Traditional Intervention Strategies
Ellis (2002b) pointed out that REBT has a multimodal emphasis because REBT counselors or therapists use so many cognitive, emotive, and behavioral interventions to bring about change. Although REBT counselors or therapists use techniques from other schools of therapy, it is important to realize that REBT "is based on a clear-cut theory of emotional health and disturbance" (Dryden & Ellis, 2001, p. 325) and that the techniques are consistent with the theory.
The most common cognitive intervention is the disputation of irrational beliefs, which involves helping clients detect the beliefs, debating with them about whether their beliefs are true or logical, and helping them discriminate between rational and irrational beliefs (Dryden & Ellis, 2001). Although Socratic questioning is often used to encourage clients to think about how logical and functional their beliefs are, skillful counselors or therapists use a variety of disputing methods (Ellis, 2002b), including didactic explanations, humorous exaggeration, or the friendship dispute, to help clients see their own unreasonable self-standards (Dryden et al., 2003).
Other cognitive interventions include written homework forms, which help clients dispute their irrational beliefs between sessions (Dryden, 2002c; Dryden & Branch, 2008), and referenting, in which clients make a list of the advantages and disadvantages of changing their irrational beliefs and behaviors (Ellis & MacClaren, 1998). Rational coping statements, which are factual and encouraging phrases such as "I can accomplish this task" or "I will work toward accomplishing this task, but if I don't succeed it doesn't make me a failure as a person" (Ellis & MacClaren, 1998, p. 67) can also be very effective, particularly if they are implemented after more forceful disputing has been done.
Semantic methods are also used, such as helping clients change "I can't" statements to "I haven't yet" (Dryden & Ellis, 2001, p. 327). Other methods to introduce or reinforce a rational philosophy include bibliotherapy or audiotherapy in which clients are assigned books and materials to read or tapes to listen to (Dryden, 2002c; Ellis, 2002a, 2002b), using REBT with others to practice rational arguments (Dryden & Ellis, 2001), and age- appropriate worksheets that help clients identify and dispute irrational beliefs (Vernon, 2002, 2006a, 2006b, 2009c).
As Dryden and Ellis (2001) pointed out, "REBT therapy has often been falsely criticized for neglecting the emotive aspects of psychotherapy" (p. 328). In fact, there are numerous emotive techniques that are routinely used by REBT counselors or therapists. For example, humor, in the form of exaggeration, is often used to help clients avoid taking themselves so seriously (Dryden, 2002c; Ellis, 2001a; Nelson-Jones, 2000), but it must be used cautiously (Vernon, 2009c). Walen (2002) stressed that it is never appropriate to make fun of clients. Another popular form of humor is to use rational humorous songs (Ellis, 2002a) that Ellis and others have written. Songs such as the following are available at the New York Institute and are frequently used in REBT workshops:
Love Me, Love Me, Only Me (Tune: "Yankee Doodle Dandy")
Love me, love me, only me
Or I'll die without you!
Make your love a guarantee
So I can never doubt you!
Love me, love me totally –
really, really try, dear;
But if you demand love, too
I'll hate you till I die, dear!
Love me, love me all the time
Thoroughly and wholly!
Life turns into slushy slime
Less you love me solely!
Love me with great tenderness
With no ifs or buts, dear.
If you love me somewhat less,
I'll hate your goddammed guts, dear!
(Lyrics by Albert Ellis. Copyright by the Albert Ellis Institute.
Reprinted with permission.)
Rational role playing is also an effective emotive intervention (Ellis, 2001a; Ellis & MacClaren, 1998; Vernon, 2002, 2009c). Role playing can help clients express feelings and can help resolve various emotionally laden issues. Ellis cautioned that even though feelings are expressed through role playing, the relief may be temporary because clients have not explored the basic beliefs that resulted in the feelings. Therefore, it is important to do rational role playing that not only helps clients express feelings but also identifies the beliefs that created those feelings.
A variation of rational role playing is to do a reverse role play, in which the counselor or therapist takes the role of the client and the client assumes the role of the counselor or therapist. In this way, the client learns to dispute his or her own irrational ideas as played out by the counselor or therapist.
