Cognitive-Behavioral therapy from this chapter, we will only cover Ellis's work on Rational Emotive (Behavioral) Therapy
To get us started let's sing! http://www.youtube.com/watch?v=Ti2U3jyvpKM
• Background Men are not disturbed by things but by the view they take of them Epictetus. Ellis was born in 1913 in Pittsburg and moved to NY at age 4. He died July 24, 2007. He was the oldest of 3 children and described his father as absent (traveling salesman) and his mother as uninterested in parenting. His parents divorced when he was 12 and he rarely saw his father after that. He had many physical ailments in his youth and was very shy, but he was a voracious reader and also loved to write. He received a bachelor's degree in business administration. He wrote the book The Case for Sexual Promiscuity and that started his career as a sex therapist. He went to Columbia University for a master's degree in marriage and family counseling, and then got his PhD in clinical psychology. He was dissatisfied with the results of the therapeutic approach his was using at the time (very directive) so he got additional training as an analyst, but he found that the results were no better. He began to experiment with a fusion of psychoanalysis and behavior therapy, and in 1955 began practicing what he termed rational therapy. This launched his career and the work of rational therapy. He acknowledged the influences of Alder, Horney, Sullivan, Rank as well as philosophers and Perls. He criticized others by saying I could fairly easily see that Socrates was something of a sophist. That Plato was often a silly idealist. That Kant courageously threw out God and then cravenly brought him in the back door. That Freud was an arrant overgeneralizer. That Jung was a brilliant but sloppily mystical thinker. That Wilhelm Reich was pretty psychotic. That Carl Rogers was a nice fellow but a FFB a fearful fucking baby. (1997)
• View of human nature REBT is fairly neutral about human nature. We are neither all evil or all good but have a little of God and the Devil in us. We are programmed to be rational and irrational in our thinking, to be self-actualizing and self-defeating. The focus is on the behavior, not the person a person is not good or bad, but the behavior is good or bad depending on the consensus of community standards. We have the inborn tendency toward growth and actualization but we sabotage ourselves with self-defeating patterns. We do not NEED to be accepted and loved, but we believe we do and when we don't feel loved and accepted we become anxious, depressed and filled with a sense of worthlessness.
• Rational emotive therapy is a form of cognitive-behavioral therapy. Basic principles are:
• Cognition is the most important, though hardly the only, determinant of emotions.
• Irrational thinking often produces dysfunctional emotional states.
• We have a natural tendency to think irrationally and upset ourselves, which gets reinforced by the environment.
• We perpetuate our own emotional distress by re-propagandizing 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.
• Rational thinking leads to a reduction in the frequency, intensity, and duration of emotional disturbance, not to flat affect or the absence of feeling.
• RET philosophy
• We are disturbed not by things, but by the views which we take of them.
• We are born with the potential for rational thinking but tend to fall victim to the uncritical acceptance of irrational beliefs that are perpetuated through self re-indoctrination.
• Behavior change comes from thinking, evaluating, deciding and doing.
• Therapy is a process of reeducation. If we can reorganize our self-statements, we can reorganize our behavior.
• Key concepts
• Although emotional disturbance is rooted in childhood, we continue to disturb ourselves through our irrational and illogical thinking. Emotional problems are the result of our beliefs, which need to be challenged.
• A-B-C theory of personality: A is the actual event, B is our belief system, C is the consequence. We do not need to change A to change C, we only need to change B.
• Therapeutic Goals:
• The goal is to eliminate a self-defeating outlook on life and acquire a more rational and tolerant philosophy.
• Clients are taught that the events in life do not disturb us, but rather our interpretation of these events.
• Clients are taught how to identify and uproot their shoulds and musts and oughts. They are taught to substitute preferences for demands.
• Therapy is focused on the here-and-now; what is presently disturbing and how can client change the patterns of thinking and feeling that were constructed earlier.
• Therapeutic Relationship
• Warm relationship is not essential, but client must feel acceptance from the therapist. The therapist does not blame or condemn clients, but rather teaches them how to avoid rating and condemning themselves.
• Therapist is a teacher, client is student.
• Therapist is active and directive.
• Therapy is generally short-term clients are taught how to apply the model to other problems.
• Techniques and procedures
• Borrows many cognitive, affective and behavioral techniques from other models, and will fit techniques to individual client. Will use humor, imagery, role-playing, using force and vigor to dispute irrational beliefs, cognitive homework, and shame-attacking techniques. The techniques are used to induce clients to examine their present beliefs and behavior. Clients are given homework assignments to put into practice the changes.
