Professional Documents
Culture Documents
Guide
tolH
RationaJEmotivi
Therapy
iusan R.Walen
Raymond DiGiuseppe
m*
Richard L.Wess
A
to
Guide
Rational-emotive Therapy
Practitioner's
Practitioner's
Guide to
Rational- emotive
Therapy
Susan R. Walen, Ph.D.
1980
Oxford
Copyright
Inc.
Walen, Susan R
Bibliography:
p.
Includes index.
1.
DiGiuseppe,
Rational-emotive psychotherapy.
I.
joint author.
II. Wessler, Richard L., joint
Raymond,
author.
III.
Title.
RC489.R3W34
616.8'914
79-9121
ISBN0-19-502667-5
ISBN 0-19-502668-3 pbk.
Andy
Audrey
Alec
2012
http://archive.org/details/practitionersguiOOwale
Foreword
Although rational- emotive therapy (RET) has now become one of the
most popular modern psychotherapies and is at the core of the new
movement
it
tively
to learn
how
to practice
most of them, for better or worse, written by me. And some of these
leave
much
Emotion
is
to be desired.
Psychotherapy, which
in the field,
Reason and
RET and
its
emotive and behavioral aspects. The same could be said about Growth
were actually seen in the 1960's; again, they emphasized cognitive restructuring and omitted many important aspects of RET.
While I published many papers giving some of the details of the
emotive and behavioral aspects of RET in the 1960's (Ellis, 1968, 1969a,
1969b), most of this material did not begin to appear in book form until
the mid-1970's
as
Therapy
(Ellis
Health Practice
cal
lished.
vii
Foreword
viii
more
clients of
psychotherapy,
it is
(I
Moreover,
Walen, Di-
as Drs.
RET
almost invar-
texts, including
some
of
my own
am
authorship,
With
all
public, a definitive
work explaining
more experienced
therapists
can
RET by
in detail exactly
use
its
many
them
all
quite
apply-
is
RET and
It is clear,
realistic applications
of
exception-
RET
to actual
many
excellent
psychotherapeutic treatments.
In surveying the
points
made
RET
in this book,
literature,
and
including the
in thinking
over
my own
quarter of a
pointed out some time ago, in rebuttal to Carl Rogers' (1957) paper "The
Necessary and Sufficient Conditions of Therapeutic Personality
Change," "there
is
is
absolutely
Foreword
terns"
(Ellis,
ix
1959,
p. 538).
with clients
sess to be effective
therapist,
me
1979). Let
Ellis,
(Ellis,
my
Intelligence.
briefly
list
some
of these.
intelligent
people,
is
from
their
a distinct
own
including
think that
solutions
rational
therapists,
may
to
problems
their
present to them.
If
so,
that
others,
therapist, including
including
their
it is
a considerable de-
most
Therapeutic knowledge.
that consciously,
on
is
likely to see.
employ many
field of
different therapeutic
methods
ability to effectively
1972).
RET practitioners do not overemphasize the kind of empathy that has been so often stressed by Rogers (1951) and his followers
Empathy.
(Carkhuff, 1969), which largely consists of reflecting the negative feelings of clients about themselves and the world
plying that their lives really are miserable and that they have
choice but to be anxious and depressed.
However, RET
little
therapists tend to
lie
behind
clients'
is
in
many
of
Foreword
therapist-instituted empathy.
It
that they are being listened to and understood, but that their therapists
understand some of their feelings better and more helpfully than they
themselves do. Consequently, they can
listen to
much
themselves
better
few RET sessions and are more in touch with their own feelings
than they ever were before. RET practitioners, partly through their
understanding and continued use of RET theory, had better acquire this
unique kind of empathy that is so important in helping many clients.
after a
Therapy
Persistence.
way they
human
is
perhaps do virtually
all
feelings, thoughts,
that
(as
If
work
gent and permit their clients (and themselves) to get by with halfhearted attempts to change themselves,
little will
be accomplished.
RET
Even
RET
if
art, it
psychotherapy
is
normally requires
interest.
An
effective
employ an
with others.
mainly
clients.
for their
The problem
own
is
They
there-
sake rather
for therapists
effective procedure
If
outlook.
As Eysenck
(1964),
Yates
(1970),
and
other
Foreword
xi
with the process of scientific inquiry and experimentaEvery time therapists see clients, they come to the sessions with a
laps significantly
tion.
theory about
how people
to change; they
is
especially true of
is
RET, which
tries to
relatively free of
be a
dogmas
is
RET
therapists, therefore,
their outlook
and procedures.
RET
itself
has
all
1955. Therapists
who
follow
its
its
Personal Use of
many
become
from the
stemmed
helpful in overcoming
some
of their
own
which we sponsor
Europe,
we
RET
and
in
problems
xii
is
Foreword
RET
this part of
is
we
see that
never neglected.
RET
effective
have to possess them ideally. One of the best points of the present book
is that it highlights and gives salient information about how people who
want to use RET can help themselves achieve or improve on some of
main
these traits and increase their therapeutic efficiency. For one of the
principles of rational-emotive therapy
is
that
human
themselves more
One
of the
own
reactions and to
main ways
knowledge and
RET
and personal
make
lives.
own
is
to study,
Institute for
Albert
Ellis,
Ph.D.
Preface
(RET). Albert
Ellis,
on rational-emotive therapy
articles
more than
The majority
forty books.
of these
are written for the patient and are useful as self-help manuals. Both
clinical reports
liotherapy
may
many
therapist.
able literature on
RET and
is
is
in
constructive
work with
RET
therapist-in-training.
format
RET is
not
difficult. In outline,
is
Ellis,
the
are catchy
A New Guide
and Harper, 1975), one can easily give an
engaging lecture. In fact, many patients can give the lecture; however,
although they may parrot the principles quite appropriately, they may
(e.g., "
to
Rational Living
(Ellis
actually
We
liefs
RET maze
own
problems. Leading a
is.
recall
from
through the
our
own
initial
down
became mired
in
slippery disputations.
we
In
as
beginning
other words,
an actual
xiii
Preface
xiv
therapy session as they are made to seem in texts. The fuzzy predicaments brought in by clients don't seem to follow the scripts.
Over the years, many therapists have come to the Institute for
Rational- Emotive Therapy for direct training in RET. Even in the brief
but intensive five-day practicum offered by the Institute, significant
progress in therapist behavior can be seen from day one to day five as
practice therapy tapes are made and supervised. In addition to rehearsal
and feedback, a large factor in this therapist behavior change is the
influence of a strong oral tradition in RET. Supervisors give their students, who in turn may become supervisors, a wealth of helpful hints in
doing RET. As is common in oral traditions, the original source of a hint
may
Some
of
the bits of clinical lore in the present manual, for example, have been
left
by supervisors such
Knaus, Ed Garcia,
as Bill
Howard Kas-
sinove, Bill Golden, Rose Oliver, Albert Ellis himself, and a host of
others
common
We
to codify
some
many
of
of the
own
seem
focusing on an
What
is
to
become
sure
its
how
best to dispute
core, this
reach for
manual
when you,
is
it;
Chapters
meant
6, 7,
and 8
may
is
not
be useful. Thus, at
to be a practical guidebook
something to
In writing this manual, we found ourselves confronted with problems of language. Sexist language has been a particularly troublesome
issue. We have tried to follow various guidelines for nonsexist language,
although occasionally
we have
settled
in
xv
Preface
order to
make
We
style.
A
sumer
similar
word
object to the
The word
individual as sick.
some
individuals
Our
it is
we
adolescents,
RET
and knowledge which are desirable, yet beyond the scope of the
skills
If you are already skilled in treating these populabook will be of help to you. If you are not, we strongly
recommend that you receive specialized training before working with
who
is
more appro-
ill
about
The
human
sexual
its
clients a disservice
is
field of sex
sexuality,
One
may
be doing
their problems.
when you are confronted with a client who presents these kinds
we recommend that you either get specialized training or
refer the client to another therapist who has done so.
There are a number of other specialized problems which, while
Again,
of problems,
amenable to some mental health interventions, are not well treated with
rational-emotive therapy.
use
One
or
population for
whom RET
is
of limited
is
which
may
The psychotic
may
may
patient,
however,
may
also
damage
it
is
itself.
For these
RET
will
xvi
Preface
impairment, but
his neurotic
problems about
this
cope with
handicap as
it
handicaps.
This manual
a
aimed
is
at practitioners
knowledge
we
new
to
RET, but
since
RET
is
some
and
any other system of
general counseling
skills.
like
is
probably of
less
which,
any case, if you have not already done so, we encourage you to
begin your study of RET by reading the first six chapters in The New
Guide to Rational Living (Ellis and Harper, 1975) and Ellis' classic text,
Reason and Emotion in Psychotherapy (1962).
Therapists-in-training at the Institute for Rational- Emotive
Therapy tape-record virtually all of their therapy sessions, of course
with the client's permission. You, the reader, will be asked to perform
many self-checking exercises throughout this book so that in addition to
obtaining peer supervision, you will be able to supervise yourself.
Therefore, if you are not already in the habit of taping your therapy
sessions, begin now.
In
We
read and
commented on
who
Ellis, Dr. George Spivack, Dr. Aaron Beck, Dr. Barry Bass, Dr. Morris
Roseman, Dr. Lawrence Donner, and graduate and undergraduate
students at Towson State University and Hofstra University.
June 1979
S. R.
W.
R. D. G.
/
R. L.
W.
Contents
RET
Get Them
Basic Principles of
Therapist Strategies:
Getting at the
37
Getting at the
51
and
The
How
to
Basic
Across
of
Doing RET
72
Therapist Strategies:
10
11
12
13
25
96
115
142
164
Answer Key
Index
288
280
285
A
to
Guide
Rational-emotive Therapy
Practitioner's
JL
RET
Get Them Across
Basic Principles of
and
The writings
How
to
rational-emotive therapy
The theory
encompass three
rational-emotive philosophy
and
causes
first
to
rational-emotive theory.
Rational-emotive Theory
human
functioning:
thoughts, feelings, and behavior. All three aspects are intertwined and
alter the
way they
behaviorally react to
it.
on changing environmental contingencies to alter behavior, and cognitive psychologies focus on altering thought content, but few psychologies deal directly with emotions because they are difficult to influence
directly. RET theory is perhaps unique in this regard since it takes as its
focus the cognitive-emotive interface. Thus, the first and most basic
principle of rational- emotive theory is that cognition is the most impor-
Guide
Practitioner's
tant determinant of
human
we do
bad";
it
make us
we
"feel
feel what we
good" or "feel
more
direct
emo-
and evaluations
and
result of dysfunctional
functional thinking include the following: exaggeration, oversimplification, overgeneralization, illogic, unvalidated assumptions, faulty deduc-
tions,
cognitive errors
tional beliefs
is
Ellis
common
to our culture,
to account
it is
Even
if
we
environment
(Ellis,
1962,
all
p. 61).
This belief
is
significant people to
be concerned with keeping their approval. Thus, the belief in the necessity for others' approval
Most
is
irrational beliefs
fall
events or individuals,
(3)
(4)
demands on
human worth,
some human beings are
statements of evaluation of
we
whenever we
itself is
comes about because the wish becomes escalated into a pernicious demand, which is the root of the disturbance. These demands or commands
form the core irrational beliefs and are recognizable by cue words such as
"should," "ought," "must," "need," and "have to."
Ellis often leads clients through the following vignette, which illustrates this model of emotional disturbance:
Basic Principles
Suppose, as you left the house this morning, you said to yourself:
"I'd like to have $5 with me today. It doesn't have to be any more
than $5, and it's not that I must have it, but I'd prefer to have that
T:
much money
in
my
pocket."
Then
later
How
C:
Well, disappointed,
T:
suppose.
guess
be pretty upset.
C:
T:
Sure you would, if you didn't have what you thought you must
have. Now, suppose you were still saying you must have $5 with
you at all times, but you reached in your pocket and found $6 How
do you think you'd feel?
Happy. Maybe ecstatic?
Yes, you probably would feel happy, but very shortly after, you'd
feel anxious again. Do you know why?
No.
Well, suppose you lost $2, or spent $2, or got your pocket picked!
So you see, you're miserable both ways when you think you must
have something. You're anxious when you don't have it, and anxious
I'd
C:
T:
C:
T:
when you
do!
what we
analysis of thought.
way
If
distress
is
is
we
that
we
feel
begin with an
to
conquer distress
human
beliefs, as
in
which we
Like
many
theory places
its
content that
we
learn.
is
that
Practitioner's
Guide
maintenance People maintain their disturbance by selfThe contemporary adherence to irrational beliefs, rather
than how they were acquired, is the cause of emotional distress. Thus, if
individuals reevaluated their former thinking and abandoned it, their
standing
its
indoctrination.
is
that contempo-
rary beliefs can be changed, although such change will not necessarily
come about
At
this point,
we would
like to dispel a
affect rather
than
its
presence or absence.
and for
psychology
tion
and behavior.
When
between
student
who
who
is
extremely anxious
has no concern at
do poorly.
Another misconception
all
may
may
levels of
emo-
is lost.
For example,
do poorly on
a test; the
will also
is
that
if
however, does not mean passive acceptance of events. There are two
general kinds of events: those we can possibly change and those we
cannot. Accepting an unfortunate reality and not getting overly upset
Basic Principles
about
is
it
it
would be
One
demand
or insist that
it
it
irrational to
we may
When we
are
may
and
In
are as
follows
1.
2.
Cognition is the most important, though hardly the only, determinant of emotion.
Irrational thinking often produces dysfunctional emotional
states.
3.
We
have a natural tendency to think irrationally and upset ourwhich gets reinforced by the environment.
We perpetuate our own emotional distress by repropagandizing
ourselves with our irrational beliefs.
The most effective way to reduce emotional distress is to change
our thinking and our behavior, a task accomplished by persistence and practice.
selves,
4.
5.
6.
Rational thinking leads to a reduction in the frequency, intensity, and duration of emotional disturbance, not to flat affect or
Rational-emotive Philosophy
The
cal
underpinnings.
Ellis
"Men
of
is
first
them."
Our view
is
a function of
Practitioner's
Guide
principles.
EPISTEMOLOGY
How do we know a thing to be true? What are the most reliable and valid
ways
of obtaining
through the methods of science that we can best obtain knowledge about the self, others, and the world. Whereas religion typically
that
it is
way
of knowing,
In
question
is,
RET, we seek
"Where is the
to make good
as the sole or
most
at conclusions. For
RET
RET
is
true?"
is,
If
we
say that
we know some-
verified
How,
Of
course,
build
we
them
we know
then, do
probability of
its
a thing to be true?
We
we hope
to
can predict
hypotheses to
determine the
new
fit
facts;
From
we hope
to
the theory
new
different circumstances.
know
that a thing
is
in
which they
live.
Basic Principles
DIALECTICS
The
expert at
illogic.
A typical
is
reasoning goes
like this:
should be perfect.
just
made
a horrible
mistake.
is
How
to
made
judgment here,
mistake), but
how
a horrible
mistake (although
for
can
it
I
Not
at all.
There
strated that
scientific scrutiny?
may
mistake"?
I'd
be too soon to
it
can be demon-
It
is
am
is
crosses the
whether
"horrible"?
it
was
How
bad
That
am
imperfect
is
surely proven by
am
my
it
al-
though people who are thinking dichotomously will say that it does. In
dichotomous thinking there are only two categories, such as "perfect"
and "worthless."
Clients are rarely aware of the major premises in their thinking or
on the conclusion
which,
if it is
illogical, is likely to
focus only
produce emotional
problems. Rational thinking, then, involves logical reasoning from empirically verified or verifiable statements. If
we
think rationally,
we
are
VALUES
Two
philosophy of
RET
by people
but not often verbalized. These two major values are survival and enjoyment. The ideas one holds can be evaluated against these values in the
search for rational thinking. Anything that promotes your survival and
Guide
Practitioner's
by
is,
definition, irrational.
much enjoyment
we
Our commonly
as possible
held
human body
and the physical and social world; to live peacefully within our chosen
group; and to relate intimately with certain people of our choosing.
explicit values
advocated by RET.
ETHICS
Rational-emotive philosophy suggests that dealing fairly with other
people can be based upon
of our actions.
What
human
is
what
is
fair
and what
is
not. If
you break
when
this
may
social
norm
breaker to
many
not in our
own
is
enough
to keep us
selfishly.
it is
wrong
to exploit
and
act
It
not wrong in an absolute sense, for that smacks of the very dogmatism
that
RET
opposes.
individual, because
It
it
is
wrong
may
it
is
The
wrong
for the
ethics that
RET
Basic Principles
fact,
RET
holds that
RET
lemmas, to evolve
that
socially responsible.
is
my
ways
actions
that set
this act
is,
like the
others do.
RESPONSIBLE HEDONISM
The philosophic stance
of
RET
is
id,
the hedonism of
as
it
RET does
not prescribe
how
to
survival,
is
survival,
RET
The term
moderation
is
hedonic calculus,
It is
not a true
to
our vari-
is
10
Guide
Practitioner's
have their advantages and disadvantages. In RET we advononcompulsively seeking an optimum solution that sacrifices neither
gratification
cate
tion.
There
is
That
is
form
a special
when one
hedonism
of
person
may want
to
show
it
is
when they
called
Low
A
a
Frustration Tol-
agree would be beneficial for them, citing reasons such as "It's too
main reason
standing of their
LFT
is
philosophy.
It is
LFT
is
perhaps the
it."
improve after they have gained an underdisturbance and how they create it.
is
sooner maintain the status quo than risk discomfort." While people
clearly
have
a right to live
by such
philosophy,
it
ness by blocking
in human relations? No, not if the person has thought through the
consequences of his or her behavior which include getting cut off from
chy
is
ETHICAL
In
HUMANISM
individual
is
almighty God. The existence of God is questioned or even denied entirely, since God is not needed to explain the creation of things (that is
the job of science), nor
is
He needed
Ellis
to create
himself
is
an ethical code
clearly an atheist,
is,
and
in
philosophy of
11
Basic Principles
life)
may
unfounded
in fact)
is
cause of psychopathology.
lute notions of right
which leads to
guilt,
is,
He contends
that
it is
as well as hostility
Many
although
it is
faith
all
Ellis'
one
atheist,
Christian and
atheism.
forms of religious
It is
belief,
life,
see,
when RET
system, they will encounter some rules of living that the client has been
trying to follow. These personal rules or philosophies of living
may
rest
upon parental teachings, religious teachings, widely held common wisdom, or highly idiosyncratic statements about how life should be lived.
These rules, because they are dogmatically held, rigidly self-enforced,
conflicting, or otherwise maladaptive for individuals, are the basis of
their disturbance.
When
fair
game
for
ful
establish beliefs
Survival
way
12
Guide
Practitioner's
RET
few others
a vital absorption in
some personally
structive self-
about by
know and
help patients
scientific/logical
attitudinal change.
Rational-emotive Therapy
Ellis
is
pragmatic and
as
young
mon
goals. In addition,
The
RET
and children
homework assignments
and enjoyment
RET
monal
psychotic.
When
it
may
Abrahms, 1978).
be
and
13
Basic Principles
ABC's
of
RET. In
system, the
this
environmental occurrence.
Consequences;
it is
is
He
calls this
schema the
usually
some obnoxious
or unfortunate
this
The B
is
fact,
the patient's
Belief
focus.
Belief systems,
in detail in
Chapter
and
6,
but for
now we
up
1.
2.
You must
treat
me
worm
if
don't).
if
you
don't).
3.
give
me what
it's
awful
want quickly,
if it
easily,
and with
doesn't).
These three Musts almost invariably lead not only to the parenthetical
evaluations above but to the following derivative cognitions:
can't stand
it.
to live
it
also
when they
event
of the presence
and
is
more
directly responsible
likely are
unaware
beliefs. Patients in
14
Practitioner's
Guide
they can also refuse to disturb themselves. In other words, the patient
has a choice of feelings and, perhaps without quite knowing
why
or
It is
is
patients to grasp.
is
tagonistic to this
as,
"He made me
could say,
filled
sound to our
so
ear!
Yet the
common
we
Thus, emotions are not foisted upon us or injected magically into us, but
largely
this notion.
How
can the therapist illustrate to clients that internal rather than ex-
B-C connection
similar to themselves,
would
is
to ask clients
how
For example, a
The
therapist
depressed
persists,
and
how
asks,
is.)
would
be
"But
what
percent
Basic Principles
15
own
with the
by
fact,
his
and
point,
when
a small percentage
this
is
confronted with the crucial question: "If Activating events (A) do, in
cause emotional Consequences (C), then
fact,
the
same event
led to so
hypothetical sample?"
"Well,
like,
guess
many
Most
clients
respond
The
for reaching
on
they
it
all
it
it
his
The
explain that
with something
or "They're
all
different,
own and
differently."
use
at this point
C"
The about-to-be-divorced
how do you
all
therapist has
to further elaborate
now
on the point.
may
help to
make
the
ABC
connec-
tions clear:
Suppose you are driving and you come to a red light. Does this
stop? If red lights make you stop, you would brake at all
make you
made you
And
if
all
red traffic
the event
stop,
it.
16
Guide
Practitioner's
"You made me
How
you
force
to love
love, but
OK, Marsha,
do
feel
if
let's
it
right
see
if I
can
want you
to
Another way
feelings
is
incongruency between this particular irraand another cognition that Americans, particularly religious
tional belief
Most Judeo-Christian
reli-
animal species
The therapist
someone made you angry, you therefore had no say in it.
Well, do you believe in free will and self-determination, or do you
might
ask: "\i
By phrasing
or in a
manner understandable
out the
the
at
human
is
the truth?
Many
17
Basic Principles
commitment
that
directly causes C.
T:
is
incorrect.
strategies:
Well, John, if your father really is the cause of your anger, we'd
better terminate therapy. You see, if the cause of the anger is
outside you, how can I help you? You'd better send your father to
me
instead,
and
let
me
change him!
this point to
young
children:
C:
T:
way!
Oh, yes you
T:
do.
You sound
as
if
puppet and
at the
Institute for
C:
(Complaining about
how
made her
feel
badly, etc.)
T:
a large
it
to
18
Practitioner's
C:
What's
T:
This
Guide
this?
Once
to
is
how we
will
how we
talk to ourselves.
we speak
It
our
own
reactions as surely as
"How
can
how
how we
we
patients find
it
many
difficult to
is
must
first
many months
them
who
it
may
it is
19
Basic Principles
is
cated clients.
As
impossible because of the past. The client might assert, for example,
"But I can't change; I've always been that way!" A therapeutic challenge
would then involve correcting the client's language and thereby the
concept. For example:
You mean you haven't changed so far. Even if that's been true
now, does that mean you won't change tomorrow? That's my
business, you know
showing you how to change.
up
to
may
also
some
Few
scientific data.
studies
show any
may
who
in
specific
firmly be-
be stating a self-fulfilling
you go into a ball game believing "I can't win, I can't win, I can't
win," you'll find that attitude very self-defeating. If you go into
therapy believing "I can't change- my early experiences fixed me
permanently," that's also self-defeating and you may not change.
T:
If
If
ogy by
is
never accurate;
it is
lives,
a reconstructive rather
than a
have indicated that our memory processes do not work like copy
machines which take pictures of events and file them away for review. In
effect, if an event occurred ten years ago, the way we remembered it a
year
later, five
tions of
memory and
all
be different recollec-
we
environmental,
Thus, the basic hypothesis that one can search for past events, recall
them accurately, and use these recollections to rearrange the personality
is
incorrect.
20
Practitioner's
Guide
distress
is
an
problem only because the client continues to think about them in the
same way. It is present cognitions, not past events, which affect us.
Thus, although your mother may have worked hard to convince you
that you were a worthless no-goodnik, it is only because you continue to
And you
believed
Why
you
If
did
you were
it?
believe it?
told so today,
The important
point, therefore,
is
it?
neurotic
SYMPTOM
STRESS
21
Basic Principles
about the
mother kept
Client's
= I wish
= Since
not) do
bitterly complaining
client's behavior.
and she's
don't like
and yelling
it,
way.
Feeling angry at mother
at her.
(RB 2
Belief
client's
"keeping
my
my
wish
were better
at
cool."
Next
Next Consequence (C 2
Clients will often
= Anger
at self or feelings of
at their
symptom
stress.
second-level
It
is
symptoms
We
will
refer to these as
for the
symptoms
shame.
ABC.
will
prevent
(Second-level
ABC
The
emotional distress; in
E they
will experience a
22
Practitioner's
Guide
level of affect
the
RET
which
therapist
Once
clients
have mastered
may
may remain
still
more
to be confronted.
Since the therapist cannot insure that clients will always live in a stressfree
how
is
to first teach
them
will
be impaired.
When disturbance is
how
to choose or
own
be their
therapists.
It is
with these
is
to
New
ABC's
the
so,
but
it
may
The answer
schema
homework assignments and
the course of therapy.
Ellis,
For the
Some
is
that
it is
not necessary to
in order to
to aid
him
experienced
may
use
do structured cognitive
in generalizing
RET therapists,
beyond
includ-
new
practitioner,
necessary to teach
ing
it is
on to
therapeutic vocabulary.
do
whether
We now move
ABC
system
clients.
23
Basic Principles
Appendix
As an overview
RET, we include
a highly
fessional
who
The
client
condensed
one
was a young proEllis at
of beginning a
new
sional activities,
practice. In outline,
A=
C =
inertia.
The
thera-
pist asked the client what she was saying to block herself; the response
was:
might flub
C:
T:
it.
C:
that do?
People might think I'm a
T:
And
that
crummy
wouldn't
C:
T:
C:
T:
Why
C:
T:
C:
(long silence)
T:
As long
C:
Anxious.
Must they
No.
T:
C:
T:
C:
T:
C:
T:
like
can't stand
can't
scientist
teacher.
would do what?
it.
you stand
prove
as
make you
upset.
it.
it
(grinning).
you believe
all like
think
that must,
how
will
you
feel?
you?
get?
Where
will that
command
get
you?
Scurrying around
Right! Anxious, depressed. Now suppose you get it they all adore
you. You know you'll still be in trouble? (pause) How do you know
you'll get it the next time? Aren't you asking, demanding for
guaranteed adoration?
C:
Hmmmm.
T:
Yes.
How
24
C:
T:
Practitioner's
Guide
Ye-s-s-s-s-s (tentatively)
T:
See
how
How
"Goddamn it! I'm determined not to put mynever do many things well!" Rating yourself as
stronger? (models):
self
down even
OK is
if I
wrong.
2. Therapist Strategies:
The
RET
Work
Beginning the
Dos
with a Client
Basic
new
clients before
to previous therapists.
beginning therapy
One
benefit
is
is
that the
A positive expec-
client's expectations
what
is
It is
during the
first
is
best given
some
major problem(s).
Patients often view therapy as "pouring your heart out" to the
some
relief in the
manner
of a confession,
it is
may
provide
the patients will not have taken the important step of understanding that
therapy
T:
is
like
will be taken.
be showing you how you can control many bad feelings and
emotions. I'll be doing that by pointing out some of your misper-
I'll
26
Practitioner's
Guide
world,
correcting
As
is
that
a rule of
it
may
thumb,
don't do something that a previous therapist has already tried unsuccessfully, or, at least, present
it
"What
differently.
it, it
client,
change
its label.
So, be sure to
did
number
like to
may
"What problem
like to
such-and-such
some
first session, to
RET
help
terms: to uncover
27
Therapist Strategies
initial sessions
many
follow.
and
field,
his
therapists
how-
incorrect,
nor
may
yet
it
always be
effective styles.
The
is
own
if
first
this experience, to
coming
new
into
your most
difficult or
embarrassing problems.
be
feel-
ing just then, and would that emotion be compatible with open discussion
Self-disclosure
is
prerequisite
psychotherapy,
for
yet
do
In
it.
many
families there
is little
talk of
may
not
is
self-
consid-
Clients
may,
know how
to
late adolescence,
when
Psychotherapists frequently
expectations for self-disclosure.
fail
Some
Failure to self-disclose
may
may
that
hypotheses
specifically, that
by
we
suggest
to consider multiple
problems in self-disclosure
have quite
be viewed by some
may
also be a
fear.
if
the therapist
is
too
28
Practitioner's
Relax.