Rational emotive imagery (REI) is one of the key REBT emotive interventions (Dryden, 2002c; Ellis, 2001a). The purpose of REI is to help clients identify more rational and appropriate emotions in a particular problematic situation, as well as provide an opportunity for them to experientially identify self-statements and coping techniques that could work for them in stressful situations. In implementing this technique, the counselor or therapist invites the client to close his or her eyes and imagine a difficult situation that evoked strong negative emotions. After the client reconstructs this image and labels the upsetting feelings, the counselor or therapist asks the client to change the upsetting feelings to a more reasonable negative emotion. When the client signals that this has been accomplished, the counselor or therapist invites the client to return to the present and describe the healthy emotions, exploring how thoughts helped contribute to these less upsetting emotions. Clients are usually encouraged to practice REI for 30 days to help them learn how to change unhealthy negative emotions.
Other emotive interventions include forceful coping statements, in which clients formulate rational coping statements and then practice them forcefully during and between sessions (Ellis, 2001a; Ellis & Velten, 1992). Ellis and MacClaren (1998) noted that because clients have usually practiced irrational statements for a long time, powerfully repeating such statements as "When I fail it NEVER, NEVER makes me a complete failure as a person" (p. 78) over and over helps them replace the irrational statements with rational alternatives.
Experiential exercises are also used by many REBT counselors or therapists in individual counseling or therapy as well as in classroom settings and small groups (Vernon, 1998a, 1998b, 1998c, 2004,2006a, 2006b, 2009b, 2009c). These exercises help clients learn new skills and give them an opportunity to explore problematic areas. For example, Ellis and MacClaren (1998) described an exercise in which clients wrote irrational beliefs on one side of an index card and, on the other side, five negative things that have happened to them because they think that way. Vernon (2002) discussed helping clients with procrastination by having them list things they typically put off doing and giving the list to the counselor or therapist. As the client lies on the floor, the counselor reads the items one by one. As each one is read, the counselor or therapist puts a stack of newspapers on the client's body. After the final item is read and the pile of newspapers is quite high, the client is invited to talk about how he or she feels with everything "all piled up" and what steps to take to get out from under the pile of procrastination.
Behavioral interventions have always played an important role in helping clients change and are used to supplement and reinforce cognitive and emotive interventions. Oftentimes behavioral interventions are incorporated into homework assignments or are used in conjunction with other techniques. An example of a behavioral intervention would be to ask the client to respond to her friend's request to borrow her car in an assertive rather than nonassertive manner.
One of REBT's most unique behavioral interventions is the shame-attack exercise (Ellis, 2004a, 2004b). Ellis (2004a) realized that shame is at the core of a significant amount of people's emotional disturbance, and that when people do something they consider shameful, they criticize their actions and think that they should never repeat them. Consequently, "In REBT we try to help people to stop putting themselves, their whole person, down no matter how badly they behave and no matter how much other people look down on them for so behaving" (Ellis, 1996, p. 92). To help clients understand this concept, counselors encourage clients to do things in public that they regard as shameful or embarrassing, such as yelling out the stops on elevators (Nelson-Jones, 2000); approaching strangers in the subway and asking them what month it is, explaining that they have just gotten out of the mental hospital (Ellis, 2004a); or singing in the street (Ellis, 2001a). Shame-attack exercises should not be illegal, harmful, immoral, or bothersome to others. Rather, they are "foolish, silly, and ridiculous" (Ellis, 2001a, p. 153) and are intended to help clients understand that while they may act "bad" or "foolish," they are not bad persons. After doing shame attacks, clients often feel much less uncomfortable and anxious; at the same time, they realize that they can stand not having others' approval.
Another behavioral intervention is skills training (Dryden, 2002b). Although considered an inelegant solution if clients do not work on identifying and disputing irrational beliefs, many clients need practical skills to help them overcome deficits that can range from trade skills to interpersonal or social skills such as assertion (Ellis & MacClaren, 1998). Other behavioral interventions include rewards and penalties, in which counselors or therapists help clients arrange reinforcement for achieving a goal, or penalties if they do not. Penalties often involve contributing money to a cause clients do not believe in as a forceful way to modify behavior (Ellis, 2001a, 2001c); rewards include things the client truly enjoys. Paradoxical homework, which involves prescribing the symptom the client is attempting to work on, is also used with some clients (Ellis & MacClaren, 1998). Ellis and MacClaren cautioned that there are some risks with this approach and it is not appropriate for all clients.