with anger problems may down themselves because they have trouble controlling their rage. Sufferers of chronic anxiety frequently get anxious about getting anxious (the 'fear' of ‘fear'). Clients in therapy may become despondent because they are not overcoming their problems as quickly as they think they 'should' be able to. For therapy to be effective, these 'secondary' problems usually need to be addressed before the primary problem will become accessible.
Discomfort disturbance Vs Ego (perception of self) Disturbance
As noted above, REBT suggests that global evaluation of the 'self' will often lead to emotional disturbance. This is referred to as 'ego disturbance' - a concept that exists (in various forms) in probably most other therapeutic orientations, under such terms as 'low self-esteem', 'poor self-image' and the like.
REBT, however uniquely argues that there is another type of disturbance of equal or even greater significance: 'DISCOMFORT DISTURBANCE', usually referred to as 'low discomfort-tolerance' (LDT), or "low frustration-tolerance' (LFT). This concept explains why people may overreact to unpleasant life experiences, to frustration, and to their own bad feelings (thus developing 'secondary' problems); or will sabotage their therapy because they consciously or subconsciously perceive it as 'too hard'.
LEARNING TO USE REBT
To practise REBT it is important to have a good understanding or irrational thinking. This can be gained quite effectively by a critical reading of the substantial literature available. A Book John uses to assist people in this self-help process along with counselling advice, is "Choose to be Happy" by Wayne Froggat; Harper-Collins