It is
Guide
some time
to get to
know
the client
and sample his or her thinking. The patient is more likely to discuss
personal problems if he or she believes that the therapist is truly interested in listening. So, for the new RET practitioner who has had only
the model of Dr. Ellis to follow, a warning: sometimes it is better to slow
down and
let
As an
active-directive therapist,
impotent
if
own
cognitive structure.
may
repeatedly
when time
charged issue. With patience, encouragement, and gentle confrontation, the client will usually shorten these hesitancy delays across ses-
sions.
29
Therapist Strategies
clients
know
that he or she
is
aware of the
clients'
positive feelings
T:
sounds
be awful
It
When
like
if
you
did
it
would
fail.
both the thought and the emotion are reflected, the client has an
and appear amazed that the therapist has "read their mind."
Respect. Respect
2.
evident
is
for the
The
respect.
if
clients, separate
you
foster
much
client
and apart
a respectful therapist,
Instead,
decisions, even
As
when
worth of the
make
their
own
independence,
and
self-confidence,
self-
reliance.
The RET
therapist
shows
clients that
Thus, the
RET
Warmth. Warmth
3.
is
and behaviors.
communicated
between the
to the client
clients
and
by appropriate
well as
intervention, by recall of personal details about the client and his or her
roles.
Make your
Your be-
30
Practitioner's
Guide
work on the
patient's problems.
Attention to detail
how)
cific
is
evident; the
client
through
comprehensive examination
of these situations.
The RET
on concrete details
and emotions. Do not encour-
age the client to supply details only about external circumstances (A),
when
fists
clenched!" Or:
(1969)
has
outlined
various
levels
of
jail?"
confrontation
The RET
most
assumptions:
(a)
there
is
no
is
based on a
number
of theoretical
by confronting
(c)
RET
to be overprotected.
good
31
Therapist Strategies
working relationship be established before confrontations
at the top of
Three additional
disclosure brings
expose their
own
human
humor, and an
some years
went through the same thing, and here's how I dealt with it." The
therapist model, in such instances, may provide hope since the therapist
is suggesting that he or she has known a similar problem and successfully grappled with it. Thus, the therapist can model rationality, demonstrating appropriate thinking and behavior in dealing with a specific
problem. In addition, the therapist is modeling self-disclosure itself, and
ago
As
matter of
fact,
one-way
is
useful, however,
only
Keep
ily
mind,
in
is
primar-
strategies.
In addition,
RET
and
utilize a
more
realistic perspective.
RET may
be instructive:
T:
As
Ellis
grim
"A
sense of humor, in
itself,
32
Practitioner's
Many therapists
ible
Guide
we
is
and
directive
disagree.
is
incompat-
Remember
that the
be,
al-
when
Ellis.
As
directive as
he
is,
members
the group
When
by
his
many
members
fre-
ques-
them some-
special
problem
in the
in
working
with children and adolescents. These clients are usually not self-referred
and have often been dragged into therapy by their parents. Children are
not aware of the role of a psychologist, and sometimes do not even
understand why they are seeing one. While the pace of therapy may be
slower with children, the same directive, honest approach is recommended.
The
groups
first
is
to provide the
professional's role.
Many
you
are a doctor,
or do the kinds
'
deeds.
comments:
Johnny, I'm
No
a psychologist.
that is?
Well, that's not totally true. Psychologists are doctors who study
how people learn things and who help people learn things they have
33
Therapist Strategies
been unable to learn. For example, some people have trouble learning to read and some psychologists help them learn to read better.
Other children are anxious or depressed and haven't learned not to
be. Psychologists help them learn not to be depressed. We help
children with other problems like fears, anger, bed-wetting, and
making friends. Do you understand?
C:
Yes.
T:
Note
that,
first,
help
problem-solving tone
is
you with?
a friend
The
who
is
child
is
is
set,
and while
of rational-emotive therapy,
is
much
of the information
is
use-
itiating
therapy
threatened by so
material
is
If
is
uneasy about
exposing their real problems, they are just as likely to hide them during
an extensive assessment as
be served by
having the therapist work efficiently on an issue that they are willing to
discuss, while transmitting
nonjudgmental acceptance
in the
hope that
whom
work
of therapy.
cated about
RET
theory.
34
Practitioner's
Since
RET is
some
assess
Guide
a cognitive therapy,
the cognitive
of
it is
is
recommended
adults,
however, in which
may
more formalized
formal
for
testing
may
be helpful in
have
a neurological basis
which
may
may
may
skill
as well.
This neuro-
work and
might be wise for the RET therapist to
keep in mind that George Gershwin spent years in psychoanalysis for
the treatment of headaches and died of a brain hemorrhage.
Good diagnosis is the first step in good treatment. In RET, the
major diagnosis focuses on identifying the dysfunctional belief systems
which produce uncomfortable emotions, but diagnoses of other problems
logical base
It
by amassing
up
From
the
first
life.
functioning
Some
of this
may
ABC
In addition to doing an
system
to
do
(as
work
is
RET
example,
therapist
may
if
the patient
is
requesting help
and request that the patient keep data on the following: where and
ate, what he ate, his mood when eating, his thoughts when
eating, and the immediate consequences (internal and environmental) of
tions
when he
eating.
The
role played
by
may also
be important: does the obese patient's wife encourage him to eat second
helpings?
What
What would
it
mean
to her
if
What
kind of information
is
example:
How many
is
Where
is
she not
35
Therapist Strategies
How far can she go? What happens to her when she tries
Who buys her clothes? Who buys the groceries? What if a
willing to go?
to go out?
tries to
Goals of Therapy
Within the
first
RET
made with
mine when and if therapeutic progress is made. In fact, frequent reassessment of these agreed-upon goals encourages not only therapist responsibility but client involvement and commitment to the process.
A verbal commitment to goals also enables the therapist to refer
back to them when the client is "goofing." For example:
T:
By not doing X,
you
aren't
out to achieve?
set
or
T:
How
if
you don't
Most
The
therapist
have, but to
may
which implies
what he wants to change.
work on
all
may
may want
up, and
recommend
that
you
establish
weekly treatment-plan
goals.
we
also
At the end
36
Practitioner's
Guide
you can review each of the problem areas listed, determine what the next step will be in working on the problem, remind
yourself to check up on the progress of older problems, and outline the
goals for the subsequent session. The use of formal treatment plans is
taken up in greater detail in Chapter 12.
of each session,
Getting at the
Identifying the
When
can think of
it
first
(3)
what happened,
how
(2)
how
A, the Activat-
ing Event; the latter relates to the client's belief system. For example,
at
patient
is
confusing
all
three elements.
The
critical
issue of
if
pened involves an objective description of what was said and the tone and
manner
in
which
it
was
said.
a criticism
may
be a
is
an
evaluative issue.
We
are
making
and perceived
a distinction, therefore,
between objective
reality
it and
presumably believe it to be. Confirmable reality refers to a social
consensus of what has happened. If it were possible for many observers
to have witnessed the same event, and they all described it the same
way, we would have obtained confirmable reality. In our example above,
if a group of people had heard the exact words and the manner in which
they were said to our client, and a high percentage of the onlookers
perceived the event as an insult, we would conclude that in confirmable
reality our client had indeed been insulted.
A further distinction we are making is between two types of cogni-
as they
tions.
The perceived
about
38
Practitioner's
Guide
in the world.
To avoid confusion,
commonly used
is
in
our
Here we
tions.
cognitions, that
is,
rational
the client.
In effect, therefore, the
ABC
model
of
RET
point as follows:
(confirmable)
as
it
of observers
A(perceived)
what
tive description of
happened; that
is,
their subjec-
it
the
evaluation
what they perceived
the emotional and behavioral consequence
of
clients'
may
cause nobody in his office likes him. Further questioning reveals that
co-workers interact primarily about business matters, that they infrequently chat or invite him to lunch, and
when they
do, he refuses.
Thus:
A(confirmable)
A(perceived)
me
B:
"It's terrible
C:
Depression
/
this point
is
new RET
practitioner to understand at
example above,
them, yet not
upset themselves about that perception. How would they do so? By
choosing not to evaluate the A as something terrible. Thus, if at B they
in itself cause upsetting emotional reactions.
no one
In the
believed that not being liked was merely unfortunate or perhaps (less
probably) that not being in the social circle had certain advantages, they
Getting at the
39
could, at C, feel quite differently about the situation. Thus, although the
perception of
the client
who
is
merely
is
irrational at B.
more
who
awful.
The
first client
has
who
misperceives the
likely to be upset
who
and
than the
thinks that
who
does not
make
more cues
thinking.
The
client
reality at
A,
theory, can
above.
If
who
who
continues to distort
the client
now
believes that
it's
still
experience a
A does
have an
effect
on the C,
albeit
distortions
is
we encourage you,
and B. Ex-
"I only
call
that success?
How
can
"I
had
It
makes me
feel so
What
cognitions
and
if
both types of
irrational
evaluative
40
Practitioner's
Guide
Two
determine
how
others feel
As you can
therapy
assumption
see, Beck's
accomplished by
is
first
is
that the
work
of cognitive
Ellis
He
considers
it
inelegant
because this strategy does not provide the patient with a coping tech-
nique to deal with his distress should reality ever match or approach his
distorted version of
it.
may
it is
entirely
ronment
in
such a fate
if
be even easier.
Which
is
the better
way
to proceed?
since the crucial experiments have not been done. In addition, the question itself
is
Ellis
as
an
initial
for
an elegant solution
is
life,
the
Getting at the
situation for the patient
41
Consequently, we recommend
challenge
Clarifying the
way
come
to therapy because
Communicating
sympathetic
this focus
may
will
is
unnecessary,
it is
who
their past. Historical A's can never be changed, of course; only the
client's evaluations of
them
The
is
problem
for
many
patients; they
T:
C:
being
all
And
after
didn't!
He
me
42
The
Practitioner's
he
Guide
is
upsetting
most
himself.
much
crucial
One
from the
detail
one and
strategy
is
The
client.
really the
utilizing
patient's
about which
more appropriate
as in the following
example:
Well, Joe, what were you upset about this week?
Well, Doctor, let me tell you exactly what happened. It all started
Saturday morning. I went over to visit my wife and children. I got
T:
C:
hug
my
kids
me
T:
with a big
Is
C:
T:
often give
me
me
tell
me
me
to you.
You
exactly
But if I don't tell you what happened, how will you understand?
We'll go back and get the details later, but for now, just try to stick
to the question: exactly what happened just before you got upset?
C:
T:
own
is
to train
them
to
T:
Joe,
Note the manner in which the therapist allows the client to review
report and learn to succinctly extract the relevant information.
the client has mistaken the forest for the trees and is unable to sum-
his
If
stories
own
T:
Joe,
it
may
sounds to
tried to change,
Getting at the
VAGUENESS
IN
43
REPORTING THE A
who have
difficulties
in presenting the
lowing:
1.
reactions
2.
3.
4.
Style.
to verbalize.
Difficulty in locating an
physiological
or
insist that
nothing
may
wrong
is
is
not
uncommon
disorders,
hysterical
and
(2)
who have
in her life.
Now, RET
in patients
(1)
as a cognitive-change
it is
accept-
The second
goal
may
even better or
the therapist
may
how
first is to
ask the
more
self-actualized. Second,
skills
and
to
problem identification
entails getting
may
be asked to
a ledger in
usually unfold.
44
Guide
Practitioner's
When
what do
made
would do well
communicate
to
The use
is
like
to
have.
RET
The RET
therapist's
view
is
of pinpointing questions
is
example,
by gently
logbooks
Another
may
difficult
insisting, "Yes,
you do."
If this
again be useful.
statement occurs
is
meaningless."
re-
therapeutic clarification
may
is
reveal a
more
What is
What might happen then? Perhaps Marie fears she might faint. What
might happen then? People on the train might look askance or disapprove of her. Thus, in this example, the patient's basic fear is of disapin.
Getting at the
45
who
does not do so at
all.
of identifying
is
has been depressed for weeks but has no idea why. Patients faced with
selves.
When
may
1.
down
2.
Pin
3.
Ask
4.
Avoid abstractions.
5.
6.
7.
Keep on
TOO MANY
Many
A'S
patients
come
The
initial
problems and
therapeutic focus
wide array
is
on
select-
may
list
problem areas, and the starting choice may be offered to the patient.
Alternatively, therapists may wish to make the choice. They may, for
example, wish to select a small problem with minor affective consequences because (1) they think they can best teach the RET principles in
a less complicated area, (2)
very few sessions so that their credibility and the patient's enthusiasm
will bolster further success, or (3)
of the others.
46
Practitioner's
Guide
Sam, who
a client,
is
is
like. It
he
is
may
ties
would be very
difficult to
is
anxious about
mother as
work on his
fre-
fear
is
if
he
help
may
him
encounter in meeting
him
go through the
to
(3)
help
difficul-
him
to put
up with his mother. Overcoming the LFT would, in effect, help overcome all three problems and would therefore be the target belief to work
on first.
Is it wise to allow the client to bring up new problem areas before
some resolution of old ones has been achieved? Usually, yes, since the
patients typically spend only one hour a week in therapy and 167 hours
in their normal environment. New problems and crises are bound to
arise,
agenda
As
a caveat,
may
new
topics
would
up over
number
If
In
some
problems or
new
may
note a
common theme
in the
new
wedge
woman who
failing.
to
do
well at a job interview because she believed she didn't deserve the job.
was good
it
mon theme
in
all
if
Getting at the
was not good enough
to reap
47
any
of these rewards.
members
after a
theme and
The
recalled
patient replied
how
Her
the other
sister died
very painful car accident, her mother died after a bout with breast
and her father after a sudden heart attack. Only she had remained
and apparently believed that it was only right, proper, and
moral for her to suffer equally.
cancer,
alive
A'S
Clients'
problem
practical
a
One component
practical
is
is
is
the
If
the
it
and
a specialist in the
is in dealing with cognitions, emoand behaviors, they would do well to refocus the discussion back
onto this area. Below is a suggestion for how this refocusing may be
tions,
approached:
"Look, Mary, you know that the information that you're givis outside my area of professional competency. I can't advise
you about medical matters. You obviously have some pretty strong
emotions about these issues, however. Why don't we talk about
how you're feeling about the medical problems?"
ing
me
C BECOMING
One
of the
AN A
tom
(e.g.,
analysis.
symptom
stress. In other
depression) becomes a
new
therapist
and
itself
is
requires an
its
RET
focus on these
48
Practitioner's
Guide
The
cycle of events
AOriginal symptom
B
(e.g.,
depression)
it
Further anxiety,
The
patient can
example, patients
guilt, or depression.
beliefs:
stop.
may become
Similarly, patients
problem which is particularly prominent in agoraphobia (Goldstein and Chambless, 1978). These clients appear to focus on the
physiological symptoms of anxiety and believe that they are signs of
impending death, doom, or unbearable discomfort:
iety, a
"I'm
of
is
know
feel the
Ellis
iety, to distinguish
crazy,
terrified of panic.
anxiety come,
the most
it
common example
of such a problem.
fear of going
Some
estimates
its
(Raimey, 1975). Clients with this problem anticipate losing conminds, such that they will become raging homicidal maRaimey has identified symptoms which phrenophobics believe
practice
trol of their
niacs.
Any
errors in reasoning or
Inability to concentrate
memory
Getting at the
49
Irritability
Insomnia
commonly
Patients
ties as well.
may
suffer equally
Primary focus on
portant
when
this
it
up" but
can't get
secondary problem
it
may
be particularly im-
may
symptoms such
may
as
overlay or secondary
symptom
depressive episodes.
is
a neurotic
to help
The same
principle
is
true, of
Sam, the
bad enough, he
weight
is
liable to
loss.
Once
a second-level stress
and the
client
is
is
RET
therapy
assisted in disputing
them.
ON CHANGING THE A
fall into two main classes: those
and those that cannot. To paraphrase the motto
50
Practitioner's
Generally,
first.
it is
Guide
A may make
more
useful accomplishment
when one
may
is
is
always
be learning not to be
Ellis is
and whether we
like it or not, new and unpleasant Activating events will always appear
on our horizons.
Additionally, RET therapists work under the basic assumption that
when Activating events can be changed, doing so will require patients to
fond of pointing out, "life"
is
skills.
They
will
Getting at the
Why do patients come to therapy? Usually because they are feeling bad;
they are in emotional distress. The therapist will not want to lose sight
of this focus. Patients usually don't just
selves of irrationalities.
typically brings
Many RET
their
them
It
is
come
in to talk or to rid
them-
fact,
it is
not unusual
may
by saying,
If
like to discuss?"
is
how do you
feel
about that?"
More
experienced therapists
may
be able to use a
clinical
hunch
about the patient's emotional state and phrase the question in another
way, such
may
as,
may
conclude that
We advise against
telling
your clients how they feel, however. Phrase your comment as a question
and be prepared to change your mind when you have sufficient data that
your hunch is wrong.
The more experienced therapist will also learn to recognize that
certain emotional states are frequently associated with specific clinical
problems. For example, avoiding certain situations usually indicates anxiety, assaultive or verbally
means depression,
self-injurious or self-
52
Practitioner's
Guide
is
likely to lead to
grief.
ways
from the
sequences
common
to
by understanding
situations,
life
and
(1)
by using cues
(3)
by deduction from
RET
all
Thus, while
when
it is
the sadness
is
it
then becomes a
A common
accurately
problem
identify
the
in the
C.
is
the failure to
because
arises
or because
the therapists assume that they and/or the client intuitively understand
what the C
is.
trouble-shoot
some
if
(cf.,
may
guilt; patients
a negative
be
emotion
p. 47).
Getting at the
53
may
be unwilling to acknowl-
somewhat more
subtle
example was seen in the case of the wife of a devoted rabbinical scholar.
She often felt compelled to interrupt his studies to remind him of his
responsibilities to his parishioners, such as visiting the sick or bereaved.
He would do
as she suggested
his
emotion.
What might
face the
1.
emotion?
Try
One
a Gestalt or
psychodrama
might be useful:
empty
chair
technique. For example, the rabbi's wife might be asked to imagine her
at the situation, or
therapist
may
may
54
Practitioner's
may
thesia
Guide
weak, and
is
is
that
emotion
all
is
want
to
communicate in this
it exists. Emotion
it
to
a
an external event,
person
is
saying to
A
which
therapist
may
mood"
homework assignment,
down all the different "I
the
feel
They can
ments of
As
" or "I'm in a
make
may
also
make use
state-
of the three
LITTLE
The
OR NO AFFECT
therapist
may
IN
want
two
to check out
1.
may
Clients
THE SESSION
is
may
solemn occasion requiring hard work and a nowill want to disabuse the client of such a
notion by direct suggestion, modeling, and use of creative strategies to
elicit more affect (e.g., encouraging disagreement with the therapist,
asking patients to pantomine their problems or express them in song or
therapy, that
it
is
poetry format).
2.
The
therapist's behavior
may
may
be fostering
little affect.
For exam-
ended questions, moving too fast and confusing the client, and so forth.
Listen to your tapes with such a client and evaluate your own remarks
minimal affect. Try to encourage verbal expresby asking simple, open-ended questions (e.g., "And then what?").
FLAT
The
patient
may
dead"
is
common
an emotional anes-
expression) or
may show
in-
Getting at the
appropriate affect
that
is,
55
an emotion that
is
may
alone
states.
RET
You can
making an appropriate
help most by
tion (Ellis
PAINFUL EMOTION
Patients
may
tion; the
problem
may
The
patient
is,
after
may
all,
avoid discussing
life
situations
which are
The problem
tolerance, in
turmoil
is
for
it
would be helpful
it
is
normal
to
can figura-
others see
own
T:
C:
T:
C:
T:
C:
if
job of the
emotions, for
in
ABC
analysis of
it.
For example:
(crying)
Well, what's the worst thing you could imagine happening? If you
lost control, would you run amok through the halls? Would you
not be able to function at all?
(smiling) No-o-o. I guess I just wouldn't want them to think I was
upset.
56
Practitioner's
And
Guide
they did
Ummmm.
upset?
still
CONFUSION OF
AND C
may
times you
respond with a
belief.
may
"When
say,
she said
felt
dumb." At other
times,
anxious."
difficulty that
new
therapists
may
dis-
is
may
have
many
1.
It
2.
It
different
may
may
meanings
everyday speech:
in
an opinion
should be low-
ered").
The
3.
It
4.
It
may
may
refer to
refer to
meaning
of "feel"
and
between their
beliefs
and emotional
B
if
as a feeling,
Tom
(1)
it is
felt
which
will
often useful to
C's,
dumb,"
Tom, "How
(2)
"dumb"
dumb."
is
In fact,
Tom's statement
"I felt
dumb"
is
am
Getting at the
"I believe that I'm
to
make
57
dumb and
this distinction
feel
"dumb"
It is
may wrongly
important
attempt to
is
dumb
because of this so-called feeling. Feelings are not open to dispute; they
data.
beliefs,
The
stage
is
now
set for
working on
is
dumb and
that he
must not
be.
DESCRIPTIVE DEFICITS
When
asked
how
is
is
she
is
feeling,
"down," the
word "depression."
it.
Again,
may
if
more
easily she
as feeling
therapist
the
may want
to take
emotions may be suggested (e.g., "Did you feel good or bad?"), after
which more descriptive terms may be suggested and discussed. Some of
the following exercises
may
assignments:
1.
of
some emotions or
feelings:
homework
58
Guide
Practitioner's
nervous
relaxed
sad
disappointed
hurt
curious
frustrated
guilty
anxious
to yourself; say
it
out loud.
no right way
is
feelings
to
do
as
you
you
different
it!)
many ways
that
of?
If
so, write
" in as
feel
can.
At
first, just
write
the statements. Later, begin to add "When such and such hap" For example, "I felt anxious when I
pened, I felt
started writing this diary."
DICHOTOMOUS THINKING
Many
continuum
if
way they
nothing happened. In
of intensity,
and
is
it
is
fact,
range of emotions to
if
feel
and
client
range of
in his
marriage and has only been able to feel rage and to express it by beating
his wife, he may not have the concept of annoyance or the skills to
it.
Getting at the
she
may
59
present a group of
It
which are
may
also occur
on dimensions
how
goal-directed behaviors.
MISLABELING EMOTIONS
a good rule of
would be wise to
ask routinely for some explanation or expansion of the patient's emotional label (e.g., "What do you mean by guilty/anxious/bothered/
etc.?") and, if the client seems to be in error, point it out (e.g., "Sam, it
sounds more like you're angry than anxious").
An interesting form of this error is seen in patients who mislabel
their problem as ego-anxiety, when it may really be low frustration
tolerance or discomfort anxiety (Ellis, 1978a, 1979c). For example, Gary
may claim that he can't go to work because he is too anxious. What this
thumb
The
it is
therapist
statement boils down to is that he is not willing to experience the discomfort of going to work and has, perhaps, sanctified his avoidance of
discomfort by labeling it as a "serious emotional problem." Obviously,
60
we
Guide
Practitioner's
advise the therapist to also attend to material and social gains which
may
may
May
may be
unclear to
says, "I
but
is
who
some
(1) is
problems
may want
come
to therapy
emergence of
no emotional distress is apparent, confrontation might be recommended. One or more of the above explanations may be discussed with
tive affect. If despite the therapist's patience for allowing
affect,
may
be
set.
may
Getting at the
instance.
The
client
no anxiety over
felt
it.
were
that
61
T:
Jerry,
C:
T:
if
so,
much
if
you
stay
at all,
away from
Do you
that test,
you avoid
something is blocking
you from getting too close, and that something is your anxiety?
Now what do you think would happen if you took the test and
experiencing
anxiety.
see that
failed?
Wow!
C:
That's
ried about.
it.
One client,
is
called for in
was concerned about the fact that she was dating only married
men; she denied any particular negative emotion and stated that she was
simply more attracted to married men. The therapist guided her through
that she
a fantasy in
a date
with an attractive
man who suddenly announced that he was single and, in fact, found her
to be the only desirable woman he'd ever met. In another case, an obese
client fantasized
clients to get in
men
blocked.
A
no
specific
He complained of
and no matter how much sleep he
truly rested. Medical evaluation revealed no physiologfatigue. Extensive questioning revealed that he had a
he never
felt
demanding yet
events. In
all
all
of the time,
respects,
life,"
athletic
yet on
havior,
we assumed
that
some
of
his
62
Practitioner's
Guide
avoidance behavior. The client was asked to fantasize a typical day in his
much
to his
own
surprise,
an irrational notion of
self-
worth based on accomplishing all that he thought he should do; thus, the
underlying emotion of guilt was successfully avoided by maintaining an
extremely active life.
A similar problem is often encountered with clients who report an
inability to control addictive behaviors such as drug abuse, smoking,
drinking, and overeating. They may not acknowledge any emotional
problems which increase the frequency of their addictive behaviors,
may
ask
guilt over
them
to
al-
clients,
sitting in front of
Consequence,
jitteriness.
This emotional
what they desire, may have remained out of their awareness since they
were so successful at avoiding the unpleasant feeling by quickly devouring that which they desired. Such an imagery exercise may help clients
get in touch with their C's.
EMOTION
IN
THE SESSION
Whether or not
want
When you
analysis. Don't
may
and so forth
may
be
be dealt with.
of avoiding
expressed in the session. Therapy does not always have to deal with
problems of past or recent history. For example:
T:
I notice that your eyes are starting to swell up and you look
you're ready to burst into tears.
Sally,
as
if
Getting at the
C:
Oh, you're
you
63
right! (Sobs)
now.
wonder
T:
Sally,
C:
if
My
you could
tell
what
have nothing to
live
for.
T:
why don't we talk about that now rather than the other
problems you had brought up for as long as you're believing that,
you're going to feel upset and cry.
Well,
Once
clients
Do
emotion? For example, they have the right to keep or give up their
Anger, after
moves people
sively often
may
all,
has
to give
its
may
be an interesting topic
On
the other
many ways
young mother.
when she yelled
In
at
her son about his messy room, he quickly tidied up. The anger display
also appeared to be intrinsically reinforcing; after she
tantrum, she
felt a
temper
aftereffects of exercise.
addition, the
had
Quite simply,
woman was
it felt
providing her
own
In
her abreactive display (e.g., "I did the right thing by getting angry!").
woman
consider the
son;
(3)
there were
righteousness.
more
helpful
64
A
which
Practitioner's
more
Guide
may
a debilitating
emotion
is
also
sometimes be operating,
in
mother who
lost
and prolonged depression, which the patient seemed unwilling to surrender. What would it mean to this woman to give up grieving? Apparently she believed that it would prove her to be an uncaring and uncommitted mother, a concept which induced an even more intense feeling of
guilt. Once this irrational belief was successfully disputed, however, the
patient
was able
work
at relieving
her
depression.
Patients
may,
at least
RET work of
"That's the way
do the hard
either (1)
may
am, and
me
can't
to be upset."
may
change" or
Once
them
hunch
that
"Is
it
more
identified, either of
be saying
(2) "It's
to test their
it's
easier to be
upset?"
The point
the patient
be able to
is
to keep in
mind
is
that there
some
may
of
be
many
reasons
why
Teaching Transcript
periencing a
is
who
describes ex-
number
goals.
We
highly
recommend
the use of these informal ratings, for they allow the patient as well as the
therapist to be
Getting at the
65
Transcript segment
Mary,
and
you were
T:
Your
C:
depressed and suicidal, and she was very concerned about you. How
are you feeling today?
The reason I had originally felt
I have very confused moments.
wife,
suicidal
because
don't even
know
accomplished
called
if I
said
know how
really
wanted
feeling particularly
commit
suicide
had,
would have
it.
T:
C:
It
to
do
answered the
therapist's question.
it?
was
T:
C:
Exactly. That's
T:
T:
C:
or thirty?
how
felt.
suicide attempts?
to
commit
suicide?
