Emotive Behaviour Therapy and Reality Therapy Methods

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Introduction

The key aim of the given paper is to study and analyse the case of a forty one year old client who is married, has two school age children, and he is in a contentious relationship with his partner with whom he started relationship in the age of fourteen. Since his adulthood (20 years old), the client threatened the partner from time to time with suicide, if the partner followed through on the threat of leaving the client. In addition, throughout childhood, the client was really concerned about the opinion of those surrounding him in all aspects of life, including the choice of partner.

The client has problems containing his emotions. When confronted by the counsellor in relation to his behaviour, he often repeats suicide threats and gets very angry with the counsellor because he thinks that the counsellor is not able to understand him. This case study will compare two differing techniques of treatment to resolve; Albert Ellis’ (1957) Rational Emotive Behavioural Therapy (REBT), which begins with A-B-C (plus D and E added by Ellis), to William Glasser’s (1965) Reality Therapy.

The paper first discusses a ten week REBT intervention plan and how it will be used with the client, followed by a description of the use of REBT therapeutic approach. It will also include a detail description of the use of Reality Therapy method.

REBT intervention plan

REBT – Rational Emotive Behaviour Therapy is a psychotherapeutic approach designed and established by Albert Ellis. It was originally named as Rational Therapy, but was renamed as Rational Emotive Therapy in the 1970s, and again as Rational Emotive Behaviour Therapy in the early 1990s. As the first of cognitive behaviour therapy, REBT was introduced in Ellis’ articles of 1950s’ (Ellis, 1957).

The cognitive approach is based on an epistemological model that conceptualizes the human being as an autonomous and potentially rational subject fundamentally capable of language, communication, and action (Groeben, 1990). Another important concept in cognition therapy is of self-management, which describes a human being’s “ability to establish aims by himself/herself spontaneously, to develop on their basis hierarchical action plans and then to behave according to his/her established aims and action plans” (Wagner, Rudolph Friedrich, Reinecker & Hans, 2003, Vol. 57, issue 3).

According to Ellis, REBT places a lot of stress on speech and communication (Ellis, 1957). In this approach, the therapist and patient collaborate in the therapeutic process and no one is a controller of the other’s behavior. So in a manner, and in sharp contrast from pure behaviorist model, cognition therapy framework assigns equal roles and responsibilities to the therapist and the patient, making both equally responsible for determining the goals of the therapy and achieving the final outcome.

One of the basic ideas of REBT is that in most of the cases, clients do not merely get upset just because of unlucky adversities, but also because of the way they make up their view of reality by the means of their own evaluative and measurable beliefs, effects and their own theories about these adversities.

REBT therapy is based on the A-B-C model of various psychological processes from the disturbance to change that are introduced in the following order: A – certain events that cause such consequences – C- as the dysfunction of patient’s emotions and behavior, where B represents patient’s believes, meanings and life experiences.

Although, the life experiences of the client might indeed cause real pain, it is the client’s unreasonable and illogical beliefs and ideas that create lasting and inconvenient problems. Thus, Ellis adds new terms: D and E to ABC, where the therapist argues and disputes (D) the illogical and irrational beliefs of the patient. Such procedure is aimed to make client to ultimately reach desirable positive psychological effects (E) of logical and rational beliefs (Ellis, 1994).

Over the years, Cognitive – REBT therapists have given themselves many names depending on their use of minor therapeutic variations. Rational Emotive Behavior Therapy is a combination of techniques aimed at addressing thoughts and behavior (Beck, 1995).

REBT, as a therapy, has been found to be most effective with depressed patients who are capable of self – direction but are overwhelmed by their circumstances to pass to certain maladaptive forms of behavior. Following this is a week by week plan of how a ten week REBT intervention plan will help a client.

Week # 1: Engaging the client

The necessary procedure that should be done at the first interview would be to introduce to the client as an ordinary formality in order not to injure his feelings or not to destroy the “acknowledgment of his own significance” (Dryden, 2002, p.73).

