Rational Emotive Behaviour Therapy in a Nutshell (Counselling in a Nutshell)

Rational EmotiveBehaviour Therapy

in a nutshell

COUNSELLING IN A NUTSHELL SERIESedited by Windy Dryden

Michael Neenan and Windy Dryden


in a nutshell


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in a nutshell

Michael Neenan and Windy Dryden

● ●

SAGE PublicationsLondon Thousand Oaks New Delhi


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© Michael Neenan and Windy Dryden 2006

First published 2006

Apart from any fair dealing for the purposes of researchor private study, or criticism or review, as permitted underthe Copyright, Designs and Patents Act, 1988, thispublication may be reproduced, stored or transmitted inany form, or by any means, only with the prior permissionin writing of the publishers, or in the case of reprographicreproduction, in accordance with the terms of licencesissued by the Copyright Licensing Agency. Enquiriesconcerning reproduction outside those terms should besent to the publishers.

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Preface vi

1 A Basic Overview of REBT 1

2 Assessment 15

3 Disputing 25

4 Homework 40

5 Working Through 55

6 Promoting Self-Change 74

References 84

Index 88

Contents

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Preface

Our aim in this book is to be comprehensively concise, i.e. tocover all of the key elements of REBT theory and practice inas few words as possible. The idea for this book came fromour students who wanted a succinct and no-frills introductionto REBT to act as a counterweight to and relief from the lengthyand sometimes complicated texts they are required to read aspart of a standard training course in REBT (any ‘frills’ in thebook are contained in the notes section at the end of eachchapter so as not to clutter up the main body of the text).Reading lengthier REBT books will not be of much use tostudents in enhancing their knowledge of REBT if they are stillstruggling to grasp its basics. We hope that this book will easetheir struggle.

Michael NeenanWindy Dryden

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Where you are looking is usually where your attention is.When clients come to therapy their attention is usuallyfocused on others or events which they blame for causingtheir emotional problems. Clients rarely blame their thinkingfor causing these problems. Rational emotive behaviour ther-apy (REBT), founded in 1955 by an American psychologist,Albert Ellis, is a system of psychotherapy which teachesindividuals that it is their beliefs which are largely respon-sible for their emotional and behavioural reactions to lifeevents. The cornerstone of REBT is stated by the Stoicphilosopher, Epictetus: ‘People are disturbed not by things,but by the view they take of them.’ REBT teaches clients tolook inward in order to examine their view of events beforeturning their attention outward to seek ways of modifyingthe adverse impact of these events.

The ABCDE Model of EmotionalDisturbance and Change

This model is the centrepiece of REBT theory and practice.Every problem is placed within the model to teach theclient and guide the therapist. In this model:

Situation = What has happened, is happening or will happen.

Critical A = What the client is most upset about.

1A Basic Overview of REBT

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iB = irrational beliefs. These beliefs are called irrational becausethey evaluate the activating event in a rigid and extreme way.

C = emotional and behavioural consequences.These disturbed feel-ings and counterproductive behaviours are largely determined bythe client’s irrational beliefs about the event.

D = disputing. This involves challenging or questioning the irrationalbeliefs at B that largely produce the client’s emotional and behav-ioural reactions at C.

E = a new and effective rational outlook.

It is vital that you teach your clients that B, not A, largelydetermines C otherwise they will see changing events atA rather than disputing beliefs at D as the solution totheir emotional problems. Let us look at an example of theABCDE model:

Situation = ‘I am presenting a workshop next week.’

Critical A = ‘The possibility that my mind will go blank when I’masked questions and I’ll look stupid in the eyes of the audience.’

iB = ‘My mind must not go blank when I’m asked questionsbecause, if it does, this will prove to the audience that I’m stupid.’

C = anxiety and overpreparation.

D = ‘I certainly hope that my mind will not go blank but I cannotguarantee that it won’t or demand that it must not. If it does goblank, this will be due to my nervousness, not because I’m stupideven if the audience think otherwise.’

E = the client now accepts, not fears, the hazards of giving presen-tations, does not judge himself on the basis of these presentationsbut only judges his performance which he wants to improve.

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Rigid and Extreme Beliefs

REBT hypothesizes that absolute and rigid musts andshoulds are to be found at the core of psychological distur-bance.1 For example, the anxiety-inducing belief, ‘I must becertain that I won’t be rejected when I ask her out’ and theanger-creating belief, ‘You absolutely should not disagreewith me when I need your support’. Musts and shoulds canbe seen as demands we make on ourselves, others and theworld. It is important to elicit the meaning of the must orshould in order to determine if it is meant in an absolutesense, for example, ‘I must get that promotion’ (the clientcan conceive of no other outcome) versus ‘I must get thatpromotion’ (the client wants the promotion very much butrealizes and accepts that he might not get it). Pursuing non-malignant musts can waste valuable therapy time and turnyou into what Dawson (1991) calls a ‘mad-dog disputer’,that is, slipping the leash of clinical restraint and attackingevery must and should uttered by your clients.

Flowing from these rigid musts and shoulds are threemajor and extreme derivatives.2

1 Awfulizing – this refers to defining negative events as soterrible that nothing could be worse and no good couldever possibly come from these events, for example, ‘It’sawful to live alone. I’d rather be dead.’

2 Low frustration tolerance (LFT) – this is the perceivedinability to endure frustration or discomfort in one’s lifeand envisage any happiness while such conditions exist,for example, ‘I can’t stand being stuck in these bloody traf-fic jams every day!’ LFT is also referred to as ‘I-can’t-stand-it-itis’. Walen et al. suggest that LFT ‘is perhaps the mainreason that clients do not improve after they have gainedan understanding of their disturbance and how they createit’ (1992: 8).

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3 Depreciation of self, others and life – this involves giving aglobal negative rating to ourselves or others as if it repre-sents the ‘true self’ and to life as if it is a true representationof life conditions, for example, ‘I didn’t get the job whichmeans I’m a failure’; ‘You’re a bastard for giving me thatextra work’; ‘Life is no good for giving me this unfairness.’

These rigid and extreme beliefs are called irrational or self-defeating because they are illogical (that is, do not makesense), unrealistic, interfere with goal-attainment and largelycreate and maintain emotional disturbance.

Flexible and Non-Extreme Beliefs

Flexible beliefs are based on wishes, wants, preferencesand desires, for example, ‘I very much want you to love mebut I realize there is no reason why you must love me.’Flexible beliefs are deemed to be at the core of psychologi-cal health and lead to less intense negative feelings ratherthan disturbed feelings about adverse events, for exam-ple, feeling sad rather than depressed about the end of arelationship.

Flowing from these flexible beliefs, are three major andnon-extreme derivatives.

1 Non-awfulizing – negative events could always be worseeven if things are very bad indeed and some good may even-tually come from the grimness of present circumstances, forexample, ‘I don’t like living alone but maybe I can learn tomake it less oppressive.’

2 High frustration tolerance (HFT) – learning to increase theability to withstand discomfort and hardship in life and stillenjoy some measure of happiness, for example, ‘I can stand

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these traffic jams without liking them and, instead of rantingand raving about them, listen to some classical music.’Acquiring HFT helps clients to achieve their goals by per-sisting with the hard work that change usually requires.

3 Acceptance of self, others and life – human beings are seenas fallible (imperfect) and in a state of continuous change,so it is futile to give ourselves or others a global rating(either positive or negative) as this can never encompassthe totality of what it means to be human, for example,‘I didn’t get the job but this does not make me a failure’;‘You’re inconsiderate for giving me that extra work, butyou’re not a bastard for doing so.’ Life is seen as a complexmixture of positive, negative and neutral events, for example,‘This situation is unfair but it does not mean that the wholeof life is.’

Thoughts and Beliefs

REBT suggests that there are different levels of cognitiveactivity that we need to be aware of in understanding emo-tional disturbance. These levels are:

Inferences

These are personally significant assumptions about eventsthat may or may not be true, for example, ‘My partner isgoing to leave me. I won’t be able to cope living on my own.I have no future.’ Inferences are often linked, as in the exam-ple, and these linkages can be revealed by asking, ‘Let’sassume that’s true, then what?’ questions. This process isknown as inference chaining and is a major technique foruncovering the client’s critical A, that is, the emotionallyhottest part of the situation. Inferences are part of the A inthe ABC model. Some therapists may find inference chaining

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too difficult to accomplish and, therefore, we would suggestthey use a more straightforward way of locating the criticalA such as asking the client: ‘What are you most upset aboutin this situation?’ (for further ways of finding the critical A,see Neenan and Dryden, 1999).

Specific evaluative beliefs

These are specific appraisals of our inferences; in otherwords, we make up our minds about specific situations anddeliver judgements. With regard to the above example, theclient’s appraisals are: ‘My partner must not leave me.I can’t stand living alone. It’s awful to have no future.’Evaluative beliefs can also be held at a general level andcover a range of situations, for example, ‘I must have peoplearound me all the time.’ When evaluative beliefs cover abroad range of situations and are at the root of the client’semotional disturbance, they are known as core beliefs.

Core beliefs

These are the central philosophies that shape our view ofourselves, others and the world. Core irrational beliefs (forexample, ‘I’m a failure’) can be difficult to detect as theyremain dormant during periods of stability in a person’slife. They usually become activated and pass into theperson’s awareness at times of emotional stress or upheavalin his life. Core beliefs are the ultimate target of REBT inter-vention if clients are to achieve what Ellis calls a ‘profoundphilosophical change’ in their outlook.

Two Types of Disturbance

REBT suggests that two types of emotional disturbance under-lie most, if not all, neurotic problems: ego and discomfort.3

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Ego disturbance involves psychological problems related toone’s self-image, for example, feeling depressed about erec-tile dysfunction, ‘I’m not a real man any more.’ Discomfortdisturbance concerns psychological problems related toone’s sense of comfort and discomfort, for example, gettingangry about the slowness of a long queue, ‘I can’t standthis situation any longer.’ These two forms of disturbanceare separate categories but frequently overlap in clients’presenting problems. For example, a person condemns him-self as ‘weak’ (ego) for getting stressed-out about his highworkload (discomfort). In assessing your clients’ problems,you need to be aware that they may have both ego anddiscomfort aspects to them.

Emotional Change

Rational thinking leads to a reduction in the intensity,frequency and duration of emotional disturbance (Walenet al., 1992). Less disturbance usually means more psy-chological stability. REBT has traditionally distinguishedbetween inappropriate and appropriate emotions (Ellis,1980) and, more recently, between unhealthy and healthynegative emotions (Dryden, 1995). Inappropriate orunhealthy negative emotions (for example, anxiety,depression) are underpinned by irrational beliefs whileappropriate or healthy negative emotions (for example,concern, sadness) are underpinned by rational beliefs.However, to date, there is no research support for the ideaof qualitatively different continua of emotions, only for acontinuum of emotional intensity.4 Therefore, avoid lec-turing clients about or insisting upon these categories; letyour clients select the words they wish to use (for exam-ple, less worried, calmer, confident, determined) for theiremotional goals. The important point is to ascertain if

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the emotional goal reflects a self-helping and flexibleoutlook.

Two Forms of Responsibility

The first form is emotional responsibility (not blame) wherebythe client accepts that his emotional disturbance is largelyself-induced by the irrational beliefs that he holds. The ABCmodel establishes emotional responsibility:

Situation = Client loses his job.

Critical A = ‘I can’t see myself as worth anything if I don’t have a job.’

iB = ‘I must have a job because, without one, I’m not worth anything.’

C = depression and withdrawal.

Losing the job is unfortunate, but the client’s depression isdetermined by his evaluation of himself as worthless, notby losing the job itself.

The second form is therapeutic responsibility wherebythe client commits himself to the hard work of personalchange by disputing his disturbance-creating beliefsand acting in support of his emerging rational beliefs. TheD and E elements of the model encourage therapeuticresponsibility:

D = ‘I’m a man without a job, not a man without worth. A job can betaken away from me, but not my worth unless I allow it to happen.’

E = starts looking for another job – ‘I will persevere until I find one.’

If your clients want to achieve a successful outcome in REBT,then it is vital that they accept both forms of responsibility –‘I disturb myself’ and ‘I will learn how to undisturb myself’.

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Maintenance of EmotionalDisturbance

REBT focuses on how emotional problems are maintainedrather than how they were acquired. Irrational ideas arethe central means of maintaining these problems. Whileexploring the past is not neglected in REBT, it is not seenas crucial in order to help your clients with their currentdifficulties:

Human emotional problems do not result from the experi-ences people have, whether these experiences are historicalor current, but from the way people interpret and continueto interpret these experiences. When a person is emotion-ally disturbed, the disturbance results from a currentlyheld way of thinking and believing. (Grieger and Boyd,1980: 76)

The past can be viewed through the lens of the present, forexample, ‘Your father told you that you would always be afailure. Do you continue to believe that yourself?’ Ideasthat may have originated in the past are owned and main-tained by the client in the present.

Elegant and InelegantChange

Elegant REBT involves clients undergoing a profoundphilosophical change by surrendering all their rigid mustsand shoulds and their extreme derivatives: ‘If people had atruly sound philosophy, they could ward off practically allneurotic thinking, feeling and behaving and arrange theirlives so that they would rarely, if ever, be self-defeating and

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antisocial’ (Ellis, 1991: 8–9). In our experience, the majorityof clients that we see are not interested in this kind of philo-sophical change but more modest cognitive or so-called inel-egant change (for example, reframing negative events in apositive light, less catastrophizing, greater self-acceptance).It is important that you do not indicate to your clients thatthe inelegant solution is the inferior solution (how manyREBT therapists truly embrace the elegant solution in theirown life?). Discuss REBT’s concept of philosophical changebut work on the change the client wants, not what you thinkshe should be working on.5

Helping Clients to Get Betterand Not Just Feel Better

Clients can usually feel better through the services of awarm and caring therapist but getting better would be con-fronting those situations in which they disturb themselves.For example, the therapist might tell her client that he is aworthwhile human being who has a lot to offer to othersdespite recent rejections and he feels better on hearingthis; getting better would be the client believing this him-self rather than relying on others to tell him and acceptinghimself in the face of further rejection. Feeling better isusually short-lived while getting better is longer-lasting(Ellis, 1994).

Relapse Prevention

This strategy teaches clients how to reduce the occurrenceof future episodes of emotional disturbance (we do notbecome permanently undisturbable). When these episodesdo occur, clients are instructed to deal with them as quickly

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as possible to minimize the chances of a lapse (a partialreturn to a problem state) turning into a relapse (a fullreturn to a problem state). If clients do slide back into emo-tional disturbance, Ellis (1984) advises clients to ‘look forthe must, look for the absolute should’ that has re-enteredtheir thinking. Relapse prevention strategies are taughtduring the last few sessions of REBT.

Active-Directive Style

This involves you actively guiding clients to the salientaspects of their presenting problems and is deemed to bemore effective in helping clients change than a passive ornon-directive style of intervention. REBT therapists areactive in, inter alia, asking questions, forming hypotheses,collecting assessment data, limiting extraneous material orclient rambling, problem-defining, goal-setting, teaching,disputing beliefs and negotiating homework tasks – allthese and other activities are aimed at directing clients’attention to the hypothesized cognitive core (that is, rigidmusts and extreme derivatives) of their emotional andbehavioural problems. In order to keep clients focused onthe ABCDE model of emotional disturbance and change,Walen et al. ‘envision the therapist as a kind of herd dogwho guides the patient through an open field full of dis-tractions, keeping the patient on course’ (1992: 229).