You never
a plan to
said:
commit
had thought
"I'm going to do
it
by
slicing
my
throat, or
jump-
pity
I'd
I'd
66
Guide
Practitioner's
after he
Extremely anxious.
Anxious?
Yes.
who
you're anxious?
Notice that the therapist
is
working from
C:
T:
C:
T:
C:
T:
C:
a conceptual
schema and
it.
My
started to
brought
to
situation.
it
my
attention.
How
T:
C:
Only when
T:
When
T:
C:
they're
know
How
frequently does
that happen?
The therapist
C:
Well, they're supposed to come in twice a year. This year it's been
only once and they'll be coming in in three weeks. It's starting to
build
the anxiety's started.
T:
come
closer
If
you had
Getting at the
67
to rate
relaxed, lying
The therapist
is
using the
SUDS
distress.
C:
T:
C:
T:
C:
will deal
T:
C:
a little
sadness
to feel
T:
is
when
see
Note that the therapist hypothesizes that one C has become another A;
he asks for feedback about this hypothesis.
C:
Right.
T:
Which one
C:
of the problems
do you think
is
more important,
then,
C:
T:
Let
T:
four-year period.
me
ask
you
this:
C:
Yes.
T:
ment
The attempt.
C:
to
the suicide
many
let's call it
is,
like
mo-
anything
68
T:
Practitioner's
Guide
have to do I have to work very hard at; nothing comes too easily for
me.
Even killing yourself! You can't even do that well, right?
Note the
therapist's attempt at
well
it is
received by the
client.
C:
could have
if I
my problems.
really
But
T:
Can we
stop?
C:
Yes.
T:
When you
C:
No.
Does
T:
think about your children and you feel the sadness when
they come, does it also remind you of the sadness you felt at that
particular time?
it
The therapist
C:
agree with me that when you think about your children comyou remember the vulnerability you had. Now is it vulnerabiltoward the children or vulnerability of being deserted by your
You
ing,
ity
wife
is
in the client's
remark,
No. Just the sadness that it's just a temporary thing I have with my
kids and I feel myself becoming distant on both sides. Their dis-
Getting at the
my
tance and
distance.
69
such
It's
we
see each
other.
is
that
you don't
see
your children
a lot.
Right.
me stop and redefine your words. You said that you feel sad. I
to 100 to
agree that you do, but again, if you used a system of
describe how sad you were, how many points would that be? Zero
Let
What do you
hopeless.
Well,
let's
bring a
little
and 100
life is
is
utterly
feel?
guilt in there
just
The therapist
is
finishing the
the session.
T:
think any
did
man would
children the
are.
way you
as debilitated as
you
You're going to feel sad about not having your children ... at
I hope so. You're not going to be cold-hearted, and I don't
think I could help you to be that way; even if I could, I don't think
I'd want to. But the point is, your problem isn't sadness
it's
depression. You're really depressed about this. And I think it's
important that maybe we use different words, rather than just sad.
of.
least
Now, what
is
The therapist has discriminated and helped the patient correctly label
his
emotions. Not only the high SUDS level, but the guilt and selfdenigration and the suicide attempt, are clues that his problem is
depression, not merely sadness.
C:
area
Whatever
70
Guide
Practitioner's
means because
felt this
T:
C:
T:
And
children?
C:
Exactly.
T:
This
is
C:
No.
You're
T:
C:
aware of
it
it.
Because what
started to
say before and I want to get that part out of me, what brought on
this attempted suicide was my lack of confidence in living
and also
friends.
T:
You
C:
Exactly.
C:
you don't
trust
women?
T:
the
Maybe,
after this
right job.
not his penis she's after, or his mind just his money?
Yeah. But in the meantime, my mind has really had it. So I told
Mary how I felt and that weekend became a disaster weekend. I
couldn't cope with the fact that my wife would go to bed with
another man at any price.
It's
Getting at the
T:
It
71
RET
you the most is something that is right now. That is, you are afraid
that your wife will leave. And any slight indication that that might
come true really leads to an awful amount of anxiety. And it appears that when you think about your children, possibly you think
about your wife having left you suddenly, and if it could happen
then, well
Even though this was a first session, the client had been introduced to
RET through books he had read. Note that the therapist summarizes the complexity of the client's problems and is hypothesizing that the client believes that he caused his former problems and
may
Belief
Ellis
1979b) has called the Rational Beliefs (RB's) and the Irrational Beliefs
(IB's).
descriptions or predictions of
it.
"What
(e.g.,
it
a catastrophe!
How
if
rational:
"How
unfortunate";
irra-
An
important task
in
they will be asked to challenge their irrational notions and replace them
my
wife
1.
left
rational belief
is
true.
criterion.
The
belief
is
it
verifiable.
realities.
It
is
Thus, a
it is
empirically
logical,
lose
would
many
2.
result
from the
we
Presumably he would
pleasant things.
rational belief
relativistic.
is
rational belief
is
it is
conditional or
73
philosophy.
Can you
it if
my
how
see
demand? The
client
feelings
to
misconception about
RET is
it would be quite a stretch of the imaginaassume that a zero level of emotional concern would be helpful or
rational. Moderate emotional arousal serves as a motivator to problem
may
if it
can be changed),
be a hindrance to this
skill.
Returning to our example above, when the client thinks about his wife
leaving him, he probably feels sad but not clinically depressed.
4.
minimizing
conflict
you
attain
living,
minimizing intrapsychic
More
a vital
conflict,
affiliation
and
absorption in
in-
some
if
he
is
his wife
Irrational beliefs,
if
behavior
may
An
irrational belief
is
not true.
It
it
tions;
it is
it
"terrible,"
or
couldn't bear
"horrible."
it if
my wife
left
me." Such
statement obviously
is
not a
reflection of reality.
2.
An
irrational belief
is
command. As
such,
it
represents an
74
Practitioner's
Guide
mands
and
is
expressed as de-
wants). Irrational beliefs are often overlearned since childhood and are
Major Musts:
You must:
me
(treat
etc.)
me,
well, love
self,
etc.)
me what I want
me
fairly, etc.)
The
(a) it's
We
awful,
(b)
can't bear
occasionally even
tradictory
money
musts
it,
manage
and
(c)
form somewhat
for example,
demanding
to
make
great deal of
"Since
my wife
"Since
can't bear
it if
iety
can't bear
my wife leaves
it if
If
you
on
step
saying,
in these statements?
like:
life
most
or anxa client
it
awful
likely experience
one of the two nonhelpful emotional extremes, apathy or anxiety. Appropriate concern, however, would be generated by a more rational
thought, sucTi as: "It matters, and I'm going to work on functioning
better, but in the meantime, it's not awful or the end of the world that
I'm functioning poorly."
one
is
An
tied
up
in absolutes
happy
life if
he
is
75
continually worried about his wife leaving
him.
we look for the should and look for the must. Although these key
words may indeed be clues to a demanding philosophy, they are often
used innocuously. A common error made by new RET therapists is
assuming that all utterances of words such as "should," "ought,"
"must," or "have to" represent a demand concept. These words have
many meanings in our language, one of which is predictive. The senliefs,
"You should
sentence
means
have."
"I expect
it
second meaning
is
advisory
as in the
movie and I
which reflects an "if-then" proposition. "I should have the vac-
liked the
tional,
uum
repaired" probably
means
should
moral imperative implying that an event must occur. Each of the examples above could have absolutistic meanings, and the therapist can make
,
and
it
As
therapist
who
may
a caveat,
it
would be wise
for the
("I
may
should not
ideas,
this
as
why
we have
do we do
tendency
is
pointed out,
so?
it
is
play. First,
certainly reinforced
in
country-western and rock songs expressed irrational philosophies (Protinsky and Popp, 1978). Second, there
thrill
achieved
when we
are irrational.
may
be a kind of self-reinforcing
Think
of the
tearful
76
Practitioner's
As an
how
An-
exercise,
many you
Guide
wish
had succeeded
X;
at
it
a lot
easier.
What
shame
Damn,
What
wish
it
get so uncomfortable
certainly
If
you want
is
well.
weren't raining!
a disappointment
It
work out
annoying to
at
far.
me.
hard.
a bother.
make
who
didn't get
course,
may
stated
by
irrationally
Strange as
Ellis
some
it
may
(1976),
seem,
it
it is
the
human
condition.
Such
may
be
THE MAJOR
Ellis
however,
because
who
in our envi-
irrational,
beliefs.
IB'S
is
client.
significant job of
77
classes.
aid in training
your
we have
ear,
its
We
rational counterpart.
we
is
embedded.
include an illustra-
encourage you to
test
your under-
my
and
life,
if
I'm not,
it's
by every
of
significant person in
awful.
Nobody
likes
me.
I'd
be a fool
if
it if
he were
would do anything
at
me!
did that.
therapy.
mad
is
among
Ellis
and
it
may
A woman
without
a partner
Janet
engage in
many
women
self-defeating behaviors.
As
assertively ask
what they want, or may passively go along with what they don't
want in sex-love relationships for fear that if they speak up, their partner
might think them inadequate and reject them.
(RB: It would be desirable and productive to concentrate on selfrespect, on winning approval for practical purposes, and on loving infor
When
He
My
your
fault.
trouble.
fair.
Then
wouldn't be in
this
78
Practitioner's
Guide
She's no good.
You male
chauvinist pig!
He's stupid.
He
deserved
it.
him
pay.
I'll
Of
irrational,
we do
mean
not
irrational or ineffective.
imposing penalties can be an important way to influence others' behaviors, we do not believe that any human being morally deserves
punishment. The elements of irrationality in
(a)
is
condemned,
to be
(c)
(b) that
effective in
is
condemning people.
in
who
awful
when
can't go
can't
But
on without
I'd like
them
my
God!
to be.
it.
if I
way
it.
oh,
me what
wanted
spend
all
my
in the past.
I'll
scream.
In
of
79
is
comment
in the statement
ken conclusion "... and she should; since she doesn't, it's awful." It is
useful to encourage the patient to finish the thought and realize that he
made an exaggerated
has, in fact,
its
consequences.
(RB:
It's
would be advisable
become more satisfactory.
and
it
If
like,
to
change
is
potentially dangerous.
could happen.
It
my
Oh,
God.
Nobody seems
on
It's
my
mind
If
to understand
it
all
how
serious this
is.
the time.
happen.
get on a horse?
based on the
is
and
when we do
results in anxiety
one.
They
demand
for certainty in
our
lives
who
hold
themselves two
will
when
the unfortu-
(RB:
One would
when
dangerous, and
5.
am
that
one major
area.
and render
it
non-
is
all
am
thoroughly competent,
times, or at least
most
of the time in at
80
Practitioner's
What an
idiot
Guide
am.
What
can
How
could
get a
shouldn't have
now
do with myself
I
C?
come
so fast.
My
is
It is
achievement-oriented society.
It is
among males
in
our competitive,
he doesn't succeed, he
is
a failure
when
failing
is
is
larly depressing
(RB:
with
It is
human
It is
creature
do well.)
There's got to be a perfect solution to this problem;
6.
certain
must be
keep searching,
just can't
make
I'll
find
it.
a decision.
be sure?
How
I
know
know what
If I
I
will
stay
I'll
want, but
still
be miserable, and
way
to
do
it?
can't decide.
if I
go
I'll
be miserable.
lack self-confidence.
Doctor, do you
mean you
can't tell
me what
to do?
There are basically two parts to this irrational notion. The first is
is an ideal or perfect solution to the problem, that one must be
that there
and
it,
81
if
terrible.
The
while
that
is
it is
may become
The
angry
at others
Our world
(RB:
enjoyed despite
fair
and
Why
can be
just.
me?
me?
didn't deserve
But
How
was supposed
right to fire
to do.
me.
dare you.
He'll get
You
it.
did everything
They had no
life
this.)
How
He
a perfect ending.
7.
it
in the end.
can't tell
me what
to do.
This belief
who
is
is
demandingness. Clients
it is
and
feel that
they can and must be better constructors of the universe than whoever
created
This IB
it.
is
system of adolescent
the clients that
fairly,
it's
The
isn't treating
them
but can ask clients where they ever got the idea that the world
should be
fair.
notions of
how
young.
It is
despite
it.)
8.
clients.
is
on enjoying oneself
at all times.
82
needed
Guide
Practitioner's
this aggravation?
It's
But
don't like
it.
But
get so hungry.
can't stand
What
I'd
be happy
Can't
it.
a hassle.
if I
we park
What,
me
away from
it all.
closer?
in line five
minutes already.
to see the
we
it'll
in the descrip-
and physical
is
form
of
Low
Frustration
very
at the
least to
may
is
interpersonally
from achieving
If
you
up
mountain stream
stones and rocks. Many people believe that they must be comfortable
whatever they do; such a notion is obviously self-defeating.
although
9.
may
may
never
like
in
it.)
anymore.
I'm so afraid
man
with
my
What'll happen to
me?
problems, and he
83
What
I
if I
lose control?
my
Anyone with
my
What
Is
does this
mind.
my
mother
that normal?
is
common
concern
among
patients
Why
dria.
is
it is
hardly
unbearable.)
somewhat
different
form. They are less clearly evaluative but they do reflect irrationality,
since they are neither empirically verifiable nor conducive to achieving
one's goals.
10. It's easier to avoid
than to face
life's difficulties.
Why
I'll
bother trying?
do anything to avoid
It's
Oh,
no
use.
it's
forget, Doc.
If I
that.
my
life is
it,
it
now, but
84
It
Guide
Practitioner's
I'll
I've
gotten around to
This notion
is
it.
must be avoided
at all costs."
iment to progress
the
in therapy,
procrastination
directly
they
way
way
is
in the
long run.)
11.
whom
to
depend or
rely.
A woman
I
When
I
needs a man.
can't do
it
on the Lord.
just rely
alone.
like
my
mother could.
do
if
rely
on the
Man
woman.
Upstairs.
you leave?
all
week
just to tell
you
this.
turn to others for advice and counsel, including counsel in prayer, exclusive reliance
one's
own
upon someone
efforts to solve
who
is
it is
said,
"God
helps those
help themselves."
(RB:
dently.)
It is
85
12.
He made me
I'll
feel like
be devastated
He made me
When
so
if
my
change
ability to control or
little
two
my
have
cents.
mad.
He'll ruin
feelings.
see red.
evening.
You made me
love you.
If
If
only
You make me
Changing
I'd
could change.
be happy.
sick.
this belief
is
assume
own
feelings
and
understand that they have produced them and can therefore change
them, they
will continually be
environmental stimuli on
is
a variety of
human
It is,
it is
tions
if
them from
is
not an
prevent people
correcting their
changed.
will
One
is
largely caused
at
My
past
is
the cause of
my
Well,
My
I
whole family's
like that.
Well,
I
was adopted.
to
do
that.
86
Practitioner's
When
had
was
Guide
a kid
a rotten childhood.
really
is
my
unless
it
me
this
way.
one
is
of the
most
Its
very statement implies that therapy cannot work and that clients are
unchangeable. The clients
may
cite their
If
this belief
is
irrational,
absolutistic nature.
but,
we
It is
a prediction
it is
as
about influences on
so because
because of
human
it
its
behavior
(RB:
One
It
may
may
of the IB's
new
rational therapist to
remember
that
all
1.
2.
An
3.
philosophy of self-denigration
intolerance of frustration
It will be wise for the therapist to keep questioning clients until they
admit one or more of these core notions. Core irrational beliefs can also
be identified by patients' evaluative definitions. An event is irrationally
labeled as horrible
calculation of
FINDING THE
its
by
negative consequences.
B'S
much
of our think-
become automatic.
We
busy
lives to think
about our
87
thinking.
suggested
ourselves
is
is
commands
This
last
cases, the
tal
patterns.
clinical issue
may
feelings
The
therapist's
tions:
1.
a session,
2.
3.
4.
There goes that old record in your head again; what was
playing this time?
it
88
Practitioner's
Guide
6.
7.
If
5.
want
to keep in
mind
of
at that
moment?
may
may
be an indicator of psychopathol-
how
to tune into
and monitor their thinking by the use of therapist suggestion. By piecing together information about the clients' situations, behaviors, and
emotional reactions, therapists
may
don't
when
know
clients as follows:
or
my
"In
making
like
Of
experience,
when
course,
it
will
something
The
irrational belief
a generality
therapist
may
89
a period,
C:
my
is
wanted
to
do with
life.
T:
And now
C:
make
it
that
don't think
can
now.
In this illustration, the therapist has fed the thought back to the client as
want
C:
T:
And
do well
to
therefore
in school.
you must,
right?
situation.
Most
on the
me
and
that's
awfulV
moment's
and even
if
many
this really
through
a chain of
Why
who
thoughts by repeating
reports difficulty in
making
Well,
do
other reasons
awful?
is
client
reflec-
her,
is
to lead the
90
Guide
Practitioner's
But
may
be useful:
"OK,
lost
What's the worst that could happen if you stood up to your wife?
She might leave me.
What's the worst thing that could happen if your wife did leave
you?
I might not find another woman. My God!
But let's suppose you never did find another woman. What's the
worst that could happen then?
I could get sick and no one would care for me.
Well, what would be the worst thing about that?
That would be the worst thing! That's so terrible I hate to even
C:
T:
C:
T:
C:
think about
it.
Don't be surprised
far
if,
when you
you
you are
unaware of
find
As
irrational beliefs
they want their mother, their spouse, their children, their boss
3).
The
might
(etc.) to
be:
"Why
believe
it's
awful that their family doesn't care for them since that would
IB.
Therapeutically,
how
91
disputation at
which procedure
therapist
may
is
better,
but
clinical
who never
may give up
may later link
may
new
well develop
prob-
"need"
tionality of self-iating
their
It is
your problem
week?" try
this
"How
to bring
new
main problem?" This factor may make the difference between Band-aid
therapy and a more elegant solution.
A key point to note in the above discussion is that behavior usually
has multiple determinants. Too often, the new RET therapist will obtain
the
(affect), find
may
is
with
spiral,
or hierarchical connections.
The
therapist needn't be
dismayed
to find a
group of
B's, or a
"regular B-hive."
irrational no-
tions as
for discussion
and evaluation. Perhaps the therapist can point out common themes, if
there are any; in their absence, the therapeutic dyad may work together
to hierarchically arrange the beliefs for disputational attack.
IB's
client
may
hold
if
he took
a different
problem of
adulterous thoughts and requests that the therapist alleviate this guilt.
monogamy?
Neither;
it
92
stance,
Practitioner's
one
set of IB's
Guide
may
his adulterous
monogamous. What
IB's
It is
and emotions
possible that he
this point,
like
you may
find yourself
common
therapist derives
we
from
common
C's.
You may be
thoughts generally
this theoretical
assumption.
By way
of illustra-
tion,
Anxiety
Anxiety.
is
are rarely afraid, for prolonged periods of time, of events in the here-
being afraid.
The
1.
2.
3.
Thus, the
first
would do well
93
statement
2, a biased
at
Beck (1976) has outlined a cognitive triad that descripview of the self, a negative view
Depression.
of the world,
and
a negative
2.
The "horror"
3.
RET theory
in depression:
Hauck
book on depression, divides the problem into three types, each with its underlying irrational structures.
Depression can be caused, first, by self-blame; the thinking pattern that
(1974), in his excellent
leads to self-blame
1.
2.
3.
is
generally as follows:
to depression
is
via self-pity
whose
irrational core
is:
want
1.
2.
It's
Finally,
1.
my
awful
way.
if I
don't get
it.
if
one believes
that:
conditions).
Guilt.
they are doing (or have done) something wrong. Second, they condemn
94
Guide
Practitioner's
first
statement
may
be
is
it
may
be
did the
wrong
thing.
I'll
Anger.
Anger covers
a large
(hostility)
The second
step
ferently" or
"You
"It's horrible;
is
"You should
condemning: "You're
a bastard!"
treat
is
me
dif-
awfulizing:
OTHER GUIDELINES
In the previous section,
client's specific
liefs.
we
described
Additionally, as
which the
how
RET
the
as a therapist,
commonly
may
you
will find
be found in the
event
which you
which patients upset themselves, you may begin with cognitive schemas
which are derived from cumulative experience with similar cases. These
schemas can serve as initial hypotheses. While it is beyond the scope of
book to suggest all of the common schemas, a few examples may be
this
the client
is
mother who
is
95
may
also
Thus, she
we have
problem
is
self- worth.
may have
frequently found
one of
is
bad mother.
her children. In working with mothers, whether their children are infants or independent adults, the therapist
may
keep such
schema
in
of such
schemas
will evolve as
you
ac-
cumulate professional experience. You may find, in fact, that you have
many such decision-making schemas already. The point we wish to
stress,
however,
maternal anger
of
women
is
is
in their
middle years
is
all
Not
all
depression
A FINAL CAVEAT
The therapist would be wise to listen for an irrational idea that commonly occurs to clients in rational-emotive therapy and prevents them
from honestly bringing problems
about their
self-talk.
is
gotten over that problem or that they're not supposed to feel anxiety or
think irrationally.
(e.g.,
Some
"I'm ashamed to
The
clients
tell
shame
therapist
may
may
find
it
may
last
week, Doctor"). In
it
is
we have
nostic
groundwork
Thus
of rational-emotive therapy.
the
far,
diag-
we might
is
set
client. Until
same
and occurs
of therapy
What
is
at
a disputation?
irrational belief
is
the real
work
D, the Disputation.
It is
cognitive, imaginal,
and/or
behavioral nature. Each of these disputational strategies will be discussed in this chapter.
therapist
"Because
"
and
may
I
it's
Only the
ask,
"Why
IB's,
when
is
a Rational Belief,
want,"
client
may
respond,
an Irrational
Belief.
patient
is
is,
bit
by
bit, to
internalize a
new
see
if
basic goal
is
if I
can bear
it.
I'm merely
as:
"It
fallible,
97
that's not
is
known
in
RET
as the elegant
solution.
The
1.
patient
is
led
Irrational Beliefs.
2.
through
The
a sentence-by-sentence challenge of
made
The
to
patient
is
helped
of A.
develop
alternative,
rational
philosophies.
now
Let's turn
to
strategies.
COGNITIVE DISPUTATION
Cognitive disputations are attempts to change the client's erroneous
beliefs
One
most important
of the
questions.
We
may
of verbal expression.
to avoid asking
tions
modes
"why"
it is
The following
is
the use of
Ellis
is
generally good
may
is
no proof
them
for
up.
(1962, 1971, 1974, 1979b) and from other therapists at the Institute
present
Emotive Therapy in
them
as
essentially asking the client to prove his or her irrational ideas to the
therapist.
The
first
any
IB:
What
is
the proof?
98
Is
Practitioner's
Why
that true?
Why
is
Guide
not?
that so?
it?
Why
In
Is
is
such an idea?
what way?
good proof?
that very
Explain to
me why
(e.g.)
college 7
What
Why
does
it
have
Let's be scientists.
to be so?
What do
the data
show 7
that belief?
be destroyed
if
you don't X?
things.
Now why
if
so,
whether they
will be as
whether
unpleasant as
the client believes. These questions are particularly useful for challenging
"awfulizing."
if
So what
How
if
that happens?
would that be so
terrible?
How
Ask
disadvantage awful?
is
99
yourself, can
What good
find happiness?
still
if
if
occurs?
How
terrible
What
The
is
me why
Explain to
How
will
third
if
X?
logic of the clients'
thinking but serves as persuasive devices to help clients assess the hedonic
value of their belief systems:
As long
as
you believe
"Whatever I want,
Is it
worth the
Is it
worth
that,
feel?
that
risk?
it?
In using the questioning strategy, allow the client time to mull over
and fully contemplate your questions. (This suggestion implies, therefore, that
you
barrages, please.)
you give
clients a
silences after
Do
your questions.
aversive, especially
if
New
own
therapists
own
no
at a time;
questions until
seem
There
no answer
isn't any.).
client,
(e.g.,
primarily because
"Where
is
many
ask
dis-
of the ques-
If
your
may
be
out what irrational beliefs they are telling themselves. Perhaps they are
awfulizing about not knowing the answers to your questions or because
100
Guide
Practitioner's
so,
if
attending to the points you are making during disputation. Uproot these
irrational beliefs before
original disputation.
when
by giving you
of
why
the situation
always be
is
is
so
a justification
between undesirable
and awful. The most common error made by new RET therapists is to be
stumped by the client's reasoning. Instead, the therapist would do well to
this
is
failing to discriminate
point out to clients that their retort was evidence for the rational state-
comes
The
C:
But
T:
Well, just
Because
C:
it's
extra
T:
awful
if
how
.
is
then
money nor
that so awful?
I'll
it.
Look, Jack, that 's evidence for why it's unfortunate or bad that you
don't get the promotion. Because it's bad, it doesn't follow that it's
terrible.
Now,
But
worked hard
try again.
it's
terrible?
deserve
C:
T:
Jack, that
C:
You mean
T:
That's right, Jack! Terrible means you can't live with this or possibly be happy. It means 101 percent bad. Now, how is failing to get
I've
it!
may
it
it
terrible?
Clients will often persist in giving similar answers far longer than the
client in the
at least as
The second
is
didactic, includ-
we
when new
may
As the
be most useful
patient
becomes familiar
101
show
is
great
room
is
faulty.
Some examples
will
RET
therapist
is
of cognitive disputation
and
primary
Ellis
(1977d)
is
awful, but
news
it.
don't see
I've ever
how
heard This
is
if
something
else,
frequently point out the senselessness of the IB to the client, and very
little
further debate
that therapy
may have
humor
may be
necessary to
must be stodgy,
make
judiciously,
you
as well as
your
Once you
client
may
is no rule
what you
together more.
is
who have
many
One
to the
same
Much
IB's,
others are not devastated by problems and can be reminded that lives go
on despite unfortunate happenings. This knowledge can then be transferred back to themselves.
teeth beforehand!
The
youngsters go through these same tortures and manage to do so unscathed and with significantly less horror.
New
102
Practitioner's
who have
Guide
rare or highly aversive Activating events (e.g.,
One
syndrome.* She
was unfamiliar with the disorder and horrified by the child's bizarre
behavior, convinced that her child was the only case in the world.
Through some investigation, the therapist found an association for parents of children with Tourette's syndrome and advised the mother to
attend a meeting of this group. This experience provided the woman
with coping models, and at her next therapy session she concluded: "I
treated the
guess
it
mother
isn't so
awful
A second disputational
may
if
in the
may
troublesome situation;
now
telling
If it
ask clients to
may
this
allow
themselves as a
way
to re-
more rational beliefs. If the emotion has not changed, there may
be more IB's present, and the imagery exercise may allow them to
emerge. If necessary, a new ABCD analysis may be conducted and the
results reexamined by a repeat of the imagery exercise. As an alternahearse
techniques,
may
known
Maultsby and
Ellis,
wish to
shift to
as REI, rational-emotive
1974).
and imagine themproblem situation (A) and try to experience their usual
emotional turmoil (C). Wait until clients report experiencing C and then
ask them to focus on the internal sentences which seem to be related to
these emotional consequences. Then instruct patients to change the feelIn negative imagery, clients close their eyes
selves in the
which
a verbal tic
103
if it's
Instruct clients that as soon as they have accomplished this task, they are
to
"How
ask:
will
reveal a cognitive shift; usually patients respond that they stopped catas-
Here
is
Now,
T:
still
good
at
computers!").
an example:
I
want you
to close
Wait
C:
Yes.
T:
Now,
want you
to
make
me when
client's signal.
C:
(nods)
T:
client's response,
which
will be
some form
your head
to
of IB.
"My
Now,
want you
situation.
Now, what
C:
Well,
client's signal.
are you
and not anxious?
you
feel
only concerned
goof,
it's
104
Practitioner's
In positive
Guide
clients
imagine themselves in
selves
behaving differently
Ellis,
1974),
and
feeling
For
differently.
example,
so.
As soon
as clients
because
coping
it
is
useful
skills.
For example:
T:
OK, Mary, now I know you've been having trouble when you think
about giving that speech to the PTA this week. I know you've been
C:
T:
What
I'd like
you
to
do now
to close
is
feeling relatively
head.