• The three musts:
• i. I must do well or get approval (and I'm a worm if I don't)
• ii. You must treat me nicely and kindly (and you're a louse if you don't)
• iii. The world must give me what I want quickly, easily and with great certainty (and it's awful if it doesn't).
• iv. These three musts lead to: things are awful, I can't stand it, and I'm (or you're) a rotten person.
• Common irrational beliefs
• i. I must be thoroughly competent in everything I do.
• ii. Others must treat me fairly and in ways that I want them to.
• iii. I must have universal approval, and if I don't get this approval from everyone, then it's horrible and I feel depressed.
• iv. Life must be the way I want it to be, and if it isn't, then I can't tolerate it.
• v. If I fail at something, the results will be catastrophic.
• vi. I should feel guilty and rotten and continue to blame myself for all of my past mistakes.
• vii. Because all of my miseries are caused by others, I have no control over my life, and I can't change things unless they change.
• We feel what we think. Events and people don't make us feel good/bad, we do it to ourselves.
• Dysfunctional emotional states are the result of dysfunctional thought processes. Dysfunctional thinking includes: exaggeration, oversimplification, overgeneralization, illogical, invalidated assumptions, faulty deductions and absolutistic notions.
• Most irrational beliefs fall into 4 basic categories:
• i. Awfulizing statements that exaggerate the negative consequence of a situation.
• ii. Shoulds, oughts, and musts that reflect our unrealistic demands on events or individuals.
• iii. Statements of evaluation of human worth, either of oneself or others, that imply that some human beings are worthless or of less value than others.
• iv. Need statements arbitrary requirements for happiness or survival.
• v. While hereditary and environmental conditions are important in the acquisition of psychopathology, they are not the primary focus in understanding its maintenance.
• vi. Beliefs can be changed.
• The art of logical thinking:
• i. I should be perfect where is the evidence of this
• ii. I made a horrible mistake can you demonstrate that it was horrible
• iii. That proves that I am imperfect and therefore worthless that you are imperfect is shown by your mistake, but how does it logically follow that you are worthless
• Using the A-B-C-D-E model
• Activating event taking a test
• Beliefs (both rational and irrational beliefs about A). I better not fail this test or my family will be disappointed in me. I'll never be able to face them again. What's the matter with me, I must be really stupid to be having so much trouble with these tests. If I fail this test, I'll flunk this course, blow my GPA, never get a job, and be miserable the rest of my life.
• Consequences Emotional and behavioral; anxious, worrying, tense muscles, sweating, blank out.
• Disputing question or challenges you can use to change your irrational beliefs. The three components of disputing are detecting, debating and discrimination. Learn to detect (notice) irrational thinking; debate these beliefs and argue with themselves; discriminate rational from irrational beliefs. Will my family really be that disappointed if I fail? Even if they are disappointed, how terrible is that really? Do I need to have them approve of me all the time? Does having trouble with an exam make me stupid? Why must I be competent in everything? Will failing this test really ruin my happiness for life? What good will worry do?
• Effect new coping statements and thoughts you obtained from disputing your irrational beliefs. I really would like to pass this test, but even if I fail it, the world won't come to an end. Sure my family will be disappointed, I will be to. But that doesn't mean that I'm worthless. Lots of people have trouble with exams, that doesn't make me a stupid person.
• Feeling new feelings that come from the process. Instead of feeling anxious we feel mildly concerned.
• Strengths and limitations of C-B-T approaches
• With multicultural counseling if counselor understands the core values of the culture, these models can help client explore their values and gain awareness of their conflicts. Because the models are very teaching oriented, they are often more accepted by some cultures. The approaches look to have the client question their absolute thinking and this can be applied to any group. Limitation however is if the counselor doesn't understand or appreciate the cultural values and tries to get the client to question values that are held very highly in a culture. Some clients would hesitate to question cultural values and may feel conflicted by the approach. American culture, where this model stems, is very independent do what is best for the individual and other cultures are more interdependent and value the group consensus and harmony. The CBT therapist must be careful to keep in mind the frame of reference of the client.
• Overall strengths help clients to explore the tapes in their head and make specific, measurable changes in behaviors. Can be used with a broad range of clients and can be taught so clients can apply the model to other problems. Overall limitations can be too confrontational and clients may feel they are not being listened to. If not done well, client could feel pressured to adopt what a powerful therapist believes to be rational thinking. Counselor must be trained and knowledgeable about the model otherwise it may come across as confrontational or advice giving rather than therapeutic.
Video: RC 480.55.035 (55 min) and practice
Exam is next week. You will have a test proctor as I will be out of town.
Homework for two weeks from now: Do the Practical applications of Choice theory on pages 152-154. Don't forget to finish reading the Glasser book.
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