Active-directiveness is the general style of REBT thera-pists, but you will need to adjust it to meet the preferences(for example, slow, reflective pace), learning requirements(for example, repetition of key REBT points in plain lan-guage) and interpersonal functioning (for example, a sub-dued approach with a histrionic client) of individual clients.If you assume that active-directive always means highlyactive and overly directive, then this is likely to have an

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adverse impact on some, maybe many, of your clients byminimizing their self-responsibility for change, impairingtheir problem-solving abilities and undermining the devel-opment of a collaborative relationship.

Three REBT Insights

REBT is an insight and action-oriented therapy because itprovides clients with a clear understanding of the primaryrole of rigid thinking in their emotional problems and howthis thinking can be tackled through in-session and home-work tasks. In particular, REBT presents clients with threemajor insights into the development, maintenance and even-tual amelioration of their problems.

1 Human emotional disturbance is largely determined byirrational beliefs. To paraphrase Epictetus: People are notdisturbed by things, but by their rigid and extreme viewsof things.

2 We remain disturbed in the present because we continuallyreindoctrinate or brainwash ourselves with these beliefsand act in ways that strengthen them.

3 The only enduring way to overcome our emotional prob-lems is through persistent hard work and practice – tothink, feel and act against our irrational beliefs and think,feel and act in support of our rational beliefs.

These three insights provide clients with a capsule account ofREBT and act as a lifelong guide to emotional problem-solving.

Keep Therapy Moving

In this chapter, we have provided you with a basic overviewof REBT. We emphasize the word ‘basic’ because we do not

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want therapy to ‘seize up’ through tedious explanationsof REBT theory which may well leave your clients bored,baffled or brain-dead. Apply REBT theory with a light touchby making it brief and clear, let your clients put REBTjargon into their own terms and, if they are not persuadedby the REBT viewpoint, focus on the disturbance-inducingideas that your clients do believe are implicated in theirproblems. Let therapy flow instead of trying to replicatetextbook REBT in your office. Textbooks do not get clientsbetter: partnerships in problem-solving do.

Notes

1 There is no empirical support for this hypothesis (see, for example,Wessler, 1996; O’Kelly et al., 1998) and it appears to be untestabledue to the current inability to measure musts adequately (Bond andDryden, 1996). Remember that you are advancing an hypothesis,not stating a fact, so you will need to be flexible in focusing ondisturbance-producing ideas that clients see as central to their prob-lems (for example, ‘I’ll never get out of debt’) but not by ‘elegant-minded’ REBTers.

2 There has been some debate within REBT as to whether musts areprimary psychological processes and derivatives are secondaryones or vice versa. We would suggest that they are, in all probabil-ity, interdependent processes which often seem to be different sidesof the same ‘cognitive coin’ (see Dryden et al., 1999). If your clientsees a particular derivative as primary, then focus on that belief anddo not waste time trying to convince her that it stems from a mustand this is where her attention should be now or directed to laterafter the derivative has been dealt with.

3 I (WD) prefer the term ‘non-ego disturbance’ as a generic alternativeto ego disturbance in REBT theory. The reasons for this are dis-cussed in Neenan and Dryden (1999).

4 Wessler points out that ‘unique to RE[B]T is the untested and unsup-ported hypothesis that there are qualitative differences between

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certain similar emotions, and that each is mediated by a differenttype of belief’ (1996: 48). For example, anxiety is inappropriate oran unhealthy negative emotion while concern is appropriate or ahealthy negative emotion – the former emotion is mediated by irra-tional beliefs while the latter is mediated by rational beliefs. Ellis, inreplying to Wessler’s criticisms of his parallel processes model ofemotion, accepts that ‘Richard [Wessler] – and other critics of mytheory of “healthy” and “unhealthy” negative feelings – are right inasking for empirical, and not merely clinical, data to back my theory’(Ellis, 1996: 114).

5 I (MN) agree with Young that ‘it’s largely a waste of time to workon irrational ideas that are unlikely to be changed. For instance,attempting to get people not to esteem themselves at all or attemptingto get them to see that there is nothing they must do seems to mean inefficient use of the therapy time you have. Why hammer awayat something at which you’re not likely to make much progress?’(quoted in Ellis et al., 1987: 248; emphasis in original). To my knowl-edge, I have never had a client who has achieved the elegant solu-tion to his or her problems even if he or she was interested in such anoutcome. However, some clients have said they did achieve philo-sophical change when such change is defined idiosyncratically, notREBT-driven.

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In REBT, therapists try to gain, as early as possible, an ABCunderstanding of the client’s presenting problem ratherthan carry out a pre-treatment case formulation.1 Gainingfurther information, both current and historical, about theproblem can be obtained as therapy proceeds. Trying toknow the ‘big picture’ (Grieger and Boyd, 1980), that is,attempting to understand every aspect of the client’s func-tioning before clinical intervention begins, can waste valu-able therapy time, prolong the client’s distress and convey toher that you are more interested in completing your paper-work than helping her.

Explaining REBT

Ensure that your explanation of REBT is brief and clear, notlengthy and elaborate. The most important initial point tomake is the thought–feeling link rather than an exclusivefocus on rigid beliefs and emotional disturbance. Here aresome ways of teaching this link.

You can write the ABC model on a piece of paper orwhiteboard.

1 In this model, at A, which is the activating event or situation, theperson is preparing to take an exam. At C, emotional conse-quences, she is feeling very anxious. At B, beliefs, she thinks, ‘IfI don’t pass this exam, I’ll be an utter failure.’ In order to really

2Assessment


understand what determines her anxiety at C, we need to focuson B, not A. We’ll be using this ABC model to understand andexamine your emotional problems.

You can be Socratic and ask your client what largely determinesC – B or A? – and the reasons for her answer.

2 Many people believe that their emotional problems are causedby others or unpleasant events in their life. Not so. REBT’s posi-tion is that our emotional problems are largely self-createdthrough the beliefs and attitudes that we hold [tapping fore-head]. If you want to change the way you feel about events inyour life, you first have to change the way you think about theseevents. Let’s see how REBT can be applied to your problems.

3 With some clients you might be able to be even more brief: ‘Theessence of REBT is that you feel as you think, so let’s see howthis principle applies in practice to your problem of … [for example,anxiety].’

4 Three men working for the same company, at the same leveland on the same salary are all sacked at the same time.The firstman feels depressed because he believes he is worthless with-out a role in life; the second man feels angry because hebelieves he should have been promoted, not sacked; and thethird man feels relieved because he never liked the job and canset up his own business now. The point is that being sackeddoes not cause each man’s emotional reaction but what doescause it is the meaning each man attaches to being sacked.We’ll be examining the meaning you attach to events in your lifein order to understand your emotional problems.2

You can be Socratic instead of telling your client what the pointof the story is and ask her what she thinks caused three differentemotional reactions to the same event.

Of course, some, or many, of your clients will have doubts,reservations or objections to the thought–feeling link (forexample, ‘Being sacked makes you depressed because if yougot your job back then you would be happy again. That makessense, doesn’t it?’). To avoid prolonged discussion and thereby

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delay problem assessment, it is probably best to suggestto your clients that doubts, reservations and objections canbe dealt with by showing REBT in action (unless your clientinsists on discussing the ABC model before therapy proceedsany further).

Listening to Clients’ Stories

Obviously clients come to therapy with a story to tell abouttheir problems. For REBT therapists, the concern is whento intervene in this storytelling or, to put it another way,how long to let it go on for. We would suggest these guide-lines for intervention:

1 Ask for permission to interrupt before the storytellingstarts, so the client will be less surprised or affronted whenyou do.

2 Interrupt if the client begins to repeat himself, for example,‘You’ve already mentioned that. Have you now given methe gist of the problem?’

3 Interrupt to clarify points in the story, for example, ‘Whatdid he actually say that you made yourself so angry about?’

4 Interrupt if the client is going off in all directions and youneed to bring him back to the central narrative or establishone, for example, ‘There seem to be so many strands to thisstory. Which one appears to be the most important to youor the one you want to focus on?’

5 Interrupt if the client is long-winded and/or you are strug-gling to understand her problem, for example, ‘Could yousum up for me in a sentence what exactly is the problemyou want to work on?’

Your goal is to move your clients away from unstructuredstorytelling to structured storytelling through the use of theABC model (Neenan and Dryden, 2001).

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Making ABC Sense of theClient’s Story

In the following dialogue, the therapist puts the client’sstory into an ABC framework:

Client: Well, it’s all to do with my best friend and what he did.Youknow we’ve been friends for a long time. We were in thearmy together. We watched each other’s backs when wewere serving in Northern Ireland and I thought it would bethe same in Civvy Street. So you think you know a bloke,know what I mean? Then he goes and does somethinglike that and it was unbelievable. I never imagined it in amillion years he’d do that. It’s unbelievable. My best friendand everything and he goes and does that and …

Therapist : Can I interrupt you there? I don’t understand what theissue is. What was it that your best friend did that youfound ‘unbelievable’?

[The therapist is attempting to focus the client’s mind on the sub-stance of the problem – clarifying the A – thereby stopping him fromtalking in general terms about it.]

Client : He pulled out of a business deal we’d set up. I thoughtwe were going into business together and he pulls theplug at the last minute. I thought I could trust him totally.I was gobsmacked and …

Therapist : When you say ‘gobsmacked’, are you referring to howyou felt about what he did?

[The therapist is now focused on eliciting C.]

Client : Yeah. I was livid, I felt totally let down.Therapist : When you say ‘livid, let down’ does that refer to anger

and hurt?Client : Yeah, angry and hurt, it’s all swirling round in my mind,

but I really feel anguish over what he did to me.Therapist : So is anguish the best word to describe how you feel?

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[The therapist uses the client’s term for C rather than shoehorn himinto using ‘REBT approved’ terms for disturbed emotional C’s.]

Client : Yeah. That really seems to sum it up for me.Therapist : What are you most anguished about in regard to him

pulling out of the deal?

[This is an alternative way to find the critical A instead of asking‘Let’s assume that’s true … then what?’ questions.]

Client: There are so many things: our friendship is gone, I feelnow that I didn’t really know him after all, I wonder why Ididn’t see it coming, can I ever trust my judgement again,he destroyed my dream of having my own business, Idon’t feel I can really trust anyone again … I don’t know.

Therapist : Can you pick one of those issues so we can focus on it?

[The therapist does not want to examine each item in the client’s listto determine which one is the most relevant to his anguish.This mightproduce more ‘anguish’ for the client with the number of questions hewould be asked and a lot of headscratching for the therapist trying tomake sense of the replies in her search for the often elusive critical A.]

Client : [ponders] That he destroyed my dream of having myown business.

Therapist : Is that the worst aspect of it for you?Client : I think it’s that he betrayed me. I think that’s what hurts

the most. I’ll never forgive him for that.

[The client refers again to hurt which seems to be synonymous withwhat he calls anguish. The theme in hurt is betrayal.]

Therapist : Okay, let’s write down what we’ve uncovered so far.

[The client is a little unsure if his friend’s betrayal is ‘what hurts themost’ but it can be considered as a reasonable or a near-critical Athat merits clinical examination. The therapist avoids what can be atrap for some REBT therapists: an almost obsessional search forthe critical A that exhausts both client and therapist.]

Situation = My best friend pulled out of a business deal with me.

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Critical A = He betrayed me.

iB = ?

C = anguish.

[At this point, the therapist explains to the client the role of rigidmusts and shoulds and their extreme derivatives in largely deter-mining emotional disturbance. The client only acknowledges theshould in his thinking (‘That should is rock-solid. There’s no way onthis earth that he should have pulled out of that deal’); he is not con-vinced by other aspects of REBT’s view of disturbance-inducingthinking and the therapist has no desire to engage in time-wastingarguments over the ‘correctness’ of the REBT viewpoint.]

Therapist : So the B, or irrational belief, is: ‘He shouldn’t havebetrayed me. I’ll never forgive him for that.’ Does thatbelief help to explain your anguish at C?

Accepting EmotionalResponsibility

Little, if any, therapeutic benefit will be achieved if yourclient steadfastly points his finger at A as the source of hisemotional problems; so take time to help your client turn hisattention away from A to focus on B. To resume the dialogue:

Client: Of course not. My best friend made me feel this way.I don’t see the belief as irrational at all. It’s common sense.

[The client does not accept emotional responsibility.]

Therapist: So if your best friend is responsible for causing you thisanguish, does that mean he is also responsible for reduc-ing it or making it go away? Is that common sense too?

Client : I don’t know. We haven’t spoken to each other since hepulled out of the deal. I’m certainly not going to go outof my way to talk to him, let alone ask him for help.

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Therapist : So will you be stuck in a state of limbo until he calls youand tries to make amends? That’s supposing he isgoing to do that. Will it make any difference anywaybecause you said you are not going to forgive him?

Client : That’s true, I’m not going to forgive him. I don’t want torely on him for anything, ever again.

Therapist : But, despite having said that, it seems to me that thelogic of your argument is that he is the only person whocan make you feel better. Apparently, you are unable tohelp yourself.

Client : Okay, I’m getting the point: I need to do something tohelp myself. What is it then?

Therapist : By taking control of how you emotionally respond tothis situation.Your anguish belongs to you, no one elsegave it to you. That’s the bad news. The good news isthat it is within your control to reduce it, irrespective ofwhat your best friend does or does not do, by examin-ing and changing that belief of yours.

Client : Okay. I suppose I could give it a try, but I still don’t likethat word ‘irrational’.

[The client is warming to the idea of emotional responsibility.]

Therapist : What would you like to call it?Client : Well, it’s keeping me stuck, isn’t it?Therapist : Shall we call it ‘the SB: stuck belief’?Client: Yeah. I’ll go along with that. [ponders] You know all this talk

about my anguish makes me seem pathetic, doesn’t it?

[The client’s last comment may indicate the presence of a meta-emotional problem. See later section.]

Establishing Goals

Ensure that your client’s goals are within her control other-wise she will be looking to others to provide the solution forher emotional problems (as the client was doing in the abovedialogue). In order to determine if your client has achieved

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her goals, measure change along the following three majordimensions:

1 Frequency – does your client make herself disturbed lessfrequently than before?

2 Intensity – when your client makes herself disturbed, doesshe do so with less intensity than before?

3 Duration – when your client makes herself disturbed, doesshe do so for shorter periods of time than before?

Encourage your client to keep a record of her disturbedfeelings using these three dimensions so that she can plother progress. To return to the dialogue:

Therapist: Now if your goal is to be less anguished, how does yourpresent level of anguish display itself?

Client : Well, I brood a lot in the evenings when I come homefrom work. My wife tells me to snap out of it.

Therapist : How long do you brood for in the evenings?Client : I don’t know – a couple of hours perhaps.Therapist : So if you were feeling less anguished, how would that

affect the time you spend brooding?Client : It’d be much less.Therapist : And what would you be doing with the time instead?

[The therapist is encouraging the client to put the goal in positiveterms (what he wants to do or have more of) rather than statedin negative terms (what he wants less of). ‘Stating goals positivelyrepresents a self-affirming position’ (Cormier and Cormier, 1985: 223)].

Client : I’d be spending it with my wife and kids and I’d be in abetter mood. Also, I’d be pottering about in the gardenon these warm, summer evenings. I like doing that sortof thing.

Therapist : So those will be some of the ways that we can see thatpositive change is occurring. Right? [client nods].

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Meta-Emotional Problems

This means disturbing ourselves about our primary emotionalproblems, for example, guilt about feeling angry, ashamedof feeling anxious. It is important to be on the alert for thepossible presence of meta-emotional problems as they canimpede your client’s progress. If a meta-emotional problemis detected, then discuss with your client if this emotionshould now become the focus of your clinical attention asshown in the following dialogue:

Therapist : You said earlier that ‘all this talk about my anguish makesme seem pathetic’. Do you see yourself as pathetic forexperiencing this anguish?

