The Process of Change
The REBT theory of change is basically optimistic in that although humans have a biological tendency to think irrationally, they also have the ability to choose to change their irrational thinking and self-defeating emotions and behavior (Dryden & Ellis, 2001; Ellis, 2001a). According to this theory, there are several levels of change. The most long-lasting and elegant change involves philosophic restructuring of the irrational beliefs (Dryden & Ellis, 2001). At this level, change can be specific or general. According to Dryden and Ellis (2001), "Specific philosophic change means that individuals change their absolutistic demands ('musts/ 'shoulds') about given situations to rational relative preferences. General philosophic changes involve adopting a nondevout attitude toward life events in general" (p. 310). Dryden and Ellis also distinguished between superelegant and semielegant philosophical change at the general level, noting that superelegant change implies that under almost all conditions for the rest of their lives, people will not upset themselves about anything, whereas semielegant change means that most of the time people will use a rational- emotive philosophy that will enable them not to upset themselves when bad events occur. Superelegant change rarely happens, as people "fall back to musturbating and thereby disturbing themselves" (p. 310).
DiGiuseppe (1999) stressed that it is far better to help clients change their core irrational beliefs at the philosophic level rather than their automatic thoughts. Challenging automatic thoughts or inferences, reframing, and reattributions are considered inelegant solutions, and although they may be a coping strategy for a particular event, they do not do so across a wide range of stimuli.
The REBT theory of change is quite simple (Dryden, 1996). Specifically, if clients choose to overcome their emotional and behavioral problems, they first must acknowledge that they have a problem. They also need to realize that, to a large extent, they create their own disturbance. Although environmental conditions can significantly contribute to their problems, it is how they think about those conditions that primarily influences their degree of disturbance (Ellis & Dryden, 1997). Second, they must identify any meta-emotional problems, which are secondary problems about primary problems (Dryden & Branch, 2008; Dryden & Neenan, 2004). For example, clients often are depressed about being depressed or denigrate themselves for having a problem. Unless clients tackle these meta-emotional problems before they deal with the original issues, they will often fail to overcome the original disturbance. Third, they need to identify irrational beliefs and understand why the belief is illogical and irrational. Fourth, they must recognize why the rational beliefs would be preferable and give them better results. Fifth, they need to learn how to challenge their irrational beliefs and replace them with rational alternatives. Finally, they need to keep working on their tendencies to think and act irrationally.
The Therapeutic Relationship
For change to occur, REBT counselors or therapists are active and involved as they educate clients and help them develop a rational perspective and effective problem-solving skills. For this reason, according to Velten (2002), "rapport is more important in REBT than in most other types of therapy" (p. 76). O'Kelly (2002) concurred, pointing out that rapport building is similar to a farmer tilling the soil to prepare it for seeding. O'Kelly stated, "Building rapport in the initial phase of therapy prepares the client to trust the therapist and to be open to the more challenging rational emotive behavior therapy techniques in later sessions" (p. 92).
Ellis (2001b) noted that "we had better be in psychological contact with our clients; be congruent, genuine, integrated persons; experience accurate, empathic understanding of clients' awareness of their own therapeutic experience" (p. 122). He noted that while none of these traits are absolutely necessary, they are all highly desirable. Ellis himself preferred an active, directive therapeutic style with most clients (Dryden, 2002a; Dryden & Branch, 2008; Ellis, 2002b), but he did not insist that there is one specific type of relationship between client and counselor or therapist, stressing that the degree to which one is active-directive is a choice (Dryden & Ellis, 2001; Ellis, 2002b). Ellis and MacClaren (1998) pointed out that there are several advantages of an active-directive approach, including the fact that some disturbed people have low frustration tolerance and will not put forth the sustained effort needed for change to occur.
