COUN A221F Lecture 9 Rational emotive behavioural therapy_Done.pptx

LECTURE 9: RATIONAL EMOTIVE BEHAVIORAL THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University FROM BEHAVIORAL TO COGNITIVE APPROACH ALBERT ELLIS (SEPTEMBER 27, 1913 – JULY 24, 2007) ▪Initially trained as a psychoanalyst. ▪He is generally cons...

LECTURE 9: RATIONAL EMOTIVE BEHAVIORAL THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University FROM BEHAVIORAL TO COGNITIVE APPROACH ALBERT ELLIS (SEPTEMBER 27, 1913 – JULY 24, 2007) ▪Initially trained as a psychoanalyst. ▪He is generally considered to be one of the originators of the cognitive revolutionary paradigm shift in psychotherapy and the founder of cognitive-behavioral therapies. ▪Based on a 1982 professional survey of USA and Canadian psychologists, he was considered as the second most influential psychotherapist in history (Carl Rogers ranked first in the survey; Sigmund Freud was ranked third). ▪It’s never the events that happen that make us disturbed, but our view of them (Ellis, 2005). OVERVIEW ▪REBT is a cognitive behavioral approach that emphasizes individuals’ capacity for creating their own self-enhancing and self-defeating emotions. ▪REBT holds that an individual’s belief system affects whether s/he attains maximum pleasure and selfactualization. Happiness is the goal of all human beings. ▪REBT is a theory of how people (who want happiness) can inadvertently create personality and emotional disturbance. BASIC CONCEPTS OF REBT ▪Comprehensive cognitive-affective-behavioral therapy / multimodal theory ▪Clients change through identification of irrational thoughts ▪Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship ▪Is highly didactic, very directive, and concerned as much with thinking as with feeling ▪Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations VIEW OF HUMAN NATURE ▪We are born with a potential for both rational and irrational thinking. ▪We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves. ▪We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk. ▪We have the capacity to change our cognitive, emotive, and behavioral processes. ▪We have an inborn tendency toward growth and actualization. BASIC PROPOSITIONS OF REBT ▪People have the potential to be rational, self preserving, or to be irrational, self-destructive. ▪Neurotic thinking is the result of unrealistic, illogical thinking. ▪Culture and family can perpetuate irrational thinking. ▪A warm therapeutic relationship may be desirable, but it is not necessary or sufficient condition for change. ▪The focus is not symptom removal but cognitive and behavioral change. BASIC PROPOSITIONS OF REBT ▪The causes of an individual’s problems are not the events that have happened but how the individual perceives them. ▪There is an element between stimulus and response; it is thought (S 🡪 thoughts/belief 🡪 R) ▪REBT holds that beliefs mediate events and emotions. ▪REBT provides clients with methods for changing irrational beliefs. 01 02 03 04 05 Internally consistent Are empiricall y verifiable Are not absolutist Results in adaptive emotions Helps us attain our goals RATIONAL BELIEFS Logically inconsistent Inconsistent with empirical reality Are absolutist and dogmatic IB’s are often over learned, rehearsed since childhood, and are frequently based on grandiose demands placed on the self, others. (Ellis 1979) IRRATIO NAL BELIEFS THE 3 CORE IRRATIONAL BELIEFS (1989) TWO TYPES OF DISTURBANCE (FROGGATT, 2005) ▪REBT suggests that human beings defeat or ‘disturb’ themselves in two main ways: ▪Holding irrational beliefs about their ‘self’ (ego disturbance). ▪Holding irrational beliefs about their emotional or physical comfort (discomfort disturbance). EGO DISTURBANCE ▪It represents an upset to the self-image. ▪ It results from holding demands about one’s ‘self’, e.g. “I must … do well / not fail / get approval from others”. ▪ Followed by negative self-evaluations such as: “When I fail / get disapproval / etc. this proves I am no good”. ▪Ego anxiety – emotional tension when personal worth is threatened. ▪ Avoidance of situations where failure, disapproval, etc. might occur. ▪ Looking to other people for acceptance. ▪ Unassertive behavior through fear of what others may think. DISCOMFORT DISTURBANCE ▪It results from demands about others (e.g. ,‘People must treat me right’) and about the world (e.g., ‘The circumstances under which I live must be the way I want’). ▪ Low frustration-tolerance (LFT) results from demands that frustration not happen, followed by catastrophizing when it does. ▪ Low discomfort-tolerance (LDT) arises from demands that one not experience emotional or physical discomfort, with catastrophizing when discomfort does occur. It is based on beliefs like: ‘I should be able to feel happy all the time’. COGNITIVE DISTORTION OF EVENTS ▪Absolutist must and should : ▪Individual believe that he/she must or should act a certain way in life. ▪“I must be the best lover.” ▪Setting up failure and excessive demands ▪Awfulizing : ▪Exaggerates events by making them horrible, terrible, awful or catastrophic. ▪“If I don’t get into the university my life will be shattered.” ▪Excessive fear and panic COMPARISON