This procedure consists of:

Determining the presence of any related clinical disorders.
Checking for any non-psychological contributing factors: physical conditions, medications, substance abuse and lifestyle/environmental factors etc.
Noting any relevant personality disorders.
Obtaining a personal and social history.
Trying to assess the severity of the problem.
Checking for secondary disturbance: how does the client feel about having this problem?
Introducing the basics of REBT techniques. (This material can be given to the client as printed handouts.

The second step that should be taken is to try to build a relationship of trust with the client on the core conditions of empathy, warmth and respect. It is also important to note of all the ‘secondary symptoms’ that prompted the patient to seek therapist’s help.

The best possible way to engage this client would be to demonstrate to him right at the onset that his situation is not as bleak as the client imagines and that the client has made the right decision in seeking professional help and that change is possible if the client and I decide to work together. The first one – hour session would conclude with the assigning of ‘homework’ to the client: It would be relevant to ask him to jot down all the problem areas in his relationship with his partner and the reason why the client wants to end his life.

Here might be drawn a parallel line with the one point of the Ellis’ theory about irrational beliefs based on the client’s idea that everybody should always bring him happiness, otherwise, he would die (Ellis, 1994). Another issue under consideration is client’s attitude towards counsellor and his belief that the counsellor ‘just does not get it’, which implies that the counselor does not understand the client. Here might be drawn a parallel line with another point form the Ellis’ theory about irrational beliefs, which represents client’s idea that everybody should be considerate toward him, otherwise, client views them as the entirely rotten personalities (Ellis, 1994). lastly, is the issue of client’s dependence on the opinion of those who are surrounding him and trying to fit it in order not to seem worthless. Ellis describes this as client’s belief that he should be evaluated by others as an outstanding person; otherwise, client would consider himself worthless (Ellis, 1994).

In order to understand the above mentioned problems of the client, it would be necessary to ask him to think over the problematic issues that he sees around and he is concerned about. It would be suggested to client, as an assignment, to imagine some new circumstances that might have appeared in client’s problematic situations.

Week #2: Assessing the problem and the person deeper, developing treatment

First of all, in the form of a game (like it is not related to the therapy), it would be necessary to ask client about the assignment. Then, while disputing on the given assignment with the client, the client should be made to acknowledge by himself, that with forthcoming of new circumstances and details, persons attitude as well as belief on the problem changes. Thus, with the help of changing client’s attitude and belief, it is possible to change his feelings.

With the help of the above mentioned technique, it is important for the therapist:

Develop friendly and trusty relations with the client.
Assess the client’s motivation to change.

The client already got information about REBT and was able to peruse it:

It is necessary to make him understand that it is a collaborative therapy and that is why therapist needs his help.
Discuss the various possible approaches to be used and the implications of the treatment.
Develop friendly and trusty relations with the client.
Assess the client’s motivation to change.

The client already got information about REBT and was able to peruse it:

It is necessary to make him understand that it is a collaborative therapy and that is why therapist needs his help.
Discuss the various possible approaches to be used and the implications of the treatment.

In order to prepare the client for the new meeting it is necessary to provide him with the assignment. Thus, it is necessary to ask the client to make a list of all the changes that he wants to see in him as an outcome of this therapeutic process. It should be in form of a game. But the client should not be asked to evaluate him self.

And here is a worksheet example for this purpose (Client should be asked to tick where applicable/ according to his wishes):

want to be more excited about life
want to feel more loved and appreciated
want to have a meaningful relationship with partner
want more laughter in life
want to change job
want to look well – groomed.

Week #3: Trying to find the roots of the problem and resolve it together with client

It might be useful to lead the client to make the arguments over his problem and his beliefs. It would be relevant to ask such questions that are similar to those designed by Ellis, as:

Are there any evidence or proofs for those believes?
Are there any evidence or proofs against those believes?
What is the worst thing that might happen if giving up those believes?
What is the best thing that can happen if giving up those believes? (Ellis, 1994).

Now, the client is indeed prepared and ready for the new assignment: to do a self-analysis of his problem, which involves: identifying the event, understanding of the fact that client’s believes, but not events lead him to an emotional experience.

