Rational Emotive Behaviour Therapy

100 Key Points and Techniques

Windy Dryden, Michael Neenan

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000318203
• Edition: 3
• Topic: Psicologia
• Subtopic: Terapia cognitivo-comportamentale

Rational Emotive Behaviour Therapy: 100 Key Points and Techniques presents 100 main features of rational emotive behaviour therapy (REBT) to help therapists improve their practice.

This new edition has been updated throughout to take account of changes in the field and to be more consistent with the ideas of the authors, which have been derived from their experience as trainers and supervisors of novice rational emotive behaviour therapists. Beginning with an introduction outlining the basics of the approach, this book offers thorough coverage of all the vital topics including:

• working alliance issues
• educational issues
• dealing with misconceptions about REBT
• encouraging clients to work at change
• dealing with obstacles to change
• using REBT creatively.

This concise and highly practical book will be invaluable to psychotherapists and counsellors in training and practice, ensuring a comprehensive understanding of the REBT approach.

Part 1

WORKING ALLIANCE ISSUES

1

USE THE CONCEPT OF THE WORKING ALLIANCE

In the late 1970s, Ed Bordin (1979) wrote what we consider to be a seminal article in the field of psychotherapy in which he introduced a tripartite model of the working alliance. His argument was that there are three major components of the alliance. First, psychotherapy is goal directed. Second, it takes place within a context of a developing bond or interpersonal relationship. Third, both clients and therapists have tasks to do. I (WD) added a fourth component to this tripartite model which I called ‘views’ (Dryden, 2006a, 2011). These represent the understandings that therapist and client have about salient aspects of therapy (e.g. how problems are conceptualized). Our contention is that all four aspects of the alliance are equally important. However, generally in the psychotherapeutic field, the bond or relationship domain is overemphasized, often to the detriment of the goal, views and task domains.

Effective rational emotive behaviour therapy (REBT) occurs when both the therapist and client:

•share views on important aspects of therapy

•know what their respective tasks are

•can implement these tasks in the service of the client’s goals

•can work together in an adult-to-adult partnership.

In this relationship the therapist and client are both equal in humanity but the therapist has greater expertise than the client in facilitating psychological change.

As those who practise REBT know well, work with clients often falls short of this ideal. When this happens, we have found it very helpful to use the working alliance concept to determine what has gone wrong in our alliance with our clients and what needs to be done to repair the rupture (Safran, 1993).

Common ruptures in the views domain of the working alliance occur when the therapist and client have different understandings about the factors that explain their problems and how these can best be addressed.

Common ruptures in the goal domain of the working alliance occur when the therapist and client are working towards different goals, when the therapist does not give their client an opportunity to state their goals, or when the client has a hidden agenda where they surreptitiously seek a goal which is at variance with their explicitly stated goals.

Ruptures in the task domain of the alliance frequently occur when the client:

•does not understand what their tasks are in REBT

•receives inadequate training from the therapist in these tasks

•does not understand the relationship between carrying out these tasks and reaching their therapeutic goals

•is being asked by the therapist to practise tasks which have insufficient potency to enable them to achieve their goals.

Ruptures in the task domain of the alliance can also occur because the therapist practises REBT unskilfully. Such errors include: failing to prepare clients for the active-directive nature of the therapy; examining attitudes before clients understand the relationship between these attitudes and their feelings and behaviours; and unilaterally assigning homework assignments to clients, rather than negotiating them with clients.

Ruptures in the bond domain of the alliance are often, in our opinion, given insufficient attention by REB therapists. While many clients do appreciate the typical down-to-earth, active-directive style of many REB therapists, quite a few clients react adversely to this style. If this is the therapist’s usual style, then they should be aware that some of their clients will regard it as evidence of lack of caring and understanding on the therapist’s part, whereas others, who may be highly reactant, will consider that the therapist is imposing a mode of thinking on them and taking away their much valued autonomy.

While we have dwelt at length on the importance of using the working alliance framework to understand when REBT does not go as smoothly as one hopes (or as smoothly as one reads in many REBT texts!), we want to stress that it can also be used as a helpful framework to enhance the effective practice of REBT. For example, it can serve as a reminder for the therapist to monitor the degree of congruence that exists between their and their client’s goals. It can encourage the therapist to check whether their client understands both their own tasks and their therapist’s. It can help the therapist to check that the client understands the relationship which exists between task completion and goal attainment. Finally, it can forcefully remind all REB therapists of the interpersonal nature of their work and that effective REBT is not just a matter of, for example, examining attitudes or encouraging clients to use self-change techniques. Rather, REBT is fundamentally an important interpersonal relationship – perhaps more important in the minds of clients than in the minds of REB therapists!

Key point

The REB therapist should¹ use the concept of the working alliance to maximize the practice of REBT and to identify and repair ruptures to the therapeutic process.

1Please note that in these key points when we use the word ‘should’, it is in its advisory not absolute sense.

2

VARY THE THERAPEUTIC BOND

Albert Ellis used to portray REB therapists as authoritative (not authoritarian) psychological educators who actively and directively teach clients the ABCs of REBT and what they need to do to overcome their psychological problems. However, common sense tells us that not all clients respond well to this style. Thus, it is important for the therapist to be prepared to vary their interpersonal style of relating to clients in an authentic way if they are to maximize their therapeutic effectiveness. Key dimensions of the therapeutic bond that are relevant to REBT are: formal/informal, self-disclosing/non-self-disclosing, and humorous/non-humorous.

We will consider the formal/informal dimension first. Whereas some clients will respond well to a therapist when the latter adopts a formal, businesslike expert style, other clients will respond more favourably to a therapist when they adopt an informal, friendly style of interaction. To have a fixed, ‘one size fits all’ interpersonal style with all clients guarantees that a therapist will fail with some of them.