(nods)
T:
client.
do what
you pictured?
C:
Well,
have
The parents
really expect
my
ideas
down on
them
all
to like
all
OK.
paper.
my
of
It'll
know what
want to say.
me. I can't
some of them
my
ideas,
make
and
if
on getting
my
point across.
ABC;
relaxation or
105
be calm ...
am
as,
.
"This really
isn't true.
an approach
less
may
anxious the
RET
once
it
to feel
fail
first
occurs. Thus,
RET can
skills to
remove
this
blow-up procedure,
these adjuncts
ally anxious.
The
may
therapist
be particularly useful
who
if
the client
is
unusu-
is
re-
third basic
form of dispute
is
challenges his or her IB's by behaving the opposite way. In fact, the
RET
new
106
Practitioner's
philosophy until
Guide
it is
it is
counter to their present irrational belief system; clients act against their
IB's.
For example,
if
they be-
If
it
out.
they believe that they need something, they are exhorted to do with-
out.
If
is
homework assignments.
office,
An
about the
client's
vinced,
how on
"How
earth
will
terrible
is
is it
problem.
is
really?"
sexual
mastectomy. Only
after
not located in
my nipple !")
One
female
a client's fears of
had
If
after
therapists
rejection
the therapist's
How can
"My
sexual-
client to
When you
make
sure
you
right thing
in
if
ass
am!"
it is
is
it is
about
cant
human worth
is still
intact.
Once you have obtained a core IB, realize that it will take a signifiamount of time to dispute it. Since the essence of RET is to change
is
critical part.
many
Don't be
sessions
if
it
107
for disputation.
taking on a
disputing
if
he or she
recalls the
problem, outlin-
ing the A's, B's, and C's quickly and beginning immediately with disputation.
client
second strategy
is
to take the
in by the
and then proceed
a disputation, to clarify
symptom
stress.
For example,
If so,
what
is
is
whether or
we
referred to
we recommend
all
cases,
work on
Low
cussed below.
Whenever
possible,
it
is
wise to work
first
want
of
any ways
may
to feel less
is
intervention.
Thus, among the disputational techniques to help the patient challenge distress-producing B's are those which
first
might
state
something
against you.
isn't
What does
it
rage do?
sets
your
It
is
working
for
you or
juices flowing,
makes you
feel
it
more
108
Practitioner's
Guide
If
your
clients are
may
become aware
problem
is
(e.g.) procrastination is
."
until the patient has exhausted all suggestions. If clients can't think of
does
comes
it
to
first
thing
mind. Stress that they need not believe what they say, nor
may
The
therapist
would do well
is
may
new
may
irrational beliefs
be revealed as well.
is
shift the
patient's position
mean
a continual
hard
sell;
disputations are soft and subtle and can take place even
therapist
is
If
reflect
beliefs.
to be supportive
For example,
by saying,
the
you are
some
when
"I
know
if
that
your
is
something you want very badly." The therapist is thus modeling a more
rational statement while conveying understanding of the client's plight.
Practitioners of cognitive therapy frequently assume that generalization of behavior change will automatically take place. While we be-
we do
is
it
program. Thus,
many
across
it
may
had better be
though the
beliefs
As with behavior
situations, even
tion,
109
whom
is
each example.
may have
when he
instructed to
resume having intercourse with his partner, he may completely reinterpret the situation and resume his irrational catastrophizing. He then
might be saying to himself, "This is the Real Thing; now if I fail, it will
indeed be terrible!" Thus, although you may have helped him counteract his irrational beliefs at lower points in the hierarchy, you cannot
assume that it will generalize to the next step. Be sure to specifically
question the patient about his cognitions during the various performance
stages.
it is not to be assumed that if clients are thinking
problem
area, they will be doing so in other problem
one
In addition,
rationally in
areas. For
example, Rose, a
client,
may
there
is
all
lem areas
One
will
own
is
success.
to help clients
number
of
is
(Meichenbaum, 1977).
an important
If
clients be-
110
A
is
Practitioner's
final
Guide
suggestion before
many
to use as
we
An
thing that
new
matching-to-sample.
but
a disputation,
RET
it
We will
sequence are fixed. These are, therefore, suggested proceedings but not
dogma to be rigidly
Once you have identified
offered as
1.
followed.
the A, B, and C:
Point out to clients that as long as they hold onto their irrational
they will be upset. This step is one device for establish-
beliefs,
Provide a rational belief and ask how clients imagine they would
they believed it. In this stage, you not only model more
helpful ideas but your prospective examination again sets a
motivational tone.
Once clients acknowledge that they would feel better, use this
feedback to encourage them to give up the irrational belief.
Then proceed to ask for evidence for the IB. In this stage, all of
the various cognitive disputational strategies described earlier
can be employed, although often you simply repeat your request
feel if
3.
4.
is made.
admit that there is no evidence, ask them how they
done to point out the change in affect as a reinforcer
Once
feel.
clients
This
is
111
is
you by saying
7.
make these
comment, we will list
Ellis will
therapist
script is
is
member
of the
group was asked to work with Ellis; not surprisingly, the first problem
dealt with was the individual's nervousness at being on display.
Getting at the B
T:
C:
T:
C:
What do you
able.
Clarifying which IB
is
more prominent
T:
C:
Yes.
T:
C:
T:
C:
T:
And you
Well,
if
C:
112
Practitioner's
Client's confusion
T:
is
Guide
may
But you'd never get anxious just from that statement. That's just
an observation or prediction. But how are you evaluating yourself
if
C:
you do
act foolishly?
don't understand.
Stages 2 and 3
T:
Well, just that statement alone doesn't cause an emotion. Something follows. You might be saying, "I might act foolishly, and
isn't that great!
might
act foolishly,
And
right?
C:
Right.
T:
C:
T:
C:
"And
if I
is still
missing
act fearful,
evaluation. "I
C:
what?"
isn't that
It
Therapist clarifies
that
"unstable"
is
not an
emotion but a
self-
evaluative belief
T:
if I
act foolishly
up here?" Or,
Yes.
Assuming
T:
Well,
the worst
They
"Ummmm,
shit, he's
113
T:
C:
As
T:
C:
instability?
a negative.
cerned.
You wouldn't
feel
But then you'd only feel conembarrassed or ashamed. You'd just say,
T:
C:
I'd
C:
T:
C:
that?
be lonely.
Rephrasing C as an
to
T:
"I
C:
alone?
Depressed.
Ellis
T:
Yes. So
feel
here,
it
C:
Yes.
Stage 4
All right. But even
C:
if
that occurred
it
would
occur
why would that be horrible? That they thought you were
boycottable and you were alone? Why would that be awful?
The evidence is in my past experience. By being different, I was
alienated.
But
why was
why was
114
Practitioner's
Guide
feel like
Prove
Stage
it!
you
T:
But
C:
Terrible.
if
believe
it,
how
will
you
feel?
Stage 5
T:
if
you
do you
feel
little
How
looser.
Stage 6
T:
Do you
that
C:
is
realize
why
you're feeling a
little
looser?
so?
Stage 7
And also, you've gotten distracted somewhat. Instead of focusing on them, you're focusing on what we're
talking about. Now, what other problem would you like to discuss?
The reader
We
discussed.
clients' idiosyncratic
of these categories.
around
Chapter
acknowledged that
not encompass
problems
fall
were
all IB's,
more
ter
in learning
In
searching
strategies,
ments of
we
we
for
we thought
irrational
an
it
alternative
better to teach
way
how
to
present
disputational
specific IB's.
When
asked ourselves what was irrational about each of the evaluative IB's,
discovered that each contained one or
more
of the
same four
basic
ingredients:
1.
musts.
2.
rible
3.
Need statements,
must have
116
4.
Practitioner's
Human
Guide
rated.
how
this IB
may
1,
elements:
a.
b.
It's
c.
d.
Now,
2,
which
is
an
anger-provoking philosophy:
a.
b.
c.
d.
deals with
same elements
in Irrational Belief 5,
which
life:
a.
b.
It's
c.
d.
achievement in
if I fail.
irrationality in turn
Should*
must
have to
got to
117
).
or
He
statements
should
...
(I
have to
),
you statements
),
(It's
got
and
sion, anger,
guilt (e.g.,
"He
make
a mistake").
illogical
and expose
philosophy
of
demand
is
The
irrational
component, therefore,
fallacy that
will
"because
be done!"
It is
as
want X,
if
it
the client
and it is perversely
thwarting his efforts. These demands produce what Karen Horney
(1945) called the "tyranny of the shoulds."
Many
Commandments, not
to
human
it
vised by
up
to
it.
is
118
Practitioner's
ous shoulds
(p. 75).
Guide
two
in their
(e.g., "I
to call
my
everyday problems
clients that
human
beings
do
so.
if
stay in bed
if
It's just that you're not willing to take the consequences of not
going to your job. You see, you almost always have a choice. Even
if someone holds a gun to your head, you can always choose to die!"
When
RET
the
is
Why
is
What law
is
Explain that to
How
me
it
should be?
it
prove
it
must be?
SHOULD
human
fallibility.
that fallibility
cally,
we do
is
in this case
not
make
we
is
human
It
species. Techni-
is
if
something
for
119
shouldn't have acted that way and messed up? Well, why
should you have succeeded? It would have been nice or advantageous; that we could prove. But there is not reason why you should
succeed. True, it would have been preferable; but why must you
You
always act well? There's no law of the universe that says you must.
It is
T:
Isn't
it
OK
to
make mistakes or bad choices? Hell, I've made hunNow, when you do that, don't you call
Yes.
T:
T:
C:
T:
If
C:
guess
fair to
rules?
did.
legislate
live
set of rules as
is
to point out to
Ellis calls
T:
C:
T:
affair:
in
120
Practitioner's
Guide
make you
T:
What
C:
T:
did
you
tell
yourself to
feel guilty?
C:
shouldn't do it.
No, I'd better not do it. There are no shoulds in the universe. You
have three choices here: you can change your values, change your
behavior, or change your evaluation. And they're not mutually
exclusive. In other words, you don't have to walk around feeling so
T:
guilty.
It
is
turmoil but
it
it
good
Tj:
There are no musts in the universe. Suppose you are saying "I
have to be rational! I have to be rational! I have to be rational?"
That would be irrational, and how do you think you'd be feeling?
T2
fix
T3
If
the situation.
They expect
a perfect,
they
fail
to
human
conflicts.
may
It
when
may
be
perpetuate the
121
some important
skills: (1)
decision-making
point (e.g., "I might choose wrongly and that would be awful"); and
(3)
The last problem often comes up with clients who report being
unhappy about a love relationship in which they feel trapped. For example, a wife reported that she was desperately unhappy in her marriage
and wanted to leave her husband but was blocked by a number of factors:
She might
his feelings.
it
the
vows say
'until
it
was wrong
etc.
conflict as well.
The
many
if
first,
that she
is
woman's
plight.
life
to keeping her
way
husband
100 percent happy. In considering the moral connotations of her behavior, the therapist might point out that right and
parable of
wrong
as indices of behavior;
Ellis'
Two Zen Buddhists were out walking. One was an old master about
ninety years of age and the other was a young novice. They came to
a swollen stream which had flooded its banks. Beside the stream
stood a beautiful, luscious young woman who said, "Look, Masters, the stream is flooded. Would you help me across?" The young
monk shrank away in horror because he would have to pick her up
to carry her across, but the old one calmly picked her up and carried
her over the stream. When they were over, he set her down and the
two monks went on. The young man couldn't get over this incident,
however, and finally said to the older, "Master! You know we're
sworn to abstinence. We're not allowed to touch a beautiful young
woman like that. How could you take that luscious young woman
122
in
Practitioner's
Guide
let
And
man
the old
said,
"My
son, you're
still
carrying her!"
decisions will
fit
this bill.
What
2.
Choosing
Choosing
3.
1.
to
to
remain
remain
in the
in the
is
three options:
erable.
if
some
gilt-edged
or accept
them
some
risk,
and the
client can
client
no perfect
solutions.
direction in
is
in
demands
for
(1)
we do
control over them; (2) there are often negative consequences attached to
(3)
we would
like.
The client usually adds two additional points as well, such as, "How
can they act that way?" and " Why do they act that way?" The answer
How
simple.
it
123
might sound
Why do they
Among
wrongly.
glib,
is
act that
why
quite
way?
others act
way
(perhaps
it
which may be perversely reinforcing to someone else). We might summarize these reasons as stupidity, ignorance, disturbance, or utility. An
understanding of this reasoning may be an important step in building
the client's tolerance for accepting the behavior of others.
When
the client
is
demanding
is
It
What's the point of being angry when someone acts the way they
act? When a dog acts like a dog, we're not surprised. When a cat
acts like a cat,
Why
are
acts like
Here
is
an example of
C:
He
T:
Why
C:
T:
Ellis
it's silly
to
demand
it.
shouldn't do that!
that?
C:
T:
don't know.
He
has a right to be
124
Practitioner's
As pointed out
merely
Guide
earlier, there
seem
whether
a decision
to choose;
The
is
right or
wrong
RET
independent of the
is
wrong
holds that
client's right
act.
therapist can also point out to the client that the very attempt
T:
to be
What
does
it
mean
may
produce further
difficulties:
we
use negative
C:
T:
OK,
is
over himself:
it's not fair. That's correct. Where is it writ that it should be?
You're saying: "she must she must she must." Now, let me ask
you, what control do you have over her? And what good does it do
you to sit here and eat yourself up alive? Let's agree. It isn't fair.
Now, you only have control over one person. What do you want to
do about it?
Finally, the therapist will point out that as long as the client holds onto a
You have
is
will
probably remain.
demand
and the
fates themselves.
How
often have
primary dispute
is
you heard
me
it's
clients wail-
way
the client
125
fact,
way they
are for
T:
am
sitting in
is
An
the following:
my office on
a hot,
sunny summer
start fantasizing
all
silly to
If
If it's silly
the client
may
object:
C:
see
is
demanding control
of
self,
he or she
should be able to
control myself.
T:
really
is
when,
some
in fact,
control.
you
Your mistake
are a fallible
is
human
insisting
being. So,
on
it
Awfulizing
Disputing this irrational concept essentially entails attacking the notion
of "awfulness,"
at least,
if
not more
than, 100 percent bad. Since people rather loosely use words such as
agree
126
Practitioner's
Guide
many
worst thing that could ever happen to you, the equivalent of being
tortured to death slowly. In essence,
exaggerated badness.
though
it
OK,
T:
let's
many
clients
no event
is
awful,
al-
therapists question
truly awful,
it
correctly, therefore,
When
is
More
client
Why
C:
T:
it
as awful.
Suppose you
just defined
C:
No.
T:
See,
it
me?" Do you
think you'd
still
it
have
your gut?
feeling.
One way
isn't
awful
is
by comparison:
100. Thus,
if
100
is
to 30.
In
list all
List.
On
TV
shows, this
is
easily
from outer space, earthquakes and atomic blasts, the therapist "remembers" one more, the child's complaint (e.g., "Tommy sat in my seat").
It will probably not be necessary to point out that one item does not
belong on the list. This exercise is used quite successfully with adults as
well.
127
Clients
"How
you be
able to bear
them?"
"Let's
Such
way
is
much more
a device not
your
prefer-
only serves to
show themselves
"How
details of
the real-
In a
RET
does
to feel
is
"No!" Unlike
"positive thinking,"
RET
some
We may not have a choice between a good and a bad event, but
merely between two bad alternatives. How, then, can RET be of help? By
through.
Suppose that an
make
(e.g., a spinal
The
may
is
something bad versus something good, but only between two bad
things. By adding their needless misery, both of these things can become
worse. Here
is
a concrete
who
ous ulcers and muscle spasms. Nothing could be done to repair the spinal
cord injury, but by becoming overly upset about his condition, the boy
significantly increased the
his depression
being.
a case, giving
up
to add depression.
Perhaps there
is
a relationship
client to accept a
is
128
Practitioner's
Guide
anger and
acceptance
through
and denial
fear),
is
many
a hypothetical conceptual
of
all
may
schema; not
all
patients will go
RET may
be
Most
who
has
ically
1978).
The
assume that
distress
is
normal
reaction.
with
maneuver,
clients,
after all,
as therapy progresses
"What
may
problems, their
it
life is
containment of the
RET
If
therapist
important to discuss
therapists
will be
it
disability to
ill,
specific areas
its
it.
it
could always be
may
it
may
more
realistic
perception of reality.
In addition to philosophic disputes, there are pragmatic reasons to
give up awfulizing. First, the high anxiety levels associated with catas-
By
decreasing anxiety,
If clients are awimpending problem, the therapist might point out that
worrying only makes it worse, since they are living through the problem
twice, in the here-and-now as well as when it occurs. If the discomfort is
fulizing about an
129
might
as well
it
occurs.
common
anxiety, a
with avoidance
is
result of
which
that although
is
it is
forcement.
As
a recent
more avoidance
generalize.
for example,
one had an
one might
dandelion, with
lions,
will
common example
of this paradox
is
seen in patients
who
avoid intimacy
relationship
might end.
Since they've defined the ending as awful, they have chosen to deprive
An
awfulizing
is
to
by his
on the desirability of encouraging patients to be risk takers.
By taking risks, by forcing themselves to do the very things which seem
"too hard" or "too scary," the patient will best be able to abandon the
notion of awfulness. In fact, Ellis has gone so far as to suggest that more
Ellis
insistence
traditional
as systematic desensitization or
help
them
to
he
asserts,
we
efficient
way
130
to
overcome
fears
force yourself to
mends
Guide
Practitioner's
jump
a flooding or
1971;
Rachman
from imaginal
et al.,
to in vivo desensitization
We
pointed by RET.
is
moving
in
the direction
Chapter 11, in
in greater detail.
Human Worth
In his original writings
of
human
on
human worth in the following way. Logino way to conclusively prove that any
is
human being has more worth to the universe than any other. Since there
no way to determine differences in human worth, one is left with the
is
null hypothesis that all people have equal worth. A problem still remained with the formulation, however, since the assumption of a quality called "worth" implies the possibility of its opposite, "worthless."
Ellis later refined his theory to eliminate the whole notion of worth,
replacing
it
change. Self-acceptance
who may
"good
difficult to
among
be surrounded by adults
child (e.g.,
more
may
who
An
this regard
that
is
people's opinions about one's worth are not facts. This discrimination
may
example, therapists
may
is
teaching
is
make
it
so?
it is
What
the
fact.
The statement, more correctly, means, "/ judge this watch to be the
most beautiful." If the client understands this concept, it may then be
131
possible to
move to more
T:
Let's
make
it
so?
If all
a turkey,
Does that
would you
be?
In other words, self-worth
We
can skip these intervening variables and simply choose to accept ourselves.
C:
T:
I'm such
You're a
which
is
it is
this
a worm!
worm? You seem
to
is
label
you
overgeneralizing?
Let's elaborate
on that
last point. It is
the difference between being a louse and acting lousily. In other words,
patients are not their behavior.
One way
is
to help
patients monitor their language so that they change their labels for
mother,"
ing."
it is
more
The former
is
mothering
acts.
who committed
ments use
bad
it
would be
only negative
change their
a linguistic structure
which
in the English
is
always an overgeneralization.
is
am
many
other things
Human
132
Practitioner's
them
to judge
Guide
as a totality.
Thus,
Ellis
their egos/' not in the sense of their executive selves but of rating
themselves.
An
complexity
is
RET
therapists to illustrate
human
the following:
Imagine that you have just received a large basket of fruit. You
reach into the basket and pull out a beautiful red apple, and then a
ripe juicy pear, and then a rotten orange, and then a perfect banana,
and then a bunch of grapes, some of which are mushy and rotten.
How would you describe the fruit? Clearly, some are good and
some are not good; you'd want to throw away some of it. And how
would you label the basket? You see, the basket represents you, and
the variety of fruits which vary in ripeness or rottenness are like
your traits. Rating yourself by a trait is like saying that the basket is
bad because it contains a piece of bad fruit.
Rich Wessler has devised a schematic diagram that illustrates the
absurdity of self-rating. Note the two intersecting continua below:
Self-esteem
Point 1
Negative conditions
Positive conditions
(e.g., failure,
(e.g., success,
rejection)
being loved)
Self-deprecation
Many
people
make
(Point 2).
When
on the
rating itself;
in
essence,
deprecation. Rating
is
state of
"wonderfulizing"
is
as
low rating
of the global
irrational
as
self-
133
of
is
down
on the
The more
implies the possibility of rating oneself down, the most elegant solution
is
to give
A
to
is
patient
it
them
is
issue
is
try to
on the
to avoid self-rating
and to
me
But
you
all
the things
failed at.
But
I've
know
a failure?
call
C:
T:
many
clients
is
among men
as
After
all,
when
is
like
futility.
what they
see,
134
Guide
Practitioner's
T:
C:
T:
The
found someone
because
it
who
liked
them;
this,
to continue to
work
The
ers.
the
A may
may
certainly
some
clients believe
adequate but that they must be more adequate than others. Their ability
to feel comfortable, therefore, depends
If
up against others and fall short, they feel not only depressed but also
jealous. The social comparison process is a normal part of life and may be
desirable for improving one's performance. It is problematic, however,
when the patient overgeneralizes and uses the comparison in a selfderogatory way.
One suggestion to such clients is that they hardly change in any
way each time they engage in comparisons; e.g., "If you're 5' 2" and
then you meet someone 6' tall, does that make you shorter than you
were?" or "If someone else gets a higher grade than you, how does that
make you stupid?" A still more elegant solution, however, is again to
work at giving up the concept of rating altogether. The therapist might
point out that, after
all,
self, to
life is
We include at this
the other
more
135
point
evocative,
didactic disputation:
what
it
telligent
sponsible, a
dumbkopf.
Know
That you're neither a wonderful, bright, marvelous, inperson, nor are you the opposite terrible, awful, stupid, irre-
is?
human
race.
And
to be
human means
that
and some weaknesses. That in some ways you're probably quite intelligent and coupled with that is a tendency to make human errors.
Because that's also what it means to be alive and to be human.
And if we're going to get you better, we'd better go after your belief
system. You're holding onto one now that insists on categorizing you as
OK-not OK, stupid-smart. You think that you are a simple little commodity and you belong in either this box or this box.
And I'm suggesting to you that there's no box that could describe
you. You're a complicated person; all humans are. That you could do an
"A" paper, and from it you don't need to leap to the conclusion that
therefore you're a wonderful, bright, intelligent, perfect person. 'Cause
you handed in a paper and it was not such a hot paper, you could
two things. You could say, "Oh my God, I'm stupid, I knew
it, I knew it, I never should've handed it in. Now I see the evidence, just
what I always thought, I'm no good. Donna belongs in the Stupid Box."
Or you could say, "Well, I'm only learning how to write stories. That's
what I'm here for. I'm not already perfect or I'd be the professor. And
he's not perfect either or he would be a famous writer! That doesn't
mean he doesn't have something to tell me, so that the next one I write I
If
do
at least
"so what" could be two favorite little words to tuck in your pocket
100 times to yourself in the next week. "Well so what if it isn't
to say
an
it
isn't a perfect
that,
paper and
it
it
isn't a perfect
doesn't
mean
paper?
It
just
means
that
thing beyond
not important at
all,
but "It's
136
An
T:
Practitioner's
Guide
evocative disputation:
You
definition, that
means
C:
T:
Just
C:
I've lost
T:
C:
T:
By
Can
how many?
C:
Like what?
T:
You
at.
manage to get up every morning, you keep up your apmanage your finances well considering your economic plight there's lots of things that you do well.
still
pearance, you
C:
T:
C:
Nobut
T:
You know,
Jack,
of the
I've ever
met!
C:
T:
The
fact that
I've just
how
lousy
am!
me how
con-
you are. You hold much higher standards for yourself than
anyone else, which implies that you think you're much better
ceited
for
than others. It's OK for those lowly slobs to have problems, but not
a terrific person like you. Isn't that contradictory to your notion
that you're worthless?
C:
Hmmmmm.
T:
How
C:
T:
things.
137
Needs
Need statements are similar to shoulds, for one is failing to discriminate
between what one would prefer to have and what one must have in
order to live or be happy. The primary disputational strategy in dealing
with need statements is to show clients how to take their own language
seriously and literally. There are relatively few things that
need in
this
world; a
little
psychology there
is
you need
some evidence
is
and to
they need
behave
first step,
as
if
get, but
they need
therefore,
it,
is
up the
highly
As long
client's language.
T:
C:
You
T:
That's right.
is
a distinction
is
seven-year-old
girl
who
is
at school:
C:
What happens
die.
C:
Same thing.
You can die.
T:
That's right.
C:
T:
Die.
C:
C:
Yeah.
And water?
Yeah.
T:
And
T:
is
it.
Love
it.
young
we have no
it
to help clean
is
we do
relation-
love." In the
start to
truly
literature of
we
That's right.
air?
You need
air.
What happens
Can we say
What happens
if
that
if
air?
138
Practitioner's
Guide
Yeah.
hole in them?
No.
So do you see the difference between
the difference?
A
A
You
try to explain
it
to
want and
need? What's
me.
It's a
is
is
want, right?
Right.
So we talked a little bit about wants and needs. Now, what happens
if you tell yourself "Oh, I need to have so-and-so play with me in
school
I need to have her like me." How do you think you're
going to feel if she doesn't like you?
Sad.
139
T:
C:
A
A
T:
little bit?
lot.
lot.
How
about
if
you
said, "I
like
me.
need
to be her friend."
C:
T:
"I
you
need to be her friend" and she wasn't, how would you feel?
And she wouldn't?
And she wouldn't. And you said, "I gotta have her friendship
need it to live! and she won't be my friend."
said, "I
C:
T:
C:
Sad.
T:
C:
Sad
little bit
Low
Ellis
or sad a lot?
a little.
Frustration Tolerance
new
which focuses on the need for comfort. Keep an ear open for these
common phrases which indicate discomfort anxiety (Ellis, 1978a):
ity
can't bear
can't stand
can't tolerate
it
it
it
it,
etc.
is
correlated with the nastiness of the aversive event. Usually, in fact, they
tially. Linguistically,
it is
silly,
it
exist.
Saying that
(although they
may
140
Practitioner's
Guide
never like it) and even be happy despite it. The philosophy is actually a
demand similar to the should statements above. Clients insist that they
must not be inconvenienced, discomforted, or frustrated, and if they are,
it is awful. The following dialogue illustrates a challenge to these notions:
C:
T:
C:
T:
Experiential disputes of
LFT provide
clients
Or use one
to
if
clients
imagery
T:
may
it,"
Rational-emotive
Let's
front door.
C:
problem. For
example,
141
T:
a rehearsal desensitization
and
A
life
philosophy of LFT
may
work necessary
many
The
"there's seldom gain without pain" and that learning that they can
work harder
more
maximize their productivity and accomplishments. Thus, reducing LFT and attacking the
need for comfort may help one write that new book, leave a spouse, start
easily,
new
to
may
be.
process.
Ask
yourself, "Is the patient just saying the right words but not
really believing
How can
1. If
you can
tions
patients
create
SUDS
session
your
a decrease in the
SUDS
rating
is
may
effective.
beginning of a
2.
Sometimes you
make
is
male
he
women,
3.
if
avoid approaching
Catholic
determination in a
"knows"
this
143
dogma and
A third validation
strategy
is
by
either.
from the
would be done only after
securing the client's agreement and making sure that he or she under-
"How
is
really
as:
"Do you
We'd
"You
better get to
4.
Since
some
see
may
see, Jack,
it
you don't
really believe
it.
work harder!"
patients remain relatively passive in therapy (often
because their therapists are too active), the therapist will want to look for
by themselves. One
good technique to check on patients' understanding is to have them fill
out self-help forms (see p. 219) as homework between sessions. If they
indicators that they can approximate a disputation
a self-help
understood. Profitable time can be spent in the next session going over
with
problem
like their
Clients' misunderstandings
am..."
am incompetent." Clients may not be aware of it, but when they say "I
am X" they imply unity and identity between the subject and predicate
of their sentence.
