Creator of rational emotive behavior therapy (REBT)
Theoretical Concepts
Human development and emotional health:
Awareness, acceptance, and appreciation of oneself and others
Social interest-contributing to the world enhances our own happiness
Self-direction and personally meaningful goals
Involvement in long-range, committing to something outside of oneself
Long-range hedonism, enjoying the present while at the same time delaying instant gratification for future pleasures
Acceptance of uncertainty
Flexibility
High frustration tolerance so we are not devastated by disappointments
Ability to think in a clear, logic, scientific, and rational way
Taking sensible risks
Recognizing we can't always be happy and life won't always go the way we plan
Accepting responsibility for our own emotional difficulties
(Ellis & Dryden, 2007, pp. 18-19) Self-acceptance: Emotional difficulties are thought to stem from conditional self-acceptance. When one uses conditional self-acceptance they look to their accomplishments to define their worth instead of realizing their basic worth as a person.
Origins of emotional disturbance: Irrational thinking is believed to have a biological link and can make people think that life is always supposed to go their way. Childhood traumas can increase a persons' irrational thoughts. Despite the biologic link, people are viewed as having a choice and an innate drive to actualize (Ellis & MacLaren, 2005).
Secular humanism: People are viewed as unique individuals who choose to live interdependently within social groups. People are evaluated by their behaviors and they are neither seen as good or bad, just as humans. People who believe in secular humanism dismiss the idea of absolute truth and seek alternatives (Ellis, 1992) (Seligman & Reichenberg, 2014).
Thoughts: People are able to change once they take ownership for creating their emotional difficulties.
Focus on present thoughts: REBT stresses the importance of present thoughts. Present difficulties and thoughts are believed to stem from previous thoughts and behaviors that are self-defeating, therefore there is less need to focus on a person's past. The goal of REBT is to help a person become more aware of their thoughts, allowing them to act as their own therapist and solve any dilemmas independently.
Insight: The origins from which difficulties arise is not the focus of treatment. Insight is seen as a hindrance to the treatment process and can cause progress to become stagnant. The only insight one needs is into the principles of REBT. Ellis (1998) states there are three levels of insight that are crucial for change.
Insight to see that we are making the choice to upset ourselves
Insight to see that we acquired our irrational thoughts and to acknowledge that we continue to preserve them
Insight that we must work hard to bring about change
(Ellis, 1998)
View of emotions: Not much emphasis placed on exploring the cause of emotions. Instead, clients' are encouraged to have an awareness of emotions and the impact they have. There are two emotional categories.
Inappropriate/self-destructive emotions: Emotions that are reoccurring, crippling, and cause overreactions leading to a poor self-image. There are eight emotional problems.
Guilt
Shame
Jealousy
Hurt
Anxiety
Depression
Envy
Unhealthy anger (Dryden, 2011)
Appropriate/nondefeating emotions: Emotions that are brief, manageable, are proportionate to the stimulus, and strengthen self-acceptance. This can include both positive and negative emotions.
Joy
Satisfaction
Peacefulness
Annoyance
Regret
Sadness
(Ellis, 1986).
View of Behavior: Behavior is considered a secondary focus but it is helpful when paired with reinforcing thoughts.
Irrational belief themes: Irrational beliefs deal with absolute truths about oneself, others, or a persons' circumstance. They are characterized by the following themes:
Awfulizing
Self-deprecation (evaluations of human worth and self-criticism)
Frustration intolerance
(Ellis, 2001) Words such as, should, ought, and must are clues for irrational beliefs. Irrational belief demands:
If I do not act perfectly all the time then I am unworthy (causes feelings of depression, anxiety, and low self-esteem)
Everyone has to treat me nicely and if they don't then they are horrible people who should be punished (causes feelings of rage and vindictiveness)
Life should be easy and never too difficult, otherwise I can't bear it (causes inaction, low-frustration tolerance, self-pity, anger, and depression)
(Ellis, 1984, p. x; 2003, pp. 236-237)
Rational beliefs: Beliefs that are nonjudgmental, acknowledge various possibilities, and strengthens problem solving skills.
Format of sessions: The first few sessions consist of gathering clients' history and exploring their thoughts, behaviors, and emotions. This is followed by the counselor enlightening the client on their irrational beliefs so they can assume responsibility for their emotional difficulties and change their thoughts to help solve certain issues. Sessions are not limited and last as long as needed. Sessions typically follow 10 predictable steps.
Review information from previous session
Check mood, behavior, thoughts, symptoms, and medications
Discuss new information (life changes)
Follow up on homework
Create agenda for the session
Use ABC format to do the work
Provide summary for the work that's been done
Assign new homework
Gather feedback regarding session
Close the session
(Walen, DiGiuseppe, & Dryden, 1992, p. 65)
Treatment
Treatment goals: REBT is a goal-oriented treatment that is meant to help clients recognize irrational thoughts, therefore replacing irrational with rational thoughts through the use of cognitive skills (Ellis & Ellis, 2011).
