Ellis's Rational Behaviour Therapy
Rational emotive behaviour therapy was developed in the 1950’s by Albert Ellis in the United States, New York to be specific. The therapy is a result oriented form of psychotherapy that teaches individuals how to identify their self-defeating ideas, beliefs and actions and replace them with more effective and life-enhancing ones. The beliefs we adopt depend on our individual ideas and our philosophy of life, it could be self-disturbing, self-healing or something in between those lines. That is basically what affects us now, depending on our ability to classify, and interpret them, we develop our rational and irrational beliefs.
What REBT does is to first locate irrational or wrong ideas and then seek to motivate the individual to transform them into rational or right ideas by the help of the ABC-model (activating event, beliefs, and consequences). Ellis says that the more apart, less equivalent one person’s system of ideas is from the “objective reality” the higher the possibility of the appearance of unhappiness, depression etc. By the rational emotive behaviour model a person learns to change his false beliefs into right ones (Dryden, Neenan, 2004).
The goal of REBT is to create happiness, happiness that comes from setting up important life goals and achieving them, but it is in our self-interest to acknowledge that we live in a social world and it is our responsibility to make the world socially and environmentally better while being able to achieve those goals.
Ellis originated the rational emotive behavioural therapy in 1955 while working as a clinical psychologist in New York. He originally started as a psychoanalyst, while learning from Freudian techniques he eventually became dissatisfied quoting inefficiency as the reason for it. He observed that the therapy took too long and wasn’t as effective as it should be, for a while he experimented with various eclectic approaches and along the line he was being more and more influenced by philosophers and not psychologists thus fuelling his interest in more practical approaches in the philosophic tradition (Dryden, Neenan, 2004).
He developed ‘rational therapy’ in a time where most therapists applied psychoanalytic approaches to dealing with clients. This posed a problem as most people believed that rational therapy only focused on the cognitive part i.e. thoughts and beliefs, but Ellis always maintained that therapy involved behaviour, cognition and emotion all working together. In a bid to counter his critics he changed the name of the therapy to rational emotive therapy in 1961 and eventually in 1993 he coined the name rational emotive behavioural therapy because he felt that people neglected the behavioural aspect of his therapy (Dryden, Neenan, 2004).
The ABC Model
To illustrate that our reactions are determined by our beliefs, Dr. Ellis developed the simple ABC format to teach people how their beliefs cause their emotional and behavioural responses:
A. Something happens. (Activating event) Activating events are the triggers that cause us potential stress. The B stands for belief you have about the situation. (Belief) We use our beliefs to interpret what is happening to us. And this more than often becomes opinion. The C stands for consequence, as you have an emotional reaction to the belief, the consequences come as a result of those beliefs and activating events.
This model is the essence of the REBT and is used to detect the irrational beliefs and ideas, to distinguish and discuss them and to create new ideas, attitudes and beliefs. For example an activating event could be a party with alcohol being served, you believe the reason everyone will attend is to drink but you’re not that big of a drinker, consequence is that you feel anxious and then you get a drink so you can relax and have fun. These steps are then taught to the client to increase participation and to more or less give the client a driver’s seat or a more advanced role.
The next step is to Dispute those selected irrational beliefs in such a way that the client can recognize the flaws in those ideas. It can be behavioural, cognitive or emotive in nature and is designed to work best when all three are used in equal amounts (Dryden, 2003).
Then comes the Effectstage. This is where the effects of disputing are observed by the therapist, the desired effect is a more constructive emotive, behavioural, and cognitive effect about the already experienced activating event (Dryden, 2003).
Rational emotive behavioural therapy suggests that there are four basic rational beliefs, they are:Full Preference belief, this belief is basically when you’re making it clear to yourself what you want and then deciding or acknowledging if what you desire exists or not. Non-awfulising belief involves you deciding if it is bad that you have not got what you want or have gotten what you don’t want vs. acknowledging that even though not getting what you want is bad it doesn’t mean it’s the end of the world. High frustration tolerance belief has three components. The first is admitting it’s a struggle keeping up with not getting what you want. The second involves acknowledging that not getting your desires met can actually be tolerated. The third component points to the fact that not only can you tolerate not getting what you want but that it is also worth it. Acceptance belief involves accepting events even if they are not up to your standards or what you originally desired. (Dryden, 2003)
Dryden states that similar to the rational beliefs there are four basic irrational beliefs, they are:
Demand – Rational emotive behavioural therapy believes that when you turn your desires to necessities or musts you make yourself emotionally disturbed when you don’t get what you believe you should have. In some cases even when you do get what you wanted you are still open to emotional disturbances when you hold a rigid demand, believing you might lose what you have and need. Awfulising Beliefis a case in which you acknowledge that it is bad that you have not got what you want or have gotten what you did not want. The second component is transforming that evaluation of badness into an evaluation of horror. Low frustration Tolerance involves concluding that you cannot bear not getting your demands met. It has three components, first recognising that it is a struggle to put up with not getting what you want. Second, acknowledging that it is not just a struggle but also intolerable not getting what you want. Thirdly, at this stage it doesn’t matter if it’s worth tolerating or not, you accept that you cannot tolerate it. Depreciation Belief is a situation where you depreciate yourself or make yourself feel lesser for not getting what you desire or having what you do not desire and spread that feeling of depreciation to others or depreciate life conditions when they do not meet your desires. (Dryden, 2003)
This is divided into the beginning, middle and ending phases of counselling, usually made up of about 1 to 50 sessions depending on the client. The beginning stage involves establishing a working alliance, a productive and therapeutic alliance is established between the therapist and the client. Discussing the clients reasons behind the therapy, their expectations and clearing any previous misconceptions the client might have had and basically establish your credibility as an effective counsellor. Teaching the ABC’s of REBT involves getting the client to be familiar with the abc model of emotional disturbances and beliefs and examining the ideas the client possesses presently. Dealing with clients doubts: encouraging clients to approach therapy with an open mind so as to know about his or her views and what approaches to implement. (Dryden, Neenan, 2004).The middle stage begins where with the aid of homework and other techniques you begin to apply the therapy with a view to identifying and working on core beliefs. This involves pointing out “common themes in the client’s irrational beliefs that underpin his problems”. The next step is encouraging your client to engage in relevant tasks involving cognitive, emotive imagery and behaviour techniques that are designed to encourage the clients new positive rational . (Dryden, Neenan, 2004).