Help the
more
144
Practitioner's
Guide
from
their
The feedback
the pejorative
is less preferable
Listen also to the client's tone of voice, looking specifically for the
registration of affect.
much
easily
to offer
cept behind
it
left
undisputed.
If
the client
is
may
help
if
recorded
all
member, don't
linguistic shorthand.
Disputation: Problems and Solutions
145
an IB here? People usually don't beseech deities unless some catastrophizing is going on in their thinking. The very question "What will I
say?" implies that he's worried and doesn't know what to say. The "Oh
my God"
is
has to do what had been asked of him, that he's trapped in and victimized
by the
situation.
is
contained in
How
to say."
do you
At
feel
"What
will
know what
how
it.
and
is
"How
a C.
"I feel
belief,
might make
And
if I
a fool of myself.
act foolishly
Even
your
ing.
client,
client's
down
the A, B, and
as they
margin of your
paper. After you think you have uncovered the hidden B's, plan
your next disputational strategy.
emerge, also noting key unusual words
in the
146
same
Guide
Practitioner's
many challenges
an RET strategy
numerous homework
to the IB.
for
sheets,
and engaging
two or three
sessions,
make
is
in
trying
munication but
As you
may
be essential in psychotherapy.
it is
important
to stress not only the rational beliefs but also the process of disputing.
beliefs, it's
alternatives. Disputing,
however,
is
a process of
rational
merely supplying
learned the
skill
may
not be able to
Another
therapists
is
inappropriate
what
style
that
develops
Remember
that
words such
as these are
harmful because of
the concepts for which they stand, not for their face value. These words
are used frequently in everyday language as figures of speech.
For
example, "That was a terrible steak!" or "You have to see the new
ballet" or "I need a cup of coffee." Thus, the Knee-jerk Disputer may be
shooting
people may, in
fact,
be irrational
about their need for coffee or the awfulness of their steak, these may not
be the clinically significant beliefs related to their pathology. So, make
sure that you have identified the relevant irrational beliefs before
ing on to the D, lest you merely establish
make sense
for the
word "shit"
to be
silly
new
mov-
to be taboo?
it
Some
clients
147
new
go over a
therapist. Let's
1.
your
to
clients?
Do
client.
their voices
have an edge?
client of
anything, and see what happens. Or, play devil's advocate and agree
(e.g.,
"You're
right, Bill,
clients
may
you
get over
2.
them with
argumentative resistance.
Such
to
"yes-but"
is
really equivalent to a
"no."
you, in
issue?
fact, off-task,
If
or have
irrelevant
you
because they attribute qualities to you that they have generalized from
may have
from anyone whom they view as an
you may consider bringing in a credible
such
from
disputational models.
reinforced
their lives to
whom
they
may
be more willing to
as
session,
you may
for clients'
"yes-but" behavior
is
that
is,
may be operating to
One client of ours,
maintain the
for example,
continually ranted, raged, and blamed her friends for not calling her as
148
Practitioner's
Guide
It
met with
a "yes-but"
is
client.
RET may
be
difficult to
in
accomplish
fill
is
The intellectualizing
3.
it
tech-
One
is
to in-
beat the therapist at deductive logic, and even sound quite rational.
Why,
The
therapist
of relying
on
would be wise
clients
(d) clients
is
(e)
to think clearly.
effective
with
C:
it:
any calmer.
to,
it
doesn't
make me
149
T:
Well, Jim, that just indicates that you haven't really given up the
C:
How
T:
By
must
do
do that?
We
Where
is
in
Another example:
know
intellectually , but
C:
T:
When you
it
say you
know
it
"intellectually,"
that
yourself convincingly?
could
C:
T:
Right, and
Another example:
T:
know that the rational beliefs make sense, but I can't feel it when
I'm actually in the situation.
Well, you can't feel more relaxed unless you rehearse a lot before
you get into the situation. Let's rehearse how you'll handle your
anxiety right now, to set a model for you.
And
finally:
C:
C:
when I'm
how
to
do
it
start obsess-
ing.
T:
is
What am
to use
anxious about?
Now
your symptom
Why am
Some
I'll
start to dispute
tied together?
150
Practitioner's
and uproot
got
it,
Guide
repeat that to
me
so
can see
if
you've
it.
The point
is
principle of
RET, which
is
is
When
or she has intellectual but not emotional insight, the therapist reinterprets this claim as either a
Now
we have
that
The
solution
hopefully you have a blueprint which will help you to build a more
elaborate structure.
disputation, however.
this
is
possible.
may
we
it
it if
will focus
behaviors.
Cautions
If
your
tress,
new
clients
skill.
Thus,
if
one
dis-
now
control her
it
it would be wise to ask, "How
you get angry again?" Such a question can not only pose a gentle warning
but can help the client prepare for this probability. If you omit this step,
the client may become discouraged the next time she does become angry
anger,
and
may
when
she
and
will be before
irrationally.
is
that
all
we
151
completely rationally.
In addition, there are often advantages to be attained
if
by displays
of
may
be an important tool
when
dealing with
government bureaucracies.
Another distortion occasionally encountered occurs when the
client
obnoxious
social behavior. In
and
by claiming
that she was responsible for her reactions and her problems; if she was
upset, she was doing it to herself. The wife, on the other hand, was
evaluating his behavior quite rationally and (in the opinion of the
therapist) was appropriately annoyed. While the husband correctly unissues,
He
152
Guide
Practitioner's
derstood the basic principle of RET, he did not understand that rational
thinkers can have negative feelings and desires to change the A. Al-
though the husband was not causing his wife's C, he was nevertheless a
component part of A and had responsibility for the marriage. RET distinguishes between not causing but still contributing to a C by being
obnoxious to someone at A. In reality, this man was demanding that his
wife have no objections to his behavior and was misusing rationalemotive theory to justify his position. The therapeutic response to such a
misinterpretation of
RET
and responsibly,
ethically
community and
in a social
is
no necessity
advantageous to do
clearly
is
key element
behave
to
The
so.
ad-
in rational-
emotive philosophy.
Although the
client in the
ples, rational-emotive
The
we
may
client
princi-
clearly
being an Activating event for another person but does not bear
the other's emotional distress.
it is
If
challenge
to
converse
which
directly
RET
any
subsequent
may
statements
that
the
exam-
ple:
C:
T:
Now,
feel guilty
You
can't have
what you
did, but
if
is
it
both ways.
so for his.
how
are
If
you're
not
He may
you
totally
The notion
of total responsibility
is
may
be more
ment:
T:
When
the consequences."
nutty idea
if I
may
153
do
this,
then
be happy;
way he wants
a notion?
Again, mini-experiments
following example, from
he'll
The
the point.
from
therapist
visit a sailor
she had
met when an Italian ship had visited the port. Her idea met with great
displeasure from her mother-in-law, who carried on in the following
vein: "What a bad person you are! Your husband is not yet cold in his
grave. How dare you take the child to strangers at a holiday time?" etc.
The daughter-in-law was suffused with guilt, concluding that her consideration of the trip had led directly to the older woman's upset and that
she was therefore a rotten person. The challenge went as follows:
T:
Let's
I
me
you're going on
a trip
respond.
C:
(complies)
T:
That's great! (Pause) So, your goirg on a trip cannot produce upset
in others. It's
beliefs that
her upsettedness.
The optimum choice is one that is both pro-self and pro-social. This
choice would involve both pleasing herself and pleasing her mother-inlaw. There are times, however,
able, as in this case.
What is
when such
Italy
and please
home
herself. If she
takes total responsibility for the mother-in-law's feelings, she will prob-
ing to her
if
own unhappiness by
and
We
make
is
may
contribut-
put a
a choice that is
dif-
both
rational.
However,
for us to
make our
life
decisions only
154
Practitioner's
Guide
is
and to take
feel
Somewhat removed
may
analogies
may
also be useful.
The
RET
them.
therapist
of the
"My,
reactions, in fact,
is
feel
more
variety of
even mirth.
As an
exercise,
list
the
list
further. (See
Answer Key,
Th en
see
if
p. 286.)
Depression cognitions:
Pity cognitions:
Mirthful cognitions:
Other:
CONCLUSION
We
ABCs
of a
session.
T:
C:
In this
meeting,
letting
my Mom
bully
me
it
and not reacting the next morning was like a major explosion.
You know, I don't even know if it pays to go into all this, the details
of it, but it ended up with my mother physically attacking me, my
brother coming between us, her pretending to faint right on the
floor, kicking her feet and banging her hands on her head and
pulling out her hair!
T:
temper tantrum?
C:
didn't
will
T:
155
work
me
my way
Let
ask
still
viewing
C:
Well
T:
Or
C:
T:
are
as a horror, then
you working
frantically?
Some
C:
like that
T:
Then what?
C:
T:
C:
am
156
T:
Practitioner's
Guide
overreacting."
C:
do
that.
T:
C:
T:
No.
But
me
(proceeds to
tell
get back to
listen to
you,
opinion.
If
it
make me
a shit."
The therapist
is helping the client to discriminate the B's and C's for two
separate emotional problems.
C:
is
T:
Well,
criticizing
C:
T:
157
get
OK?
C:
OK.
T:
T:
C:
C:
OK.
T:
Look
C:
Well,
for a
I
"should" again.
is
being so
unjust to me.
T:
C:
T:
C:
T:
OK,
C:
(Tells
T:
OK,
C:
All right.
home
incident)
treating
me
preferred.
T:
And
C:
T:
C:
T:
C:
158
T:
She should
shoulds.
C:
T:
Guide
Practitioner's
treat
We know
C:
T:
OK.
We've
got the anger and the anger cognitions, which are all those
Now let's do a D. What are some questions you want to
shoulds.
Why can't
fact that
T:
anger.
C:
OK. At
this point,
or to feel anger.
feel that it
It is
would
it
me
to feel nothing or to
T:
If
C:
159
physical things.
And
try to hold
it
in so
and
my
case,
OK,
T:
so let's work on the anger. It's been a while since we've done
an ABCD formally, so let's sort of retrain. When you do D you go
back to the nutty ideas, one by one, and you ask yourself questions.
Why should my mother be fair to me?
Right! Where's the evidence that your mother should act nicely to
C:
T:
C:
you?
don't know. Going to school,
see so
many
people at
home
living
T:
C:
T:
Why?
C:
Just because
want her
to. (laughs)
The therapist has allowed the client to repeatedly struggle with the
question rather than answering it for her.
T:
Hmmmmm.
T:
Now
The therapist never disputes the desirability of the client's claim that it
would be advantageous to have what she wants, merely the de-
mand.
C:
It's
possible at
realizes
feel
T:
it, it
some level
make her
can't
she's
feel
good.
Right. So
fairly.
that
if
if
she
mother
160
Practitioner's
C:
Right,
T:
But
it
might
why must
maybe good
for
be.
for her.
Why
it
would be good
for
you and
you?
OK,
T:
C:
Guide
is
being repeated.
don't think
you
believe that.
T:
C:
T:
C:
T:
Now?
C:
Now
the
unpleasant.
T:
hear you saying, "It's good that my father is not upsetting himself
about her nuttiness any longer. He lays back and it rolls off him."
He is not trying to train her or shape her up by confronting her.
C:
Right.
T:
C:
T:
at all. She's
Disputation: Problems and Solutions
161
tough job. You're going to try to retrain this woman who's had
sixty-some years of reinforcement for this kind of behavior. You're
going to have a tough job. That knowledge may help you make
your decision about whether or not to stand up to her is it worth
it?
C:
Right.
T:
watched
my
men
I've
been
many
years and
did get
T:
were
C:
Now
attack back.
T:
C:
T:
C:
T:
own
C:
T:
adaptation.
Right.
The therapist
is
father's behavior.
C:
T:
OK.
What I hear you saying
OK. His
is
some-
162
Practitioner's
Guide
nutty
let
her be her
self.
same behavior
C:
T:
Right.
C:
T:
Let
patterns.
back.
me
suggest, before
we go
As
off,
maybe we can
a series of strategies
we
could try.
Step one, however, is still the same. Let's get over the rage. Now,
once you can accomplish that, you can probably problem-solve the
situation better. "Let's see, I can try experiments. I can try retorting and see how that works. I can try reinforcing better behavior
and see how that works. I can try doing what my father does and
shutting up and doing whatever she asks and see what that does. I
can try being very assertive and confronting her. I could try giving
her lectures. I could try giving her books to read." You might try
strategies. If a strategy doesn't work, after a reasonable try, you
end the experiment and say "Well, that didn't affect her behavior,
I'll try something else." All those are strategies
they're just be-
haviors.
C:
me
good.
feel
could try
this or that.
T:
he's
if
demanding
is
wants
The therapist
is
pointing out
why
would not be
appropriate.
C:
Yeah.
T:
As long
as you're
demanding
that
C:
T:
Yeah.
Step one
strategies
C:
T:
"
doesn't
and
seem
me
The therapist
C:
T:
way
she
is
for
to
sitting
is
163
now
she
to change,
When you
today.
C:
horrible thing to
T:
C:
T:
really do.
mean,
C:
OK.
T:
That's
why
good book
is
handy thing
to have.
it
between
Theme
Active-Directive Style
RET therapists
vary quite a
with patients,
RET
more
tion
is
a dialogue
carefully following
An easy trap for an active therapist to fall into is the Advice Trap, in
which the therapist either gives patients solutions to their problems or
appears to be recommending a particular solution.
clients see that
tant,
is
however,
is
more impor-
problem solving
particularly when they have seen how not
more
important to help
Still
discussed
It is
fully in
Chapter 10.
is
it
will
be
165
Therapist Strategies
want
If
which RET
they will want to speak tentatively and check out the ideas with
the client. Thus, the therapist might say: "It sounds like you're saying
Why
but:
What
or:
not:
but:
or:
not:
but:
or:
beliefs
by phras-
did
telling yourself
such
as,
them
than
but:
How
or:
What
What
or:
it's
not true?
At
we want to point
RET principles: (1)
this juncture,
of presenting
and
166
The
logue.
Guide
Practitioner's
own
make
The
what
more on
the point.
evocative ques-
The
latter,
therefore,
as did
and more
a slower
is
vices,
It
is
therapy, since
it
may
Mini-lectures
is
some
pect a
of course, appropriate
results
who
is,
come
to
female client
orgasm
in inter-
course).
The use
lecture,
is
your
client
If
you give
it
in a
(mental)
notebook and filing it away for the next test in this case, the next
therapy session. Be aware of this tendency and, without labeling it as
such,
is
program
really
little tests
"with you."
Do
make
that the client has understood the previous one. Also, give behavioral
homework assignments
and
recall.
memory
Whereas the
lec-
method allows
retention.
167
Therapist Strategies
What
understanding?
mother's doing to you, doesn't cause all these different reactions. It's really what you think
your belief system. Now,
different kinds of beliefs cause different kinds of emotions.
Illogical or irrational beliefs which exaggerate things cause
very disturbed emotions, and rational, logical beliefs cause
more appropriate, less disturbed emotions.
Socratic dialogue:
T:
OK,
168
C:
T:
Practitioner's
Guide
C:
T:
C:
T:
me.
That could be. The word "meaning" is very important, isn't it?
Because it's the meaning we put on situations, in this case your
mother's behavior, that leads to our emotional feelings. What
meaning do you think you're putting on your mother's behavior?
(pause) That's a hard question.
But you're obviously not saying, "Oh, it's fine that she acts that
way. I'm really pleased." Are you?
C:
Oh, no!
T:
What
C:
T:
It's
some
Listen to
to
of
Now,
specific
If
to see
if
Later, review
it.
slip into
may
169
Therapist Strategies
may
help
them
important to learn
how
to ask
it is
good questions.
Why
but:
What do you
you anxious?
think makes you anxious?
Are you aware of the fact that you are
OR:
are
in control of
your
anxiety?
As a handy
a "how."
"why," the
therapist
may
who
in obtaining cognitive
who
suffers
T:
from headaches:
Such questions
may
is,
patients
resem-
may
be
170
Practitioner's
Guide
on
issue
a verbal level
is
less
lives,
direct behaviors.
we
are not
how
close
all
Tape
Note that
the form of
declarative sentences.
you come
to this goal.
evocative questions.
to clients
if
merely designed
your
in
it
repertoire.
PACING OF QUESTIONS
To
monologues or
to hold back
is
an avalanche
Ask the next question as soon as the client answers the last, even if
means interrupting the client's speech. It is difficult to guide the dia-
fully.
this
is
willing to be assertive.
Why
non sequitur,
do
this
may
If
he or she responds
clients not
misunderstood
it;
may
(4) their
conversation; or
(6)
they
may
may
behavior
may
be de-
be unskilled at social
skills
and help
If
patients repeatedly
fail
to
answer questions,
useful
171
Therapist Strategies
strategy
is
the question.
relates to
Many new
an attentional
who
is
It
might be helpful
to
remember
who
is
that therapy
forty-five
that
it is
the
point
an
clients
deficit,
skills.
they remember
rude to redirect the client and worry that the client will be
is
it
if
patient's digressions
that
is
it.
is
not
social interaction;
it
is
The important
with approximately
appropriate to stay on
target.
helpful
Many
drift is inappropriate.
therapists
172
Guide
Practitioner's
You can
session.
It
increase focusing
is
better to take
ple:
T:
therapist
is
may
on one
a conversation
psychotherapy.
If
is,
this skill
after
topic
all,
and being
a prerequisite
is
1.
may
a task.
The following
You may
client in order to
sharpen your
skills in
detecting conversational
slippage.
2.
Clients
may
identify the
3.
You can
helpful to us."
On
and
may
it's
"You
understand how
point out:
I really don't
again!" As in behavioral training,
putting the emphasis on the positive reinforcers.
we recommend
way you
Implementing any or
all
and
it
to
me
and
173
Therapist Strategies
you
believe
What
is
a deflection
and not
Jim, I'm going to let you talk about your root canal work at the end
of the session; we'll save time for that. But first, I have some very
T:
T:
shall
is
want
to discuss about
at least sets
some
your marriage.
the following:
Jim, your root canal seems to be important to you. Let's give the
You may
how
tion. If they're
angry,
similar situations
an
it
may
issue
they
be useful to ask
if
feel
to the
main
therapeutic problem.
If you sense that the client's new issue
you may confront the client as follows:
T:
More
is
a distraction
maneuver,
directly,
client
how
with the
avoided one:
T:
Jim,
Ultimately, you
may want
to share
to
an interpretation of the
in
client's
behavior:
*The Premack Principle
low-probability behavior.
be used to reinforce
174
T:
Practitioner's
Guide
it seems like week after week you come in with your agenda
items which seem to get us off the track of the original problem
your marriage! It appears to me you may be trying to avoid that
problem. What do you think it is you could be frightened of?
Jim,
If
may
tions that allow only "yes/no" answers. If you become aware that the
problem focus has already been lost and the conversation has gone far
afield,
In a few sentences,
What
are the
Another useful
what
is
most prominent
tactic to
basic questions:
irrational beliefs?
is
to keep
Redundancy
Therapy,
It
will
demands
a certain
amount
of redundancy.
broken record.
RET
may
feel that
you sound
like a
many
pa-
175
Therapist Strategies
tone and modulation
may
and
in Chapters 6
7)
Disputation
you must
says
"Where
is
(as
was seen
the evidence?"
"Why
is it
awful?"
same
"Who
?").
Language Style
Adjustments in language style
clients
woman,
sorority.
she
is
will often be
who
is
young
afraid to
conversations.
point.
ers,"
is
to be
"Some
they are!
If
it
it
own
idiosyncratic lan-
lives as a "shit" or a
own words
(e.g.,
awful"; they
"Oh,
my
may have
said
it
many
pits,"
etc.). It is preferable,
times in their
176
Practitioner's
Guide
client's
thumb:
if
may
Obscenity
Another aspect
is
of style
will
therapists
model closely
beginning
RET
want
Ellis'
to be flexible about
phrase).
common
may
Many RET
RET
terms,
by referring
how
stuit
is
to his
behavior makes him "a shit." Obviously, other terms will do the trick as
to use
Ellis
tives,
even
if
times even the most subdued and reserved clients find that
when they
words are the most appropriate and evocative descriptors. They often help loosen people up and
have a strong emotive and motivating quality.
are describing serious
life
hassles, four-letter
may sound
remember
is
rapport building.
who
It
curses, but
177
Therapist Strategies
those with
whom
off guard.
Thus,
it is
common
observation of therapists that once they provide a model for the use of
obscenity and thereby give permission for the patient to follow suit, the
patient feels
more
To prove
free.
rapport building,
We
do not
"sprightly use"
is
indiscriminately.
Its
("Why
("You sound
like
really a shit!").
life
the
and that
third use
is
to
and
not directed at
it is
is
all,
since
Intonation
is
voice intonation.
want
which the
RET
communicated
in this modality.
is
is
discussing his feelings of guilt about not visiting his parents as often as
like. The incautious therapist might say: "You only go once
week?" or "You don't go frequently at allV Inflections of the
they would
a
therapist's voice
may make
how
the patient
as
irrational beliefs.
When you
listen to
one of
Ellis'
important discrimina-
178
of
RET in
Guide
Practitioner's
for clarification.
of the
words that
reflect
he
drops his voice several notes, stretches out the word, and increases his
volume, producing
a dreary,
awwwwwfull that he
doesn't like
me!"
when he changes
Later,
it's
the "aw-
the words,
now
way.
He
speaks
the key word slowly, enunciates very clearly, and raises the pitch of his
voice as well as the volume. Thus, different auditory stimuli are asso-
style.
He
is
volume may
increase
the probability that the client will attend to and learn from the therapist.
make an important
is
crucial
when
the therapist
is
about
point.
when
it is
appropriate.
is
to signal
of
T:
You can
as the following:
tell
you something
OR
T:
If
them
for five
179
Therapist Strategies
Silences
may
Silence
may
communicative.
also be
When you
is
a parallel
true
often
in
If
conversations.
For
example,
the
if
client
loses
the
may
is
making
tive
is
these remarks
may
thereby prolonging
belief,
its
A better
or to reflectively paraphrase
saying that
stress
would be hard
that silence
is
always
it
is
to check
on your
Patients
agreement.
patient's understanding of
may
It is
your
interpret our
wise, therefore,
silence
and correct
Some
In the
Final Points
above section,
doing RET;
it is
we have
new
therapist
become comfortable
all
the
glib,
always allowing no
180
Guide
Practitioner's
may
be
productive for your client and boring for you. Interpersonal style
is
less
your
tool,
who
prescribes the
same medica-
This injunction
seem
to
is
RET
RET
dictum
is
which
is
members must be
present at every
session.
is
is
always taken,
ing.
The
practice of psychotherapy usually assumes a forty-five- to fiftyminute hour, but there is nothing sacred about the length of the session.
It may be advantageous for you to alter the session length and use a
somewhat
individualistic approach.
Some
the
session
it
before
sit
through
time in their
many
example,
may
re-
philosophical disputation.
able to
clients, for
On
a fifty-minute discussion.
lives that
some
clients
may
be un-
first
Therapist Strategies
181
clients, a
may
be desirable
you can get them to converse for a full session. If you do schedule
fixed-length sessions, you may wish to spend only part of the time in an
before
intellectual
ing exercise.
Our
amount
remained the same, and the amount of time spent avoiding topics or
of time limitations
we have found
session,
that
we
is
the therapist.
more
are
directive,
is
may
to
keep their attention span on one topic for more than thirty
minutes. Recognizing the limitations of yourself and your
client can
Similarly, there
is
no reason
always
on the
session
sit
example,
always
them
where they
why
every
it
may
a client
first
this point,
An
example of
be beneficial
from you
across
place in the
sit
be no therapeutic reason
must take
therapist's office
it is
client to
"Why
don't
however, particularly
if
we have
you operate
182
this
Guide
Practitioner's
sion progressed in the hallway, the client experienced a gradual reduction in anxiety.
down
the client into the elevator, and they eventually rode up and
while
conducting the remainder of the session. This format led to the reduction
of the situation-specific phobia in three sessions.
RET
Roles of the
RET
RET
practitioners
Therapist
may
What do you
foremost, you teach mental health. Second, since the goal of therapy
to enable patients to
do an
ABCDE
only ask
many
method
analysis themselves,
Good
of reasoning.
may want
teachers not
is
you are
own
to periodically ask
yourself:
Is
Am
Am
doing too
much
How can
Am
of the
have said?
work?
really believe
what
giving enough
more strongly?
husband
might say.
acceptance,
").
you
were
in
you may
your situation,
will
want
disturbing behaviors.
refuse to
183
Therapist Strategies
and Countertransference
Issues of Transference
By
transference,
we mean
it
may
first
job
is
to identify the
emotional tone of the interaction and then the belief systems behind the
emotion. Once these are specified, you can ask clients whether they
relate to others in their lives in the
example:
"You know,
same way
wonder
if
that's
how you
relate to other
as
we
.
talk
.
about sex,
notice
women?" Such
me.
confrontation
Even
in a
may
be
exam-
ple,
all
the
wrong
Such
a patient
is
are.
therapist.
Your attitude toward the client countertransference is also important, and you may use yourself as a measuring device. Ask yourself:
how do you feel when you know the client is coming to see you? Do you
look forward to the visit or dread it? For what reasons? What are your
feelings about the client during the session?
is
What
other people, you are in a good position to give direct feedback that
184
Practitioner's
may
others
Guide
that
is,
how
tone of voice,
little
time).
"Yes,
" or
if I
why someone
like herself
Subsequently, the therapist will also raise the issue of what the question
meant and
It is
if it
feelings. In re-
sponse to a serious question about dating such as the one above, you
might say,
before
we
started therapy,
if I
my
clients.
Achieving
in other circumstances or
will not
is
that
we
are involved in a
is left
unresolved, they
may
and keep
fully
withhold informa-
by reaching closure in
discrimination between thoughts and
modeling a
may have a nice sexual fantasy, but I choose
not to act on it." This may be a very educational message about how to
deal with desires; just because they exist does not mean you have to act
on them.
Suppose the patient asks the therapist if she is attracted to him, and
this
actions
also
the therapist
is
not; what might she say in this case? Quite simply and
may
say: "No, I'm not." If the patient reacts to this information by becoming more depressed, the therapist has a perfect inroad
to a major irrational belief, for surely she will not be the only female
gently, she
statements such
attractive,
as:
no one
may
that because
him with
you
don't find
else will?"
is
surprised
that
we recommend
that the
185
Therapist Strategies
One
is
is
more psychodynamic
"Why do you want
to know if I'm attracted to you?" may seem like a phony dodge to the
patient. The question may be a good one, but it would be better to ask it
course,
is
quite different
in
at a later time.
"clinical," such as
want
to
by asking,
sincerity. It
is
"Why
is
is
that important?
Why
do you
directly
somewhat
different environ-
"clinical"
make
friend.
my
my
question!"
Patients
may
also ask
many
knows
that there
is
RET
may
On
the
swering them directly, you might ask patients how they feel about this
new information, how they feel about you, and what were their reasons
for asking. For
186
Practitioner's
may
This pattern
Guide
you
you are
mere mortal.
relationships,
beliefs
Patients
may
not take orders except from Perfect People; this style often leads to a
kind of self-downing philosophy.
clients
if
It
might be profitable
respond,
"Oh
no,
why
to ask such
If
the patients
can guess that they are doing the same thing with other people in their
lives,
the university.
It
will
addition to yourself.
If
do
so.
up transference
issues,
to
homework
each time
beliefs
give
It
will also
be important to
identify the beliefs that led to the inhibition of direct expression of these
feelings.
is
curative reasons but to help the therapist recognize relevant A's, C's,
Two
1.
Try
as the
therapy session
is
coming
to an
clients
Therapist Strategies
187
As
2.
feedback,
you may
"Was
ask:
there anything
did or said in
the session which bothered you in any way?" Also, "Was there
anything I did or said today which seemed particularly useful to
you?" And most important, "What did you learn from today's
session?" Questions such as these may (a) enable you to adapt
your style to your patient, (b) provide information to be taken
up in the next session, (c) give an opportunity for a brief rehearsal by the patient, and (d) help identify other B's which can be
taken up later.
