REBT - Proposed Treatment Plan

CAAP601 Fall 2011

Week 5 Discussion Leadership: Jo Friesen, Maria Elsdon, Sharon Kroeker

Introduction
Rationale for REBT
The ABCs of REBT

Albert Ellis argued against the common psychoanalytic belief that people become disturbed because of the traumatic events of their childhood (Albert & Dryden, 1997). He believed that people take many of their preferences and standards from their early caretakers, but add their own musts and needs into them. No matter where they originally acquired their dysfunctional beliefs, Ellis believed it is possible for people to acknowledge, understand, and change them. Rational Emotive Behavior Therapy (REBT) is an effective approach to psychotherapy with adolescents to help them overcome emotional and behavioral conflicts (Young, 2006). When REBT is used with children and adolescents, it seems to be most effective for individuals who alienate classmates and adults with disruptive and bothersome behavior in school (Gonzalez et. al, 2004). REBT may also be particularly effective for children and youth with emotional disturbances (Banks & Zionts, 2008). For these reasons, REBT is a promising approach for the case of Tory.

the self-defeating behavior so common to adolescence is primarily the result of the young persons evaluation and appraisal of his or her life experiences rather than being the result of any particular set of biological, social, or environmental circumstances (Young, 2006, p. 115)

Proposed Treatment Plan for Tory

Treatment Goals for Tory 1. 2. 3. 4. Recognize and change dysfunctional thoughts Work towards unconditional self-acceptance (USA) Recognize and understand self-defeating emotions and behavior Learn social skills to make new friends and strengthen current friendships

Length of Treatment REBT emphasizes psychotherapeutic efficiency, which includes helping clients in as short a time as possible (Dryden & Neenan, 2006). Although a longer duration of therapy is preferable, the client should be able to learn the ABCs of REBT and begin to make changes within 1-10 sessions (Corsini & Wedding, 2011). In Torys case, treatment would end once he is able to meet all of the specific treatment objectives listed below.

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REBT Treatment Plan

Proposed Treatment Plan (continued)

Treatment Techniques

Technique

Application
Understanding the relationship between thinking, feeling, and action is pivotal to REBT. For a teen like Tory, the ABCs principle should be taught more concretely in small chunks and repeated Teens may be more likely than adults to catastrophize, which is why teaching them to be aware of and to dispute their own irrational thinking is so important Using inaccurate, catastrophizing language causes distorted thinking. REBT will help Tory change his language to become more realistic and tolerant Constructing and repeating realistic, logical, and rational coping statements will help Tory put things in perspective and internalize rational language Using humor helps clients to take themselves and their problems less seriously. Shared humor is important in both First Nations culture and teen culture Tory can become less disturbable if he can accept himself without being accepted by others and if he can avoid rating himself based on his own actions or performance This type of role playing has a lot of opportunities for humor, and will allow Tory to practice disputing irrational beliefs

Specific Objective or Tasks

Cognitive Techniques
Use cartoons or drawing to illustrate how thinking leads to emotions and behaviour Use concrete examples from other teens lives Give examples from therapists own life Objective: Tory can explain, in his own words, how beliefs can be irrational and lead to emotional and behavioral problems. Teach Tory to: detect Irrational Beliefs (IBs) discriminate IBs from Rational Beliefs debate/dispute IBs (empirically, logically, or pragmatically) Objective: Tory can detect and debate one of his own irrational beliefs without direction and/or can fill out an REBT Self-Help Form Describe the difference between insistent, unreasonable must/ought/should statements and preferences Objective: Tory will independently be able to replace a must/ought/should statement with a preference statement. E.g. I would prefer it if all my classmates liked me Teach the difference between useless positive self-talk (Ill do better next time.) and rational coping statements (I didnt do well, but its not a disaster. or Even if I act stupidly and make a bad impression on some people, I can still enjoy myself and have fun with them.) Show how this thinking can turn into an Effective New Philosophy Objective: Tory will construct his own rational coping and remember to repeat the statements to himself at least once a day Reveal how Torys thoughts and beliefs can be absurd Encourage Tory to imagine how his terrible situation could be worse by exaggerating or adding ridiculous elements Objective: Without prompting, Tory will use humor to make fun of his own thinking or beliefs Show Tory unconditional acceptance Teach Tory to recognize over-generalizing language (I failed, so I am a failure) Explain to Tory that you can accept a person without accepting all their actions (a car with a flat tire isnt junk) Objective: Tory will be able to describe a past action that he does not accept, and argue for why it doesnt make him bad or worthless After identifying one of Torys core irrational beliefs, set up a reverse role-playing situation in which he must try and argue logically against the belief Objective: Tory will be able to use logic and rational thinking to come up with at least one argument against a belief that he is holding

Teaching the ABCs of REBT

Debating/disputing Irrational Beliefs

Changing Language

Using Coping SelfStatements

Using Humor

Emotive and Behavioral Techniques

Unconditional Self-Acceptance

Reverse Role-Playing

REBT (Rational) Role-Playing

See Specific Counseling Task These exercises can increase Torys self-acceptance and positive behavior by making him less concerned about being ashamed or humiliated (losing face) in front of peers/teachers Teach Tory how avoiding humiliation or disapproval from others may inhibit positive behavior Set a homework assignment for Tory to act foolishly in public Set an assignment for Tory to talk to two new girls a day Objective: Tory will be able to develop and follow through on his own shame-attacking exercise

