PCN 107

· "Rational Emotive Behavior Therapy Background," located below.

· Therapy Session 2: the rational emotive behavior therapy session between Rebekah and Dr. Allen below. Take notes on the interaction between Rebekah and Dr. Allen.

· Complete the written assignment according to the assignment directions.

Rational Emotive Behavior Therapy Background

REBT is an action- and results-oriented psychotherapy which teaches clients how to identify self-defeating thoughts, beliefs and actions and replace them with more effective, life-enhancing ones. One of the first of the modern cognitive behavior therapies, REBT was developed in 1955 by Albert Ellis, Ph.D.

Using a technique called “uncovering the ABCs of personality formation,” REBT therapists state that it is not the (A) Activating event that causes emotional Consequences (C), but (B) the Belief (B) about the event. For instance, faced with the loss of a relationship, one client’s belief system might lead to suicidal depression, while another client’s belief system might leave him or her feeling fine about the breakup.

One role of the REBT therapist is to create (D) a Disputing intervention (D) for (B) the Belief that is irrational. This will (E) Effect a new, and better, (F) Feeling. REBT practitioners teach their clients to (1) analyze episodes of emotional and behavioral disturbance with the ABC model; (2) discriminate between irrational and rational beliefs; (3) distinguish healthy negative emotions from unhealthy emotions and (4) utilize a variety of means for modifying the irrational beliefs that support their emotional and behavior problems.

In working with clients, the REBT therapist uses a number of cognitive, behavioral, and emotive techniques, including.

1. Actively disputing irrational beliefs throughout the day.

2. Bibliotherapy.

3. Role-Playing new ways of living

4. Practicing what might be for the client new, unconventional ways of living in the world (e.g., an introvert acting extroverted at a party)

5. Imagery exercises, where the client imagines how he or she would like to be.

6. Practicing new behaviors through traditional behavioral techniques (e.g., conditioning, modeling, assertiveness training)

In the following role-play, watch how Dr. Korrie Allen uses the ABC of Rational Emotive Behavior Therapy to assist Rebekah with her feelings about a recent break-up with her girlfriend.

Rational Emotive Behavior Therapy Session

Dr. Allen: Good morning Rebecca, what brings you here?

Rebekah: Um, I’m just feeling depressed and upset, and just a little worthless.

Dr. Allen: is there anything that’s going on that’s different in your life right now?

Rebekah: Um, my girlfriend and I are having some problems. Um, she’s been talking about breaking up and um, actually I think that she’s gonna break up with me.

Dr. Allen: so that must be really difficult to think about. Um, what are some of the thoughts that are going through your head when you think of the possibility of you guys breaking up?

Rebekah: All kinds of things like, I need a girlfriend, I really miss her. I mean, just even now we’re having a lot of problems and ya know, I just miss things being the way it used to be. I want to have a family one day, we’ve just made all kinds of plans and it’s not going to happen.

Dr. Allen: And what if you were to break up?

Rebekah: Well, I mean I guess I think about the fact that I mean, we’ve been together for 3 years. I’m 25, I’ve already invested 3 years into this relationship. Um, we talked about the future and having kids. I need a girlfriend, I need a girlfriend to have all those things that I planned on having, that we had planned on having.

Dr. Allen: I hear you saying that you need a girlfriend in order to have certain things in your life in place. When I think of a need, I think of things that you absolutely must have. For example, if you didn’t have food, what would happen?

Rebekah: I would die

Dr. Allen: And what if you didn’t have water?

Rebekah: I would eventually die.

Dr. Allen: And even along a little bit of a different line, have you ever been….I know you’re in graduate school, I’m sure you have lots of tests. Have you ever been studying, go to get in your car and your car doesn’t start?

Rebekah: Yea

Dr. Allen: And how did you feel at that point?

Rebekah: Um, really mad. Just really upset.

Dr. Allen: Do you recall what was going through your mind at that time?

Rebekah: Just that I was really upset. Um, I needed my car to start so I could get to school.

Dr. Allen: Mmhmm, and were you able to problem solve and come up with a solution that you’re thinking “I need my car to start”, “I have to have it to start?”

Rebekah: Um, no.

Dr. Allen: You just kind of froze?

Rebekah: yea, well I guess I would just be so upset that my car wasn’t starting that I probably wouldn’t be able to think about anything else.

Dr. Allen: Mmhmm, do you think it was the fact that your car wasn’t starting that caused you to feel upset?

Rebekah: Yes

Dr. Allen: Ok, well in REBT, what we have are called the ABC’s. And A is the activating event, which in that situation would be the car not starting, and the B is the belief and C is the consequence. And do you think that it was the fact that the car didn’t start? Or what you were telling yourself about the car not starting? That was causing you to feel upset

Rebekah: Um, I guess it would be what I was telling myself.

Dr. Allen: And that was?

Rebekah: that I needed to have the car to start to get to school.

Dr. Allen: Mmhm, and in that situation what do you think you might have been able to say that would have caused you to feel a little less upset, and would have enabled you to problem solve and come up with an alternative solution quicker?

Rebekah: I guess if I wasn’t so focused on you know, my piece of crap car, I could think about “Ok my car won’t start, now what am I going to do?” I guess I need to call a friend, or just figured out another way to get to school.

Dr. Allen: Right, you’d really like it to start but you’re okay. You didn’t die because it didn’t start

Rebekah: Right

Dr. Allen: And you’re able to get through the problem okay, right? So in that situation, you can see that it’s actually the belief that’s causing you to feel upset, not the fact that the car didn’t start, the activating event. Does that make sense?