Summary: Common
Failure to listen.
1.
if
you
fail
may
wrong
Among
may
may
clients'
may
misdiagnose
mean by
direction. Similarly,
such as
ample; you
they
Errors to Avoid
this
may
term because
idiosyncratic phrases,
beliefs.
2.
that
you can
It
will
clarify or correct
It is
You
them, or
want
to determine the
know
these concepts so
will also
important to
if
many
New
therapists
may
err in
may
be
made
in either
ramble or cutting them off too abruptly. What is happening when you are not sufficiently directive and
allow the client too often to lead? Perhaps you have forgotten your game
offending clients
if
you are
afraid of
188
Guide
Practitioner's
error, either
by
criticizing or
asking what you thought at the next session or by complaining that you
therapy session
is
You
Errors in questioning.
5.
mistakes:
(a)
will
using too
(e.g.,
many "why"
to "because" excuses.
"When you
(e.g.,
would be better
It
do
this,
want
in
to use
"What
"how," "where," or
are you telling your-
(d)
overusing
(e)
any one of them; (f) answering the questions for the clients instead of
letting them grapple with questions on their own or helping them by
breaking questions down into simpler components; (g) failing to note
whether the client has, in fact, answered your question or simply zigzagged off into a story. If the question was unanswered, bring the client
back to task.
6.
you
fail
to check
and see
way
patient to acquire
to learn
RET
the client
is
something
is
to teach
if
principles, therefore,
is
it;
the best
way
when
tell
us
for the
didactic lecture.
7.
It is
feedback from clients to assure that they are understanding you. Listen
to tapes of
weren't
what you think are your good sessions; make sure that
"Unvhmmm-ing" you
clients
It is
just said or to
example,
why
it.
It is
may
same
insight.
Therapist Strategies
9.
Attitudinal errors.
You
189
will
want
(e.g.,
"You have
a big
to challenge
problem;
it's
going
is
The reader
is
encouraged to
listen to a recent
all
of these errors at
You won't
_LU Comprehensive
Rational- emotive
Therapy
The
RET from
it is
this
other cog-
and cognitive-behavioral systems of therapy. The reader will refrom our discussion on page 40, that the elegant solution entails
the assumption that the Activating event is true and will remain so
("assuming the worst") and encourages clients to change their evaluanitive
call,
more
1979b), he has expanded his theory to include both elegant and inelegant
solutions,
recognizing
that
clinical
realities
may
dictate
both
to
1.
2.
fall
we have
discovered
Self-instructional training
4.
191
Rational- emotive
try
to
we
therapists
utilize
all
four
modalities
of
work in each of the three areas not covered so far. This presentation is
not meant to be all-inclusive of other cognitive-learning therapies but to
provide what, in our estimation, are representative examples.
Self-Instructional Training
Some
may
Among
clients
therapy.
is
too
is
intellectually limited,
is
is
RET
therapist
may
turn
Self-instructional training
Meichenbaum
is
work with
(1977) in his
anxiety.
self- statements
help the client focus on the task rather than on the anxiety.
is
The
principle
192
Practitioner's
What
Guide
is it I
become
how
to begin. Well,
clearer as
I'll
and maybe
2.
it'll
go along.
self-
statements are designed to help the patient cope with anxiety and reinterpret
it.
The message
is
is
is
the anxiety
Slow down
label
I'll
a little.
my
thought
anxiety from
to 10
manageable.
it
reminder for
all
me to cope.
in a panic.
and watch
it
change. There,
now
3.
is
and others may not be able to reward the patient for small increments of
control. Examples:
It's
working.
can control
did
it!
am
in control.
It's
how
The procedure
for doing
feel.
of
my
fear than
it
was worth.
least to
may
for a
be "sitting
in class when the instructor announces that a test will be given in two
weeks." The highest item on the hierarchy might be "taking the exam
and seeing other students finishing and leaving the room." Hierarchies
typically consist of at least ten items, arranged on spatial, temporal, or
is
is
later
self-statements
covertly,
from each
of
the
193
above three
categories.
The technique
tient
with
may
a philosophic
mental stressors.
It
may
RET
helped her to
feel less
depressed and
guilty about the rape experience, but her fear in the presence of
men
fear hierarchy
The reader might try to suggest some coping statements, utilizing each of Meichenbaum's three categories, for clients with
each of the following types of problems:
p.
286.
194
Practitioner's
Guide
men
client
A less
elaborate version of
is
known
may
then
therapists
as the Rational
tell
a four-eyes,
If
clients
call
her a
same responses
name
(e.g.,
make me
(give her a
"Well, you
bad person").
many
annoyed
may
is
may
may
feel sad
feel this
way
a substantial
proportion of
the time. In such cases, even though clients think rationally and feel an
still
un-
worthy of psychological intervention. Two major procedures to which the rational therapist may turn are (1) helping them to
examine the accuracy of their perception of the A, and (2) helping them
pleasant and
to develop strategies to
PERCEPTION OF THE A
In
Chapter
3),
everyone in
sumed
we used
who
(see
believed that
we
as-
was correct and attempted to deawfulize his evaluation of this situation. Even if the disputation were
successful, however, the client would be left with unpleasant emotional
effects and would undoubtedly be uncomfortable when he went to work
if
195
The
additional task of
scientific in his
RET,
therefore,
is
to
from them.
his conclusions
we human
Wegner and
Vallacher
we may
be unaware of perform-
social
same phenomena but may not know how to funcgood scientists. Without careful monitoring, we can easily slip
at control.
One
of the first
no immutable
to
is
role as
methodology.
axioms
in the
philosophy of science
is
it
it.
logic of
to discon-
fail
The
scientist
are prepared to
the client
is
who
and their
Now,
let's
the distinction
between
facts
is
to
them. These steps are precisely the ones used by therapists such as
196
Guide
Practitioner's
is
The
scientist's
utmost importance. In
of the
therapy, the patient in our example would be asked for data to support
his hypothesis that
no one
likes
How
does he
know
is
client.
is
listen
him?
who
hardly objective,
is
to be repeated, therefore:
likes
of persons
list
and there
no one
that
distort
et al.,
data:
selective
and
magnification/
more
tion
ment" Beck
et al.,
1978,
p. 7).
this ele-
8). In
tures of the world around them, so that they are gathering biased data.
In selective abstraction, clients focus
others;
in
on one category
magnification/minimization,
clients
of data
ignore
and ignore
information
within a category.
For example, our hypothetical client
may
when
business
is
being dis-
He may
inaccu-
rately discount these data as being irrelevant to his hypothesis. In addition, the client
to lunch; in fact,
is
indi-
cate maximization.
If
your job
as a therapist
is
and the
client
had better
you want
agree on which
to use? For
more
197
ond, frequency counts in logbooks will help the client keep accurate
records and avoid the problem of magnification/minimization.
may
more
If
accurate accountings, he
contact with
him
was invited
first
no one
likes
him, but
if
may
he
still
believes
he
it,
is
making
logical errors in
his data.
If
is,
in fact, low,
many hypothmay
behave unsociably
in the office
and
his
co-workers
may
is
may
believe that he
because
of status
be a particularly important
client.
numerous
In
alternative hypotheses
all
logical errors
of
The
1.
which Beck
refers are:
198
2.
3.
Guide
Practitioner's
when
there
is
no
basis for
making such
a connection.
was making
One way
be tested
is
own
interpretations of the
above, the therapist has hypothesized that the client draws a conclusion
("no one
likes
place. This
me") when
work
therapist's conclusion
is
The point
is
how
Thus, the
manner, the
client's
of these procedures
In
to take
fail
A in a much
is
to
more
have done.
likely to
the patient to objectively collect and accurately label data outside the
(2)
whether the
as reported
is
true or
if
first
procedure evaluates
The
client,
be wise,
first
of
all,
to
It
would
A useful
human
beings,
it.
The client, Bill, who works in the art department of a large New
York advertising agency, claims, "I'm no good at snappy conversation!"
Is this
statement correct?
If
may
be a result of
199
as
who make
a talented reference
New York
group
Ron, reports that someone criticized him and he acfact. There are two parts to this
challenge: (1) determining if the other's comments were indeed
critical, and (2) determining if they made sense as statements of
fact. In the first instance, for example, the patient might say that
someone insulted him; questions the therapist may use as challenges include: "What actually happened?" "How was that an insult?" In the second instance, the therapist might consider use of an
analogy such as the following:
"Suppose a little child came in at 4 p.m. and began whining for
cookies, but his mother told him 'No.' The child threw himself on the floor and began screaming, 'You're a bad mother
you're mean
you're stupid!' That's an Activating event. Do
you think Mom will react badly to it? Probably not, because
she knows differently. In fact, isn't she acting like a good
mother by restricting sweets to protect the child's teeth, and
especially just before dinner so he won't spoil his appetite?
Now, let's see if what Mr. X said to you made sense."
The
patient,
Just because he
an affair?
C:
We-e-1-1, no.
T:
There's no
members
C:
T:
way you
200
Practitioner's
Guide
guess so.
Yes,
And
it
is
sexual encounter
C:
T:
make
C:
T:
C:
T:
C:
T:
C:
T:
mean?
it
true?
But if he has an affair, that means I'm not enough for him.
No, that's your perception of that, and you think that's what it
means. Because you believe it, that doesn't make it true. You're
assuming that a person (1) can only love one person at a time, and
(2) can only have sex with people they love, and (3) will not love people
if they're having sexual relations with someone else. All these
assumptions are in your thinking.
It could mean he didn't think enough of me to abide by my wishes
and not have outside sex.
Right. It could also mean that he thought he could get away with it
I want him to be only mine.
I would like that too with my mate. Maybe that's not possible. It
doesn't mean we can't enjoy them at all.
But if he does that, I'm going to be very upset.
I think it's appropriate for you to be disappointed, but do you have
to be really upset?
don't want
him
do
C:
T:
C:
T:
C:
You
to
didn't answer
my
it!
question.
don't have to be very upset, but so far I've been doing that.
want him
to.
T:
How
C:
T:
C:
T:
C:
T:
therapists
seem
engage
to
201
outlined above, perhaps not realizing that they are working very similarly to Beck,
make
clear to
therapist
ciently.
We
hope that
new
go about clarifying perceptions of the A more effimight point out that the process of correcting mispercep-
how
tions of the
We
to
is
you
believe
is
many
different forms:
namely,
"Where
is
the
really true?"
CHANGING THE A
Once you have helped the
perception of the A,
issues. Absolutistic
will
it
client
his or her
may
etc.)
some
and
a psychological intervention
is
a legitimate
and
important endeavor for the rational therapist. This cue has been taken
from
Ellis,
who,
in his
a significant
proportion of
Changes in the A
are of two basic types: (1) attempts to change the environment in which
the patient operates and (2) attempts to change personal aspects of the
time helping clients develop social and survival
skills.
client.
Changing the world. Clients are frequently beset by real-life adversities which can be changed. There may be severe financial problems,
legal
RET therapist can serve two basic roles: giving informawhere appropriate and, more importantly, teaching problem-
solving
skills.
deciding
may
profit
from
is
discrimina-
tion training
that
their expertise
may
is,
the limits of
202
Practitioner's
Guide
We
develop a
list
handy reference.
The second skill
oriented set.
recommend
that
all
therapists
By
this
clients
may
phrase
we mean
profit
from
is
maintaining a problem-
tions:
1.
Clients are not helpless; they can do something about the situation.
As we
with them.
many
is
realistic expectations
3.
many
have
difficulty clients
volves failure to take risks, beliefs in the necessity for certainty, a belief
and awfulizing about making the wrong deciThese concerns are dealt with by disputations of the irrational
beliefs. Once clients have learned that there is no such thing as a perfect
solution, no guarantee of a given outcome, and no shame in choosing the
in foretelling the future,
sion.
wrong
road, they
may
still
draw up what
Ellis
has
A
making
hedonic calculus
is
a fancy
way
relative value to the patient, and the relative probability of various longand short-term consequences; tallying up the pro's and con's; and then
203
being brave enough to act upon these data. Each of these steps
may
entail
elaborate discussion between the client and therapist, the client and
outside experts, and the client and others involved in the decision.
considering marrying a
new
is
partner
a divorcee
who
lives in
disability.
who
a workaholic
a stable job,
the
man,
and
cal-
culus, she discussed with her therapist the relative probabilities of vari-
commitment by her
discussed the import of the medical disability; with her children she
discussed their reaction to the contemplated union; and with others in
employment
in the
new
location.
Once the
it
was
clear that
the
new
relationship.
management. Many interpersonal difficulties can be helped by the judicious use of contingency management to shape new behaviors and extinguish or punish undesired behaviors. Parents
may
same
principles in attempting to
change
any age
in virtually
any interpersonal
may
situation.
be useful for
If
the reader
Here
is
modification (as
RET
RET which
it is
includes behavior
204
Practitioner's
Guide
its
more
in-
more and
her child-rearing
from some
guilt,
and the
guilt,
much
home. Her
definition
Cognitively, the
may occasionally
and the
It is
an
risk of confront-
contingency to change
sion to
Even
TV
however,
this
potent penalty
number
of hours.
mother remained
205
assigned. Accordingly, an
skills,
clients'
them.
We
turn
Changing the
now
client.
your
If
clients are
performing poorly
in
some
endeavor and are denigrating themselves for their poor results, the
order of business in therapy, as
downing.
If
the
work
of therapy
we have
were
said,
is
to stop there,
to
work on the
however, the
life
first
self-
clients
might very well accept themselves but remain what Goldfried and Davison (1976) labeled a "relaxed incompetent." The question the therapist
will
want
to ask
is:
"Is
my
and does he
now
to
some common
skill
deficits that
may
We
turn
solving skills.
While
Goldfried, 1971),
number
Allen
we
is
of researchers
et al.,
Piatt,
problem of getting along with one's secretary. Social probis not correlated with IQ but has been shown to correlate
with other measures of psychopathology and poor social adjustment.
to solve the
lem solving
skills
may
be present
206
even
when
Practitioner's
there
is
Guide
ner which
is
may
which society
self-defeating and
define as inappro-
priate.
him
treatment
The following day, Spivack discussed with the child his reasons for the
trip. As a good analytic psychologist, he had many hypotheses to explain
the child's aberrant behavior. Possibly the boy was behaving masochistically and desired to be punished for his behavior, or was acting out his
anger toward his caretakers. As the therapist proceeded to gather information
in
many
questions
about his behavior. The boy reported that he was going to town to buy
an item that he had seen in one of the stores. The therapist asked, didn't
at that
thought of
it.
was breaking a rule? The boy responded that he hadn't thought of it.
Didn't he realize the consequences of his actions
that the staff would be
angry with him and that his privileges would be curtailed? The boy
responded that he just hadn't thought of it. Didn't he realize that there
were other ways to get the desired item? The boy responded again that
he just hadn't thought of it. At this point, Spivack reported having a
own hypotheses
think?
some
it
be that
simply didn't
The
have suggested
which,
when
number
of hierarchi-
fac-
in
number
207
are important, the next being the ability to stop and think (e.g.,
here
is
the problem,
to attack it?").
phenomenon
majority of those
who
fact is
it.
"OK,
skill is
an observable or
upon by
observe
Another
is
at least a
the ability to
recognize that others will have different opinions than oneself about the
same facts.
Once recognized and acknowledged, the
dealing with the problem
skill
is
first
necessary
The more
more
likely
is
who
skill
for
he or she
number
to function adaptively.
is
of
Consider
many
showed
that a
alternative courses of
action to deal with the situation; for example, he or she could (1) ask the
child for the toy, (2) trade for the toy, (3) hit the child
(4)
it
when
the child
is
skill
of generating alterna-
that
more appropriate
be-
The
skill is
is
a skill
which the
client
may
need to
many
silly ideas,
encouraged before the therapist leads the client to the next step
in the
hierarchy.
The second
is
labeled con-
sequential thinking. This term refers to the ability to predict the conse-
its
effects
behavior likely to
How
is
the other
compliance?
Is
Is
the
208
Practitioner's
Guide
predictive
make
who
is
may
trying to decide
Among
how
to
the behavioral
when he whined.
It
is
and
Once
one(s) that appear to have the best probability of success, the next step
entails
how
and how she will respond if her child escalates his whining. For example,
how would she cope with the whining if she is in a public place with the
child?
The plan
implemented and its effects are evaluated. How did it work? What
went wrorig? Can it be fixed? If the results are negative and the plan
is
is
new approaches
to
step one,
to the social
problem.
ments which
that
assumes
If
the
209
Spivack and his colleagues points out, however, that personal problemsolving skills
may
Many
social
problem-solving
skills
al.
program
training
in
therapists.
It
is
routinely
are
RET
RET
by
taught
rational
done with
workshop called
therapists have
conducted
"Creative Contacts for Singles," one of the most popular ones given at
the Institute for Rational-Emotive Therapy. In this workshop, he
first
helps people identify and challenge their inhibiting thoughts and then
teaches
mem-
When
is
simply un-
anti-catastrophizing)
is
an indispensable
and
tool.
ASSERTIVENESS TRAINING
One
generalized behavioral
skill
that
is
may
Thus, clients
may
may
be
210
Practitioner's
may
professional
fall
Guide
meek
as a
mouse
at
home. The
assertive female
may
when
it
mind:
Behaving assertively
1.
wants, although
outcome.
2.
it
is
may
will get
what one
If one knows how to behave assertively, that does not mean that
one must behave this way all the time. In some instances, discre-
tion
may
skill
The
first
more
assertively
is
to
is
is
communi-
is
all.
Aggressive be-
is
usually
righteous or hostile, and often has the intent of punishing the other.
aggressive responses, or ideas with which the client punishes himself for
inept assertive responses, for assertions
all.
Clients
rights as
may
then find
it
tive, a step
which
spouse or as parent?
may
211
communication and developing training procedures to bridge the gaps in his or her skills. The
following list, adapted from one prepared by Janet Wolfe, may act as a
checklist for both therapist and patient in determining skills and skill
deficits in verbal and nonverbal behaviors.
client's strengths
and weaknesses
in assertive
When
you
Give
as
prompt and
unduly apologetic.
When
why
applic-
brief a reply as
tion.
3.
4.
Look directly at the person you're talking to. Check your other
body language for things that might convey indirectness or lack
of self-assurance (e.g., hand over mouth, shuffling feet). Watch
your vocal tone and inflection, making sure that you speak
neither too loudly nor too softly.
5.
6.
kind of inconveniencing").
7.
Keep
talk
8.
9.
a log of
212
Guide
Practitioner's
Obviously,
lists
is
RET
How
Brain damage
Psychosis
Do you
tell
is
your
clients that
some
socially unacceptable or
of
your
is
dowdy
cal
fashion.
advice that
is
an older
become
may
be relevant?
How
a bit
if
you withheld
practi-
changes that might enhance her chances of reaching her goal? You
213
experience that
women
like
client herself.
disturbed clients
may
may
be more direct.
more
forceful
More
may
preferably be
seriously
enough
if
any, in the
your timid-
was
problem given by the patient was her lack of friends, about which she
much
own
eyes, even
that hospitalization
when
is
required.
own
The
someone wasting
young
the patient vehemently
away from
woman
a terminal disease
in search of friends
hardly
would
desire.
At
first
denied that her appearance played any role in her social difficulties, but
with repeated and vigorous challenge by her therapist, she finally recalled a recent interaction
with
woman
had
by the
therapist,
state,
on
The psychotic
patient
may
similarly be
unaware
fact,
some psychologists
many
areas of
life.
may
it
progresses,
may
time the patient mumbles, goes off the topic, or inappropriately breaks
eye contact. Second, you can train the patient to become a more careful
observer of the reactions of others. Reports of these verbal and nonverbal reactions to inappropriate behaviors can then be discussed in therapy.
Finally,
you can
some
self-statements which
may
Meichenbaum
patient.
as
In
cal
summary,
It's
not clear;
let
me try again."
and philosophi-
RET therapist, many other skills and techAmong these, we have considered the use of
niques
may
be helpful.
client to
we
helping clients change their world (e.g., problem solving and con-
and providing
niques drawn from the work of psychologists such as Beck and Meichen-
baum, we realize that we have not been able to do them justice, but we
do want the^ reader to understand how the RET therapist incorporates
their work.
We
many
lists
of
recommended
11
Homework Assignments
Rationale
Rational-emotive therapy
in
RET, therefore,
is
the
is
a cognitive-learning system.
that
principle
unless
major tenet
clients
put
their
meaningful or durable.
down
be turned
If
it
client
If it
behaves differently. In
One
differently
client a
is
of the principal
following a cognitive-dissonance
means
of generalizing the
change
fact,
dif-
means
RET.
The
first
specific goals
work
of therapy
Homework assignments
of the
(1)
to
determine
how
216
Practitioner's
Guide
Reading assignments
Listening assignments
Writing assignments
Imagining assignments
Thinking assignments
Relaxation and other distraction assignments
Action assignments
As we suggested above, major emphasis is placed on the last cateIf that is so, you may ask, why do RET therapists use the other
gory.
when
may
RET
same
may
on an educational
model, and good educators know that the use of multiple modalities and
multiple learning trials will maximize learning. After all, how much can
is,
in part, based
RET
therapist will
want
to
with the client is, "What can my client do this week to put into practice
what we have discussed during this session?"
Before we move on to discuss specific homework suggestions, let us
point out that useful
homework assignments
characteristics:
1.
in the session
of the session.
2.
Specificity.
and with
example,
if
in sufficient detail
the client
is
asked to
homework assignment
Homework Assignments
ment
of one
4.
217
homework assignment
When
homework assignments,
it is
best
ment
it;
understanding
ment procedure
in this
memory
but also
Examples of
Homework
READING ASSIGNMENTS
218
At the
Guide
Practitioner's
clients
are given a free packet of materials to read at the end of their first
New
Rational Living by
The
Guide
to
Ellis
it is
the client.
LISTENING ASSIGNMENTS
The reader
will recall
sions after getting the client's permission. Clients are also encouraged to
bring in their
either case,
own
it is
trials of
the
same lesson
are beneficial to
learning.
homework
disabilities.
sung by Dr.
Ellis
Rational-Emotive Therapy.
tapes
is
Tapes of
RET
for clients
An
Listening to tapes
is
particularly valuable
may
(see p.
283)
own
when
the therapist
A prerecorded tape,
may
be recommended, or the
therapist's voice
is
some
last
most
procedure
may
thereby aid in
may
is
such as the
may
it
home. The
Homework Assignments
bring in the tape and demonstrate
219
its
the therapist can periodically stop the tape and check out the client's
much
work
as a
te-
much
homework assignment.
WRITING ASSIGNMENTS
RET therapists and generone of three forms: self-help homework sheets, written essays,
assignment
is
A client has filled out a homework form and given it to you, the
counselor. A portion of the form is reproduced below. What
would your response be? What corrections, if any, would you
make?
Activating event = I went for a job interview.
Rational belief = I was turned down.
Irrational belief
It is
Emotional consequence
Disputing
Answers
horrible that
felt
are given
on page 287.
depressed.
didn't get the job.
220
A
take a
Practitioner's
Guide
related assignment
number
is
debate to one or
more
may be asked
it
or not.
to write out a
They can be
The
is
told to
to argue the
therapist
is
thus
challenged at the top of a sheet of blank paper (using a separate sheet for
fills
Statement: If my children
a bad mother.
make mistakes
in their lives,
it
proves that
am
Challenge:
1.
2.
My
It is
human
characteristic.
by
trial
a positive
my
am
tween
my
more
alike.
They con-
tinue to have even greater input from other people and experiences, and from themselves. As they meet each new life situa-
moment. So
Homework Assignments
221
might as well take some credit for their good qualities too, if I
were to insist on responsibility for their negative qualities. I
know I've done much good for my kids.
If I concentrated on my finished mistakes as a mother, I would
trap/freeze myself in the past. I would deny recognition of time
elapsed, growth and change taken place. That would be living
the life of another (albeit someone I knew most intimately). And
continued guilt amounts to self-pity. That's bor-ring!
4.
5.
In a related
form
it.
For example,
male
if
client has
been complain-
ing that his mother shouldn't act irascibly or nag at him, the therapist
may
way
she
is.
He might
why
explore what he
his mother
knows of her
upbringing and the history of his interactions with her, and he will
undoubtedly find that her behavior is quite understandable. Such an
exercise
may
is
is
teaching problem-solving
ment
skills.
logical
The
an agoraphobic client
break
is a
down while
who
she was
might
it
these so-
lutions:
1.
call
family
member.
2.
3.
4.
5.
Similarly, the
mother
of a
them
him out
of bed (that's
1.
could drag
2.
what
do).
get out of
222
3.
Practitioner's
could ignore
Guide
him and
let
him
late.
4.
5.
6.
7.
own wake-up.
Homework
The
third
is
The
the
log book.
may
call
up
get turned
client can
eating,
keep a log of foods eaten, the amount, kind, time and place of
and so
(1) to correct
client's
may
serve
many
functions:
(2) to correct
the
(3) to identify
havior.
IMAGINING ASSIGNMENTS
Homework
RET
Homework Assignments
emotion, changes
it,
223
effect the
change.
Clients can also be asked to do cognitive rehearsal of
new
behaviors
agination for desensitization, or to use the techniques of covert conditioning. In covert conditioning, the stimuli, responses, reinforcers, or
who is
is
the
man
may
lose
some
of
its sting.
Similarly,
hearse this act just at the point of his manually induced orgasm, thus
a response.
mug
The
of beer
THINKING ASSIGNMENTS
Clients can be asked to keep records of the irrational or disturbing
thoughts they have between sessions. This record can then become the
starting point for the next therapy visit. Alternatively, clients can write
may
even prescribe
is
covert.
The
therapist
What
way
the best
to
down. As an aid to
"Things to Remember to Think." After all, pilots use a
checklist of things to do before takeoff; why not a list of things to think?
it
checklist of
224
Practitioner's
Guide
RELAXATION ASSIGNMENTS
As mentioned above, under "Listening Assignments/'
relaxation
is
Soon, however, the patients can do the exercises without the external
cueing. In fact, as their
at
muscle groups
skill at
at their
it
(e.g.,
own
pace.
may
find that
work at
them into
to
An
homework assignment
is
assuring that clients have structured their time to allow for the exercises
away from
distractions, in
recline.
ACTION ASSIGNMENTS
Two
underlying
The reader
it
it.
Thus,
it is
difficult to
some
work on
it.
If
he
is
may have
Homework Assignments
225
may
therapist
eye and, by
client's
an assignment
even
he
as
toward
sets
fails. If
his goal,
itself,
up
RET
suggestion
a
change
may bring a
and
a positive
if
twinkle to the
Such
produce
therapist
may
two major
reasons: (1) they are instructive, and (2) they allow for desensitization,
since
the client
if
afraid to
is
fail,
he
will
first
place.
RET
may
night, the obsessive to obsess 100 times per day, the impotent male to
not get an erection (Fay, 1978). Being given the assignment to do the
very thing which troubles them often removes the "horror" of the
behavior, and clients
commonly
it
making
deliberately
who had
dread of
assignment was to
nonethe-
himself to
make an
tion: that
occasional error.
He
a catastrophe
a failure for
making one.
Shame
(Ellis,
is
form
1973, 1977b)
perform
a silly
of self-downing,
is
if
they actually
come
is
to
to
226
Practitioner's
Guide
human
being.
They
thereby apply the principle of learning to rate their behaviors, not themselves.
proval,
which
is
We
is
unnecessarily stifling as
if
we
facial
The
belief.
Additionally, these exercises are fun and can help the client to take social
RET
1
by
his
therapist:
Go up
to a stranger
3.
Stand on a busy street corner. Stretch out your arms and say,
five times, "Your messiah has come. Follow me."
In a restaurant, go up to an attractive person's table and inquire
if the meal is satisfactory and if you can bring him or her
anything.
4.
Go
to a
sell
someone
copy
of yesterday's newspaper.