Dryden and Neenan (2004) emphasized that REBT counselors or therapists are encouraged to be flexible, and Dryden and Branch (2008) stressed the importance of varying the amount of structure as well as degree of direction. According to Dryden and Ellis (2001), even though not all REBT practitioners agree with the active-directive style, it is possible to vary the style and, at the same time, adhere to the theoretical principles on which it is based. As Dryden (1999) stated, "effective rational emotive behavioral counselors vary their therapeutic styles and can adopt a variety of therapeutic styles to fit with the therapeutic requirements of different clients" (p. 20).
With children and adolescents, establishing a good therapeutic relationship is particularly important. Being patient, flexible, and often less directive are essential, in addition to using a wider variety of techniques (Vernon, 2009a, 2009b, 2009d). Using various rapportbuilding activities and being personable and approachable are critical (Vernon, 2009c).
In accordance with this theory, REBT counselors or therapists believe that because clients come to counseling or therapy for problems and want help, part of establishing a good relationship is to help them work on their problems immediately (DiGiuseppe, 2002). Thus, part of the rapport-building process involves coming to an agreement on the goals for change (Dryden, 2002b; O'Kelly, 2002), as well as being active and helping clients discover what they are doing to upset themselves (Dryden, 2002a). In this way, clients can leave the first session with some insight and hope, which in turn enhances the client- counselor / therapist relationship.
Contrary to what many believe, this theory has been influenced by Rogers's core conditions. The concepts of unconditional acceptance and genuineness are endorsed by REBT counselors or therapists (Dryden, 2002a; Dryden & Branch, 2008; Ellis, 2001b). They encourage their clients to accept themselves unconditionally as fallible human beings but acknowledge that it is very difficult for most people to reach this unconditional level of acceptance, because, according to Ellis, "a low level of self-acceptance is the universal condition" (Bernard, 2009, p. 67). Consequently, counselors or therapists must work diligently to teach clients unconditional self-acceptance and repeatedly reinforce their efforts to put it into practice. In addition, they also help clients develop unconditional acceptance of others.
Because they feel free to be themselves and at times self-disclose their own fallibilities, REBT counselors or therapists are genuine (Dryden, 2002a). This genuineness has therapeutic purposes because it indicates to clients that counselors or therapists are humans, too, and it also teaches clients what counselors or therapists did to overcome their own problems. Obviously, it is inappropriate to self-disclose when counselors or therapists think it inappropriate or think the client might use such self-disclosure against them.
In addition, REBT counselors or therapists are empathic, both affectively and philosophically, communicating that they understand how clients feel and also showing clients that they understand the beliefs underlying the feelings (Dryden, 1999). The counselor or therapist may also be appropriately humorous, as many clients tend to take life too seriously. Dryden (2002a) stressed that humorous interventions are not directed at the clients themselves but at their irrational beliefs and self-defeating feelings and behaviors. He cautioned that the use of humor may not be appropriate with all clients, which is why it is so important to be flexible.
Dryden (1999) noted that the preferred counseling or therapy relationship is egalitarian in that the client and counselor or therapist are equal in their humanity. From another perspective, however, the relationship is unequal because the counselor or therapist has more expertise and skills and needs to help clients in their personal problem solving. This changes, however, as clients gain more insight and the counselor or therapist encourages them to assume more responsibility for change. Thus, as the counselor or therapist becomes less directive and clients become more effective problem solvers, the relationship becomes more egalitarian.
The A-B-C Model
Ellis developed a conceptual model to illustrate the major constructs of this theory as well as the process of change (Dryden & Branch, 2008; Dryden & Ellis, 2001; Ellis, 2001b). In essence, the nature of emotional disturbance can be explained by recognizing that as people attempt to fulfill their goals, they encounter an activating event (A) that either blocks or helps them achieve these goals. Activating events may be positive or negative; may refer to real or perceived events; can be past, present, or future oriented; and can be an individual's own thoughts, memories, or emotions (Dryden & Branch, 2008). When individuals seek counseling or therapy, they strongly believe that the activating event has caused their negative emotional and behavioral consequences (C).