OF IRRATIONAL AND RATIONAL BELIEF “Must” I must be the perfect trainee. I must be liked by everyone. I must always be in control of my family. “Would” I would prefer to be a highly competent trainee, but I am learning and am bound to make some mistakes. I would prefer to be liked but it is also even more important to be true to myself. I would prefer to influence my family in ways in attain important goals, but total control is both undesirable and unrealistic. COGNITIVE DISTORTION OF EVENTS ▪ Can’t-Stand-It-It is (discomfort intolerance): ▪ It continually see events as being unbearable. ▪ “I just can’t stand with my boss anymore.” ▪ Excessive worry and depression ▪ People rating : ▪ Judging the total value or worth of a person. It represents an overgeneralization whereby a person evaluates a specific trait, behavior or action according to some standard of desirability or worth. ▪ “I did a bad thing; therefore I am a bad person.” ▪ “I love you so much , why you leave me?” ▪ Negative self and emotions THE ABCDES OF FEELING AND BEHAVIOR (ELLIS & HARPER, 1975) ▪A = Activating event ▪B = Belief system ( iB = irrational belief) ▪C = Emotional / behavioral consequences of A and B ▪D = Disputing irrational thoughts and beliefs ( Treatment of REBT) ▪E = Cognitive and Emotional effects of revised beliefs EXAMPLE EXAMPLE ▪Sometimes in depression there is much resentment, envy and anger under the surface (Gilbert, 2000). ▪The person has difficulty in coping with these feelings because they see it as evidence of a bad self (i.e., are ashamed for these feelings - the inner critic tells them it is bad to feel these things). ▪Some people feel that they do not have the right to be angry, while others feel that anger makes them unlovable, thus anger cues an internal attack and the client takes a defensive position to it, e.g., “I am a horrible or ungrateful person to feel this kind of anger” (Gilbert, 2000). EXAMPLE ▪The fear of revealing powerful feelings is also a common problem in some depressions and can say much about the internal self-structure and self-other schema. ▪‘Has the person been punished in the past for showing strong feelings of distress?’ EXAMPLE EXAMPLE THE THERAPEUTIC PROCESS ▪Therapy is seen as an educational process. ▪Clients learn: ▪Their psychological self ▪To identify and dispute irrational beliefs ▪To replace ineffective ways of thinking with effective and rational cognitions ▪To stop absolutistic thinking, blaming, and repeating false beliefs THE THERAPEUTI C PROCESS Engage Engage client (empathy, warmth and respect) Assess Assess the problem, person, and situation Prepare Prepare the client for therapy (informed consent) Implemen Implement the treatment programme t Evaluate Evaluate progress Prepare Prepare the client for termination THE THERAPEUTIC GOALS ▪To teach clients how to change their dysfunctional emotions and behaviors via cognitive and behavioral methods - into healthy ones. ▪To assist clients to achieve unconditional selfacceptance and unconditional accept others. ▪To assist clients in seeing how giving up perfectionism improves their lives. THE THERAPEUTIC GOALS ▪To teach clients to differentiate between desires and “musts”. ▪To change the clients’ habits as well as cognition. ▪To help the clients to develop a more “rational”, non-demanding philosophy and thinking style. THERAPIST’S FUNCTION AND ROLE ▪Encouraging clients to discover their irrational beliefs and ideas. ▪Making connection of how these irrational beliefs lead to emotional disturbances. ▪Challenging clients to modify or abandon their irrational beliefs. ▪Dispute the irrational beliefs and substitute rational beliefs and behaviors. ▪Displaying warmth toward clients may be desirable but it is not necessary. CLIENT’S EXPERIENCE IN THERAPY ▪Client is a student and learner--- the client learns how to apply logical thoughts, experiential exercises, and behavioral homework to problem solving and emotional change. ▪Focus on here-and-now experiences. ▪Does not spend much time on exploring clients’ early history and connecting present and past. ▪Expect to actively work outside the therapy sessions. Cognitive technique s • Demonstrate and teaching REBT philosophy (ABC Model) • Disputing irrational beliefs • Cognitive role-playing • Cognitive homework Behaviora • Shame-attacking exercise l • Operant conditioning technique • Skill training and s Modeling Emotive • Role Reversal technique • Rational emotive imagery s THERAPEUTI C TECHNIQUES COGNITIVE TECHNIQUES 1. DISPUTING IRRATIONAL BELIEFS ▪Empirical ▪Encourage client to look for empirical evidence that confirm or disconfirms their irrational belief, usually iB is counter with reality. ▪Logical ▪Encourage client to look for examine whether or not the iB are logical. ▪“Does it make sounds that if you fail one test in police recruiting means you will fail again ?” DISPUTING IRRATIONAL BELIEFS ▪Functional: pragmatic ▪Detach the client form their beliefs by emphasizing the consequences, ask them whether the iB helps to pursues the goals. ▪“What happen if you continue to engage in causal sex relationship, does it help you to find the true one?” EXAMPLE EXAMPLE EXAMPLE DISPUTING IRRATIONAL