5.
Go
transvestite or fetishist.
6.
7.
8.
9.
10.
Go
Homework Assignments
If
227
clients are
"spotlight"
act.
Clients can adopt one of these stock assignments or, preferably with
example, one
is
more personally
relevant. For
for fear of
is
from school, or
arrest.
If
not helpful.
It
street.
first of
which
is
is
is
designed to accomplish
to
ABCD
analysis
may
prepare the
The second
how
is
Most
of us
overestimate the extent to which others care about or even notice our
behavior. For example,
tried to find the
Ellis tells of
courage to
call
one of
his clients
New
trous happened.
one stop and saw that nothing disasThe next week he gave himself the assignment of yell-
happened?
therapist.
haviors
may
228
Guide
Practitioner's
To
may go
may want
to set an example.
behaviors to
behavior than
We
example
The
therapist
suggest that
at
new RET
more
are
tolerant of our
this?
own
project,
good idea
from the
and do an exercise
list
week
this
it is
at periodic intervals to
keep up your
may
skills.
may be told to do
something nice for herself before the next session. The sexually troubled
couple
may
guilt
self-
Trouble-Shooting
When
Homework Problems
clients return to
homework assignments
which
is
is
new
way
Patients
a sys-
may
expect their
week, as they do in
at a behavioral
homework assignments
classroom situation or in
work
issue
is
to
change each
a physician's office
when
assignment for
number
of
may
Homework Assignments
229
may
uncorrected, they
may
"Oh
if
Lord,
What do you do if clients have failed to do their homework assignments? You investigate; such failures often provide valuable diagnostic
information about their belief systems. The uncompleted assignment
may
be treated as a
new
may
have resulted
in
may
T:
How
C:
Terrible.
T:
Terrible? In
C:
T:
You
C:
Because
T:
Do you
it now
do you
believe
Do you
C:
Yes;
homework.
it? Well,
about not doing it.
it
nice
if
if
I
you
did
why
should you?
it,
but
didn't.
Too
it.
Too
bad.
I'll
try
it
Try
I'll
if
belief?
it
How?
What would you do
I'd
bad.
milk
C:
my
didn't do
C:
C:
should've done
T:
T:
feel so terrible
it
what way?
feel guilty.
try
T:
feel
if
you wanted
to be sure to
remember
to
buy
at the store?
write
just said
it
.
to
it
we
may follow failure to do a homework assignexample above, or may be the cause of the failure. Thus,
the patient may have been stopped by the cognition: "It's hopeless
why try?" Typically, the patient will not have answered this question,
and the therapist may help the patient to challenge the notion of
helplessness and to review the reasons why it would be beneficial to try.
Do not be afraid to confront your client and ask why the assignment
was not completed. Why was it so difficult to accomplish? One
Depressive cognitions
ment,
as in the
hypothesis to investigate
as too large.
As we
is
stated earlier,
RET
230
Guide
Practitioner's
How do
assignment?
you
when your
feel
Do you
do you
feel
patient
fails to
do
homework
If so, it
would
dispute them.
Or
for cognitions
such as, "If I were a good therapist, he'd have done his assignment," and challenge them. Homework assignments can indeed
be diagnostic tools.
ing model, urging their clients to take large rather than small steps.
Although the
theoretical
model
is
is
down
which the
down
smaller steps
client
is
may
difficult
Remember
and a
who
little
assignments into
dependent adult
it is
if
the
and yet wants to sever some of these ties, she may be unwilling to
refrain from calling her for a week but may contract for a two-day hiatus
at first. Success at
it
more
want
more
is
woman
more
likely to read a
plishments at
less,
first;
the therapist
learning
is,
after
all,
improvements
a gradual procedure.
will
is,
Neverthe-
choice, but the therapist can be sure that they understand the conse-
quences.
A common
their
homework
Homework Assignments
231
"Today
the cycle
is
morrow"
is
too hectic
I'll
I'll
relax to-
really buckle
down
tomorrow."
A related
also lose
if
goal
is
if
he
diets,
he
will
smoke
more.
as the above illustrate a philosophy of Low Frustraand are best treated by a direct confrontation, a determined course of action, and perhaps the addition of a program of external contingencies. It might be pointed out to the smoker in the example
above that he has three choices for change: (1) he could stop smoking
and not worry about his weight for the first few difficult weeks of
withdrawal; (2) he could work very hard at losing ten pounds and then
begin his smoking cessation program; or (3) he could do both at the same
time, which is merely harder. Thus, the patient is confronted with the
fact that the two problems can be treated independently. Once a goal is
Problems such
tion Tolerance
be outlined.
homework
is critical
that clients
It is
even desirable, when clients repeatedly "cop out" on their homework for
reasons of
Low
Frustration Tolerance, to
course, this plan had better be administered with clinical judgment, and
certainly
patient or others
232
Practitioner's
Guide
A terminal
goal of therapy
To achieve
is
to
have
clients function
and behavioral
skills to
own
homework
assignments. Thus,
projects
when
independently and
be their
own
therapist.
and encourage
clients
on their
previous week's progress, the therapist can ask, "What could you do
next week to follow up on that?" By gradual shaping and fading of
to think of their
clients report
homework.
own
self-help
2. The Course
Therapy
of
the novice
RET
therapist
may make is to
we recommend
you work on each problem separately but develop a treatment plan to assure that you don't
neglect any and don't become mired in the client's complaints.
Treatment plans are frequently used at mental health clinics and
psychiatric hospitals; they will probably be required by many thirdparty payment systems (e.g., APA-CHAMPUS program) and appear to
be an inevitable development in professional peer review systems.
Treatment plans are best developed from a problem-oriented record system such as the one outlined below. Realize that not every therapist
constructs treatment plans, nor will it be necessary to do so for each of
your clients. We offer this as a model to help you understand the ongoproblems into one. Instead,
that
ment treatment.
To begin a treatment
plan,
list
and behavioral
234
Guide
Practitioner's
the emotional and behavioral aspects of the C. Look for relations be-
tween these components and between the C's and their accompanying
cognitions.
1.
Emotions
Cognitions
Relationship
Anger,
He
with boss
anxiety
icize
shouldn't
me.
terrible
It
if
Behaviors
crit-
would be
the boss
Talking angrily to
boss. Inefficiency at
work due
to
time
2.
Problems in
Anxiety
dating
Avoidance of
me.
contact. Lack of
awful to get
It's
rejected.
3.
Relationship
Guilt
should
social skills.
visit
my
with parents
social
Daily undesired
phone
calls to
mother. Undesired
Sat. night dinners
at
4.
Obesity
The
Agitation
I've got to
(when not
eating), de-
hopeless;
pression
control
(after eating)
good.
ne,xt step is to
addition,
have what
want (LFT).
it;
I'll
mother's house
Overeating.
It's
never
I'm no
problem
we recommend
that
you
how you
therapy hour in blocks of time. Realize that your plan will best be kept
flexible, so that you remain sensitive to your client's immediate conIf
your
lose sight of
your
The Course
original goals.
of
Therapy
Another purpose of
235
a
is
to help
The following
with a
new
client;
is
you may
Session 5
Problem
1.
2.
3.
4.
5.
work
6.
Emmons,
rehearsed
session
in
do
ABCD homework
read
(a)
Your Perfect
Problem 2
at
situation.
with
off- task,
the
boss,
(c)
use as a cue to
sheet on catastrophizing.
7.
If
1.
Session 6
Problem
ses-
Review disputation
work situations.
in
3.
4.
Problem 2
5.
6.
(b)
continue to do
when work
homework
efficiency drops.
236
Practitioner's
7.
Guide
Session 7
Problem
1.
2.
3.
Homework
assignments:
as needed,
and
new
assertive responses
fears of rejection.
Problem 2
4.
Reinforce or trouble-shoot.
5.
Do REI
in dating situation to
in-session disputing.
6.
Begin
asking a
woman
for a date.
7.
Problem 3
Homework assignment
coming
rejections
this
homework
sheet(s).
8.
9.
If
client appears to
week;
self- worth
if
distressed,
do
causing guilt.
Summarize major
work assignments
home-
coming week.
After reading over the above treatment plan, you may find it overwhelming; how could any therapist accomplish that much in any session, and do clients really move that quickly? Rest easy; the sample
above is somewhat exaggerated and was used to make three major
points:
1.
The Course
of
Therapy
237
New
2.
more
the
3.
Some
While
number
number
all
of these steps
might be taken
number
in
and
at different points in
therapy.
review of
homework
(usually a
is
comprehended or
is
trouble-shooting
is
having
problems
with
If
your
the
homework
sheet,
the client
If
that the client should have felt better or at least have performed better.
client's behavior.
permission to be beginners.
If
your
worked out
homework
sheet and
dispute,
of
at this point in
therapy:
1.
The
client
may
C somewhat
RET
modeled
technique.
2.
A new C may
emerge.
If
more
more appropriate
238
Practitioner's
Guide
emotional reactions. When well practiced, the new RB's will tend
to become as automatic to the client as were the original IB's.
Continuing Therapy
In
many
make appointments or will request a continuation of therapy. What do you do then? You listen. Very often the
behavioral changes made in therapy will present clients with new social
situations
which they
with issues of
new problems
For example,
may
encounter
although there
may
profit
management" lives,
new one each week.
When
in
"crisis
be a
clients
do bring
at
may
some point
in
gloomy future filled with problems for which they must get professional
help. At such times, it is useful to have the patients recollect their earlier
problems, now in the background; point these out to them and reinforce
them lavishly for the progress already achieved. An analogy such as the
following
may
you go
to
teen splinters in your hand, even after five are out, your hand
It
just takes
may
still
re-
The Course
member, your
of
239
Therapy
you to go on removing
you point out that five have
may waver
"psychological splinters"
unless
and
nose,
might be
useful.
a dull headache,
first
ommended
it
or
how
it is
alleviated,
how
it
tend to forget
made aware of
was accomplished, they may be more
We all
If
patients are
therapists (e.g.,
Beck
et al.,
therapy hour, not only for personal feedback but also to identify any
lingering irrational beliefs or to correct
The
client's
periodic review
may
termination. Terminating
example, they
may
feel that
goals?
also ask:
How much
"How
is
for the
you may
any misperceptions.
good preparation
also serve as a
are
When
it is
we coming
When
we
schedule
Termination of Therapy
In a sense,
tion.
RET
in particular, following
240
Practitioner's
Guide
generalized to
new problem
situations.
As the
client improves,
the
specific
problems.
When
may
may
have
number
However,
help.
if
may
clients
which you
may
to deal with
"should" about
your own
how
perfectionistic standards.
clients will
perform
at the
Do
end of
therapy? Clients will not always arrive at the end points you'd prefer,
is
may be a
some clients
terminated; there
may
to
im-
suggest to clients
however,
it
Some
will
clients
come
in after just a
how
it
will
be extremely
RET
principles?
Have
The Course
of
Therapy
241
(e.g., to please
Have
the therapist)?
they improved because the obnoxious A's in their lives are less frequent?
As
may
ask
them
to think of
now
do not and to explain why. The latter part of this question highlights
cognitive change and enables the therapist to evaluate whether or not the
client
is
If
Many
clinics
what
a letter
is
the
noting
Phone
intrusive, they
the client.
If
may
most
if
more
however, phone
client well,
some
patients
may
calls
may
many
In
nate therapy before either they or you feel they are ready.
helpful for
you
to stop
may
be
my
It
would be
last session to
work with this patient. How can I structure the session so that it
of maximal value to him or her?" Here are some suggestions:
Ask the
1.
clients
to accomplish
in
will
be
the final
session(s).
Try
2.
why
they originally
came to treatment, what they have learned, and what they still
want to change. You may then compare your own ideas on these
three questions and share them with the clients.
Suggest a continuation of behavioral assignments to bridge the
gap after therapy. Assignments may also serve as a reminder to
patients of the concepts you have taught them.
3.
If
you can
move
to a
new community,
It
a referral to
new
locale or to suggest
therapist.
The
how
may
Therapy has
new
a referral list
242
of
RET
Practitioner's
Guide
a dollar to
E.
65th Street,
list
may
be
New York,
N.Y.
move
itself
if it
may
be a
life stress.
for backsliding,
In this
may
it.
may
manner. In
this
change but
may
been
my
patient,
act in a depressed
have
a feeling
we
to add:
have gotten
been
If
"You know,
How
reactions to
you
comment on
if
you hadn't
do you
feel
feel
about our
may never
may have
this
help
this instance,
terminating?"
may
lives.
Booster Shots
call
for
may
find occasional
is
a brief
be absolutely rational.
JL J)
Couple counseling
is
analogous to running
member
is all
RET group
joint sessions,
however,
is
is
RET
if
is
easier
you
re-
much more
difficult to
vidual psychotherapy for several reasons. First, there are added dis-
by having two people in the room. Second, the interactions or arguments between the clients may be distracting. Third,
there are more problems to be dealt with: his, hers, and theirs. Fourth,
most therapeutic maneuvers have repercussive effects on the partner; a
change in one partner may provide a significant Activating event for the
other and result in pleasure or displeasure. Fifth, a major difficulty in
couple counseling is that the two clients may have different agendas; the
therapist may have a hard time assessing and meeting these incompatible
tractions provided
goals.
As a therapist, you had better be clear about whom you are serving:
him, her, or the marriage. Professionals refer to this area of work as
"marriage counseling," as
if
is
the
party being served. In the view of the rational therapist, however, the
two individual
if
are the clients, not the marriage. This viewpoint had better be
to the clients; they
may
made
clear
two independent adults, and that the goals of counseling are to help each
one maximize his or her happiness, whether this means living with or
244
Practitioner's
Guide
We
much
of
what goes on
suspect that
most
in marriage counseling
is
people are basically compatible but have problems in one or a few areas
skills to
enced
Many
come
substantial
who
bitterness,
strained communications.
how-
One
diminished
of the partners
may
have experi-
involvement,
sexual
and
1.
Is
2.
Is
3.
Is
4.
5.
6.
7.
8.
9.
is?
as
open
245
marriage?
their
own
decisions?
12.
you
you
if
your own
"shoulds" in this area. If you do have biases and your values dictate one
therapeutic goal over another, make your goals clear to your clients and
resolve marital and divorce problems are greater
if
you
dispel
is
to
a colleague or acquain-
Do you
know nothing
is
getting a
when you
beforehand. The
if
new member
of the trio
may
also
change
in contract
may
resentful.
In addition, the
new
in individual therapy,
conflict; the
client
may
new
party
some
may
of
feel
246
Guide
Practitioner's
Problems such
them
as the
make
contract clearly;
above
may
new
now
Some
both,
point
on
is
embarking
joint sessions.
Another important
that of confidentiality.
Some
therapists
demand
is
no
from each other or from the therapist; everything is grist for the
Other therapists inform clients that nothing that is told to them in
individual consultations will be kept secret from the spouse; this
therapist wants no burdens. Still other therapists promise strict confisecrets
mill.
The
What
is
the best
way
to proceed?
no privileged
communication between the therapist and one of the marriage partners
seems foolish to us. How many individual clients would confide in you if
they learned you had a "no secrets" rule? In marriage counseling, such a
rule forces the client to keep secret what may be valuable clinical information or to reveal it even though this may have unnecessary and
unfortunate consequences. Therapists who insist on complete disclosure
between the partners and who encourage the unburdening of secrets
usually believe that it is the secrets themselves (A) which cause marital
decision to never allow secrets and to provide
disturbance (C).
We
is
What you
can do
If
is
to share
one party
Such information
is
likely to be
important
facts.
be given to each
is
a certain
if
Few
rules
willing to
it is
to the client,
important
your
wise to
and you
degree of confiden-
sion.
We
How many
questionable value.
no
secrets in marriage
247
lies)
were
told
of
is
if all
and no
Now
some
in marriage,
marital counseling
is
1.
2.
some
of
your
of the ethical
first
to see
which are
come
listed
couple.
The
first
task in
below:
To help improve the relationship. This is the most obvious reason, but by far not the only one.
To help the spouse form a relationship with a therapist in whose
hands he or she plans to leave the spouse on departing.
3.
4.
To obtain help
in deciding
to stay
together.
5.
6.
7.
8.
If
To
you assume
that
all
couples
wrong problem.
their
It is
also
come
may
in
waste
many
sessions working on
They may be
quite
we
248
Practitioner's
Guide
the couple together for a session but then see each partner individually
for a half, full, or several sessions to assess
best accomplished
is
what each
desires,
which is
Here
"Well, Mr. Jones, when we met last week with your wife, you said
you were coming here to help your marriage. What I'd like to do
now is to ask you if there are things you would like to tell me in
confidence without your wife present. Now before you answer, let
me explain something. People usually come to marriage counseling
for lots of reasons. Some come for permission to separate, or to help
you to tell me just what your feelings are and what you would
hope to gain from these sessions. If there is something troubling
you that you do not want your spouse to know, please tell me now
and we can keep it confidential."
like
When
is
said.
For example,
if
the
tells this to
of therapy
may
may
ily.
If
both parties have the same agenda, you can proceed to see them
together.
If
difficult,
al-
249
tries to
Sam and Jean were a couple in their mid-thirties who had been
married for ten years and had three children. After an argument
concerning Sam's suspicion that Jean was having an extramarital
affair, Sam moved out. They had been separated for two weeks
when Sam suggested that they go for marital counseling. Sam reported that he knew his suspicions were false. He had a quick
temper and frequently exploded. He was sorry and wanted to be
forgiven and to return home. Jean refused to accept him back. She
reported that Sam was a strict and rigid man who always criticized
her housework and was generally disapproving of her family. Sam
retorted that Jean had many faults too. She frequently deceived him
about financial matters and sided against him in family arguments.
At
Sam
riage
He was aware
them
alone.
He
would do anything to keep Jean. Jean reported that she was disgusted with Sam's criticisms and compulsive neatness. She had
never engaged in extramarital sex with her accused lover, although
she did see the man and was very fond of him. Jean wished to leave
the marriage and responded negatively to suggestions of how they
could improve their relationship. Jean did not want to tell Sam of
her decision for fear of his wrath. Her biggest fear, however, was
not his reaction, but that of her parents and their children. She
believed that these people would view her as the wrongdoer and
reject her. Thus, Sam, and especially her family, must never know
of her wish.
Jean was seen for one further session. She reported that she
would seek a divorce when she could figure out a way that all blame
could fall on Sam. The therapist had agreed to keep this information
confidential. The three parties then proceeded to work together.
During these sessions, as one would guess, Sam was most cooperative. After Jean had identified his behaviors that most annoyed her,
Sam worked diligently at changing them. He listened carefully to
all advice and followed all behavioral assignments exactly. Jean, on
the other hand, would admit to no wrongdoing, expressed no commitment to change, and denied any anger or unpleasant feelings
250
Practitioner's
Guide
toward Sam. Jean never mentioned her anger at Sam or her plans to
leave the marriage; this area was off-limits to the therapist because
of the pledge of confidentiality. The joint therapy was terminated
after several unrewarding sessions.
This case was particularly disturbing to the therapist, primarily
because Sam was being deceived. While Sam was working very hard
at the goal of improving his marriage, the therapist and Jean knew
that this was a hopeless endeavor. She had decided to take Sam back
after a short stay in marriage counseling, resume the marriage for a
while, and then provoke him into leaving. Thus, he would receive
all the blame, and family and friends would not reject her for
getting a divorce. While it could be argued that Sam did receive
many benefits from these sessions, they were not the ones for
which he had contracted. He did correct his compulsive neatness,
which had offended many other people in addition to his wife. He
definitely reduced his anxiety about being single. He learned better
among them
the ability to communicate more effecand other women. All of these things could be
of benefit to him whether or not he stayed married. But, again, he
had not contracted for these gains. It appears in retrospect that the
therapist made an initial error in taking this case on for marital
therapy because there was a clear conflict between the agendas of
the two parties.
Individual sessions were subsequently recommended to Sam
and Jean to help correct the problems that had arisen. The therapist
suggested to Jean that her decision to leave could have been based
on intense anger at Sam. If she changed her demanding philosophy
and as a result relinquished her anger, she might feel differently
about leaving. Once this issue had been discussed, Jean decided that
she still wanted to leave, but the fear of rejection from her family
remained a problem. This problem was worked on for a significant
period of time, and its resolution made Jean's decision easier. Concurrently, the therapist worked individually with Sam at some of
his goals: overcoming his demandingness, his anxiety about rejection, his compulsive neatness, and his poor social skills. While Sam
believed these things would make him more attractive to Jean, the
therapist stated that they were good for Sam and would help make
social skills,
him more
when
women;
the therapist
conflicts of
251
The Decision
to Separate
who
from doing
ally blocked
so, are
not
uncommon.
is
worry about
if
may
rejection
anyone
good
as
now") or
will
is
mate
Clients often
a divorce.
They
("I'll
never find
be rejected
when they
love and
approval.
for
In addition,
clients.
your
a client.
it
also helpful to
is
For example,
when
do
who
because of loss of approval from others, the therapist can ask the following kinds of questions:
1.
Are the
over
number
of years really
endured for
a short period of
time?
Will the disapproval really be that great, given the general accep-
now?
make you leave?
What would
it
Nonsupport?
How
take to
physical assault?
of oth-
ers then?
new mate
Guilt
is
252
Practitioner's
marriage.
Guide
wanted
to
"crushed
When
seen alone,
Ron
leave the
she
who
Ron,
How
reported that he
Elaine
would be
who
if
Let's discuss
how
first belief,
mean "commit
apart,
fall
it is
means. Does
it
mean "having a psychotic episode reDoes it mean "crying a lot"? Does it mean
suicide"? Does
quiring hospitalization"?
"fall apart"
it
a period of
time"? The
and
it is
and
this
is
likely to last
when you
apart"
"fall
someone
leave.
If,
It is
loves
you
somewhat
so
however, the
much
reassuring, yet
evidence that the spouse will behave very badly and react with significant psychopathology, the motivation for such behavior had better be
investigated.
It
is
by the
Thus, rather
fragility, the
behavior
is
reinforced
depression
life will
be miserable,
it
While
may
it is
may undergo
a significant
How
much
who
is
worth the
initial
may
What
is
that worth?
Is this
long-term
be better
253
whom
she could
The second
belief, that
you
is
only partially true. While Ron has provided the Activating event for
Elaine,
it is
her
If
may
be feeling
is
of her
own
is
pression.
The
third belief
is
Ron
person? Again,
all
make him
a
a
bad or worthless
and
self-rating.
decision
on the
Inability to
So
far,
Once
Make
we have
is
a Decision
beliefs,
guilt.
partner
clients
more
difficult
may
or not to stay.
When
when
clients are
part of a couple.
clients
to
marriage but
make
may have
is,
clients can
remain
in the
On
marriage but have emotional problems and irrational beliefs which prevent them from doing
choose the
first,
so.
you may
Which
is
the therapist to
work on?
If
you
all
254
Practitioner's
Guide
marriages must be saved, or that at least one must try to save them. If
you choose the latter, you encourage divorce and may enforce the value
judgment that transient or short-term relationships are more valued.
Regardless of your convictions and regardless of how good your reasons
are for making such a value judgment, we believe that the decision of
whether or not to remain married is best made by the client. That
decision will be easier to make if you work on both areas simultaneously.
You can discuss with clients the Activating events which might
occur
if
these events, and the irrational beliefs which lead to these emotions.
Conversely, you can have the clients discuss what would result
decided to leave the marriage.
is
a life option,
path
if its
is
The
client
is
standing
if
they
at a crossroads;
each
littered
emotional turmoil. Once the stones are removed from both paths, the
client can
more
maximizing
course,
is
rationally decide
a greater probability of
Removing the
stones, of
key irrational
belief to
watch for
is
needs the partner and remains in the relationship largely because of a fear of leaving the "other half" behind. Such a belief
is
to the partner.
(or
How
would you
feel if
you knew
that
your wife
afraid of leaving
you?
It is
this
realize that
irrational
is
neurotic.
belief can
be challenged, clients
it
will
be because of
its
If
may
they choose to
positive qualities
would be helpful
through
it
255
Even
if
clients
beliefs
about staying in
or leaving the marriage and have done the hedonic calculus and decided
whether
make
a decision to become committed to the marriage. After discussing the matter, he admitted believing that he was unwilling to
He wanted
wanted
to travel.
his relationship
with Marlene.
256
Practitioner's
Guide
dif-
The
ficult is a belief in
somehow
is
quite destruc-
dispel the
myth
None
and time machines have not yet been perfected. All of our decisions
lack certainty. Uncertainty is a basic fact of life, and clients will be
will
less
quences
if
is
put into an
ABC
fact.
myth and no
longer aw-
alternative.
Assuming
to
joint marital sessions. Ellis (1962, 1977a) believes that disturbed marital
Many
disturbances occur
when one
or both believe
257
tolerant
is
more
demanding. You would do well to carefully evaluate the couple's selfdiagnosis and make sure that you agree with it. Communication, for
example, really means the transmission of a message from one party to
the other; it does not mean that the receiver will necessarily comply with
the sender's wishes.
The RET
stem from
and
on the individual's
diffi-
husband believes that his wife should always please him, and
state of anger, he will probably:
culties. If a
he
is
in a
1.
"She never
pleases
me," when
in fact she
does).
2.
Be poor
at social
me? Nothing!").
3.
Be inept
at
communications
tantrums).
4. Be experiencing
The
little
(e.g.,
258
Practitioner's
Guide
skills.
present their major problems briefly, but avoid getting into a prolonged
history-taking or complaint-hearing discussion. Then, as soon as possible, focus
(in
help this mate identify and dispute his or her irrational philosophies.
Periodically focus your gaze or nod at the observing partner
convey the message, "Pay attention I want you to learn
The observer
may
in order to
this, too."
is
lies
husband
initial
is
disputation
has been completed, the therapist will shift the focus to the husband in
order to examine his emotional excesses and point out and dispute his
irrational thinking.
While
simple,
it
dyad and an
isolate.
is
skilled at avoiding
it,
and the mate siding together against the focal client. As pointed
out above, some clients welcome an alliance with the therapist because
it "shows that I'm right." A simple solution to help avoid this trap is to
address roughly equal numbers of remarks to each person; show that
therapist
own
when
who is less skilled at basic RET techniques may find that time
runs out before he or she has had a chance to balance the session. To
therapist
avoid this problem, you can explain your strategy to both clients beforehand. Thus, you might say:
Well, Mr. and Mrs. Jones, I've listened to both of you outline
your problems. You both have some difficulties which lead to your
arguments. Mr. Jones, you appear to be angry whenever your wife
259
which
react nastily,
in turn
is
rather annoy-
Now, both
depressed.
and thinking
who would
The
if
go
like to
first?
There are
First,
Third, the spouse can actively engage in the discussion and help the
Communication Problems
Poor communication patterns between marriage partners are often
result of emotional blocks.
tional stress
If
by disputational
you have
may
still
skill deficits.
exhibit
emocom-
Problems can
on the part of the sender as well as the receiver. The most common
problem seems to be the transmission of vague or ambiguous communications (Rausch, Barry, Hertel, and Swain, 1974).
exist
Ambiguous communication
occurs
when
there
is
a discrepancy be-
tween the verbal and nonverbal parts of a message. For example, the
spouse may deny feelings of anger, yet speak in a cold and distancing
tone of voice. There are several possible reasons for this dishonest communication, such as fear of rejection, reprisals, or loss of control, or
how
to
may
communicate
directly. Receivers of
such
260
Practitioner's
Guide
is
en-
Raush
One
exercise
found useful
et al. (1974)
to
is
They continue
alternating as
appreciate
resent
it
While the partners are caught up in their anger or hurt at one another,
neither will want to take the first step of doing something positive for
the other in order to
make
It is
which
their relationship
may
more
fulfilling.
emo-
may
The RET
therapist recognizes,
how-
riage."
fulfilling
marriage entails
many
both partners.
Behavior therapists have conceptualized marital discord as a problem of unbalanced or low-frequency reinforcement. When the partners
261
are giving each other very few positive "strokes" and are attempting to
many
One way
tactics,
if
may make
emotionally
the relationship
less desirable.