Client : Sometimes.Therapist : How do you feel when, on these occasions, you see

yourself as pathetic?Client : I suppose I feel ashamed of myself for not ‘snapping

out of it’ as my wife says I should do. It’s being weak,isn’t it?

Therapist : I wouldn’t agree with that but we can discuss that idealater. For now, I would like to find out if you feel ashamedof yourself at this moment for not ‘snapping out of it’?

[The therapist does not want to get sidetracked into discussing theclient’s meta-emotional problem unless it will block him from workingon his primary emotional problem.]

Client : No, not really.Therapist : So will this shame prevent you from focusing on your

anguish and how to tackle it?Client : Shouldn’t think so. How can I be sure though?Therapist : If you spend more time absorbed by your shame than

you do listening to me! If your mind appears to be else-where, I will point this out to you.

Client : Okay, seems reasonable.

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Therapist : So shall we turn our attention now to examining thisstuck belief of yours, ‘He shouldn’t have betrayed me.I’ll never forgive him for that’?

Client : Okay, but I’m not convinced yet it’s the main cause ofmy anguish. I’ll keep an open mind on it though.

Therapist : That’ll do.

[The client is still expressing his doubts about the concept of emo-tional responsibility. The therapist does not expect her client, or anyclient, to be a strong believer in this concept in the early stage oftherapy. It is enough that the client will keep an ‘open mind’ on thesubject.]

In this chapter, the client has pinpointed what he considersis the crucial aspect of his presenting problem, idiosyncrati-cally defined his disturbance-inducing beliefs and disturbedfeelings, and is prepared to be receptive to the concept ofemotional responsibility. The next step is to dispute or exam-ine his ‘stuck beliefs’.

Notes

1 A case formulation is necessary if the referral is a complex one oryour client is not making anticipated progress or you feel stuck anddo not know why. One example of an REBT case formulation isknown as UPCP: Understanding the Person in the Context of his orher Problems (see Dryden, 1998a).

2 In classical REBT, these three men are facing different critical As:loss of role (man 1), unfair treatment (man 2) and relief (man 3).However, initially it is sufficient to help clients understand that peoplereact to the same objective event (loss of job) in different waysbecause of the different meanings they attach to this event. In clas-sical REBT, meaning is usually considered to be a fusion of criticalA and B factors.

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DiGiuseppe states that ‘disputing irrational beliefs has alwaysbeen at the heart of RE[B]T’ (1991: 173) and is the principalactivity of experienced REBT therapists. The Concise OxfordEnglish Dictionary provides a definition of disputing as ‘ques-tion the truth or correctness or validity of (a statement, allegedfact, etc.)’. Disputing in REBT is a questioning or examiningof your clients’ irrational beliefs (these beliefs can be REBT‘approved’ or idiosyncratically defined) in order to lead tothe development of flexible and non-extreme belief systems.1

Disputing is not about arguing, being abrasive or rude, in-your-face confrontation or engaging in power struggles; ifsome of these things do occur, then pay attention to yourbeliefs that may be driving such behaviour, for example,‘I have to prove my competence as a therapist by getting theclient to accept my arguments.’

Disputing helps clients to see that their beliefs

are both theoretically untenable (e.g., are unfactual or tau-tological, contain internal inconsistencies, are based onfalse premises, are non-sequiturial) and are impractical orimpossible (e.g., lead to poor results, cannot be obtained oraccomplished, result in short range gain at the expense oflong range cost). (Grieger and Boyd, 1980: 130; originalauthors’ italics)

This outcome is achieved by encouraging your clients toreflect on what they believe – an activity which may for

3Disputing


some clients be painful, unsettling or effortful. As Blackburnobserves:

Human beings are relentlessly capable of reflecting onthemselves. We might do something out of habit, but thenwe can begin to reflect on the habit. We can habituallythink things, and then reflect on what we are thinking.We can ask ourselves (or sometimes we get asked by otherpeople) whether we know what we are talking about. Toanswer that we need to reflect on our own positions, ourown understanding of what we are saying, our own sourcesof authority. (2001: 4)

Helping clients to reflect on and challenge aspects of theirthinking, empirically testing their beliefs and developingalternative, more self-helping ways of viewing themselves,others and the world results in them ‘functioning at a muchfuller realization of their thought potential’ (Grieger and Boyd,1980: 131).

Belief Levels

Irrational beliefs can be ‘stated at varying levels of abstrac-tion’ (DiGiuseppe, 1991: 186). The level of abstractionranges from beliefs held in specific situations (for exam-ple, ‘I must have my partner’s approval’), across situa-tions (for example, ‘I must have the approval of my friendsand colleagues’) and globally (for example, ‘Everyone mustapprove of me’). An irrational belief that is challenged at ageneral level (demanding approval from friends and col-leagues) will tackle a greater number of activating eventsthat the client disturbs herself about than an irrationalbelief held in a specific situation (demanding the approvalof her partner). Similarly, the more abstract the rational

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belief, the more generalizable and disturbance-reducing itwill be.

A common mistake made by some REBTers, particularlytrainees, is to presume that a client holds a general versionof a situation-specific irrational belief and then start disput-ing it thereby leaving the client feeling baffled by the ther-apist’s behaviour. For example, a client says that it is unfairhe did not get promoted after years of loyal service to thecompany; the therapist asks: ‘Why must the world treat youfairly?’ The client, perplexed by the therapist’s question,replies: ‘It’s the company’s behaviour I’m unhappy with,not how the world treats me.’ Disputing should start with asituation-specific irrational belief and only move to moregeneral or core irrational beliefs if the client acknowledgestheir existence and wants to work on them.2

Formulaic Disputing

This means disputing in an unintelligent or slavish way. Inmany REBT textbooks, including our own, a formula fordisputing is offered to therapists. Such a formula is askingthe client if her belief is rigid or flexible, extreme or non-extreme, and questioning the logical, empirical and pragmaticstatus of the belief (Neenan and Dryden, 2000). Providinga formula is only meant to be a guide to disputing: it is notintended to provide therapists with a complete ‘disputingkit’. Formulaic disputing, which we hear a lot of, often goessomething like this:

Trainee: Is your belief ‘I must never show any weaknesses’ rigid orflexible?

Client : I suppose it does sound somewhat rigid.Trainee: That’s right. Do you think that calling yourself ‘weak’ for

showing a weakness is an extreme way of judging your-self for being a fallible human being?

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Client : I suppose it is a bit over the top.Trainee: Right. Now does it logically follow that because you

strongly prefer not to show any weaknesses therefore youmust not show them?

Client : Well, if you put it like that, I suppose it doesn’t logicallyfollow.

Trainee: It doesn’t, does it? Now, is it true that you have nevershown a weakness?

Client : I suppose it’s not true. I don’t really know.Trainee: Not true then. Now, where is it going to get you holding

onto that belief, ‘I must never show any weaknessesbecause, if I do, this will prove to others I’m weak’?

Client : I suppose it will give me some trouble now and again.Trainee: Probably a lot of trouble. Can you now see why your

belief is irrational?Client : Hmm.

The outcome of such disputing is usually highly unsatisfac-tory for both therapist and client: the former believes thatdisputing cannot be as straightforward as this while thelatter remains unconvinced by the points the therapist ismaking as indicated by her ‘I suppose …’ replies. Disputingas if you are on automatic pilot is unlikely to engage yourclients in a productive discussion of their irrational beliefs,let alone lead to constructive changes in them.

Creative Disputing

This means moving beyond textbook formulas for disput-ing and thinking for yourself. What arguments can youdevise that will help to turn the tide in your clients’ irra-tional thinking? In a chapter called ‘The Best RationalArguments’, Paul Hauck comments that

Your strength as an RE[B]T counselor is measured in partby the ease with which you can call up rational arguments

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to counterattack irrational arguments. But, in addition toease, you also seek arguments that have uniqueness, humor,and an overriding impression of correctness. The moresuch arguments you possess, the better counselor you willbe. (1980: 117)

While we are not denigrating the use of standard argu-ments (for example, the best friend dispute, ‘Where’s theevidence?’), we would urge you to be looking for whatHauck calls ‘fresh debate material’. Using the same argu-ments with all of your clients is bound to lead to stalenessand boredom in therapy (for some fresh debate materialsee Neenan and Dryden, 2002). To return to the above dia-logue, it is important for the trainee to try out some of hisown ideas and monitor the client’s reaction to them inorder to determine which ones capture her attention:

Trainee: Now your belief is ‘I must not show any weaknesses’.Right? [client nods]. Do you see coming to therapy as asign of weakness?

Client : Er … I don’t know.Trainee: Do you see it as a sign of strength?Client : I don’t suppose it’s that. People come to therapy because

they can’t sort out their own problems. I suppose comingto therapy is a sign of weakness.

Trainee: So how does that support your belief that you must notshow any weaknesses? In other words, is your belief true?

Client : [shrugs her shoulders] Well, I suppose it isn’t true after all.

[The client seems uninterested in her own conclusion. The traineetries another argument.]

Trainee: When you say that you must not show any weaknesses,does that mean you do have some weaknesses butothers must not see them?

Client : [concentrating] I do have some weaknesses like feelinganxious when I meet new people or being the centre ofattention. I try to keep myself under control because Idon’t want them to think badly of me.

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[The client is becoming engaged in the conversation.]

Trainee: You say you try to keep yourself under control so theywon’t think badly of you, but how do you know yourattempts at a control are successful?

Client : What do you mean?Trainee: Well, does that must statement guarantee that your

weaknesses will not be exposed to other people andtherefore you will avoid being judged negatively by them?

Client : I know it won’t guarantee it and I’m sure other people dosee how nervous I am, no matter what I say to myself.The funny thing is the more I try to suppress my ner-vousness, the more nervous I become. I don’t really getmuch peace of mind.

Trainee: Would you like to start giving yourself some peace ofmind by changing that belief of yours?

Client : How do I do that?Trainee: First, release the pressure in your mind by giving up that

must. Second, learn to accept yourself with your weak-nesses irrespective of how others see you and, third,learn to tackle constructively those behaviours you call‘weaknesses’.

Client : That’s a tall order.Trainee: Maybe, but your way hasn’t worked so far, so are you

willing to give my way a try? You can always go back toyour ways if you don’t like mine or they don’t work out.

[Pointing out to clients that they can return to their old ways of think-ing, feeling and behaving shows them that you are not trying to ‘force’a new way on them and they remain in control of the change process.]

Client : [nodding her head] Okay. I’m willing to give your way a try.Trainee: If you find my way helpful, I hope you will take it over and

make it your way.

Initial disputing has not dislodged the client’s irrationalbelief nor was it intended to, but it has presented her withthe possibility of developing a different perspective on

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tackling her problems – clients do not usually give up theirirrational ideas unless they have alternative ideas to replacethem with. Disputing is usually carried out in each sessionto ameliorate the client’s original problem, tackle new oneswhich emerge, overcome resistance and remove obstaclesto change (self-disputation is also required when some ofyour beliefs become obstacles to client change, for example,‘The client has to accept my arguments because they areright and hers are wrong’).

From Formulaic to CreativeDisputing

Earlier in this chapter, we cautioned you against the use offormulaic disputing and encouraged you to be creative indisputing your clients’ irrational beliefs. However, we real-ize that you are unlikely to be creative at the outset of yourtherapy career. REBT, in this respect, is like jazz: improvi-sation is the essence of jazz but can only be achieved oncethe player has mastered the basics of his instrument. Toimprovise without learning the basics first will lead toa cacophony of sound. Similarly in REBT, attemptingcreative disputing without learning the basics first willlead to a discordant ‘sound’ of ill-considered arguments,conflicting ideas, feel-good phrasemaking and ramblingreflections.

To avoid this outcome, it is important to understand thatat the beginning of your career you may sound formulaicin your use of disputing strategies, but once you have mas-tered the basics you can go on to improvise and be creative –the ‘boring’ part before the exciting part. What we stronglydiscourage you from doing is resting on your laurels onceyou have learnt the basics of disputing. The REBT thera-pists who do this are the ones who sound formulaic in their

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disputing work and are also the ones who are the leasteffective disputers.

Preparing Your ClientsFor Disputing

Disputing can be an uncomfortable experience for clientsas they are being asked, in essence, to defend their beliefs.In order to pave the way for disputing and avoid the impres-sion that you are attacking your clients, there are a numberof activities to carry out:

1 Review the ABC’s of the client’s presenting problem.2 Remind the client of the importance of the B–C connection,

that is, that irrational beliefs (B) largely determine emotionalconsequences (C). This will help her to see the sense in dis-puting B rather than attempting to change A.

3 Help the client to understand that her new C (emotionalgoal) is achieved by changing B: emotional change flowsfrom belief change.

4 Explain to your client what is involved in the disputingprocess (that is, an examination of her irrational beliefs) andwhat is not involved (for example, arguing, ‘brainwashing’).

Mixing Basic and CreativeDisputing

Elements of basic and creative disputing are likely to befound, or rather heard, in the session audiotapes of experi-enced REBT practitioners. Such a mixture is present in themain therapist–client dialogue of this book to which wenow return.

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Therapist : Just to recap on what we’ve done so far: you’re feelinganguished about your best friend pulling out of a busi-ness deal with you. Your belief about this situation,which we’ve agreed to call the ‘stuck belief’, is ‘Heshouldn’t have betrayed me. I’ll never forgive him forthat’ [client nods]. Now I know you’re not convinced butyou are prepared to consider the possibility that yourbelief about your best friend’s behaviour rather than thebehaviour itself is largely responsible for your currentanguish [client nods]. If you want to reduce your anguishand get yourself into a better mood, then you need toget yourself unstuck from that belief. To do that, we willcarefully examine that belief and decide if there aremore helpful ways of thinking about your problem. I’ll beoffering you arguments to consider, but I certainly won’tbe trying to force you to accept my viewpoint. Okay?

Client : That’s okay with me. How do we begin then?Therapist : Now you said previously that your should was ‘rock

solid’.Client : That’s right.Therapist: Does that rock solid should allow you to accept the

reality of what actually occurred, integrate that painfulepisode into your experience and move on with your life?

[The therapist is seeking to discover if the client sees his irrationalbelief as realistic, adaptable and conducive to therapeutic move-ment in his life.]

Client : Of course not! How can I ‘move on’, as you say, whenhe betrayed me?

Therapist : I’ll come to the issue of betrayal a little later if I may, butas long as your should remains rock solid, what willhappen to your anguish?

[The therapist is disconnecting the rock-solid should from the issueof betrayal. Separate consideration of these areas may help theclient to be more objective in his discussion of them.]

Client : Nothing will happen to it, it’ll just still be there.

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Therapist : And how will that help you to reduce your anguish then?Client : It won’t. Do you expect me to forget all about it then?Therapist : I don’t expect you to forget it, but it’s the way you hang

onto what’s happened that’s keeping your anguish goingrather than diminishing. Your rock-solid should is, inessence, a demand that your best friend should nothave acted in the way that he did at that time.

[In other words, the empirical reality at that time should have beenother than it was. The therapist is pointing out the absurdity of theclient’s reality-denying should.]

Client : Are you taking his side then?Therapist : I’m not taking his side. I’m trying to encourage you to

step back from the problem and try to view it moreobjectively. Look, who ultimately determines what yourbest friend does – you or him?

[If rock-solid shoulds were realistic, then they would determinehis best friend’s behaviour irrespective of what the best friendwanted to do.]

Client : Well, he does obviously. Am I supposed to feel sorryfor him or something?

Therapist : I’m not asking you to feel sorry for him. People act inthe ways that they do based upon what’s happening intheir life at any given moment.Therefore, what’s impor-tant to him will not always coincide with what you seeas important in your life.