Shame-Attacking Exercises

REBT Treatment Plan

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Specific Counseling Task: REBT Role-Playing

Introduction REBT Role-Playing, also known as Rational Role-Playing, is based upon previous role-playing techniques used by therapists. It is a combination of emotive-evocative role-playing techniques (e.g. Fritz Perls), and role-playing for skill-training (e.g. Raymond Corsini). REBT Role-Playing introduces a new element that involves paying attention to any emotions that arise and temporarily stopping the role-play to detect the irrational beliefs leading to the emotions. This component of therapy would normally happen in later sessions, when enough rapport has been established and the client has had some practice at detecting and disputing irrational beliefs. However, this technique could also be used in the very first session to illustrate the ABC principle. REBT role-playing allows the client to rehearse certain social situations in order to examine relevant feelings (e.g. anxiety, shame, anger), and the specific thinking and beliefs that caused those feelings. It also allows for the client to practice social situations and for the therapist to give feedback and specific suggestions for social behavior. The situation being reenacted could be a conflict with a friend or family member, or a fearful situation such as a job interview. Using REBT Role-Playing with Tory There are two objectives of this technique for Tory. The first is that he will independently recognize an unhealthy negative emotion he associates with a similar, real social situation when role-playing a personally relevant situation. The second objective is that Tory will detect his associated irrational belief, in order to dispute it. Ideally, Tory would be able to then apply this procedure to a live situation. If Tory feels uncomfortable or embarrassed with playing a role, an alternative would be to describe the situation and dialogue in detail. For example, the counselor could say Well, if I was your dad, I would probably tell you No, you cant go out again tonight and then what would you say? Steps and Instructions 1. Collaborate with Tory to choose a situation for role-playing. It might be a situation that would freak him out like asking out a girl he likes or pisses him off like being told by his parents what to do. You could also ask him to describe the last time he lost his cool. For this description, well use the situation that Torys parents wouldnt let his friends come over to his house. Continued on next page

"... the therapist may employ role playing to show clients how to adopt different ideas ..." (Ellis, 2011, p. 212)

"Experiential exercises are used to help clients overcome denial of their feelings and then work at REBT's ABCD's ... to change their self-defeating emotions." (Ellis, 2011, p. 212)

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REBT Treatment Plan

REBT Role-Playing (continued)

As you practice disputing you really see how crazy some of your ideas are, observe how you strongly and ridiculously cling to them, and learn how you can finally let go of them. (Ellis, 2007, p. 138)

Albert Ellis

2. As you proceed through the role-play, watch Tory for signs of emotions such as anxiety, depression, or in this case, likely anger. 3. When appropriate, pause the role-play and ask Tory to identify what emotion he is experiencing. Ask him if what he is feeling is a healthy negative emotion (concern, sadness, remorse, disappointment, healthy anger, healthy jealousy, and healthy envy) or an unhealthy negative emotion (anxiety, depression, guilt, shame, hurt, unhealthy anger, unhealthy jealousy, and unhealthy envy). 4. Once Tory has identified the emotion hes feeling, ask him what hes thinking that is making him upset. His irrational belief(s) may be something like: My parents shouldnt tell me what to do I cant stand it when they do this to me My friends will stop hanging out with me 5. Guide Tory through disputing the irrational belief. 6. Redirects Tory attention to the original emotion and ask if the disputing has reduced it. 7. Resume the role-playing situation, and critique Torys social skills. Offer specific suggestions and language to use, and let Tory rehearse them. 8. Repeat this situation with several different social role-playing situations: interactions with friends, classmates, parents, and teachers. Similar irrational beliefs will appear in various situations, and Tory should become more adept at identifying emotions and the thinking that is making him upset. 9. Encourage Tory to pay close attention to what he thinks and feels in real versions of these situations and how they are related. (Ellis, 2009; Young, 2006)

References
Banks, T., & Zionts, P. (2009). REBT used with children and adolescents who have emotional and behavioral disorders in educational settings: A review of the literature. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 27(1), 51-65. doi:10.1007/s10942-008-0081-x Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thomson Brooks/Cole. Ellis, A., & Dryden, W. (1997). The practice of rational emotive behavior therapy. New York: Springer Publishing. Ellis, A. (2001). Feeling better, getting better, staying better. Atascadero, CA: Impact Publishers. Ellis, A. (2007). How to make yourself happy and remarkably less disturbable. Atascadero, CA: Impact Publishers. Ellis, A. (2011). Rational emotive behavior therapy. In Corsini, R. J. & Wedding, D. (Eds.), Current psychotherapies (9th ed.) (pp. 196-234). Belmont, CA: Thomson Brooks/Cole. Gonzalez, J. E., Ron Nelson, J. J., Gutkin, T. B., Saunders, A., Galloway, A., & Shwery, C. S. (2004). Rational emotive therapy with children and adolescents: A meta-analysis. Journal of Emotional & Behavioral Disorders, 12(4), 222-235. Neenan, M., & Dryden, W. (2006). Rational emotive behaviour therapy in a nutshell. Thousand Oaks, CA: SAGE. Young, H. (2006). REBT assessment and treatment with adolescents. In Ellis, A. & Bernard, M. E. (Eds.), Rational emotive behavioral approaches to childhood disorders (pp. 115-132). Boston, MA: Springer US. doi:10.1007/0-387-26375-6_3