Rebekah: Yea, I see what you’re saying…yeah

Dr. Allen: And this, to me sounds a little similar to some of the things that are going through your head about your girlfriend. If you’re saying to yourself “I need to have a girlfriend, I must have a girlfriend in order to be happy. I’m 25, I need to have a family, that’s what everybody’s doing that’s my age”, how are you feeling at that point?

Rebekah: Depressed, I mean that’s how I’m feeling now.

Dr. Allen: Right, and so how do you think you would feel if you were to say something along the lines of: “I’d prefer to have a girlfriend, I’d like to have a girlfriend, but if I don’t, it’s okay.” How do you think you would feel at that point?

Rebkah: I would still be upset, but I guess it would change my focus.

Dr. Allen: Do you think you would be as anxious around your girlfriend?

Rebekah: Probably not.

Dr. Allen: Right, and so if you had to explain to me the difference between a want and a need, what would you, how would you describe that?

Rebekah: Um, I guess like you said you know, if you’re talking about food and water, I mean it is something that you have to have or you’re gonna die. And a want is something that you would like to have, would be nice if you had.

Dr. Allen: And even if we go back to the car example, if you said to yourself: “I’d really like to have a car, I want to have a car, it’s important to be on time”. How do you think you would feel at that point?

Rebekah: Upset, but I would still…I would feel better about making other arrangements, and not being so focused on being angry.

Dr. Allen: Right, so what this models shows is when anybody, it doesn’t matter if you’re black, white, rich, poor, male or female; whenever you turn a preference or a desire or a want into an absolute must, you’re going to feel miserable. Do you see how that applies to you?

Rebekah: Yeah, I guess I never really thought about it that way.

Dr. Allen: Mmhm, and today we’ve talked really only about one need that you brought up. The need to really have a relationship and be with your girlfriend, but can you give me a different way to think about that that might help you feel a little less depressed?

Rebekah: Well, I guess I’m gonna still be upset but if we do break up and I don’t have her, I’m not gonna die. Even though it may feel that way, I’m not going to. I guess it’s a want, I would like to have, I would like for us to stay together, I would like to have her as a girlfriend.

Dr. Allen: Yeah, and when you’re with her and you’re thinking I would like to be with her, I enjoy being with her, how do you feel?

Rebekah: Good.

Dr. Allen: Good, but when you’re with her and you’re thinking “I really hope she doesn’t break up with me, I really need this relationship, its important that we stay together.” How do you feel at that point?

Rebekah: Bad, I mean, depressed I guess. A lot of pressure.

Dr. Allen: Yeah, and how do you act around her?

Rebekah: Strange (laughing)

Dr. Allen: Yeah, then she’s kinda going “okay.” Yeah. Um, so like I’m sure you’ve experienced many hassles and when you have, for example a test, a lot of times you don’t want to study for the test but you do. So when you take things like your wants and your desires to have a girlfriend and turn that into an absolute must, a need, it makes you feel depressed, it leads to a dysfunctional emotion. However, when you change that to more “I would like to be with my girlfriend, it’s important that we’re together and I enjoy spending time with her” you feel better, and you act differently around her. So one of the things that I really hope you’re able to see now is that it’s that belief about having the girlfriend that’s causing you to feel depressed than the activating event, the thought of her breaking up with you. Does that make sense?

Rebekah: Yeah. I’ve just never thought about things in that way before.

Dr. Allen: Right, well that’s great. I’m glad that you’re starting to make that connection cause that’s really the fundamental idea behind REBT, that it’s the belief that’s causing us to feel unhappy. So what I’d like you to do over this week is a little bit of homework. In REBT we always give homework. I want you to practice the process we’ve gone over. I’d like you to just jot down whenever you feel panicked or anxious or depressed during the week. And then once you put that down, think about what was the activating event, what was the event that kind of started that? And then what was the belief that you have that caused you to feel anxious, depressed, or self-hatred. Does that make sense?

Rebekah: Yeah.

Dr. Allen: Can you give me an example from what we’ve talked about today.

Rebekah: When I’m studying for a test and I get really really anxious and I just start thinking about, “I have to make an A, I have to study, I can’t be in graduate school, I can’t do bad.”

Dr. Allen: And so in that situation, the A is…the activating event would be…

Rebekah: Studying, I have to study

Dr. Allen: Right, and the belief is, the irrational thought is “I have to do well”

Rebekah: I have to make an A

Dr. Allen: Right, and that would cause you to feel anxious. Okay, so what could you maybe think a little differently that would cause you to feel less anxious? Because some anxiety is gonna be there, but what could cause you to feel a little less anxious?

Rebekah: That I studied and, you know, just to calm myself down “Okay, I studied for the test, I’m

gonna do well, I know the material, if I don’t make an A I’m not gonna get kicked out of the school.”

Dr. Allen: That’s great, and so what I want you to do this week is focus on those situations when they come up and really write down, what was the A, what’s the activating event, the belief, focus on that belief. And whether it’s rational or irrational, I want you to really focus on either one. And try to catch those irrational ones so you can start to really work on those and then whatever emotions they made lead to. So do you think you would be able to do that over the next week? Jot down those situations?

Rebekah: Yeah

Dr. Allen: And then we can go over them next week and really start to identify some of the irrational beliefs that may be causing you to feel depressed and anxious.

Rebekah: Okay.

Dr. Allen: Do you feel good about that?

Rebekah: Yeah.

Dr. Allen: Okay, well then I look forward to seeing you next week.

Rebekah: Okay, thank you.