[The therapist is pointing out the unpalatable truth that the clientis not necessarily at the centre of his best friend’s universe; otherfactors or priorities compete for attention in his best friend’s life.]

Client : But he said he was going to go into business with me.He gave me his word.

Therapist : And I’m sure he meant it at the time but circumstanceschange and people cannot always keep to what they’veagreed or promised. Have you ever broken a promise?

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[The therapist does a little ‘mind-reading’ regarding the client’s bestfriend in order to emphasize the point that what is promised is notnecessarily translated into later action, for whatever reason.]

Client : Yes, but it wasn’t a really important promise like goinginto business with someone.

Therapist: Who determines the importance of the broken promise:youor the person on the receiving end of your broken promise?

Client : [sheepishly] I suppose they do.Therapist : Okay. Let’s get back to that immovable should in your

mind (tapping head). Such shoulds are reality-denying:reality should have been other than it was at that time;in other words, the business deal had gone throughbecause your best friend had kept his word.

[The therapist returns to the issue of what was and compares it withthe client’s dictates of how things should have been. The therapistis trying to encourage the client to see the futility of clinging to his‘immovable should’.]

Client : Well, he should have done.Therapist : If you hang onto that should, do you think it will act as

a time machine and take you back in time to alter real-ity in your favour?

[The therapist is imagining the client as a time lord who can return tothe past and rewrite it. In reality, is the past irrevocable or a tabula rasa?]

Client : I know that’s impossible, there is no time machine. Itsounds silly when you put it like that. What’s happenedhas happened. You just have to get on with your life.[ponders] You know when I was serving in NorthernIreland I had good friends who were killed, wounded,maimed for life.You had to focus on the job, that’s whatkept you going. If you dwelt on all that unpleasant stuffthat was going on, you would lose it up here [tappingthe side of his head] as some blokes did. Then youwould be a danger to your comrades. They might notbe able to rely on you when things got sticky.

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Therapist : Do you think you now have a job to get on with?

[The therapist links the client’s experiences in Northern Ireland tohis present problems in order to encourage the emergence of aproblem-solving outlook.]

Client : [nodding] Deep down I know it’s the only thing to do.I’ve got to move beyond it as my wife says, but not allin one go.

Therapist : What would you need to tell yourself in order to startmoving yourself out of this stuck zone?

[The therapist focuses the client’s attention on how problem-solvingis actually going to start.]

Client : [ponders] Hmm.Well, something like ‘It happened, nowmove forward’.

Therapist : What would that actually mean? For example, would itmean that you have accepted, without liking it in anyway, that your best friend pulled out of the deal?

[The therapist seeks clarity regarding the meaning of the client’sstatement.]

Client : Yes, it would mean that. I’ve dealt with many difficultsituations in my life, particularly in the army, and I don’twant to be defeated by this one.

Therapist : Good. Now, can we turn our attention to the issue ofbetrayal. What do you mean by betrayal?

[The client may have an idiosyncratic definition of betrayal ratherthan a standard dictionary one.]

Client : Well, that you’ve been stabbed in the back. You putyour trust in someone who turns out to be a snake inthe grass.

Therapist : Do you think he deliberately set out to deceive you,knowing full well that he was going to pull out of thedeal at the last minute?

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[The therapist is now encouraging the client to ‘mind-read’ in orderto get him to consider the totality of his lifelong relationship with hisbest friend. Based on the evidence, is his best friend likely tobehave in that way?]

Client : [shaking his head] If I’m to be honest, I don’t think hewould do that. I’ve known him all my life. He pulled meout of a few tough scrapes in the army. I shouldn’t havecalled him a snake in the grass but when you’ve put allyour trust in someone so close …

Therapist: Because you’ve put all your trust in someone so close toyou does that person have to meet that trust no matterwhat is happening in their life at any given moment?

[The ‘have to’ may be a binding commitment in the client’s mind buthis friend may and did have a different view on it.]

Client : Well, you would expect them to do their best to fulfil it.I would try to do my best if somebody put their full trustin me.

Therapist : I’m not talking about ‘expect them to’ or ‘try to’ whichis perfectly reasonable, but a rock-solid have to, nomatter what.

[The therapist is emphasizing the distinction between flexibleexpectations and rigid, uncompromising demands.]

Client : You mean like my rock-solid should [therapist nods].Well, I suppose their life cannot revolve around thatrock-solid have to. I don’t live their life, so I may notknow what’s really going on. Circumstances change intheir life which I’m not aware of.

Therapist : That’s right. Nothing stays constant. No matter whatanyone promises you, you cannot guarantee that thosepromises will be carried out. That’s the grim reality. Sowe come back to whether or not you will accept, albeitreluctantly, this grim reality or continue to hang onto thatrock-solid should – ‘He shouldn’t have betrayed me.’

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[The therapist sums up the choices for the client: continue to denyreality or reluctantly accept it – stasis or change.]

Client : No, I don’t want to hang onto it and you’ve given mesome ideas about betrayal which never occurred tome. I expect you want me to forgive him now.

Therapist : That’s entirely up to you. Reducing your anguish overthis matter is the main goal. You don’t need to forgivehim in order to reduce your anguish. The two issuesare not related.

[Forgiveness is optional; the important point is for the client to makepeace with himself over past events and move on. Making peacewith himself can be facilitated by absorbing some of the realisticpoints made in therapy.]

Client : There’s a lot for me to think about. How do I get myhead around all this?

Therapist : As the session is drawing to a close, now would be agood time to answer that in terms of your homework.

In this chapter, the client has been introduced to disputing.The therapist has presented the client with some ideas forhim to consider which may have the effect of ‘chippingaway’ at his irrational beliefs. Therapist-initiated disputingis expected to lead to self-disputing as part of the client’sdeveloping role as his own therapist.

Notes

1 Clients frequently cling to their irrational beliefs with considerabletenacity. Ellis (1979) has advised therapists to attack such beliefswith force and energy. While a vigorous disputing approach may workwith some clients, others may see it as intimidating or overwhelming;therefore, do not be a one-note disputer. In our experience, the quietpresentation of telling arguments can work wonders in eroding aclient’s support for her irrational beliefs.

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2 As DiGiuseppe notes, a situation-specific belief ‘resembles aself-statement than an unspoken philosophy’ (1991: 187). Makingmanifest and disputing an unspoken irrational philosophy leads to amore elegant outcome for the client as a wide number of adverse orpotentially adverse situations are covered by his new rational outlookwhich a situation-specific self-statement would obviously not be ableto encompass.

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4Rationale For HomeworkTasks

Homework has been an important feature of REBT sinceits inception in 1955 (Wessler and Wessler, 1980). If yourclient sees you for one hour every week, what is he/shegoing to do with the other 111 hours before the next appoint-ment (we assume that the client has eight hours sleep pernight)? As Persons remarks:

Situations that arouse powerful affect probably involvethe patient’s key underlying ideas, and the ability to workon these when they are activated offers a potent opportu-nity for change that would be missed if all therapeuticwork took place during therapy sessions. (1989: 141–2)

Homework is the activity carried out by clients betweensessions and puts into practice the learning that has occurredwithin your office.1 Clients can claim that their irrationalthinking is changing, but how is this claim to be verified ifthey do not provide behavioural evidence of such change?For example, a client who states that he can now standdoing boring tasks still procrastinates over doing them. Hashe really tackled his low frustration tolerance (LFT) ideasabout such tasks? We doubt it. We might say that he hascognition without ignition (that is, cognitive change without

Homework


accompanying behavioural change). Unless a nascent rationalphilosophy is acted upon, it will not be internalized and theclient will be marooned at the level of intellectual insightinto his problems; therefore, homework is a vital part ofREBT practice, never an optional extra on the therapeuticagenda.

Homework tasks allow clients to develop competenceand confidence in facing their problems and, therefore,they are less likely to become dependent on you as theagent of change in their lives; in other words, they arebecoming their own self-therapist. For clients who dragtheir feet over carrying out homework, point out to them‘that compliance with self-help assignments may be themost important predictor of therapeutic success’ (Burns,1989: 545). With those clients who are consistently recalci-trant in executing their homework assignments, a contractcan be used whereby further therapy is contingent uponclients completing their homework tasks. Non-compliancein carrying out their homework tasks means these clientsare likely to maintain the status quo in their life, that is,remain emotionally disturbed.2

Types of HomeworkAssignments

These can be described as cognitive, behavioural, emotiveand imaginal.

Cognitive tasks

These ‘rely solely on verbal interchange between therapistand client (within sessions), between the client and himself(written or thinking homework), and between author andclient (reading and listening to tapes as homework’ (Wesslerand Wessler, 1980: 113). These tasks help clients to become

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more informed about the theory and practice of REBT andthereby deepen their intellectual insight into their problemsand what steps are needed to overcome them.

ReadingReading REBT materials to promote therapeutic change iscalled bibliotherapy. There is a substantial body of REBT self-help literature, for example, Hold Your Head Up High by PaulHauck (1991) and 10 Steps to Positive Living by Windy Dryden(1994). Reading self-help literature in the absence of therapydoes not usually lead to lasting change as people infre-quently act in a persistent and forceful way to implement theideas contained in this literature; or, as one of us (WD) haswritten, self-help books do not work in the sense that read-ing them does not in itself promote psychotherapeutic change(Dryden, 1998b).

You should, ideally, have read the literature you recommendto your clients so you can discuss it with some authoritywhen the client refers to it and correct any misconceptionsthe client may have developed about what she has read (forexample, ‘It seems to me that enlightened self-interest is justa clever way of saying “I’m going to be selfish”’). Alwaysascertain if your client has any reading difficulties as he maybe reluctant or embarrassed to tell you.

ListeningThis can be to tapes of lectures by leading REBTers, forexample, Albert Ellis on Unconditionally Accepting Yourselfand Others (1986) and Ray DiGiuseppe discussing What DoI Do With My Anger: Hold It In or Let It Out? (1989) or torelaxation tapes as an adjunct to cognitive restructuring ofclients’ anxiogenic thinking.

REBT favours clients tape-recording their therapy sessionsin order to listen to them away from your office. Listeningto the tapes between sessions often brings greater under-standing of important points made in the session – points

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missed or inadequately processed at the time by the clientbecause he was, for example, overly disturbed or reluctantto admit he did not understand what you were saying.3

On their own, clients are likely to feel less inhibited ordistracted and thereby more able to focus on the sessioncontent and bring their comments about it to the nextsession.

WritingA formal method of challenging irrational beliefs is byencouraging clients to guide themselves through theABCDE model of emotional disturbance and change byasking a series of questions which they can write down. Anexample of a self-help form is:

Situation = Describe clearly and concisely.Critical A = What am I most disturbed about in this situation?Beliefs = What is my irrational belief about this situation?Consequences = What are my disturbed emotions and behaviours

in this situation?Disputing = What is a different way to think about this situation

through disputing my irrational beliefs?Effects = What are my new beliefs, emotions and

behaviours in this situation?

This example of cognitive homework is given to clientsonly after they have gained proficiency in the use of suchself-help forms through in-session practice.

Other tasks include writing essays that explore rationalideas, for example, a client who believes that she mustalways perform perfectly agrees to write a compositionentitled ‘Why fallibility (imperfection) is an ineradicablepart of human nature’. Clients can also keep diaries torecord their upsetting thoughts and disturbed feelings andthe situations in which they occur. Keeping a diary helpsclients to note constructive changes in these thoughts andfeelings.

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Behavioural tasks

You behave as you think. Forcefully and persistently actingagainst one’s self-defeating ideas not only underminesthese ideas but also strengthens new ways of thinking andfeeling. Therefore, behavioural tasks serve as a means toachieve a cognitive end (that is, philosophical change):

For example, if clients believe they cannot stand waitingfor events, they are asked to practice postponing gratifica-tions. If they believe that they cannot stand rejection, theyare encouraged to seek it out. If they believe that they needsomething, they are exhorted to do without. If they believetheir worth is based on doing well, they are asked to pur-posely do poorly. (Walen et al., 1992: 169)

Two of the most frequently used homework tasks are stay-in-there exercises and risk-taking activities (Grieger and Boyd,1980). Stay-in-there exercises encourage clients to enter themost aversive situation straightaway (for example, gettinginto a lift and going all the way to the top floor) or workingthrough a hierarchy of aversive situations, from least to mostaversive (for example, one or two floors at a time; going allthe way to the top floor may be several weeks away orlonger). Risk-taking activities involve clients undertakingtasks they may fail at or not do well or may incur criticism,disapproval or rejection from others (for example, speakingup in a group to voice one’s opinions instead of alwaysagreeing with the majority view in order not to be the oddone out).

It is important that in both types of behavioural assign-ments you encourage your clients to repeat their rationalbeliefs at the same time as they carry out these assignments.While thinking rationally is the primary means of achiev-ing emotional insight (rational beliefs deeply and consis-tently held), behavioural tasks are very important because

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clients may doubt the efficacy of their new rational beliefsif they are not acted upon.

Emotive tasks

These are designed to engage fully clients’ disturbed feel-ings in order to ameliorate them through sustained and vig-orous disputing of ingrained irrational ideas. The mostwell-known emotive technique is shame-attacking exercises(Ellis, 1969).4 This encourages clients to act in a ‘shameful’way in real life in order to attract criticism or provoke dis-approval (for example, a man goes into a chemist’s shop andasks for the smallest condoms possible) or design an exer-cise that is more relevant to the client’s problem (for example,a client with strong approval needs puts his overheadsupside down when giving a presentation to his colleagues).Simultaneously with this behavioural component of theexercise, clients are reminded to dispute vigorously theirshame-inducing beliefs: ‘Just because I acted in a foolishmanner does not mean I’m foolish.’

Such exercises are designed to teach clients (1) to strivefor self-acceptance and refrain from self-denigration; (2) thatthey frequently overestimate the negative reactions of othersto their behaviour; (3) that it is not awful to behave stupidlyor reveal a weakness; (4) and that the disapproving looksand comments of others cannot ‘crush’ or humiliate them.It is important to note that shame-attacking exercises shouldnot put clients or others in harm’s way, violate their ethicalstandards, break the law or bring about self-defeating con-sequences such as losing their job or jeopardizing their pro-motion chances.

Imagery tasks

These tasks use mental images or pictures to disputeclients’ irrational beliefs. Imagery tasks often involve using

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rational-emotive imagery (REI; Maultsby and Ellis, 1974).One example of REI is to ask a client to close her eyes andvividly imagine an adverse event where she experiences adisturbed feeling (for example, angry about her husbandflirting with a woman at a party). The client is urged toexperience the full force of her disturbed feeling and then,without altering any details of the adverse event, to changeher feeling to a non-disturbed one or diminish the intensityof the disturbed feeling (for example, irritated about herhusband’s flirting). The client is asked to open her eyes andreport how this emotional shift was achieved. The idealanswer is that this shift occurred when the client replacedher irrational belief (for example, ‘He absolutely shouldn’tbe flirting with that woman’) with a rational belief (forexample, ‘I know he’s flirting with her and I don’t like it. Ishall speak to him about his behaviour when we get home’).

Obviously it is important to elicit feedback from theclient to determine if the imagery exercise was carried outin the prescribed way. The client might reveal that emo-tional change was achieved by, for example, distraction (‘Iimagined myself walking into another room so as not to seewhat he was doing’), making the event more tolerable (‘Hewon’t get anywhere with her. She’s too posh for him’) andengaging in rationalizing rather than rational thinking(That’s the whole point of a party – to let your hair down.That’s all he was doing, having a good time’).