According to REBT theory, it is not the activating event (A) that creates the emotional and behavioral consequences (C), but rather the beliefs (B) people hold about these activating events. While the activating event may certainly contribute to the consequence, two individuals can experience the same event and feel and react differently, which explains the relationship between A, B, and C. For example, consider two individuals who both applied for the same job and did not get it. Assume that one individual was devastated and the other was just disappointed. The difference in how they felt can be attributed to what they were thinking about the event. The devastated individual equated her failure to attain this job with her self-worth, thinking that this proved how incompetent she was. The disappointed individual wished that he would have gotten the job but realized that his failure to do so was not necessarily a reflection on his lack of skill.
Beliefs (B) are either rational or irrational. Rational beliefs are self-enhancing and help people achieve their goals; they are flexible, logical, and pragmatic (Dryden & Branch, 2008; Dryden et al., 2003). Rational beliefs are realistic nondogmatic preferences that typically result in constructive behavior patterns and moderate negative emotions when the activating events (A) fall short of the desired outcome (Dryden, 1999; Dryden & Branch, 2008). Irrational beliefs are rigid and emanate from absolutistic evaluations that ultimately sabotage goals. They result in negative emotions such as depression, anger, anxiety, resentment, self-pity, worthlessness, and rage, as well as in maladaptive behaviors such as withdrawal, avoidance, violence, and procrastination.
Originally, Ellis identified 11 irrational beliefs, but now there is one core irrational belief, which is a "must" with several derivatives:
1. I must be successful at important performances and relationships, or I am inadequate and worthless.
2. Other people must treat me considerately and fairly, or else they are bad and deserve to be punished.
3. The conditions under which I live must be absolutely comfortable and pleasurable or I can't stand it. (Ellis, 1996, p. 13)
These basic irrational beliefs share four key elements: demanding, awfulizing, low frustration tolerance, and global rating of self or others. Irrational beliefs are illogical and are not validly inferred, whereas rational beliefs are logical and can be validly inferred from earlier premises. For instance, if a student wanted to get a good grade on his test, his rational and logical conclusion would be that studying and doing homework would help him achieve that goal. However, if he assumed that studying for tests and doing his homework meant that he absolutely must get a good grade and that the teacher cannot give him anything except a top grade, he would be thinking irrationally because his conclusions are illogical.
Counselors or therapists can detect irrational beliefs in several ways: cognitively, emotionally, and behaviorally. Cognitively, irrational beliefs can be identified by listening for "shoulds, oughts, and musts," as well as phrases such as "I can't stand it" or "that is horrible" (Nelson-Jones, 2000, p. 204). Emotionally, irrational beliefs are present when there are extreme negative emotions such as panic, depression, or intense anger. When clients report feelings of depression, guilt, or extreme sadness, they are probably engaging in self-downing. When they are angry, they look for "musts" and are demanding. Frustration and anxiety are often present with low frustration tolerance. Behaviorally, self-defeating actions signal the likelihood of irrational beliefs. Once the emotional and behavioral consequences and the irrational beliefs have been identified, the next step in the A-B-C-model is disputation (D), which is what REBT is probably best known for. Disputation is an active process that helps clients assess the rationality of their irrational beliefs (Dryden & Branch, 2008) and whether these irrational beliefs are helpful. The purpose of challenging these rigid and inflexible beliefs is to replace them with rational alternatives.
In an interview conducted by Michael Bernard 2 years before Ellis's death, Ellis and Bernard discussed the importance of not only disputing irrational beliefs but also "strengthening the conviction to which rational beliefs are held" (see Bernard, 2009, p. 71). As Ellis stated at that time, "That's why I talk about helping clients prove to themselves the benefits of rational beliefs and to reinforce their conviction in rational beliefs" (p. 71). Ellis went on to say that it is particularly important to strengthen rational beliefs when working with children because they may not be able to learn disputing.