One
is
to re-
that
is
it is
of a behavior,
may
What
characteristics
would
new
What changes
her)
The
more
may
therapist
(or
acceptable?
also
may
how
not
to say nice
come
easily
at first.
Contracting
skills will
weekend
if
partners learn
maximizes
way
done
work with
is
thinking rationally.
is
more
262
Practitioner's
Guide
Sexual Enhancement
on the
a disturbed
marital relationship and function quite well sexually, while couples with
Sexual contact
people.
is
may
The presence
a sexual
made
to
it is
probadvis-
may
many
target,
whether
You can
it is
you have
clients
skills.
work. Refer-
ences for further reading in this area are given in the Appendix.
Summary
In
summary, the
see
if
is
and to
the husband and wife both have congruent agendas for therapy.
alone to help
him
we recommend
that
you
If
When
agen-
is still
on each individual
client.
You do
263
not initially work on the relationship or the system, but work on helping
each
member
piness and as
shoulds
unrealistic expectations or
or the marriage.
much
hap-
Once
end
is
the partner's
other,
them to improve
communications and improve their interpersonal relationship so
that they maximize the pleasure that each contributes to the other.
is
their
Appendix:
Selected Readings
for Therapists and Clients
In this
of books, arti-
to
recommend
hope
it
to clients.
will provide
an
Although
this list
is
far
from complete, we
topic headings,
we
provide,
is
organized
first, a list
of
Some
and tapes) can be purchased only from the Institute for Rational-Emotive
Therapy, 45 E. 65th St., New York, N.Y. 10021; many of the books are
also available through bookstores. The first group of recommended
readings are general writings on rational-emotive therapy and other
cognitive therapies.
New York:
Interna-
development of Beck's cognitive approach to psychopathology and psychotherapy, an approach very similar to RET.
Discusses
how
265
Appendix
1971.
Ellis.
series of
Humanistic Psychotherapy by A.
1973.
An
topics as a
update of
Ellis'
Ellis.
New
on
original thinking
to be-
The
in
Psychotherapy by A.
original text
by
the
Ellis,
Ellis.
first
marital
RET and
therapy,
states.
It
group
therapy,
sexual
dysfunction,
schizophrenia,
and
psychopathy.
Handbook
of Rational-Emotive Therapy
by A.
Ellis
and R. Grieger.
New
York:
Springer Publishing Co., 1977. The latest and most comprehensive collection of
papers on rational-emotive therapy. The book has five major sections: theoreti-
cal
Contributors include Arnold Lazarus, Aaron Beck, Michael Mahoney, and Donald
Meichenbaum.
Pamphlets:
The following
series of four
may
therapy.
(1)
"An Answer
Psychotherapy," by A.
to
Ellis,
Some
Objections in Rational-Emotive
may
be particularly
you face your first client or your first class in which you
defend RET. (2) "Showing Clients They Are Not Worthless Indi-
useful before
266
Practitioner's
Guide
Ellis,
outlines
It
Ellis'
all
Ellis,
must
"What
get
Really
originally appeared in
Voices, 1968.
Tapes:
Institute
listening.
The
first is a
may
Ellis in
background
1962 entitled
"Theory and
the
traces
ical
humor
Ellis
speaks of the
many
A New Guide
to
Rational Living by A.
explain
how
"how
far
your own feelings," "recognizing and attacking neurotic behaviors," "overcoming the influences of the past," "controlling
your own destiny," and "conquering anxiety." This is probably the most comself-analysis?",
"how you
monly recommended
Help Yourself
to
create
self-help
Happiness by M. Maultsby,
Jr.
New
therapists.
267
Appendix
many
has
It
illustrations
is
educated clients.
Living, 1974.
by
prescribed
New
for adolescents,
who
find
its
style
and
RET, often
particularly useful
Two
It is
It is
also an
Pamphlets:
first is
homework assignments
(DIBS)" by A.
models for
Tapes:
who are
filling
Two
out
a self-help
tapes available
from the
Institute
Ellis.
may
"Techniques
is
It
provides clear
a disputation.
is
is
a basic
gave to
review of the
first,
"Solv-
a college audience.
ABC
theory and
its
delightfully
irreverant
best.
He
discusses
acceptance
of
those
ir-
BEHAVIOR THERAPY
For the therapist
who
is
Clinical Behavior
268
learn
Practitioner's
Guide
its
techniques.
It
includes chapters on
labeling,
behavior change.
theme
is
Clinical
Lavin.
Guide
New
to
many aspects of
Behavior Therapy by
S. R.
P.
comprehensive, problem-
symptoms or syndromes.
statistical
information,
commonly
practitioner.
clinical
falls
Also helpful
by
Ellis
is
Ellis emphasizes the connection between behavior therapy and rational-emotive therapy and points out the
interactive view of human activity. That is, we perceive, cognize, emote,
and
act,
therefore,
is
a cognitive-behavior therapist.
RET
Professional References
The Art and Science of Love by A. Ellis. New York: Lyle Stewart, 1960. Perhaps
one of Ellis' original important writings, useful for both therapist and client. It
includes discussions of the entire range of sexual issues, from a description of
269
Appendix
human
The
sterility, fertility,
Kaplan.
human
sexuality, etiology
is
a psychia-
on the
relief of
is
more akin
clinical population.
to cognitive
This book
is
and learning-
very well
illustrated.
It is
a collec-
from professional journals and books, plus ten contributions prepared especially for this volume. Major section headings are: An Overview of Sex Therapy; Female Orgasmic Dysfunction; Dysparunia and Vaginismus; Male Orgasmic Dysfunctions; Male Erectile Dysfunction; Sexual Dysfunction in Special Populations: Group Procedures; Comments on Sex Therapy and
other Therapeutic Approaches to Sex Dysfunction; and Professional Issues. We
would recommend this book to therapists who wish to increase their expertise in
the rapidly expanding field of sexual counseling.
tion of articles reprinted
Human
Sexual Inadequacy by
Brown and
Co., 1970.
sex therapy.
W. H.
Masters and V.
A classic reference
E.
Johnson. Boston:
new
Little,
to the field of
of sexual dysfunctions
and the treatment procedures used by Masters and Johnson at the Reproductive
Biology Research Foundation in St. Louis. The authors' dual-therapist model for
is introduced, using both physiological and psychological
methods of treating impotence, ejaculatory incompetence, premature ejaculation, orgasmic dysfunction, vaginismus, and painful intercourse. Although the
authors are perhaps not the clearest writers, the therapist-in-training should
certainly review this
landmark book.
women
to their bodies
women
can achieve orgasm and strive for greater fulfillment of their sexual
270
Practitioner's
The book
potential.
is
Guide
many
based on experiences of
of the
women who
attended
female sexuality workshops with the author. Their insights and comments are
included as useful models and examples.
Our
Bodies,
Our
Selves:
women and
helps to teach
in order to control
them.
book
care. This
is
recommended
for
any female
client, especially
or sexual concerns.
It
New
is
women who
also an artist
many examples
many lovely illustrations of women's genianatomy and encouraging acceptance of one's own
and includes
body.
One
human
sexuality,
its
among
most helpful
in this series:
The Art of Erotic Seduction by A. Ellis and R. O. Conway. New York: Ace
Books, 1967. A useful primer for men who have never had their basic questions
about sexuality answered. This brief paperback
is
unique, addressing
"What
is
meant by
light petting?"
and
itself to
"How
do you
young men
though
this
important
book has
skill
a chauvinistic slant,
builder.
Sex and the Liberated Man by A. Ellis. Secaucus, N.J.: Lyle Stewart, 1976. A
more advanced and more contemporary hardcover version of the above, including a much broader and more detailed set of topics. The focus is on male sexuality, but the book is equally valuable for female clients. It discusses such topics as
271
Appendix
masturbation, the sexuality of
women, how
and how to
Ellis.
Attacks the myths and misconceptions with which patients unfortunately upset
is
myths about
and the
love,
to
Extra-Marital Adventure by A.
Ellis.
New
York: Pinnacle Books, 1972. Discusses the pro's and con's of extramarital sexuality. It
some
of the
well as
problems that
how one
may
can be happily
arise
It
describes
how
monogamous
in a
nonmonogamous
its
to handle
as
world.
and how
pamphlet by J. Wolfe
entitled "Rational-Emotive Therapy as an Effective Feminist Therapy,"
reprinted from Rational Living, 1975. In this delightful paper, Wolfe
analyzes some of the problems which prevent women from maximizing
their happiness in love-sex relationships. A second pamphlet by Wolfe is
ing) of interest for therapists interested in feminist therapy
RET
relates to
"How
to
first is a
in 1976. In this
pamphlet,
own
orgasms.
RET and
new model
is
the problems of
is
It is
own
sexuality, their
own
women
"Rawhich
in
women,
272
Practitioner's
from
the
Guide
audience.
second
tape
is
"Sex,
called
Sanity
and
shame about
the irrational beliefs which lead to these two problematic, sexually inhibiting emotions.
and
How to
third tape
Exorcise
by
Ellis is called
Handbook
of Marriage Counseling by B. N.
Ard and
Science and Behavior Books, 1976. Consists of fifty chapters grouped under the
counselor.
The book
is
a conve-
Two
Ellis,
first,
"The Nature
of
of interest
is
a tape recording
by
Ellis entitled
"RET
273
Appendix
trates how he keeps the focus on the individuals, each
improve their relationship.
in turn, in order to
Guide
Ca.
Marriage by A.
to Successful
Ellis
Wilshire Book Co., 1974. Discusses topics such as gauging marital compati-
bility,
problem solving in marriage, sexual preparation for marriage, nondesires, communication in marriage, and divorce. It also lists a
monogamous
Marriage
a Loving Business
Is
Press, 1977.
"How
by
to
Ellis at
the Institute.
is
Ellis rationally
is
New
illustrated
calls a
"rough spot,"
how
at the
RET and
social
Have Feelings by T.
young audience
for a
more
accurate percep-
illustrates a
combina-
problem-solving approaches.
Berger.
New
York:
Human
274
Practitioner's
ings, both
is
Guide
by
as precipitated
different
life
and
is
illustrated
by
sensitive
realistic
teacher, or counselor.
How
to
Happy Child by A.
lywood, Ca.
to Prevent
1977.
Ellis.
Neurotic Adult."
It
North Hol-
1966 text
"How
illustrates
how
and Anxieties; Helping Children with Problems of Achievement; Helping Children Overcome Hostility; Helping Children Become Self-disciplined; Helping
Children with Sex Problems; Helping Children with Conduct Problems; Helping
How
with
It.
selves as
to enter adolescence
ability to
Homer
how
overcome the
the
fail,
stresses of
modern
E.
J.
Homer
the
is
New
York:
homely hound
learns
how
to
overcome
a better
life.
drawings and
recommend,
Homer overcome
his
who
to stimulate discussion
is
good book
his or
The Rational Management of Children by P. A. Hauck. New York: Libra Publishers, 1967. Written for the parent, this book discusses techniques of child
management, habits of kindness and firmness, and discipline. It includes five
chapters on fears: of people, of failure, of injury, of rejection, and of ridicule.
Further chapters deal with anger, worry and depression, lack of self-discipline,
teens.
275
Appendix
chotherapy in 1975. The author discusses
this client population, defining the
how
to develop a relationship
with
W.
J.
Knaus.
New
A Manual
by
by teachers
in a classroom setting.
can use to teach the following concepts: feelings, the art of challenging irrational
beliefs, challenging feelings of inferiority, challenging concepts of
human
worth,
also deals
It
seven to thirteen.
PROBLEMS OF ANGER
For the Professional and the Client
How
to Live
Press, 1977.
ing this technique to other points of view and thus giving a comprehensive and
critical
An
Remaining
Hauck
P.
for
is
the
of anger.
points out that by blaming people or events and reacting with anger,
hostility,
destructive, preventing
distress.
will backfire
and ultimately be
self-
for correcting
suggests techniques for coping with frustration and for being firm without being
angry.
pamphlet on anger
is
Ellis'
276
Guide
Practitioner's
out
its
sion,
we may
more
well survive
happily.
PROBLEMS OF ANXIETY
How
to
how
Ellis.
New York:
own
An
Ellis
a discussion of anxiety
is
P.
who
how
problems in
fears
stride.
Hauck
major irrational
belief that
is
and learning
challenged
is
that
beliefs. In
if
something
is
dangerous or
it
A useful paper for students who suffer from test anxiety is "Overcoming
Test Anxiety" by R. Oliver, reprinted from Rational Living, 1975.
Oliver discusses and disputes irrational beliefs which maintain test anx-
test anxiety.
A tape
to Stop
recording on anxiety by
Worrying."
Ellis
Ellis is entitled
reviews a large
number
"Twenty-one Ways
of palliative techniques
277
Appendix
elegant series of procedures that the anxious individual can use to di-
how to engage
in anti-awfulizing
PROBLEMS OF DEPRESSION
Cognitive Therapy of Depression: A Treatment Manual by A. T. Beck, A. J.
Rush, B. F. Shaw, andG. Emery. Copyright, A. T. Beck, 1978. Recommended to
therapists
clients.
Initial
The
manual
is
detailed
and provides
many
of Therapy.
The
book
is
may
clients as well.
be helpful to clients.
(1)
"Thinking
self-criticisms
L.
"Coping
to
examine
is
par-
their cognitive
systems with a checklist of negative thoughts but providing space for a weekly
activity schedule
a
by
P.
problems of depression.
and
to the
(3)
may
by Hauck
in his
is a
It is
of Depression"
brief review of
client.
ASSERTIVENESS TRAINING
Your Perfect Right by R. Alberti and M. Emmons. San Luis Obispo, Ca. Impact
Press, 1974. A classic book on assertiveness training, including not only a com:
278
for
Practitioner's
Guide
struction
by A. Lange and
P.
Jakubowski. Champaign,
who wants
111.:
to learn
An
of
Assertion
Consciousness-raising
Can
If I
Want To by A.
own
number
New
York: William
Morrow and
which
program of change. The three steps are (1) understanding basic mistakes
your life, (2) understanding the faulty assumptions underlying these
mistakes, and (3) applying techniques to combat the mistakes by changing your
thinking and your behavior. The book is clear and concise and is organized for
quick reading and easy reference.
step
that ruin
PROBLEMS OF PROCRASTINATION
Overcoming Procrastination by A.
Ellis
and
W.
J.
Knaus.
and
its
New
main
York: Institute
causes, as well as
clude:
Two
why
279
Appendix
tion tendencies,
procrastination. Second,
titudes
ful
program
and
at-
Self-Control
Pamphlets:
Two
I.
may
be recommended. The
first is
"A
reasons for obesity and for excess food consumption, emphasizing the dieter's
pamphlet
is
"The Psychology
of Dieting"
by
J.
techniques to help the dieter stay on task, including both cognitive (tackling your
"need"
and
to eat)
self- monitoring)
Tapes:
methods.
who
very helpful.
for
it
It is
immediate
is
any
gratification,
trying to give up a bad habit, whether smokother, the following tape recording will be
But ..." by A.
Ellis,
how
not to
down
both cognitive and behavioral procedures are described and illustrated for the
patient.
References
Alberti, R.
Calif.:
J.,
J.,
New
York: Inter-
Depression:
Camp,
J.,
Shaw, B.
F.,
B. Verbal mediation in
J.
New
1,
Dyer,
Relations:
Modification, 1977,
cal
Human
Approach.
W. Your
New
J.
351-368.
Clini-
Erroneous Zones.
New
Books, 1976.
D'Zurilla, T. and Goldfried,
M.
Psychology, 1959,
Ellis,
New
281
A. The Essence of Rational Psychotherapy: A Comprehensive Approach
New York: Institute for Rational Living, 1969. (a)
Ellis,
to
Treatment.
A.
Ellis,
Psychiatry
Ellis,
Calif.:
Wilshire Books,
1971.
Ellis,
feel better.
Rational
New
A. Humanistic Psychotherapy.
McGraw-Hill Paperbacks, 1973.
Ellis,
Ellis,
York:
Crown
Publishers
rational-emotive therapist.
and
Voices,
Ellis,
Burtle (Eds.),
Women
in
Therapy.
Ellis,
chology
New
A. The basic
Ellis,
human
Grieger
clinical
(Eds.),
Ellis
and R.
A.
Ellis,
How
to Live
With
Ellis,
New
York:
Ellis,
Rational-Emotive Therapy.
New
Ellis
New
and R. Grieger
(Eds.),
Handbook
of
Ellis,
2-^3. (e)
Ellis,
A. Discomfort anxiety:
A new
Advancement
Advancement
New
York:
of Behavior
BMA
Therapy Annual
A.
Rational-emotive
therapy.
In
R.
111.:
J.
Corsini
(Ed.),
Current
282
Ellis,
Practitioner's
Monterey,
Ellis,
Guide
A.
(c)
A. and Abrahms,
Ellis,
New
Ellis,
E.
and Health
Practice.
A Handbook of Rational-Emotive
A. and Grieger, R.
Therapy.
New York:
Springer, 1977.
Ellis,
A New
A. and Harper, R.
Guide
to
Cliffs,
A. and Knaus,
W. Overcoming
Procrastination.
New
New
York: Irvington
Press, 1976.
Eysenck, H. Experiments
Making Things
Fay, A.
in
Behavior Therapy.
Better by
New
Press, 1978.
Fodor,
I.
at the
New
York, 1978.
M.
Goldfried,
New
York:
Goldstein, A.
and Chambless, D.
J.
Therapy, 1978,
Harlow, H.
Hauck,
P.
Hauck,
P.
F.
9,
L.
47-59.
The nature
of love.
13, 673-685.
Press, 1974.
J.
Conflicts.
New
status.
Johnson,
W.
People in Quandaries.
New
44^5.
283
Kelly, G. The Psychology of Personal Constructs,
Volumes
and
II.
New York:
Norton, 1955.
Kimmel,
J.
The
Rational
Kubler-Ross,
E.
On Death and
New
Dying.
New
New York:
McGraw-Hill, 1972.
Pa. 16802.
Lembo,
Therapy, 45
J.
E.
65th
St.,
New
York, N. Y. 10021.
New
A.
Maltzman
(Eds.),
A Handbook
of
Cole and
I.
New
Mahoney, M. Personal
Grieger (Eds.),
science:
A Handbook
Ellis
of Rational-Emotive Therapy.
New
and R.
York:
Springer, 1977.
Marks,
Boulougouris,
J.,
J.,
and Marset,
P.
to
Happiness.
New
1971, 119,
Living, 1975.
Maultsby, M. and
New
Ellis,
Un-
New
1977.
M. Rational-Emotive Therapy.
Boston: Houghton
Mifflin, 1975.
Novaco, R.
W. Anger
New York:
284
Practitioner's
Guide
33, 821-830.
Powell,
Fully
J.
Human,
111.:
Argus, 1976.
Rachman,
Marks,
S.,
I.
2,
71-74.
Calif.: Josey-Bass,
1974.
459^61.
J.,
New
York, 1978.
to
Ad-
J.
New
York: Wiley,
1959.
Tosi, D.
Tosi, D.
J.
J.
and Reardon,
J.
The treatment
Vygotsky,
L.
Walen,
R.,
S.
Therapy.
New
to
Behavior
New
to
Wessler, R. and
(Ed.),
Wolfe,
J.
L.
Wolpe,
J.
Yates, A.
Behavior Therapy.
New
New
Answer Key
Chapter
1.
2.
did poorly on
Oh, I'm such a
No one
I
3.
3:
talks to
that
exam
failure
me
Activating event.
self-evaluation.
Activating event.
My
hedonic evaluation.
know she
hates
me.
last
week
evaluation of
Activating event.
My
5.
wife told
You
see,
about
6.
me
Activating event.
Activating event.
know now
no good
evaluative conclusion
self.
an evaluation, however.)
Do you
7.
call
that success?
How
can
makes
Chapter
me
feel so
me
self-evaluation.
5:
All statements in the exercise are rational beliefs, expressing an evaluation but not an absolutistic
demand.
286
Guide
Practitioner's
Chapter
8:
Others have
I
to depression:
what
better than
it
want.
I.
can't cope.
How
to pity:
Poor me!
Sample cognitions leading
It's
great to be
What
what
want!
to mirth:
alive!
wonderful time
had!
Chapter 10:
Sample coping statements:
(a)
1.
Yelling won't help anything. Try to state your ideas clearly with-
(b)
When
my
2.
Calm down
3.
calm down.
It's working! I'm not escalating the argument.
1.
There
a little.
raise
voice,
it's a
is
is
3.
(c)
1.
it's
This fear
It's
is
1.
what
my
working!
sexier
(d)
take
if I
myself and
3.
It's
OK
for
to feel that
my
I
expected.
It
how
probably be
me to focus on enjoying
on what she might think of me.
reminds
can control
will
likes.
And
feel!
the
more
relax, the
feel.
how
me
not so bad.
satisfied
2.
but
feel afraid
way;
that she
might
fire
287
2.
can
My
3.
feel
me
unless
It's
try.
let
probably
I'll
still
speak up.
it.
feel
even more in
Chapter 11:
Activating event:
went
Rational Belief:
(Incorrectly stated
by the
as a Rational Belief.)
down.
wanted the
job.
guess.)
Irrational Belief:
It is
(Correct. There
be sought
horrible that
may
later.)
Emotional Consequence:
(Correct.
depressed.
felt
(The
Why
may
later.)
is it
horrible that
is
The
resulting beliefs, at E,
New
effect:
It
is
unfortunate that
There
is
I'd better
Index
flat
beyond
therapist's expertise,
47
of,
40
changing the client, 205-9
social problem solving, instruction of, 205-9
changing the environment, 201-5
contingency management, 203
conflict resolution training, 202
discrimination training, 201, 202
problem-oriented set, 202
clarification of, 41-42
client errors in perceiving, 194-201
confirmable reality and, 37
dealing with, 194-201
identification of, 37-41
large numbers of, 45^17
perceived reality and, 37
symptom
stress,
47^8
164-65
Active listening
Affect
avoidance
skills,
of, 55,
144
or inappropriate, 54-55
60
Agendas, client assessment of, 247-50
Anger, irrational beliefs in, 94
Anxiety, irrational beliefs in, 92-93
Attention training, 172
Assertiveness Training, 209-12
lack of during session, 54,
211
suggested readings in, 277-78
Avoidance behavior and awfulizing,
129
Awfulizing statements, 125-30
B. See Belief
system
magnification/minimization, 196
patient's distortion of events,
196-98
196
Behavior modification, 103^1
Behavior therapy, marriage counseling and, 260-61
Belief system (B), 13
confusion with C, 56-57
selective abstraction,
identification of,
techniques
60
in,
86-92
88-90
therapist suggestion, 88
289
Index
290
Belief
system
behavioral, 105-6
(B), (cont.)
147-50
97-102
sentence completion, 89
simple questioning, 89
cognitive,
self-talk, 87
Blow-up procedure, 105
didactic strategies,
100-1
humor
in, 101
use of questioning, 97-99
defined, 96
behavioral
Camp,
B., 191
Catastrophe list, 126
Client expectations, 25
Children and RET, 32
Communication problems in marriage,
Consequence
108-9
imaginal, 102-5
259
(C), emotional
and be-
hypnosis, 104
changing, 63-64
rational-emotive imagery,
52-53
shame, 53-54
102-4
guilt,
Concreteness in RET, 30
Conflict resolution training, 202
of self-denigration statements,
130-36
of should statements,
119-26
142-47
D. See Disputation
Deep relaxation, 104
Depression, irrational beliefs in, 93
Diagnosis, as first step in treatment,
34
Dialectics, 7
Dichotomous thinking,
E.
See Effect
21-22
Effect (E),
7,
58-59
Diekstra, R., 18
A.
absolutism and, 180
Ellis,
126-30
40
discomfort anxiety, 48, 139
disputation, questioning in, 97
human
denigration, 130
Index
291
language
style,
175
irrational beliefs
in depression, 93
love slobbism, 77
121-22
rational and
Zen Buddhists,
Homework assignments,
irrational beliefs, 72
rational-emotive philosophy, 5
harmful, 52
mislabeling of, 59-60
55-56
62-63
vocabulary, 57-58
Empathy, 28-29
painful,
in session,
Epictetus, 5
Epistemology, 6
Ethics,
8-9
247-50
216-17
217-28
characteristics of,
examples
of,
Humor
in
in individual counseling, 25
in marriage counseling,
186-87, 215,
32
action assignments, 224-28
RET, 31
in disputation, 101
Free will, 16
in anger, 94
108-9
Genuineness in RET, 29-30
awfulizing, 125-30
180-81
Gestures, use of, 178
sessions,
in anxiety,
92-93
93-94
76-86
in guilt,
93-94
292
Index
Maintenance of irrational ideas, 3^1,
20
Marriage counseling, 243-63
behavior therapy and, 260-61
client agendas, 247-50
communication problems in marriage, 259-60
confidentiality, 246
schemas, 94
and listening skills, to detect,
144-45
maintenance of, 3-4, 20
multiple determinants of, 91
need statements, 137-39
about self-worth, 130-36
shoulds and musts, identification
of,
75
should statements, 116-25
about inanimate objects, 124-25
about oneself, 118-22
about others, 122-24
Irrational diagonal, 133
256
260-61
individual therapy, 243
separation, decisions in, 251-56
Neisser, V., 19
and acceptance
of distress,
127-28
Obscenity, therapist's use
of,
176
Phrenophobia, 48, 83
Positive thinking, 127
Premack principle, 173
Present behavior, emphasis on, 19-20
Problem-oriented set in changing activating events, 202
Progress reviews in therapy, 239
Questioning, form
of,
169-71
Magnification/minimization, 196
C, Jr., 191
Maultsby, M.
Index
293
emphasis on present, 3
Ellis
and, 5
epistemology, 6
ethics,
8-9
11-12
hedonism, 9-10
humanism in, 10-11
goals,
scientific
thinking and, 6
values in, 7
thinking, 3
maintenance of irrational
ideas,
3-4
152-53
Rational-emotive therapist, necessary
qualities for
187-89
basic principles,
belief
system
12-22
(B),
13
children and, 32
client expectations,
Scientific thinking in
Self -denigration,
25
RET,
Self-help
130-36
Self-instructional training,
confrontation, 30-31
Self-rating, 132
diagnosis, 34
difference
127
disputation of irrational beliefs, 21
empathy, 28-29
free-will, 16, 117
genuineness, 29-30
geographical restrictions, 180-81
goals, 22,
35-36
195-96
homework, 219
concreteness, 30
havioral, 13
6,
191-94
294 Index
Spivack, G.,
J.
Piatt,
and M. Shure,
205-9
Socratic dialogue,
166-67
64
Suggestion, therapist's, 88
SUDS scale, 64
Symptom stress, 21, 47^*8, 83,
in disputation, 107
Time-projection questioning, 90
Tosi, D. J. and J. Reardon, 104
deep relaxation or hypnosis in imagery, 104
Transference, 183
Values in RET, 7
marriage counseling and,
Vicarious modeling, 101-2
Therapist roles
behavioral model, 182-83
teacher, 182
Therapist style
active-directive style, 32,
form
164-65
244^6
Vygotsky, L., 87
submerging speech, 87
of questioning
language
style,
175-76
RET
principles
Watson, John, 87
Wegner, D., and R. Vallacher, 195
Wessler, Richard, 132
Wolfe, Janet, 77, 111
Written essays, 220
/,
mpet
is
tub
^vtrmJcE
is
a contemporary cognitive-behav-
years ago,
because
This
it is
is
and
since then
applicable to so
the
first
it
book written
and for the professional who wants to learn how to practice RET. The
book introduces the basic principles of RET as well as the idea that
while the therapist takes a persuasive, directive role, the patient and
therapist share in working toward common goals. The authors, all
RET
many
The Authors
Susan R. Walen
is
member
Towson
State
He
is
Rational Living.
Mm
Cover desigi by Charles and Ruth Kaplan
ISBN
0-19-5026G8-3