Happiness Assignments

These are not routinely mentioned in the REBT literaturebut point out to clients that REBT is ‘not merely workingto dispel misery, but actively working to promote happiness’(Walen et al., 1992: 269; original authors’ italics). You candiscuss with your clients what things give them pleasureand to engage in some of these activities alongside the‘unexciting’ side of therapy – the work between sessions.

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Pleasure does not have to be put on hold until clients’emotional problems are resolved.

Negotiating HomeworkTasks Using the Criterion ofChallenging, But NotOverwhelming

Some clients might take ‘tiny steps’ in the problem-solvingprocess which convince them they are getting nowherewith their snail-like progress or reinforce their low frustra-tion tolerance ideas about the hard work of change (forexample, ‘I can’t bear this discomfort’). Other clients might‘bite off more than one can chew’ and conclude that feel-ing overwhelmed by the tasks facing them means theyhave wiped out the progress they have made (for example,‘I’ve gone back to square one’). A middle way between toolittle, too slow and too much, too fast is challenging, butnot overwhelming, that is, tasks that take clients outside oftheir comfort zone but without losing sight of it. For exam-ple, a client who was procrastinating over tackling sometedious paperwork agreed to work on it for 30 minuteseach day; attempting to complete it in one sitting would betoo effortful for him. Negotiated homework tasks can begraded as IC (insufficiently challenging), CNO (challenging,but not overwhelming) or TC (too challenging) from thestandpoint of your client’s current skills and progress.

‘No Lose’ Formula ofHomework Tasks

This reassures clients that no matter what happens withtheir homework tasks, some learning can be extracted from

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the experience. Do not negotiate homework tasks in termsof success or failure, for example, ‘It really is important thatyou do the homework. If you don’t do it, what’s the pointin you being in therapy?’. Focus on what learning the clienthas derived from:

1 successfully completing the homework task;2 undertaking the homework task but only achieving poor

results;3 not doing the homework task.

Information gathered from homework reviews helps youand your client to determine what are the spurs or blocksto task completion. If your client does not carry out hisagreed homework tasks, the learning to be extracted fromthis is stark: he will remain emotionally disturbed andcontradicts his stated goal of ameliorating his disturbedfeelings.

Can Your Client Seethe Link Between theSession Work, HomeworkTask and Her Goal?

If not, the client will be less inclined to carry out the task(do you see the link?). For example, a client does not see therelevance of deliberately getting into long queues in thesupermarket when it is long meetings, not long queues,that she upsets herself about. If the client’s goal is to tolerate,in a non-disturbed way, long meetings and even longer-winded colleagues, then she needs to internalize some force-ful coping statements such as ‘There is no reason why mytime cannot be wasted by long meetings or verbosity but Ican look for ways to reduce both if possible’.

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Does Your Client Believe HeCan Carry Out TheHomework Assignment?

Even though your clients have agreed to carry out the tasks,do they have sufficient skills to carry them out? Self-efficacytheory (Bandura, 1977) predicts that your client is morelikely to carry out a homework task if he believes that hecan actually do it than if he lacks what Bandura calls an‘efficacy expectation’. Therefore, carry out a skills assessmentand determine what, if any, remedial training may be nec-essary; if the client does have the necessary skills, ascertainif he is confident about using them. In the latter case, theclient does have the skills but lacks an efficacy expectationabout their use in a particular setting. For example, a clientwho can see the difference between failing at an activitybut not labelling himself a failure because of it, might needin-session imaginal rehearsal of putting this distinction intopractice when taking his driving test.

Trying versus Doing

‘One of the more common waffling responses when aperson is asked to do homework is “I’ll try”. Notice howlittle personal responsibility this response communicates’(Grieger, 1991: 60). Trying suggests that some effort mightbe made but lacks the commitment that doing denotes, thatis, persistent and forceful action to get the job done. If someclients have been trying to solve a problem outside of ther-apy, do they want to continue with this unproductive atti-tude in therapy? Even when clients say they will ‘tryharder’, they often engage in more of the same behaviourthat prevents task completion (for example, a client withsocial anxiety attends more social functions but still does not

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initiate conversations). You can demonstrate the differencebetween trying and doing by asking your clients, for example,to try and stand up or try to leave the room – trying lacksthe determination of doing. Clients usually grasp this dis-tinction straightaway but do not expect them to put intoimmediate effect!

When, Where and How Often?

Vague assurances from the client that the task will be done‘sometime in the next week’ does not inspire confidencethat the task will actually be done – something more inter-esting may intervene and push the task to the margins ofthe client’s mind. In order to concentrate the client’s mindon the task ahead, ask the following questions: when willyou carry out the task? where will you do it? and how oftenwill you do it? Specificity, not vagueness, should guide home-work negotiation and thereby make it more likely that theclient will execute her agreed assignment.

Troubleshooting Obstaclesto Homework Completion

This involves looking at any actual or potential blocks tohomework completion. Once blocks are identified, ways ofovercoming them are then discussed. For example, a clientmight say, ‘We are having our house decorated at themoment, so it’s going to be a very tight squeeze fitting inthe imagery exercises.’ You might reply that the clientcould find some time in his lunch break at work. If yourclients keep on finding reasons (a polite term for excuses)why they will have trouble executing their assignments,probe for and address underlying issues, for example, the

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avoidance of discomfort: ‘if you want to feel relativelycomfortable in these situations, you first have to makeyourself uncomfortable by entering and staying in themuntil your anxiety subsides. Unpleasant but necessary I’mafraid.’ You can liken your role as a troubleshooter to beinga ‘cognitive cop’, that is, apprehending and dealing withclients’ thoughts and beliefs that hinder their progress(Neenan and Dryden, 2002).

Avoid Rushing HomeworkNegotiation

We hope that we have made clear that homework is vitalif therapeutic progress is to occur. We might say: no home-work, not much hope for change. Therefore, make provi-sion for homework negotiation in your session agenda; tenminutes or more for novice REBT therapists. If a suitablehomework task has emerged earlier in the session and theclient has agreed to do it, then less time will be needed atthe end of the session to discuss it. Always ensure that yougive your clients a written copy of the homework task as areminder of what they have agreed to do; relying on purelyverbal agreement can lead to disagreements when the taskis reviewed at the next session (for example, the clientthought he was supposed to carry out the task twice aweek while you believed the agreement was to do it twicedaily).

Negotiating the Client’sHomework Task

In the last chapter, the client said near the end of the ses-sion: ‘How do I get my head around all this?’ (that is, all

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the issues that surfaced during the session). A homeworktask now needs to be agreed that flows logically from thework done in the session:

Therapist : What would you like to do as your first homework taskbased on what we’ve discussed here today?

Client : As I said, there’s a lot to think about. Listening to thetape of the session would be a help. I can mull over thepoints you’ve been making and my own responses tothem.

[The client has chosen a cognitive homework task.]

Therapist : Good. I’ll be interested to hear your comments at ournext session.When do you think you’ll listen to the tape?The reason I ask that is because clients are sometimesvery vague when they will actually do their tasks.

Client : Fair enough. I’ll listen to it tonight after everyone hasgone to bed. I might listen to it more than once.

Therapist : Can you see any obstacles to listening to it tonight?Client : None that I can think of.Therapist: Okay. Can I suggest that you write down some com-

ments as you listen to the tape.

[The therapist has suggested this to help the client be active in thelistening process rather than passive.]

Client : Yes, that sounds like a good idea.

Reviewing HomeworkAssignments

At the beginning of every session, review your client’shomework unless a crisis supervenes which needs to bedealt with immediately and normal agenda-setting is sus-pended. Not reviewing your client’s homework indicates

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you speak with a ‘forked-tongue’: you stress the vitalimportance of homework and then not bother to discuss itwhen your client has done it. As Beck observes: ‘In ourexperience, if the homework is not reviewed, the patientbegins to believe that it is not important and compliancewith homework drops off dramatically’ (1995: 52; originalauthor’s emphasis). Whether or not the client has com-pleted her homework, elicit the learning from it, as we saidearlier in this chapter.

If clients do not carry out their homework, monitor yourown emotional reactions to non-compliance. For example, youmight get angry because your client is not working as hardas you are or feel anxious because client non-compliancemeans you are an incompetent therapist. You will need todeal with your own disturbance-inducing thinking firstbefore you can regain your clinical focus on tackling yourclients’ blocks to homework completion.

In this chapter, we have considered what is involved indesigning and negotiating homework tasks. Homework isthe means by which clients move from intellectual insightto emotional insight into their problems, that is, they even-tually internalize a rational outlook to problem-solving.The client has taken his first step in this process by agree-ing to carry out his first homework assignment.

Notes

1 For some clients, the word homework ‘often has surplus meaning,bringing to mind teacher–student relationships, with the client see-ing himself or herself in a subservient role rather than as a joint part-ner in a collaborative venture’ (Meichenbaum, 1985: 44). To uncoversurplus meaning, ask your clients if they experience any negativereactions when you talk of homework. If they do experience suchreactions, then use other terms such as real-life activities or self-helpassignments.

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2 In the final analysis, if one of your clients steadfastly refuses to carryout homework assignments, you will have to decide whether to con-tinue to see him for REBT and hope that he might do some home-work eventually or refer him to a different type of therapy wherehomework is not an integral therapeutic feature.

3 Some clients may become disturbed when listening to the sessiontapes (for example, ‘I sound so pathetic with all the whining I keep ondoing’; ‘I can’t believe I talk so much nonsense’).These reactions canbe processed at the next session and a more balanced appraisalsought (for example, ‘My whining is a product of not knowing what todo about my problem. This state of affairs will now hopefully changewith the help of my therapist’). If some clients insist that the tapingmust stop because they do not like listening to themselves, thencomply with this request.

4 I (WD) have suggested that these exercises could more accuratelybe called ‘embarrassment-attacking exercises because it seems tome that one of the differences between shame and embarrassmentis that you are more likely to feel ashamed when you reveal some-thing very inadequate about yourself, whereas embarrassment is lessserious’ (Dryden, 1991: 38). Gilbert makes a similar point and adds:‘shame-attacking exercises which involve acting in mildly embar-rassing ways … are inappropriate in severe depressive-shame’ (2000:166). We might say that whether the person experiences shame orembarrassment depends on how he evaluates himself on the basisof others’ responses to his shame-attacking exercise. On balance, mostof the tasks clients perform are probably embarrassment-attackingexercises.R

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Working through means that for change to occur, time andeffort are required. When some clients complain that theycannot see light at the end of the tunnel (that is, the desiredchange) this is because they have not entered the tunnel ormoved along it (that is, little, if any, action on their part hasoccurred). In this context, if ‘therapy isn’t working’, it isbecause the client is not working to make therapy work.Moving through the tunnel is the working through phase oftherapy. Grieger and Boyd state that

Helping clients work through their problems – that is, sys-tematically giving up their irrational ideas – is where mostof the therapist’s energy and time are directed and wherelonglasting change takes place. Successful working throughleads to significant change, whereas unsuccessful workingthrough leads to no gain or to superficial gain at best. It isas simple as that. (1980: 122)

Your clients are unlikely to experience enduring changewith their emotional problems unless they repeatedly think,feel and act against their irrational beliefs in a variety ofaversive situations. In this way, multimodal disputing (D)leads to the gradual weakening of clients’ irrational beliefsand the increasing strengthening of their rational beliefsto achieve new effects (E) in their thoughts, feelings andbehaviours. With regard to disputing, Hauck states that

5Working Through


in all counseling one task is more critical than any other. Itis self-debate. Throughout your counseling it is practicallyalways critical that you keep the client oriented towardquestioning, challenging, and debating with himself overhis irrational ideas … debate, debate, debate. (1980: 244)

During the working through phase, clients, ideally, takeincreasing responsibility for the change process and thedirection of therapy. Clients who rely on you for theirprogress will actually make little progress, so point out tothem that you cannot do their thinking or execute theirassignments for them. Grieger states that ‘it is best forclients to view their RE[B]T as being a 24-hours-a-day, seven-day-a-week thing. To this end, I repeatedly tell them this’(1991: 60). On first hearing this statement, clients usuallyblanch at its implications, and while it is extreme, never-theless it does point to the importance of clients workingon their problems consistently rather than intermittently.

Explaining the DifferenceBetween Understanding andIntegration

Understanding involves a client seeing how a rational out-look will lead to constructive changes in her irrationalbeliefs, distressing feelings and counterproductive behav-iours. Understanding is associated with a weak convictionor belief in this new outlook (for example, ‘I understandwhat you say, but I don’t believe it yet’). Integration involvesboth understanding and action, that is, the client sees thebenefits of a rational outlook and practises this outlook on adaily or frequent basis. Integration is associated with a strongconviction or belief in her rational outlook (for example, ‘Iunderstand what you’re saying and I really believe it

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because I know it works’). From the client’s viewpoint,understanding is located in the head while integration isexperienced in the gut.1 Understanding precedes integra-tion – the former occurs in your office while the latter takesplace in the client’s everyday life.

To get across in a vivid way the difference betweenunderstanding and integration, ask your client how a desireto be fit is transformed into a reality or if reading a book onchess is enough to turn a person into a competent player.

Suggest MultimodalHomework Tasks to Disputethe Same Irrational Belief

REBT theory hypothesizes that thoughts, feelings and behav-iours are interdependent and interactive processes: namely,that thoughts, feelings and behaviours will each havecomponents of the other two modalities embedded withinthem. Therefore, the preferred and possibly optimal way ofchallenging an irrational belief and developing a rationalalternative is through several modalities: cognitive, emo-tive, behavioural and imaginal. This multimodal approachcan help to keep your clients interested in the change processand engender greater change than is likely to occur withina unimodal approach.

For example, a client, whose perfectionist standards ‘arebeyond reach or reason’ (Burns, 1980), responds favourablyto intellectual disputing and reading assignments as theseactivities increase his awareness of the self-defeating natureof his irrational beliefs (‘My perfectionist beliefs hold meback: I achieve less, not more, in my life’). However, usingonly one modality (cognitive, in the above example) is anarrow way of advancing personal change and is oftenineffective in achieving this. In this client’s case, little real

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change occurs as he still avoids taking on tasks he mightfail at (for example, giving a presentation – behavioural) orengaging in activities where he might be seen as less than‘perfect’ (for example, disclosing to others some of hisimperfections – emotive). The client eventually admits thattherapy is becoming ‘arid’ through ‘all talk and no action’and that he has not in any meaningful way modified hisrigid and unrealistically high standards through his presentcourse of action (or, more accurately, inaction).

Discuss the Non-LinearModel of Change

Some clients might assume that change, once initiated, is asmooth and uneventful process.2 These clients haveaccepted the logic and wisdom of their new rational ideas inyour office and now believe that they will put these ideasinto immediate effect which will then lead to an immediatebeneficial effect on their problems (an expected double doseof ‘immediate’, we might say). In order to disabuse theseclients of such notions, prepare them for the vicissitudesof the change process by explaining to them the non-linearmodel of change. This model suggests that they will proba-bly experience varying degrees of success in disputing theirirrational beliefs in relevant contexts, they may hold them-selves back from initiating the disputing process (for example,‘I don’t feel in the right mood yet’), suffer some setbacks intheir efforts to change and that feeling better may takelonger than anticipated (changes in feelings often lag behindchanges in thoughts and behaviours). A realistic view of howchange actually occurs can help clients to develop greaterpsychological resilience in tackling their problems.