A Therapeutic Model
Dryden et al. (2003) identified 18 steps that counselors or therapists can use in each session to help them implement the A-B-C process to effect client change. They noted that these steps can be applied to all age groups, even though the techniques used at each step may differ. O'Kelly, DiMattia, and Vernon have adapted this model and have used it successfully in international training seminars. Their process is as follows.
The first step is to ask clients to identify the problem they would like to work on, which is considered the activating event (A). In the event that the client describes several different problems, the client and counselor must come to an agreement about which problem to work on first. The REBT counselor or therapist also might ask for a specific example to help clarify the problem and generally does not encourage long, detailed descriptions, but instead, moves on rather quickly to ask about the emotional and behavioral consequence (C): how clients feel about the problem and how they behaved in response to it. This is particularly helpful in that clients frequently minimize the degree of intensity of the feeling, and asking for the behavioral reaction is an effective way to more accurately identify the emotional consequence. After the emotional and behavioral consequences have been described, the counselor or therapist then asks clients to rate the intensity of the feeling, saying something like, "On a 1-10 scale, with 10 being high, how would you rate the intensity of your emotion?" This rating is especially important because if the intensity level is low, and the identified emotion is healthy versus unhealthy (i.e., sadness instead of extreme depression, regret instead of guilt, irritation instead of strong anger, or concern instead of high anxiety), the REBT counselor or therapist has more insight into whether clients have irrational beliefs, because these are correlated with high-intensity unhealthy emotions.
Following the evaluation of the emotional consequence, the counselor or therapist evaluates secondary emotions by asking clients how they feel about feeling depressed, anxious, guilty, and so forth. As previously stated, it is important to deal with this secondary emotion first. In doing so, the counselor might ask something such as, "When you are so depressed, do you have any feelings about being depressed?" Clients may state that they feel angry about being depressed or depressed about it because it interferes with their life in so many ways. If a secondary emotion exists, the counselor or therapist helps the client identify and dispute these irrational beliefs.
After successfully dealing with any existing secondary emotions, the counselor or therapist then asks clients to identify their beliefs related to the identified emotional and behavioral consequence (B). This is a critical step and is often complicated by the fact that clients have difficulty identifying core beliefs but rather offer automatic thoughts or inferences. For example, if a client identified anger and rated it as an 8 in response to her teenage children not picking up their rooms and leaving their things all over the house, the counselor might ask, "So when you felt strong anger, what were you thinking?" The client might say,
"Well, I wish they would learn to pick up after themselves without my having to remind them; I don't like the house to be such a mess." This response is actually quite rational because it is expresses as a wish instead of a demand, but because anger is a strong emotion that correlates with a demand, the counselor would then need to translate this into a core belief and help the client see the difference between her two beliefs by saying, "Well, if you were just wishing that they would pick things up without having to be reminded, you probably wouldn't feel so angry, so are you really thinking that your teens shouldn't leave things all over, that you shouldn't have to remind them to do it, and that you can't stand the mess?"
Once the beliefs have been elicited, the next step is to help the client see the connection between the beliefs and the emotions, which is the crux of this theory. Counselors and therapists want their clients to understand that it is not the event that creates their emotional and behavioral response, it is what they think about it. Therefore, the REBT counselor or therapist might ask the client if she always feels this angry when her teenagers do not pick up the house, or if she thinks that all mothers throughout the world would feel as angry as she does. Then the counselor or therapist would ask her what she is thinking when she is not as angry or what others might be thinking that would result in a less intense emotional response, helping her see that it is not the event but what she tells herself that results in the emotional disturbance. This step leads to goal setting: "So now that you see that your thinking influences your feelings, do you want to work on changing your thinking so that you feel less disturbed?"