The ending stage involves ending the therapy, knowing and observing when the client has made progress towards overcoming those problems. The therapist and the client decide to gradually decrease the sessions remaining or could also set a date for termination. The goal in this stage is to encourage your client that they are their own center or source of solving problems and identify and change relevant irrational beliefs (Dryden, Neener, 2004).
There are cognitive, imagery and emotive evocative techniques. They all have different approaches but aim to create a change and maintain a balance within the client. Cognitive Techniques such as tape recorded examination of beliefs; this involves your client recording a tape of him playing the role of his rational self and his irrational self with a view to giving him insight as to which is more logical. Semantic precision, occurs when the therapist is creating awareness in the use of the clients language to support his rational or irrational beliefs. Dibs(Disputing irrational beliefs), Is a form of questioning irrational beliefs. Usually applied in the middle stage where the client is made to ask himself or herself questions and produce answers e.g. what evidence exists in support of the truth of this belief? (Dryden, Neenan, 2004)
Imagery Techniques like rational emotive imagery where the client is encouraged to practice changing his unhealthy negative emotion to a healthy negative emotion at the point C while maintaining the image of A and changing his irrational belief at stage B (Maultsby and Ellis, 1974).Coping imagery: the client pictures carrying a positive behaviour in real life before he actually does. Time projection involves helping the client understand that they can be happy even after a ‘terrible’ event has occurred by the use of intervals. (Dryden, Neenan, 2004)
Emotive evocative techniques include Humorous exaggerations Involving showing the client how amusing his irrational beliefs are, it is usually directed at the clients ideas and not the client himself to avoid discrepancies. Rational humorous songs can be used as well; this is done with the intention of making the client take his irrational beliefs less seriously. (Dryden, Neenan, 2004)
As a therapist your role is to ensure that the client achieves a psychotherapeutic change during the process of rational emotive behavioural therapy and is thereafter able to apply it to his everyday life.The therapist must create a working relationship, it is important that one is established as it is an important vehicle for change. Core conditions imply that the therapist sticks to the core of the therapy; it is stressed that the therapist be able to offer philosophic as well as affective empathy. This involves understanding the client’s beliefs and how they relate to how they feel, therapists have to unconditionally accept their clients for whom they are as humans that are complex. Therapists also have to be genuine and congruent when they engage in self-disclosure with clients as to address problems. Therapy is a collaborative effort and should be approached empirically while being authoritative even when giving encouragement (Dryden, 2004).
The clients role involves being open to the demands of the therapy as well as being disciplined with homework given by the therapist. The client assumes the “student” role. They have to comply or “highly desire to adhere” with the demands of the rational emotive behavioural techniques. The client has to be able to describe problems clearly, meaning being able to give an understandable and relevant account of his problem. Also the client must be able to focus on the here and now, highlighting how current problems are being maintained and not dwelling on how the problems came about in the first place. The most important role of the client is making a commitment to change, which is opening up to changing that irrational belief so as to become a better individual(Dryden, 2004).
Some critics have argued that limitations exist in the REBT research base especially on the treatment of alcohol abuse and dependence and that future reliance on therapeutic strategies will become problematic without proper empirical support. For example the case of Brian (1984) and Rosenberg and Brian (1986) in which the court had referred DUI offenders to therapists and Ellis’s rational emotive therapy were applied in 90 minute sessions over a period of 6 months.
Dependent measures such as a Knowledge Questionnaire, the Michigan Alcoholism Screening Test, the Alcohol Assertiveness Inventory, seven questions to assess (scale 1 to 7) self-reported frequency of alcohol, and the Washington Sentence Completion Test were set out to gauge the effect of the treatment. The studies did not report complete enough statistics to calculate effect sizes for all comparisons for all dependent variables and of all the tests only one was able to report a significant difference at post-treatment (Terjesen,DiGiuseppe, 2000).
The confrontational approach of the therapy has also been questioned as you must be mentally tough to be able to accept an attack on your beliefs. Also there have been calls for more qualitative research in order to know the limits of the therapy itself. (Terjesen, DiGiuseppe, 2000).