BELIEFS ▪Double-standard dispute ▪If the client is holding a ‘should’ about their behavior, ask whether they would globally rate another person (e.g., best friend, therapist, etc.) for doing the same thing, or recommend that person hold their demanding core belief. ROLE REVERSAL PLAYING ▪Client take the role of counselor, learn how to dispute his or her own iB. ▪Allow the client to view interactions from another person’s perspective. ▪Useful exercise when a client is experiencing conflict of values or feelings or a conflict with his or her self-image but is unable to isolate and understand the nature of the conflict. ROLE REVERSAL PLAYING ▪The purpose of role reversal is to project the client into a paradoxical examination of views, attitudes, or beliefs. ▪ E.g., The client was having conflicts with his boss that affected his emotion, so the counsellor reversed the client’s role by having him enact an encounter as the client’s boss. ▪How were you feeling in that role play? ▪How well do you think your skills in that rehearsal? ▪What difficulties do you anticipate in implementing your changed behavior and how can you overcome them? BEHAVIOURAL TECHNIQUES BEHAVIOURAL TECHNIQUES ▪Operant Conditioning ▪Help client arrange reinforcements and penalties. ▪Use most of the standard behavioral therapy approaches. ▪Skill Training and Modeling ▪Teach client various skills e.g., social skills, assertion skills, and time management. BEHAVIOURAL TECHNIQUES ▪Exposure ▪Test the validity of one’s fears ▪De-awfulise them (by seeing that catastrophe does not ensue) ▪Develop confidence in one’s ability to cope (by successfully managing one’s reactions) ▪Increase tolerance for discomfort (by progressively discovering that it is bearable). SHAME-ATTACKING EXERCISE ▪Purposely acting out of a situation that might normally cause embarrassment in public. ▪ E.g., yelling out of the lobby, asking stranger for dollars bills, singing in the street, repeatedly stop a bus without getting off, or asking strangers in the street to give them money. ▪Help client understand approval from others not necessary for self-acceptance. ▪Not illegal, immoral but silly and weird. RATIONAL EMOTIVE IMAGERY (REI) ▪Client ask to close their eyes and focus intensely on the situation that is causing extreme emotional disturbances, after reconstruct the image and signals the counselor, counselor then ask the client to change the upsetting feelings to a more reasonable emotions. ▪By using REI, client able to control over the thoughts and ultimately control their emotions and behaviors. LIMITATIONS OF REBT ▪Extensive training is required to practice Cognitive Behavior approaches. ▪Therapist may misuse power by imposing their ideas of what constitutes “rational” thinking on a client. ▪Therapists must take special care to encourage clients to act rationally within their own value system and cultural context. ▪The strong confrontational style of Ellis’ REBT may overwhelm some clients. LIMITATIONS OF REBT ▪Does not emphasize the client's past, saying it is ineffective in helping clients change faulty thinking and behavior. It is thought that clients may have need to express and explore their feelings. Some clients may be put off by confrontation. ▪Lacks the concern for unconscious processes and ego. IN-CLASS EXERCISE (1) ▪REBT helps clients deal primarily with: ▪rational beliefs ▪rational beliefs that have an unpleasant activating event ▪irrational beliefs that have an unpleasant activating event ▪irrational beliefs that have a pleasant activating event IN-CLASS EXERCISE (2) ▪Which of the following statement is not true about Ellis’ theory? ▪He saw thinking, feelings, and behaviors as important. ▪He believed that people could change. ▪He increasingly incorporated additional behavioral and feeling techniques into his theory. ▪He saw empathy as critical to building the relationship. IN-CLASS EXERCISE (3) ▪Asking the client to close their eyes and focus intensely on the situation that is causing them extreme emotional upset and then working on changing a self-defeating emotion to an appropriate emotion is called: ▪changing the emotion ▪disputing feelings ▪rational-emotive imagery ▪challenging irrational feelings REFERENCES ▪ Archer, J., & McCarthy, C. J. (2007). Theories of Counseling and Psychotherapy: Contemporary Applications. Upper Saddle River, NJ: Merrill Prentice Hall. ▪ Corey , G (2008). Theory and Practice of Counseling and Psychotherapy , Thomson Learning ▪ Deborah, D., & Keith, S. D. (2009). Evidence-based Practice of Cognitive Behavioral Therapy. US: Guilford Press. ▪ Froggatt, W. (2005). A brief introduction to rational emotive behaviour therapy. Journal of Rational-Emotive and Cognitive Behaviour Therapy. ▪ Gilbert, P. (2000) Counselling for depression. (2nd ed.). London: Robinsons and New York: Oxford University Press. ▪ Gilbert, P. (2000). Overcoming Depression: A Self-Guide Using Cognitive Behavioural Techniques. (Revised ed.). London: Robinsons and New York: Oxford University Press. ▪ Mcleod, J. (2003) An Introduction to Counselling. (3rd ed.). Open University Press. ▪ Raymond, J. C., & Danny, W. (2005). Current Psychotherapies. (7th ed.). Thomson Brooks / Cole.