And here is a worksheet example for the above mentioned assignment:

Activating Event

Asking following questions in order to identifying the event: What exactly irritates you about your partner; what really drives you to negative thoughts, when you reach a point where you see just one recourse, i.e. end your life?

Consequence (How client reacted)

Client sates that he felt worthless depressed and gradually began to avoid his partner.

Beliefs (Client’s evaluative thinking about the ‘A’)

Can not understand why partner acts so cold and non – responsive to any loving gesture that client makes;
Partner does not explain where she goes in the evening;
Lately, partner has been receiving phone calls and partner abruptly hangs up when client saunters into the room;
To feel worthwhile and be happy must be liked and approved by everyone significant to client.

Disputing (new rational beliefs that should be acknowledged by him to help client achieve this new reaction)

There is nothing to prove that client is not a good friend/lover to his partner. However if for some reason partner continues to dislike him, client must try to find out a logical reason for this dislike. It may be something related to client that he is completely ignorant about.
If despite his best attempts, partner wants to quit, he should not hold against partner’s will. Sometimes, it is in the best interest of both the partners to break free and seek love elsewhere
Love, approval and appreciation are highly desirable. Nevertheless, they are not absolute necessities. Making them so is not only illogical, but actually screws client up when he thinks they may not be forthcoming. Client must better view them as preferences rather than his demands.

Further Action (what client would do to avoid repeating the same irrational/thoughts reactions)

Sit down and speak to his partner. Have a real heart-to-heart talk with partner on a day when partner appears to be in a real, good listing mood.
If at the end of their open discussion he still feels that their relationship, howsoever old has ended, client would respect partners feelings and let go. Client does not want to hold anyone to him, against the person’s will. He has enough feelings for partner to let her make up her own mind.
Challenge client’s irrational demand for approval by doing one thing each day (for the next week) that he would normally avoid doing because of fear it may lead to disapproval.

Client should be also advised by the therapist, for example, as Ellis suggests, to record his experiences that caused strong positive or negative emotions(Ellis, 1975).

Case Analysis in Terms of Rational Emotive Behavioral Therapy

An important method that should be used is the “unconditional self – acceptance” named such way by Ellis (Ellis, 1994, p. 4). Ellis suggests that people should accept themselves not for their achievements, but for their original self.

Very useful approach here would be to assure the client of the natural and distinct value of him as a human being. Most theories make a great deal out of self – esteem and ego – strength and similar concepts. He also suggested that human beings are naturally evaluating creatures, and that is fine.

Description of the Reality Therapy and Case Analysis in Terms of such therapy

Reality therapy approach of the counseling was created by Doctor William Glasser in the middle of 1960’s. It is based on the choice theory; it is quite simple and available to anyone. The approach is basically people – friendly and concentrated on people.

Reality theory studies five basic needs of the person. William Glasser suggested naming them in the following way: “Power, love and belonging, freedom, fun and survival” (Glasser, 2000, p.98).

Reality Therapy approach suggests that, aware of it or not, people are acting such way, so they can meet above mentioned needs all the time. But such actions are not always effective. Socializing is one of the key steps in the Reality Therapy because it helps person to meet need for the belonging. It is necessary to outline that the issue which drives person as social being is one’s wants and desires.

Following this, it would be relevant to our case study counseling analysis to point out that the given client should be asked three basic questions that would identify, if a client is meeting his needs or not. These questions are:

What do you want?
What are you doing to get what you want?
Is it working?

Another important thing to do for therapist – is to help client to make a workable plan based on the issues of what client wants. The key idea of such plan in Reality Therapy is to concentrate on the things that are in client’s control to do. It might be composed in the following way:

Maybe you are not able to make your wife talk to you but you can talk to your wife;
Maybe you are not able to make other people like you, but you can try to make some friends and they may like.
Maybe the counsellor that is assigned to you “does not get it”, so just try to understand what he is saying to you.