How does a therapist judge which style to use with which client? Our own practice is to discuss quite openly with clients what they expect from a therapist. Do they see their ideal therapist as someone who is authoritative and can teach them the emotional facts of life in a formal and businesslike way? Is their ideal therapist someone who is less formal, downplays the trappings of professionalism, and comes across more as an ordinary human being? Of course, it is important to guard against reinforcing a client’s dire need for approval. However, we believe that it is usually possible for a therapist to meet their client’s preferences on this issue without compromising their work as an REB therapist. No matter what hunches a therapist may have about their client, the therapist can only determine the actual way their client responds to their interpersonal style by trial and error and get feedback from their client on this point at the end of therapy sessions.

If REB therapists are first and foremost good teachers, then they need to recognize that teaching can be done in a variety of styles. So, the therapist needs to consider whether their client will respond more profitably to a formal or an informal style and modify their own interactive style accordingly.

Some clients are deeply affected by therapist self-disclosure. I (WD) have found that sharing my own difficulties with anxiety about speaking in public because of my stammer has been a profoundly important experience for some clients. First, they learn that I have used REBT with myself to overcome my problems. Second, they learn that, rather than being an all knowing therapist, I have had my own difficulties too. This latter point can lead to profound learning for some clients who need to experience rather than know intellectually that their therapist is equal to them in humanity. However, to other clients, such self-disclosures either fall on deaf ears or are in fact quite anti-therapeutic. Such clients shrug their shoulders at such disclosures or indicate that they are just not interested in knowing about the private life of their therapist. These are clients who only wish to be helped by you as a non-self-disclosing therapist who emphasizes expertise, not human vulnerability. One way of finding out which clients will respond well to therapist self-disclosure and who will not is to ask them before making the disclosure.

The third dimension of interpersonal style we wish to discuss is therapist humour. In REBT there are a number of concepts that a therapist needs to teach a client. With some clients a therapist will be able to teach these concepts best if they use humour. In our experience, clients who respond well to therapist humour are, in fact, humorous individuals themselves. However, the therapist needs to appreciate that when some clients respond well to humour, they may become overly giggly. Because they are having so much fun in therapy, they may stop taking the therapist seriously as a viable helper. For such clients, the therapist’s humour turns therapy into entertainment rather than a serious endeavour.

Other clients regard therapy as very serious and consequently consider therapist humour as inappropriate, in that they may view the therapist as a flippant person who is not taking them and their problems seriously. They may also consider the therapist immature.

It goes without saying that when a therapist uses humour in REBT, they should direct it at the client’s rigid and extreme attitudes rather than at the client themself. The therapist should not assume that because they are directing their humorous remarks at their client’s attitudes, the latter will not experience them as a personal attack. The therapist would do well to explain what they plan to do and ask their client’s permission before they do it.

We have argued that the therapist should try to ascertain the interactive style to which their client responds best quite early in therapy, perhaps even in the first session. However, it is also important for the therapist to elicit their client’s feedback concerning how they react to the therapist’s therapeutic style throughout therapy, as noted above. Here we believe REB therapists can learn a lot from cognitive therapists, who routinely seek feedback from clients at the end of every session about various matters to do with the session itself and the therapist’s contribution to it. Asking for frank feedback from a client concerning the therapist’s therapeutic style will be quite useful in helping the therapist to calibrate their style in the best interests of their client. When the client gives the therapist feedback, it is very important that the therapist responds non-defensively or else they will be perceived as not practising what they preach.

While we consider that it is important for the therapist to vary their bond with different clients, it is important that they do so authentically. Arnold Lazarus (1989) coined the term ‘authentic chameleon’ to describe a therapist who varies their interpersonal style with clients, but does so authentically. If the therapist is going to apply this concept in their practice of REBT, rather than pay lip service to it, then it is crucial that they consider honestly their range of authentic interpersonal behaviour – as their range will not be limitless! We advise the therapist to be genuine in their interactions with their clients rather than inauthentically try to meet their preferences for therapist behaviour. The therapist should refer a client to a colleague who will authentically offer that client a preferred bond when the therapist cannot do so.

Key point

The REB therapist is advised to vary their bond with different clients, but do so authentically.

3

VARY THE BASE OF THERAPEUTIC INFLUENCE

Some clients seek out therapists with national and international reputations. Such people used to seek out Albert Ellis purely because he was Albert Ellis. It is possible that if Albert Ellis had taught them something anti-therapeutic, then they might well have been influenced by him because of his reputation. However, REB therapists avoid basing their communications on an authoritarian position. We prefer to encourage clients to think for themselves and hopefully would not insist that clients think in a certain way purely because we say so. As Albert Ellis used to emphasize, there is a world of difference between being authoritarian and being authoritative. Thus, with a client who is im...

Table of contents

• Cover
• Half Title
• Series Information
• Title Page
• Copyright Page
• Contents
• PREFACE
• THE BASICS OF RATIONAL EMOTIVE BEHAVIOUR THERAPY
• PART 1 WORKING ALLIANCE ISSUES
• PART 2 EDUCATIONAL ISSUES
• PART 3 DEALING WITH MISCONCEPTIONS ABOUT REBT
• PART 4 TECHNICAL ISSUES
• PART 5 ENCOURAGING CHANGE WORK
• PART 6 DIALECTICAL EXAMINATION
• PART 7 DEALING WITH OBSTACLES TO CHANGE
• PART 8 CREATIVITY I: GENERAL ISSUES
• PART 9 CREATIVITY II: THE USE OF REBT IN SINGLE-SESSION THERAPY
• PART 10 DEVELOP YOURSELF PERSONALLY AND PROFESSIONALLY
• REFERENCES
• INDEX