Therapeutic alliance: Clinicians in REBT often use their influence, persuasion, praise, exaggeration, instruction, and self-disclosure to help people think more rationally (Dryden & Branch, 2008). REBT counselors should be:
Structured and flexible
Intellectually, cognitively, and philosophically inclined
Active and directive in style
Comfortable with behavioral instruction and teaching
Willing to take responsible risks and unflustered by failure
Emotionally healthy, accepting of others, and accepting of themselves
Practical and scientific
Comfortable with various interventions
(Ellis & Dryden, 2007, p. 29) REBT promotes the ideas set forth by Carl Rogers of a therapeutic alliance that displays unconditional positive regard, congruence, and authenticity. Ellis defined them as, unconditional other acceptance (UOA), unconditional self-acceptance (USA), and unconditional other acceptance-multicultural. The necessary conditions for change are in place when all three are present. Clinicians' can express disapproval of clients' behaviors, but they must be careful not to create a situation where the client changes on the clinician's behalf as opposed to doing it for themselves.
Identifying, assessing, disrupting, and modifying irrational beliefs: Used to help people identify their beliefs.
A-Identify and describe the activating event, or external source of discomfort.
B-Determine belief about the activating event. Was the event positive, negative, or neutral? These beliefs may be rational or irrational.
C-What are the consequences of the belief. If the belief is irrational, the consequence is considered to be unhealthy and may promote self-destructive behaviors. If the belief is rational, the consequences usually lead to appropriate emotions and behaviors. Initial consequences can cause additional reinforcing consequences.
D-Dispute or debate by exploring beliefs about the consequences, revealing if the beliefs are rational or irrational. Cognitive, emotional, and behavioral approaches to change should be utilized.
E-New rational effect or beliefs helps the client determine how to reach the desired outcome through the use of appropriate and acceptable behaviors.
(Ellis & Ellis, 2011)
Approaches for disrupting irrational beliefs: Persistent use of cognitive, emotional, and behavioral interventions is the key to identifying, disrupting, and replacing irrational thoughts. There are four strategies of disruption.
Logical disputes: Identify leaps in logic. Example-A person's sibling does not answer the phone and now the person feels like their sibling doesn't want a close relationship with them.
Empirical disputes: An accumulation of evidence. Example-Your siblings phone was broken, but they called you as soon as they got their new phone and wanted set up a time to get together.
Functional disputing strategies: Do the beliefs help to achieve the desired outcome or contradict it? Example-You want to strengthen your relationship with your sibling but you are withdrawing from them because you believe they ignored you. This belief is not strengthening your relationship.
Rational Alternative beliefs: Offers other potential possibilities. Example-You mentioned that your sibling is very clumsy with technology, I wonder if they lost or broke their phone and that is why they have been unreachable.
(Beal, Kopec, & DiGiuseppe, 1996)
Four disrupting styles developed by Beal et al.
Didactic style: Giving information, rather than dialect, that is explanatory. Example-I think you may be jumping to conclusion about your sibling avoiding you. Keep in mind that your sibling just got a new job and has been extremely busy.
Socratic style: Promotes reasoning through the use of questions. Example-What do you make of the greeting card you received in the mail from your sibling the other day? Do you think that behavior is aligned with your belief about them withdrawing from your relationship?
Metaphorical style: Using analogies, especially from clients' experience, to dispute beliefs. Example-Your reaction to your sibling not answering your call reminds me of the time you believed your friend was ignoring your phone calls and messages on social media. Then later you found out that they were on a cruise and they did not have access to a phone or internet.
Humorous style: Disputing the belief in a lighthearted manner making sure to never make fun of the client. Example-It sounds like you are associating every time someone does not answer or reply immediately to if they want to continue a relationship. How about for the next few days you count how many times people do not answer or return your phone calls right away and we can see who likes you the best.
Other interventions: Cognitive strategies
Detecting, evaluating, and modifying irrational thoughts
Write to express and explore feelings
Teaching how to differentiate between rational and irrational thought
Confront irrational beliefs
Identify disadvantages of beliefs
Socratic questioning
Reduce thinking to absurdity
Identifying and changing self-talk
Reframing situations by changing labels and language
Listing ways to cope with worst possible outcome
Rating experiences to counteract awfulizing
Generate alternatives
Distracting oneself
Using visualization
Rating degree of conviction in belief and rerating after change
Formulating, writing down, and repeating rational coping statements
Promoting focus on happiness
Exercising high frustration tolerance
Behavioral strategies
Using relaxation strategies
Engaging in shame-attacking exercises
Creating challenging situation to cope with
Role-playing
Taping sessions for review
Reversing roles; clinician takes on irrational beliefs and client talks clinician out of those beliefs
Using two chairs representing rational and irrational beliefs
Step out of character and act as a person is someone else
Reading self-help books and listening to tapes
Training in skills like assertiveness and effective communication
Planning pleasurable activities for long-range pursuit
Affective strategies
Imagining the worst that can happen
Providing powerful emotional stories, metaphors, and parables
Using emotionally charged language
Persuading
Eliciting inappropriate emotions through imagery and practice changing them