Change in REBT involves clients making themselves lessemotionally disturbable, but never undisturbable – we cannottranscend our fallibility no matter how much we might like

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to. Therefore, change is measured in relative terms, notabsolute terms (for example, ‘My anxiety about enteringsocial situations has greatly diminished in terms of fre-quency, intensity and duration, but it has not completelygone’). Sometimes clients make themselves disillusionedabout their perceived lack of progress (for example, ‘I’m justthe same – miserable and angry’). One way to combat thisdisillusionment is to encourage clients to keep a log of theirthoughts, feelings and behaviours so they can pinpoint cog-nitive, emotive and behavioural shifts that are more gradual,even subtle, than the dramatic shifts they are hoping for. Logkeeping helps them to see that improvement is taking placedespite their doubts. Also, recommend to your clients AlbertEllis’s (1984) pamphlet, How to Maintain and Enhance YourRational-Emotive Therapy Gains, which encapsulates many ofthe key points of the working through process.

Encourage Your Clients toTransform Themselves intoTheir Own Therapist

From the first session onwards, you should be looking forways to help your clients become their own therapist – theessence of REBT is self-help. If some clients baulk at theidea of self-help, remind them of this fact:

My job is to help you help yourself. I can’t do the work for you, andeven if I could, you would be no better off because you would bedependent on me to sort out your present and future problems.Therapy would be like an umbilical cord that is never severed.

Transforming themselves into a self-therapist means clientsusing the ABCDE model to understand and tackle theirproblems. If your clients are successful in developing thisrole, you will notice a corresponding decrease in your own

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level of activity, for example, the client sets the agenda,uncovers and disputes her irrational thinking, designs herown homework assignments, detects themes runningthrough her problems such as failure or approval. With theclient acting as a self-therapist, you can reconceptualizeyour role as a consultant, coach, trainer, mentor or adviserrather than stick to your role as a therapist. Point out toyour clients that being a self-therapist is not just for presentproblem-solving but should, ideally, be maintained on alifelong basis (some clients go ‘off the boil’ when therapyis terminated and their newly-learnt self-help skills fall intodisuse).

To encourage your clients to be more active in the problem-solving process, use less didactic teaching and more Socraticquestioning as a means of promoting independent thinkingand reducing dependence on your problem-solving abilities.Short, probing questions can help your clients to work theirway through the ABCDE model:

• ‘What was the situation in which you disturbed yourself?’• ‘How did you feel at C?’• ‘What were you most upset about in that situation?’• ‘What were you telling yourself at B to feel and act in that

way at C?’• ‘What effective disputes (D) did you use to challenge your

irrational belief?’• ‘What would be a relevant homework assignment to tackle

that belief?’• ‘What rational belief would you like to hold?’• ‘If you internalize that rational belief, what new thoughts,

feelings and behaviours (E) might you experience?’

We realize that not all clients can become their own thera-pists in the way described above; so do not automaticallyexpect them to take on this role. Some clients will haveconsiderable difficulty in thinking through their problems

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in a more constructive way; so whatever self-help abilitiesthey do have, endeavour to make the best use of them. Forexample, a client who believes that overreacting to nega-tive comments from others is the heart of his problem, ishelped to lower his level of emotional arousal by writing ona card: ‘Words only hurt me if I let them.’ The card acts asa continual reminder to the client that his emotional dis-turbance is largely self-induced.

The Use of Force and Energyin Disputing Irrational Beliefs

Clients can adhere tenaciously to their irrational beliefsdespite acknowledging the considerable costs that thesebeliefs incur (for example, high stress levels, fraught rela-tionships). Ellis (1979) has urged therapists to employ forceand energy in helping clients to uproot their irrationalbeliefs and, through such modelling, clients learn to usevigour in the disputing process. Clients who challenge theirirrational thinking in a tepid manner are unlikely to makea dent in such thinking, let alone dislodge it, for example,‘I suppose it wouldn’t be awful if I lost my job, would it?’Such a response might not even help the client to gainintellectual insight into her fears as she is still probablyconvinced that it would be awful to lose her job. Force andenergy helps clients to ‘shake up’ the cognitive status quo(that is, prise loose their rigid thinking) and develop astrong conviction in their new rational beliefs, for example,‘I don’t want to lose my job but if it happens, too bad!Things will be harder for me until I find another job, but itcertainly will not be the end of my world. That happenswith my last breath on my deathbed.’

Having said all that, some clients will see the use of forceand energy as ego-dystonic, that is, not in keeping with

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their self-image, and will want to challenge their irrationalthinking in their own way such as ‘with quiet determina-tion’, ‘whittling away at it’ or ‘chewing things over’. Whateverapproach is used, the key question is: are your client’s irra-tional beliefs being weakened over time and with behaviouralevidence to corroborate it?

Extend Situation-SpecificBeliefs to Uncover Core Beliefs

Clients usually subscribe to irrational beliefs in specificand general contexts. A situation-specific belief might be aperson’s demand that he should not have to complete histax return as it is ‘monumentally boring to do it’. A coreirrational belief can be seen as a very general form of someof the situation-specific beliefs your client adheres to. Withregard to the above example, the client exhibits low frus-tration tolerance in a variety of situations: traffic jams,waiting for lifts, meetings, gadgets not working, boringconversations, when things do not go his way, cleaninghis house; the core belief underpinning these situations is,‘I absolutely shouldn’t have to be inconvenienced in anyway and when I am, I can’t stand having to cope with it.’Tackling a core belief deals with a number of situationsconcurrently, whereas with a situation-specific belief, prob-lems are resolved consecutively.

Dryden and Yankura (1995) suggest some guidelines forworking with core beliefs:

1 Look for common themes

While you are working on your clients’ problems, particularthemes often emerge that link these problems. For example,a client who procrastinates over a career change, stays ina relationship he is bored with, goes to the same holiday

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destination every year and pursues hobbies he is no longerinterested in are all connected by the theme of uncertainty:‘I must be certain that if I make changes in my life theywill turn out well for me. If they don’t turn out well, mylife will be awful.’ Another client who engages in mind-reading with her partner, friends, colleagues, new associ-ates is preoccupied with the theme of approval: ‘I mustknow that others approve of me. If they don’t, this meansI’m unlikeable.’ If there is a thematic continuity in yourclients’ problems and they have not yet pinpointed ornoticed it, remember to present your ideas as hypothesesto be confirmed, modified or rejected by your clients, notas established facts.

2 Encourage your clients toengage in self-observation

When your clients detect a core belief that connects a numberof problems they are working on, ask them if they canpoint to other, as yet, undiscussed problem areas wherethis core belief may be operative. Such detective work canhelp your clients to improve considerably their cognitiveawareness of the adverse impact of their core belief onmany areas of their life. Some clients may be overwhelmedby the seemingly limitless number of problems confrontingthem; they may even terminate therapy. Therefore, this self-observation exercise should be based on your client’s genuinecuriosity about investigating the pervasiveness of his corebelief. Do not engage in this exercise if your client is strug-gling to manage the problem areas that have already beenidentified.

3 Help your clients to design acore rational philosophy

If your clients have uncovered a core irrational philosophy(for example, ‘I must never show any anxiety; if I do, it

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means I’m weak’), then a core rational philosophy needsto be constructed to challenge it in every situation thatit is operative (for example, ‘There is no reason why Imust never show any anxiety. When I do show it, and Ican’t avoid showing it sometimes, it means I’m human, notweak’). Remember that a core rational philosophy evolvesthrough trial and error in real-life situations and is notinstantly formed in the artificial environment of youroffice.

4 Help your clients to see howthey perpetuate their core beliefs

There are three main ways in which clients perpetuatetheir core irrational beliefs:

(a) Maintenance of coreirrational beliefsThis refers to ways of thinking and behaving that perpetu-ate core beliefs, for example, a client who sees herselfas unlikeable behaves in a curt and aggressive way withothers in order to protect herself from her imagined rejec-tion by them. Unfortunately, her manner brings about thevery rejection she fears and, in her mind, confirms hernegative self-image.

(b) Avoidance of activatingcore irrational beliefsThis refers to the cognitive, emotive and behavioural strate-gies that clients use to avoid activating their core beliefs andthe painful affect associated with them, for example, a clientrefuses to listen to rumours that his wife is having an affairor confront her about these rumours. To do so, might provethat the rumours are true which, in turn, would ‘prove’ thathe is worthless because his wife is unfaithful.

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(c) Compensation for coreirrational beliefsThis refers to the client ‘fighting back’ against the core belief,for example, a client who sees herself as ‘not good enough’takes on many tasks to prove she is ‘good enough’: ‘The moretasks I do will make me a better person.’ However, this strat-egy backfires as she is overwhelmed by the work she hastaken on and this puts her back at square one – ‘I fight andfight but never win.’

It is important to help your clients understand their ownparticular ways of perpetuating their core irrational beliefsand develop robust strategies to stop the perpetuationprocess. For example, in 4(c) above, the client realizes thattrying to prove she is good enough just continually rein-forces in her mind that she is not good enough. Instead ofpursuing this self-defeating strategy any longer, she adoptsself-acceptance as the basis of change with a strong prefer-ence to be task competent as a measure of her performanceand not ‘task incontinent’ to prove her worth. The clientstarts learning to enjoy her life rather than always trying toprove something about herself.

Change: Is it Elegant?

We discussed in Chapter 1 the differences between elegant(philosophical) and inelegant (non-philosophical) change.Just to reiterate, the type of change is determined by yourclient, not you. By all means discuss REBT’s view of whatconstitutes far-reaching and enduring change, but do notpush for it in order to give yourself a pat on the back fordoing ‘proper’ REBT. Change that may be disappointingfor you can be highly significant for your client. After all,you have not lived your client’s life or experienced the

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struggles he has gone through to achieve his current levelof progress.

Assessing Progress

Periodically carrying this out allows you to determine ifyour clients are on course to achieve their goals, have stalledin some way or are falling back after some initial success.In the last chapter, our client had agreed his first home-work task. We now return to him to make a progress checkmidway through therapy.

Therapist : Is that should of yours still rock-solid?Client : No, it’s crumbling.Therapist : How has that occurred?Client : Listening to the session tapes, talking to my wife who,

like you, keeps on reminding me that what’s happenedhas happened. I can’t turn the clock back. So now Ikeep on reminding myself ‘It happened, now move on’.

Therapist : How can you prove to yourself that you have indeedmoved on?

[The client has been using cognitive methods of change.The therapistwants to ascertain if this is supported by behavioural change – isthe change just in his head or visible in his daily life?]

Client : My anguish has gone down a lot.Therapist : Good, but in what specific ways has it gone down?

[The client has not yet provided the evidence, so the therapist con-tinues to probe for it.]

Client : I certainly brood much less and I’m more fun to bearound now. I feel it within myself and certainly my wifeand children tell me I’m easier to live with now.The burdenis lifting.

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Therapist : One of the things you said would show improvementwould be pottering around in the garden on these warm,summer evenings. Is that happening?

Client : Definitely. We’ve also had a few barbecues and invitedsome friends round.

Therapist : What about the issue of betrayal? Any new thinkingthere?

Client : I’m convinced that he did not stab me in the back, youknow, string me along knowing he was going to pull outat the last minute.

Therapist : Let me ask you this: just supposing you found out thatthis is exactly what he did. How would you react then?

[The therapist is investigating whether the client’s new outlook onhis problem will be able to absorb this highly unpalatable fact.]

Client : [ponders] I wouldn’t like to hear it and I would beshocked if it was true but … [pauses] but I would copewith it. I wouldn’t go back into a state of anguish or any-thing like that. He has to live with what he did – that’s ifhe did do that – and I have to make the best of thingsin the light of what he did.

Therapist : There is a way to find out why he pulled out of the busi-ness deal.

Client : I know. My wife says the same thing: contact him andfind out instead of speculating about it. And that,believe it or not, is my next task.

[The client is setting his own homework task as part of his devel-oping role as a self-therapist.]

Therapist : Good.

Client Obstacles to theWorking Through Phase

Some of the obstacles found in this phase of therapy are:

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1 Low frustration tolerance

We have discussed LFT in Chapter 1, but just to recap:clients can easily disturb themselves about the often hardwork to move from understanding to integration of their ratio-nal beliefs. Examples of LFT-related beliefs are, ‘I shouldn’thave to work this hard to overcome my problems. I can’tstand the effort involved’ and ‘I’m fed up with these set-backs. It’s too much to put up with.’ You need to encour-age your clients to develop a philosophy of effort if theywant to achieve their therapeutic goals (for example, ‘I canstand the struggle and effort involved in change. I willpersevere’).

2 Cognitive-emotive dissonance

This occurs when clients say they feel ‘strange’ or ‘unnat-ural’ as they work towards strengthening their emergingrational beliefs while simultaneously still experiencingthe strong ‘pull’ of their old self-defeating thoughts, feel-ings and behaviours. This dissonant state, created bythe clash or tension between the old and the new, leadssome clients to terminate therapy in order to feel ‘nat-ural again’ (paradoxically, a return to their emotionallydisturbed state). Cognitive-emotive dissonant reactionsinclude clients claiming that they will lose their identity,become a phoney or turn into a machine (Grieger andBoyd, 1980).

Sloughing off the old, familiar self and acquiring a new,unfamiliar self can be uncomfortable and disorientatingfor some clients. Explaining to clients the basis for thesedissonant reactions is enough in most cases to carry themthrough this stage of change (if it is not enough, then theseclients will have to work harder in tolerating theircognitive-emotive dissonance until it passes: ‘Focus on the

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benefits to come rather than on your present discomfortand strangeness’).

3 Pseudo-rationality (Neenan andDryden, 1996)

Some clients, usually a small number, project a false or pre-tended acceptance of REBT. They are usually erudite aboutthe theory and practice of REBT and provide the ‘correct’answers to the questions you ask. However, this knowledge ofREBT is not put into daily practice – it remains in the client’shead; so understanding is achieved but not integration (seeearlier section). Clients who display pseudo-rationality maygenuinely believe that understanding alone is sufficient toeffect constructive change, may like the feeling of being a‘textbook’ authority on REBT or may have LFT-related ideasabout the hard work involved in translating REBT theoryinto practice. Whatever the reasons underpinning theirpseudo-rationality, these clients need to internalize REBT’sview of genuine rationality by committing themselves toaction – and lots of it!

4 ‘Kangaroo’ problem-solving

This means jumping from problem to problem beforeeach one has been tackled successfully. Such an approachcan lead to the fragmentation of therapy as the continuityof working through each problem is never established. Toavoid this situation, agree on a coping criterion with yourclients, that is, a method of assessing when they havereached the stage of managing their problems rather thanmastering them. A coping criterion helps you and yourclients to decide the right time to move on to the nextproblem.3

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5 Fear of mediocrity (Grieger andBoyd, 1980)

Clients with perfectionist traits are often reluctant tosurrender their rigid musts and shoulds as they believethese are the source of their motivation and success in life,for example, ‘If I stop driving myself in this way, my stan-dards will plummet and my success will vanish.’ In short,surrendering their musts and shoulds will lead to medioc-rity – in their mind, the equivalent of a ‘living death’. It isimportant to show these clients that introducing flexibilityinto their thinking about motivation and success does notlead to demotivation and failure. Instead, it allows them toavoid becoming overly disturbed when standards are notmet or success proves temporarily elusive. From a prag-matic viewpoint, time wasted on emotional disturbance canbe more usefully channelled towards problem-solving (forexample, what led to an inferior performance in this situa-tion) or engaging in leisure activities (some perfectionistspursue achievement to such an extent that little time is leftfor anything else that might ease the pressure in their life).