Once there is an agreed-upon goal, the counselor or therapist initiates disputing (D). There are various types of disputations that can be used mildly or vigorously (Ellis, 2002b). Disputing can be didactic, which is informational. In this process, the counselor or therapist explains the difference between rational beliefs, which are flexible and adaptive and help in goal attainment; and irrational beliefs, which are rigid, illogical, and interfere with goal achievement (Dryden, 2002a; Ellis & MacClaren, 1998). The Socratic questioning approach, another common form of disputation that is more preferable than the didactic dispute, involves questioning that gives clients insight into the irrationality of their thinking (Dryden, 2002a).
During the disputation process, several different types of cognitive disputes are used. In a functional dispute, the purpose is to question the practicality of the client's irrational beliefs. Because irrational beliefs result in self-defeating behaviors and unhealthy emotions, questions such as "How is what you are doing helping you?" or "How is continuing to think this way affecting your life?" are helpful (Ellis & MacClaren, 1998, p. 60). Another type of dispute is the empirical dispute, which helps clients evaluate the factual aspects of their beliefs. Examples of empirical disputes include "Where is the evidence that you are no good simply because you failed an exam?" "Where is the proof that life is not worth living if you do not get into graduate school?" "So you did not get the job you wanted. Where is it written that you will never be employed for the rest of your life?"
A third type of dispute is the logical dispute, which helps clients see how illogical it is to escalate their desires and preferences into demands (Dryden & Branch, 2008; Nelson-Jones, 2000). Typical questions could include, "Where is the logic that you must..." (Dryden & Branch, 2008) or "How logical is it for you to think that just because you want a high-paying job that you should get one the first time you interview?" Philosophical disputing is another approach that helps clients look at meaning and satisfaction in life. Because clients often focus on specific problems and lose perspective on other aspects of their life, a philosophical dispute such as the following will help them develop that perspective: "Despite the fact that things will probably not go the way you want some/most of the time in this area, can you still derive some satisfaction in your life?" (Ellis & MacClaren, 1998, p. 66).
After the counselor or therapist has thoroughly disputed the irrational beliefs, the next step is to help the client develop more effective beliefs (E) by asking the client to identify more effective thoughts to help him or her with goal attainment. For example, the counselor might say, "So instead of thinking that you are a total failure because you didn't perform perfectly in your piano recital, what could you think to yourself when you put yourself down for not being perfect?" After the client has verbalized several more effective beliefs, the counselor or therapist collaborates with the client in selecting meaningful homework assignments that help the client practice new learnings and maintain change. Homework assignments may include worksheets or various types of cognitive, emotive, or behavioral activities that are reviewed in the next session.
The REBT counselor or therapist recognizes that clients will backslide and therefore teaches them that it will take work and practice to maintain change (Dryden & Neenan, 2004). Throughout the counseling or therapy process, the counselor or therapist uses bib- liotherapy, homework assignments, and self-help materials to help clients develop skills to use inside and outside of counseling or therapy (Dryden et al., 2003; Vernon, 2009c). The counselor or therapist also helps clients review the A-B-C model to determine what caused them to fall back into their old patterns and then encourages them to practice disputing again and again until they can replace their irrational beliefs with rational alternatives (Nelson-Jones, 2000). Recording counseling or therapy sessions so that clients can listen to them again can also be very effective (Velten, 2002).
Clients can readily recognize that their beliefs are not rational, but as Dryden (1999) cautioned, even if counselors or therapists are successful in helping clients achieve this understanding, it does not mean that they have a strong conviction in the rational alternative. Although intellectual insight indicates some progress, it is not sufficient to promote emotional and behavioral change. Therefore, counselors or therapists must persist in helping clients give up their irrational beliefs by continuing to use directive questions, as well as other cognitive, emotive-evocative, imaginal, and behavioral techniques to help change irrational ideas. The ultimate goal is to help clients develop effective new beliefs or philosophy (E) (Ellis, 1996, 2001a) and effective new feelings (F) (Corey, 2001).