Following these, it might be stated that the Reality Therapy empowers the client by outlining the issues that are in client’s control to do. But in our case, it is really hard for the given client to change the way he thinks.

Another issue under consideration in the context of Reality Therapy is control, which is the base of this theory. Control causes trouble for our patient in the following ways: when he tries to control other people (by threatening the partner and counsellor), and when other people actually control him (because client is dependent on social opinion and views of those surrounding him).

Glasser’s theory is based on the statement that only person by him or herself can really control his or her own life. That is why it is necessary to make client to believe and understand that he should stick to what is in his own personal control to do, that he should respect the right of other people, for example, his partner, to meet their needs.

Outcome of this two approaches and conclusion

Thus, the main goal of REBT is to help patients with their problems by changing their maladaptive thinking and behavior patterns and improving their moods. Intervention is driven by working hypotheses (formulations) developed jointly by patient and therapist from the assessment information. Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self – talk skills (Hawton, Salkovskis, Kirk, and Clark, 1989, p. 43).

The main advantage with the REBT is that the therapist and the client work together to:

Develop a shared understanding of the client’s problem
Identify how these affect the client’s thoughts, behaviours, feelings and daily functioning
Identify personalized, time-bound therapy goals and strategies, which are continually monitored and evaluated through intensive talk and discussion.

REBT model helps people make sense of the world and plan and evaluate behavior according to their core belief systems, derived from early experience and significant others. REBT theorists believe that individuals have a set of “core beliefs” about themselves, others, and the world, that operate as conditional assumptions, (“if–then” statements) or rules for living.

A probable reason why REBT does work marginally well with depressed patients (such as the case cited above) is that depression interacts with both cognitive and motivational processes; and REBT attacks both these aspects.

Speaking of Reality Therapy, it is necessary to outline that while treating patient, the psychotherapists of Reality Therapy “visit” the client’s past but to a lesser amount than other therapies who use other psychotherapy approaches. In this context must be pointed out Glasser’s belief that people’s past contains both failures and successes. Reality Therapy aims to use these experiences in order to make client feel himself better in present and future (Glasser, 2000).

The above mentioned processes happen because of the perceptions that influence person’s present behavior. Thus, with the help of the Reality Therapy, therapist helps the client to work through such perceptions. It should be outlined that the given theory is effective because it is a therapy of hope. It is based on the conviction that people are connected to their past but they do not have to be dependent on it or to “be its victims” (Glasser, 1972, p.94).

References

Beck, A. (1995). Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1(2), 184-200.

Corey, G. (2005). Theory and Practice of Counseling and Psychotherapy (7^th edn) Belmont, California: Brooks/Cole.

Dryden, W. (2002) Fundamentals of Rational Emotive Behaviour Therapy: A Training Manual; Wiley.

Ellis, A. (1957). Rational psychotherapy and individual psychology. Journal of Individual Psychology, 13, 38-44.

Ellis, A. (1975). A New Guide to Rational Living. New Jersey: Prentice Hall.

Ellis, A. (1994). Reason and Emotion In Psychotherapy, Revised and Updated. Secaucus, NJ: Carol Publishing Group.

Ellis, A. (2001). Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy. Prometheus Books.

Glasser, W. (1972). The Identity Society. New York: Springer.

Glasser, W. (2000). Reality Therapy: A New Approach to Psychiatry. N.J.: Carol Publishing Group.

Glasser, W. (2001). Counseling with Choice Theory. New York: Springer.

Groeben N (1990). Subjective Theories and the Explanation of Human Action. In G. R. Semin & K. J. Gergen (Eds.), Everyday understanding. Social and scientific implications , pp. 19-44. London: Sage.

Hawton, K., Salkovskis, P. M., Kirk, J., & Clark, D. M. (1989). Cognitive behaviour therapy for psychiatric problems: A practical guide. Oxford: Oxford Medical Publications.

Wagner, Rudolph Friedrich, Reinecker, Hans, Problems and Solutions: Two Concepts of Mankind in Cognitive-Behaviour Therapy, American Journal of Psychotherapy, 2003, Vol. 57, Issue 3

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