Relapse Prevention

As discussed in Chapter 1, relapse prevention helps clientsto identify those future situations (for example, negativeemotional states, interpersonal strife, work pressures) thatcould trigger a return to their emotional and behaviouraldifficulties and teaches them coping strategies to managethese situations. Relapse prevention in REBT will be basedon the skills that your clients have learnt in therapy with you.It is important to build in these coping skills to your treat-ment plan as ‘outcome is increasingly measured not onlyby treatment success but by relapse prevention’ (Padeskyand Greenberger, 1995: 70).4

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Criteria to Decide if theWorking Through Phase ofTherapy Has BeenSuccessful

If this phase has been successful, your clients should beclose to termination because they have:

1 internalized a rational outlook and made significant reduc-tions in the frequency, intensity and duration of their pre-senting problems;

2 successfully applied REBT to their presenting issues aswell as other problem areas in their life;

3 identified, challenged and changed core irrational beliefs;4 developed competence and confidence in acting as a

self-therapist;5 agreed with you that termination is near as the evidence

supports this view, namely, that insight and hard work havebeen successfully applied to problem-solving.

However, the reality is that probably only a few clients willmeet the above criteria for termination. Most clients will, forexample, terminate therapy once they experience sympto-matic relief rather than philosophical relief from their prob-lems or focus only on dealing with situation-specific irrationalbeliefs thereby limiting the generalizability of their therapeu-tic gains (of course, a problem can be strictly situation-specificas is the case with our client). You can present a rationale toyour clients to stay longer in therapy in order to learn how tomake themselves, generally, less emotionally disturbable but,obviously, the final decision regarding termination rests withyour clients. You can offer follow-up appointments to monitoryour clients’ progress and see if they are maintaining theirtherapeutic gains. Clients can contact you if they encounterproblems they cannot handle themselves.

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Summary of the Client’sProgress

In this chapter, the client said he was going to contact hisformer best friend to discover why he had pulled-out oftheir proposed business deal (‘Stop brooding about it andfind out why’). The answer he discovered was that his bestfriend was experiencing severe financial difficulties at thetime and could not commit himself to the deal but was tooembarrassed to tell the client. The client suggested that theymeet to discuss the collapse of the business deal (‘I feltI was being my own therapist by talking control of theproblem instead of letting the problem control me’). At themeeting, a tentative reconciliation was achieved. The clientsaid that he was in the right frame of mind for the meetingby letting go of ‘my rock-solid should’, understanding the dis-tinction between his best friend contributing to his anguishbut not causing it (he had embraced emotional responsibil-ity) and reflecting on the issue of betrayal in a less emotiveway. The client said that he still wished the business dealhad gone through but ‘I no longer experience any anguishover it. That’s good news for me and my wife.’

In this chapter, we looked at what constitutes the work-ing through phase of therapy and described some of theobstacles to progress found there. The client had eventu-ally internalized a rational outlook to tackle his situation-specific problem and was able to make peace with himselfand, to some extent, with his former best friend.

Notes

1 Understanding is equivalent to intellectual insight (rational beliefs lightlyand intermittently held) and integration is equivalent to emotional insight(rational beliefs deeply and consistently held). Walen et al. suggest that

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‘Emotional insight’ is a non sequitur; people do not achieveinsight viscerally. When the client claims he or she has intellec-tual but not emotional insight, the therapist reinterprets this claimas either a problem of ‘knowing’ but not ‘believing’ the rationalideas, or of inconsistency of beliefs across time. (1992: 216)

Knowing but not believing usually occurs because clients are notacting in support of their new knowledge and, therefore, it is not inte-grated into their belief system. Inconsistency of beliefs across timemeans that in some situations a client might believe, for example,that it is not awful to make mistakes, but believes it in other situations.

2 It is important to discuss with your clients what is involved in thechange process. Do not assume it is self-evident. As Hanna pointsout: ‘One of the fundamental mistakes made in psychotherapy andcounseling is to assume that clients understand change processes.If they did, change might be accomplished much quicker and easieron a routine basis’ (2002: 43).

3 Obviously do not be inflexible about this rule. If circumstanceswarrant it, you should switch to another problem before a coping cri-terion is reached on the previous one, for example, a crisis in theclient’s life; another issue on your client’s problem list is deemed tobe of greater clinical significance than the one initially selected.Once the switch has been made, ensure that a coping criterion isachieved on this problem before another one is discussed. If yourclient turns out to be a relentless ‘kangaroo’ problem-solver, spendtime eliciting the ideas underlying her behaviour, for example, shehas a low threshold for sustained concentration on ‘boring’ topics.

4 Given REBT’s view on our seemingly limitless ability to disturb our-selves about anything in our life, relapse reduction rather than relapseprevention would seem to us a more realistic strategy to pursue.Prevention offers more than it can probably deliver as it suggests wecan always stop a full-blown reoccurrence of our original problems.Relapse reduction better describes the post-therapy progress offallible human beings.

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Once formal therapy has ended with your clients achievingtheir goals, what happens next? The answer is that therapynever ends:

We may stop going to visit our therapist, but the process ofmanaging our moods and behaviors is ongoing. We easilyunderstand that we cannot make ourselves thin this yearand then coast through the rest of life, eating whatever wewant. We accept that we cannot get in shape with an exer-cise program and maintain our fitness without continuedeffort. In a similar way, cognitive therapy or rational-emotiveliving skills require maintenance. (Walen et al., 1992: 312)

Maintenance is your clients’ responsibility. How do youget this message across to them? By explicitly addressingthis issue: ‘What do you think you need to do in order tomaintain and strengthen your progress after therapy hasended?’ Some clients might reply that change perpetuatesitself unaided by them, ‘I don’t know’ or that rational ideas‘sink into’ their subconscious and now guide their post-therapy behaviour without any conscious effort from them.An abdication of personal responsibility for continued changeor misconceptions about what is involved in this processspell trouble, that is, the decay of REBT skills throughinfrequent use or disuse. You might want to say somethinglike this as a ‘maintenance message’ to your clients:

In therapy, you learnt two forms of responsibility: emotional andtherapeutic. The former acknowledges that you are in charge of

6Promoting Self-Change


your feelings, no one else; the latter takes on the hard work ofchange. Both types of responsibility helped you to reach yourgoals. Now another form of responsibility is called for and it iseven more important than the other two because it covers therest of your life – a lifelong responsibility to protect your progressfrom your own forgetfulness, inaction or neglect. Without thisprotection, you will probably see the return of your old irrationalideas and/or the formation of new ones.

So encourage your clients to spend some time every dayrehearsing their rational beliefs, looking after their mentalhygiene we might say, in the same way they spend timeevery day attending to their physical hygiene. For example,a client with now modified perfectionist tendencies, issuesa daily reminder to herself that ‘good enough’ is the stan-dard to aim for in getting her work done on time and her oldprocrastinating-producing torment of ‘never good enough’ isnow a distant echo. In this and other ways, self-therapy takesover from therapist-led therapy.

Proselytizing

This means teaching REBT concepts to others not only to‘spread the word’ but also for clients to deepen their ownunderstanding of and strengthen their conviction in theseconcepts. Hauck urges clients not to be shy about doingthis: ‘Use anyone who is interested to give you opportu-nities to think out loud and thus improve your health. Themore you teach, the more you learn’ (1991: 100; originalauthor’s italics). For example, a client teaches her bestfriend, who asks for her advice, that losing his job is mostunfortunate, not awful as he sees it, and he is not immunefrom experiencing such losses in his life. Such teachinghelps to reinforce this point in the client’s mind.

It is important in teaching REBT to others that clients donot become smug or superior (for example, ‘If only you had

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my wisdom in these matters’); turn into a tub-thumper (thatis, a ranter) or fanatic (for example, ‘All other therapies areinferior’); or interrupt the conversations of others every timethey hear a ‘should’ or ‘must’ or other perceived irrationali-ties uttered (for example, ‘Why must you get that promotion?Explain the must as there is no evidence for it’). Behavinglike this can turn the client into an REBT bore, turn othersoff the REBT viewpoint and turn friends and colleagues inthe opposite direction when they see her coming into view(a lot of ‘turning’ for the client to think about!).

In order to ensure that your clients will be rational, notirrational, proselytizers before they leave therapy, engagethem in, for example, rational role reversal to determineif they have truly grasped the REBT view of rationality,otherwise they will be talking nonsense to others as well asthemselves (Grieger and Boyd, 1980). Explain to your clientsthat it is important to select those individuals for proselytiz-ing who might be receptive to the REBT message, or at leastwilling to listen to it, and avoid those who might be hostileto it or believe that ‘all therapy is crap’. If you see yourclients for follow-up or booster sessions, discuss how suc-cessful their proselytizing efforts have been. Listen keenlyfor any ‘slippage’ in their rational thinking which, if it hasoccurred, you will need to help them correct (for example,‘You said your friend thought it was awful, in the REBTsense, when she discovered her husband’s unfaithfulnessand you agreed with her. Let us consider again the conceptof awfulizing and see where you have got yourself stuck’).

Regular PsychologicalWorkouts

This means seeking out and confronting adverse situations.A robust rational outlook may become less robust if your

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clients rest on their laurels (for example, ‘I’ve got the REBTfirmly fixed in my brain. I don’t have to prove it to myselfevery five minutes’). We do not expect clients to continu-ally ‘prove it’ to themselves ‘every five minutes’ but oncea month, for example, can keep them psychologically trim.For example, client who believes he no longer needs theapproval of others and wishes to prove this to himself, canseek out situations where he might be criticized or ostra-cized for his behaviour or comments:

• telling those of his friends who are passionately anti-Tory and make no secret of it that he votes Conservative(something he was reluctant to disclose before on ‘needingapproval’ grounds, not because it was nobody else’s busi-ness but his).

• asking a work colleague, whom previously he did not wantto ‘upset’, to lower her voice when he is on the phone.

• pointing out to verbose colleagues at a meeting ‘that we allhave busy departments to get back to, so can you makeyour comments concise and pertinent to the agenda’ (pre-viously he would have let the meeting drone on so as notto offend his colleagues).

• taking a neighbour to task for playing his music too loudly(before he would have suffered in silence).

These examples are not meant to show the client becom-ing insensitive or cantankerous in his dealings with others(though some may see it that way), but to keep at bayhis approval-seeking tendencies which slip back into histhinking from time to time (‘I don’t want or need to bepatted on the head by others and told I’m a nice person inorder to justify my existence or please others to my owndetriment’).

Another reason for regular psychological workouts is thatsome clients can slip into self-deception, that is, they believethey are maintaining their therapeutic gains when, in fact,

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these gains are being eroded through inaction. For example,a client who developed high frustration tolerance (HFT) inorder to deal with some tedious tasks in her life, found, post-therapy, similar tasks piling up again through a pattern ofavoidance which she justified by saying, ‘I just don’t wantto do them, that’s all. I learnt high frustration tolerance intherapy, so I have got it.’

Telling herself she had ‘got it’ became her rationaliza-tion for avoiding undertaking necessary but dull tasksand she eventually relapsed into discomfort disturbanceor low frustration tolerance (‘I can’t stand doing thesebloody tedious things! I shouldn’t have to do what I don’twant to do. Why don’t they go away?’). Returning to therapyfor a booster session on maintaining her HFT, convincedthe client that regular psychological workouts were nec-essary if she wanted to keep on top of ‘tedious things’ inher life.

Personal Development Goals

These are goals that are considered after clients havetackled their psychological problems in therapy; embark-ing on personal development while still psychologicallydisturbed means the former is likely to be underminedby the latter (for example, a client prevents herself fromgetting fitter by her fear that if she goes to the gym somepeople will poke fun at her for being overweight and becom-ing breathless after only a few minutes on the exercisemachines). Personal development (PD) goals provide clientswith new opportunities for greater personal growth andthe possibility of realizing their potential (for example,becoming self-employed, writing a book, going into localpolitics).

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Pursuing PD goals requires:

• considerable persistence coupled with accepting theuncertainty of whether the client’s goals will be realized, forexample, putting in a lot of effort may not result in her bookbeing completed or, if completed, not being published.

• learning from her experience and changing her behaviourif required, for example, that scribbling down a few notesoccasionally when ‘I’m in the mood’ will not get a book writ-ten, but learning the daily discipline of writing 500 words,whether or not she is in the mood, is more likely to help herfinish her book.

• acquiring new skills if necessary, for example, learningwhat steps are required in selling an idea for a book to apublishing company.

Clients can schedule appointments with you (for example,every six months) to monitor their progress towards attain-ing their PD goals.

Developing a RationalPhilosophy of Living

While clients may have learnt specific rational concepts(for example, non-awfulizing, self-acceptance) to tackle theirparticular problems, some may wish to consider developinga general rational outlook as part of their self-development.This general outlook would include:

Thinking for oneself

This involves the client no longer accepting uncriticallywhat others tell her and expending mental effort on decid-ing what is true or right for her and coming to her own

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conclusions, for example, ‘My friend keeps on telling meI can’t be happy without a man in my life. I used to letmyself be persuaded by her. I’m quite happy at presentwithout one and I’ll decide what is right for me and when.’

Learning tolerance

This means the client is willing to allow the existence ofothers’ views but without necessarily agreeing with or likingtheir views. If the client finds someone else’s opinion objec-tionable, he can argue against it without condemning theperson for holding it. Tolerance also allows the client tounderstand that others have the right to be wrong about himwithout becoming upset over their comments (for example,‘We think you’re the weak link in this team. What haveyou got to say about that?’).

Enlightened self-interest

This means the client puts his own interests first some of thetime in order to remind himself that his life, not just others,needs looking after too (selfishness would be putting hisinterests first all of the time). If the client does not look afterhis own physical and psychological welfare he will not be ofmuch use to himself or others if he becomes, for example,burnt-out through excessively long hours at the office.

Thinking and acting flexibly

Changing circumstances require adaptive responses fromthe client. Demanding that what exists in her life at anygiven moment should not exist (for example, losing a job,illness, the end of a relationship) will not make these situa-tions easier for her to deal with. In all probability, heremotional distress will intensify if she refuses to accept thegrim or frustrating reality of events (for example, depression

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and withdrawal from social activity; increase in anger).Research shows that people with good coping skills havelearnt to think and act flexibly in the face of adverse events(Kleinke, 1991).

Balancing short- and long-terminterests

Living only for the present can undermine the client’slonger-term interests while forgoing all current pleasuresfor longer-term achievement can make his present life dulland miserable. Keeping an eye on the present as well as thefuture can help the client to arrive at a balance betweencompeting interests, for example, partying and studyingensures that the client enjoys the present but also remainsfocused on his future prospects. Ellis sums up this balancesuccinctly: ‘The seeking of pleasure today and the non-sabotaging of tomorrow’s satisfactions’ (1980: 18).

Learning to accept uncertainty

We live in a world of probability and chance where noabsolutes guarantees exist. If the client demands certaintyof outcome or success before she embarks on various activi-ties, she is likely to become very indecisive and continuallypostpone action because she is overly focused on ‘What if …’catastrophic thinking (for example, ‘What if I take the joband don’t like it? That will be awful’). Even when the clientis given a guarantee, she is still doubtful because the otherperson could be wrong about the guarantee. Instead of con-tinually worrying about uncertainties in life, the client canbecome probabilistic-minded, that is, the probability thatshe will get more of what she wants from life and less ofwhat she does not want if she works hard, takes risks andis determined to forge ahead.

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Taking calculated risks

These are to be distinguished from impulsive or foolish ones.Calculated risks are based on considering the short- andlong-term consequences of a particular course of action (forexample, becoming self-employed) and the degree of prob-ability of the desired outcome occurring. Risk-taking cancreate new and exciting possibilities for the client but alsoinvolves failures and setbacks.

A great deal of time and effort may be invested in a par-ticular activity which turns out unfavourably; however,instead of feeling despair, the client can extract learningfrom the experience in order to help him make better deci-sions next time. Trying and sometimes failing is better thannever trying at all because of a risk-averse outlook.

Acting as a Role Model

Internalizing a rational outlook does not mean the client hasbecome a paragon – far from it – but she can model what shebelieves is healthy behaviour for her partner and children.As Hauck observes: ‘The behavior you teach and thebehaviour you practice determine the kind of model youpresent to your loved ones’ (1991: 96). The client can teachher loved ones, for example, to refrain from self-judgement(but not from judging their behaviour or performance) inorder to reduce the occurrence of ego-based problems orhow to stop procrastinating over making difficult decisionsor carrying out unpleasant tasks.

Obviously it is important for the client to make what shesays and does congruent or her loved ones will no doubtbe quick to point out her hypocrisy. Acting as a role modelpasses on to others valuable information the client has learntin therapy and, like anything else the client considers to bevaluable, she wants others to benefit from this information.

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In this chapter, we have discussed some of the ways clientscan promote self-change after formal therapy has ended.Maintaining the momentum of change requires a lifelongcommitment to hard work, but the more natural a rationaloutlook becomes for clients, the less effort and time will beneeded from them to support it.

In this book, we have emphasized the importance ofkeeping therapy as straightforward as possible in order toconcentrate clients’ minds on the essence of REBT: namely,identifying, challenging and changing their disturbance-inducing thinking (such thinking, as we have said before,can be REBT-driven or idiosyncratically defined). Therapyis not served by allowing or encouraging client ramblingor you engaging in long-winded and jargon-ridden explana-tions of REBT theory and practice. Your guiding principlethroughout therapy should be: ‘To communicate REBT tomy clients in a clear and concise way that will facilitate theirunderstanding and practise of it.’ Regular feedback fromyour clients will enable you to determine if this principle isbeing realized. As the philosopher, John Searle, observed:‘If you can’t explain it clearly, then you don’t understand ityourself.’ Practise with fellow students, colleagues, friendsand others to ensure you understand the concepts you areteaching before you teach them to your clients.

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Bandura, A. (1977) ‘Self-efficacy: Toward a unifying theory of behavioralchange’, Psychological Review, 84: 191–215.

Beck, J.S. (1995) Cognitive Therapy: Basics and Beyond. New York:Guilford.

Blackburn, S. (2001) Think. Oxford: Oxford University Press.Bond, F.W. and Dryden, W. (1996) ‘Why two, central REBT hypotheses

appear untestable’, Journal of Rational-Emotive & Cognitive-BehaviorTherapy, 14 (1): 29–40.

Burns, D.D. (1980) ‘The perfectionist’s script for self-defeat’, PsychologyToday, November: 34–57.

Burns, D.D. (1989) The Feeling Good Handbook. New York: WilliamMorrow.

Cormier, W.H. and Cormier, L.S. (1985) Interviewing Strategies ForHelpers. Second edition. Monterey, CA: Brooks/Cole.

Dawson, R.W. (1991) ‘REGIME: A counseling and educational model forusing RET effectively’, in M.E. Bernard (ed.), Using Rational-EmotiveTherapy Effectively: A Practitioner’s Guide. New York: Plenum.

DiGiuseppe, R. (1989) (audio cassette recording) What Do I Do With MyAnger: Hold It In or Let It Out? New York: Albert Ellis Institute forRational Emotive Behavior Therapy.

DiGiuseppe, R. (1991) ‘Comprehensive cognitive disputing in RET’, inM.E. Bernard (ed.), Using Rational-Emotive Therapy Effectively: APractitioner’s Guide. New York: Plenum.

Dryden, W. (1991) A Dialogue with Albert Ellis: Against Dogma. MiltonKeynes: Open University Press.

Dryden, W. (1994) 10 Steps to Positive Living. London: Sheldon Press.Dryden, W. (1995) Preparing For Client Change in Rational Emotive

Behaviour Therapy. London: Whurr.Dryden, W. (1998a) ‘Understanding persons in the context of their prob-

lems: A rational emotive behaviour therapy perspective’, in M. Bruch

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and F.W. Bond (eds), Beyond Diagnosis: Case Formulation Approachesin CBT. Chichester: Wiley.

Dryden, W. (1998b) Are You Sitting Uncomfortably? Ross-on-Wye:PCCS Books.

Dryden, W. and Yankura, J. (1995) Developing Rational EmotiveBehavioural Counselling. London: Sage.

Dryden, W., Neenan, M. and Yankura, J. (1999) Counselling Individuals:A Rational Emotive Behavioural Handbook. Third edition. London:Whurr.

Ellis, A. (1969) ‘A weekend of rational encounter’, in A. Burton (ed.),Encounter: The Theory and Practice of Encounter Groups. SanFrancisco, CA: Jossey-Bass.

Ellis, A. (1979) ‘The issue of force and energy in behavior change’,Journal of Contemporary Psychotherapy, 10: 83–97.

Ellis, A. (1980) ‘An overview of the clinical theory of rational-emotivetherapy’, in R. Grieger and J. Boyd, Rational-Emotive Therapy: ASkills-Based Approach. New York. Van Nostrand Reinhold.

Ellis, A. (1984) How to Maintain and Enhance Your Rational-EmotiveTherapy Gains. New York: Albert Ellis Institute for Rational EmotiveBehavior Therapy.

Ellis, A. (1986) (audio cassette recording) Unconditionally AcceptingYourself and Others. New York: Albert Ellis Institute for RationalEmotive Behavior Therapy.

Ellis, A. (1991) ‘Using RET effectively: reflections and interview’, inM.E. Bernard (ed.), Using Rational-Emotive Therapy Effectively: APractitioner’s Guide. New York: Plenum.

Ellis, A. (1994) Reason and Emotion in Psychotherapy. Second edition.New York: Birch Lane Press.

Ellis, A. (1996) ‘Responses to criticisms of rational emotive behaviourtherapy (REBT) by Ray DiGiuseppe, Frank Bond, Windy Dryden,Steve Weinrach, and Richard Wessler’, Journal of Rational-Emotive &Cognitive-Behavior Therapy, 14 (2): 97–121.

Ellis, A., Young, J. and Lockwood, G. (1987) ‘Cognitive therapy and rational-emotive therapy: a dialogue’, Journal of Cognitive Psychotherapy, 1 (4):205–55.

Gilbert, P. (2000) Counselling for Depression. Second edition. London:Sage.

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Grieger, R. (1991) ‘Keys to effective RET’, in M.E. Bernard (ed.), UsingRational-Emotive Therapy Effectively: A Practitioner’s Guide. New York:Plenum.

Grieger, R. and Boyd, J. (1980) Rational-Emotive Therapy: A Skills-Based Approach. New York: Van Nostrand Reinhold.

Hanna, F.J. (2002) Therapy With Difficult Clients. Washington, DC:American Psychological Association.

Hauck, P. (1980) Brief Counseling with RET. Philadelphia, PA:WestminsterPress.

Hauck, P. (1991) Hold Your Head Up High. London: Sheldon Press.Kleinke, C.L. (1991) Coping with Life Challenges. Pacific Grove, CA:

Brooks/Code.Maultsby, Jr, M.C. and Ellis, A. (1974) Technique for Using Rational-

Emotive Imagery. New York: Albert Ellis Institute for Rational EmotiveBehavior Therapy.

Meichenbaum, D. (1985) Stress Inoculation Training. New York:Pergamon Press.

Neenan, M. and Dryden, W. (1996) Dealing With Difficulties in RationalEmotive Behaviour Therapy. London: Whurr.

Neenan, M. and Dryden, W. (1999) Rational Emotive BehaviourTherapy: Advances in Theory and Practice. London: Whurr.

Neenan, M. and Dryden, W. (2000) Essential Rational EmotiveBehaviour Therapy. London: Whurr.

Neenan, M. and Dryden, W. (2001) Learning From Errors in RationalEmotive Behaviour Therapy. London: Whurr.

Neenan, M. and Dryden, W. (2002) Cognitive Behaviour Therapy: AnA–Z of Persuasive Arguments. London: Whurr.

O’Kelly, M., Joyce, M.R. and Greaves, D. (1998) ‘The primacy of the“shoulds”: Where is the evidence?’, Journal of Rational-Emotive &Cognitive-Behavior Therapy, 16 (4): 223–34.

Padesky, C.A. and Greenberger, D. (1995) Clinician’s Guide to MindOver Mood. New York: Guilford.

Persons, J.B. (1989) Cognitive Therapy in Practice: A Case FormulationApproach. New York: Norton.

Walen, S.R., DiGiuseppe, R. and Dryden, W. (1992) A Practitioner’sGuide to Rational-Emotive Therapy. Second edition. New York: OxfordUniversity Press.

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Wessler, R.L. (1996) ‘Idiosyncratic definitions and unsupported hypotheses:Rational emotive behaviour therapy as pseudoscience’, Journal ofRational-Emotive & Cognitive-Behavior Therapy, 14 (1): 41–61.

Wessler, R.A. and Wessler, R.L. (1980) The Principles and Practice ofRational-Emotive Therapy. San Francisco, CA: Jossey-Bass.

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ABCDE modeldescribed 1–2explaining to client 15–17keeping client focused 11–12preparing client for

disputing 32self-help form 43self-therapist 59–60structured storytelling

17, 18–20active-directive style 11–12assessment

emotional responsibility 20establishing goals 21–2explaining REBT to clients

12, 15–17listening to and structuring

clients’ stories 17, 18–20assignments see homeworkawfulizing

absence from flexiblebeliefs 4

defined 3

Bandura, A. 49Beck, J. S. 53behaviour

consequences 1, 2homework tasks 44–6

beliefscore 6, 62–4flexible and non-extreme

4–5

beliefs cont.irrational 25, 26, 30–1,

33, 63–5and ABCDE model 1, 2‘musts’ and ‘shoulds’

3–4, 13, 63–4levels 26–7rational, repetition of 44rigid and extreme 3–4situation-specific 62specific evaluative 6see also disputing

Blackburn, S. 26Bond, F. W. 13, 25Boyd, J. 9, 15, 25, 26, 44,

55, 68, 76Burns, D. D. 41

case formulation 24change

elegant and inelegant9–10, 65–6

non-linear model 58–9see also self-change

cognitive homework tasks41–3, 66

cognitive levels 5–6cognitive-emotive dissonance

68–9core beliefs

avoiding activationof 64–5

common themes 62–3

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core beliefs cont.compensating for 65defined 6developing a rational

philosophy 63–4irrational, maintaining

64, 65and self-observation 63

Dawson, R. W. 3depreciation of self 4diary 22, 43, 59DiGiuseppe, R. 25, 26, 39, 42discomfort disturbance 6–7disputing 25–6, 32–8

and ABCDE model 1, 2, 32belief levels 26–7creative 28–31, 31–2fomulaic 27–8, 31–2and multimodal tasks 57–8preparing clients for 32use of force and energy

61–2dissonant reaction of client 68disturbance see emotional

disturbanceDryden, W. 6, 13, 17, 24,

27, 29, 42, 54, 62, 69

ego disturbance 6–7, 13elegant change 9–10, 65–6Ellis, A.

core beliefs 6disputing 38elegant and inelegant

change 10emotions 14founder of REBT 1How to Maintain and Enhance

Your Rational-EmotiveTherapy Gains 59

Ellis, A. cont.imagery 46lecture tape 42shame-attacking

exercises 45short and long term

interests 81emotional change

ABCDE model 1–2inappropriate and

appropriate emotions7–8

emotional disturbanceABCDE model 1–2cognitive-emotional

dissonance 68–9and emotive tasks 45inappropriate emotions

7–8maintenance 9responsibility for 8types of 6–7

emotionsclient responsibility for

8, 20–1consequences 1, 2continuum of intensity 7inappropriate and

appropriate 7–8keeping record of

22, 43, 59meta-emotional problems

21, 23–4emotive tasks 45Epictetus 12evaluative beliefs, specific 6

feelings, record of22, 43, 59

follow-up 71forgiveness 38

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frustration see highfrustration;low frustration

Gilbert, P. 54goals 21

and homework 48and self-change 78–9short and long term

interests 81Greenberger, D. 70Grieger, R. 9, 15, 25, 26, 44,

55, 56, 68, 76

Hanna, F. J. 73happiness assignments 46–7Hauck, P. 28, 29, 42, 55, 75, 82high frustration tolerance

defined 4and psychological

workouts 78homework

behavioural tasks 44–5choice of term for 53client reluctance to

complete 41, 49, 50–1,53, 54

cognitive tasks 41–3happiness assignments 46–7links with session and

goals 48, 52multimodal tasks 57–8negotiating

allowing adequatesession time 51

grading difficulty 47skills assessment and

self-efficacy 49troubleshooting obstacles

50–1trying versus doing 49–50

homework cont.‘no lose’ formula 47–8rationale 40–1reviewing tasks 52–3

How to Maintain and EnhanceYour Rational-EmotiveTherapy Gains 59

imagery tasks 45–6inelegant change 9–10inferences and inference

chaining 5–6insights, REBT 12irrational beliefs

see under beliefs

Kleinke, C. L. 81

listening homework 42living, philosophy of 79–82low frustration tolerance

defined 3and homework 40as obstacle to progress 68

Maultsby, M. C. 46mediocrity, fear of 70Meichenbaum, D. 53meta-emotional problems

21, 23–4mind-reading 37multimodal approaches 57‘musts and shoulds’ 3–4, 13,

35, 70

Neenan, M. 6, 13, 17,27, 29, 69

non-linear model ofchange 58–9

O’Kelly, M. 13

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Padesky, C. A. 70personal development 78–9Persons, J. B. 40philosophy of living 79–82problem-solving 36

‘kangaroo’ 69progress, assessing 66, 71, 72proselytizing 75–6pseudo-rationality 69psychological health 4psychological workouts

76–8

rational beliefsphilosophy of living 79repetition of 44

rational outlookeffective 1, 2integration of 56–7

reading homework 42reality-denying 34REBT

assessment 15–24case formulation 24disputing 25–39explaining to clients

12, 15–17, 83homework 40–54insights 12maintenance of skills 74–5overview 1–14promoting self-change

74–83working through 55–73

relapse prevention 10–11,70, 73

REBT insights 12see also self-change

relaxation tape 42responsibility, emotional

8, 20–1

risk-takingactivities 44and rational philosophy

of living 82role model, client as 82

self-acceptance 5, 45self-change, promoting

74–5client as role model 82–3personal development

goals 78–9proselytizing 75–6psychological workouts

76–8rational philosophy of living

79–82self-depreciation 4self-efficacy theory 49self-help 56, 59–60

form 43reminder card 61see also self-change

self-interest, enlightened 80self-therapist 59–60, 67sessions

follow-up 71links with homework

and goals 48tape-recording 42

shame-attacking exercise 45, 54‘shoulds and musts’ 3–4, 13, 35situation-specific beliefs 62Socratic questioning 16, 60storytelling, client 17, 18–20

tape-recording of sessions42, 54

termination of therapy 71, 74therapeutic responsibility 8tolerance 80

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uncertainty 81Unconditionally Accepting Yourself

and Others 42

Walen, S. R. 3, 44, 46, 72, 74Wessler, R. A. 40, 41Wessler, R. L. 13, 40, 41What Do I Do With My Anger:

Hold It In or Let It Out? 42working through REBT 55–6

assessing progress 66–7client obstacles to progress

67–70core beliefs 62–5

working through REBT cont.elegant and inelegant

change 65–6force and energy in

disputing 61–2integration compared to

understanding 56–7multimodal approaches 57–8non-linear model of

change 58self-therapist 59–60success criteria 71summing up progress 72

writing homework 43

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Documents

Rational Emotive Behaviour Therapy in a Nutshell (Counselling in a Nutshell)