Using Rational-Emotive Therapy Effectively A Practitioner's Guide APPLIED CLINICAL PSYCHOLOGY

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USING RATIONAL-EMOTIVE THERAPY EFFECTIVELY A Practitioner's Guide Michael E. Bernard

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EOITEO BY MICHAEL E. BERNARD The University af Melbaume Parkville, Victaria, Australia

Springer Science+Business Media, LLC Library of Congress Cataloging-in-Publication Data

Using rational-emotive therapy effectively : a practitioner's guide / edited by Michael E. Bernard. p. cm. — (Applied clinical psychology) Includes bibliographical references and index. 1. Rational-emotive psychotherapy. I. Bernard, Michael Edwin, 1950- . II. Series. [DNLM: 1. Psychotherapy, Rational-Emotive—methods. WM 420 U85] RC489.R3U85 1991 616.89' 14—dc20 DNLM/DLC for Library of Congress 91-3749 CIP

ISBN 978-0-306-43755-7 ISBN 978-1-4899-0641-0 (eBook) DOI 10.1007/978-1-4899-0641-0

© Springer Science+Business Media New York 1991 Originally published by Plenum Press, New York in 1991 Softcover reprint of the hardcover 1st edition 1991 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors

MICHAEL E. BERNARD, School of Education, University of Melbourne, Park• ville, Victoria, Australia 3052, and Australian Institute for Rational• Emotive Therapy, P.O. Box 1160, Carlton, Victoria, Australia 3053

ROBERT W. DAWSON, Australian Institute for Rational-Emotive Therapy, P.O. Box 1160, Carlton, Victoria, Australia 3053, and Community Training Systems, 459 Swanston Street, Melbourne, Australia 3000

RAYMOND DIGIUSEPPE, Department of Psychology, St. John's University, Jamaica, New York 11432, and Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, New York 10021

DOMINIC J. DIMATTIA, Department of Counseling and Human Resources, University of Bridgeport, Bridgeport, Connecticut 06602, and Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, New York 10021

WINDY DRYDEN, Department of Psychology, Goldsmiths' College, Univer• sity of London, New Cross, London, England SE14 6NW

ALBERT ELLlS, Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, New York 10021

RUSSELL M. GRIEGER, 818 East High Street, Charlottesville, Virginia 22901

PAUL A. HAucK, 1800 Third Avenue, Suite 302, Rock Island, Illinois 61201

MARIE R. JOYCE, Centre for Family Studies, Australian Catholic University, Oakleigh, Victoria, Australia 3168

v vi CONTRIBUTORS

HEDWIN NAIMARK, Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, New York 10021

MARY W. RADER, The Kennedy Family Center, 1235 East Monument Street, Baltimore, Maryland 21202

SUSAN R. WALEN, Department of Psychology, Towson State University, and Baltimore Center for Cognitive Therapy, 6303 Greenspring Avenue, Baltimore, Maryland 21209

JANET L. WOLFE, Institute for Rational-Emotive Therapy, 45 East 65th Street, New York, New York 10021

PAUL J. WOODS, Department of Psychology, Hollins College, Roanoke, Vir• ginia 24020 Preface

The initial conceptualization of this book was much more narrow than the final product that has emerged. I started out believing that it would be enlightening to have a group of acknowledged rational-emotive therapy (RET) expert practitioners with well-established literary credentials write about how they approach the problem of modifying dient irrationality. Many RET practitioners of all levels of experience are, on the one hand, enamored of the economy, the precision, and the accuracy of psychological insight that RET theory offers, but they are, on the other hand, equally frustrated by their own inability to "persuade" or otherwise change some of the dients they work with more quickly or even at all. Indeed, dients themselves frequently express the view that RET is illuminating, yet they find themselves at the same time puzzled and perplexed by their inability to make the substantial changes that RET invites. It became dearer as I discussed the project with many of the contrib• utors that to practice RET effectively requires more than just innovative and persistent assessment and intervention techniques. For example, Rus• sell Grieger expressed the view that more prerequisite work needs to be done on the value and philosophical systems of dients-induding person• al responsibility and the philosophy of happiness-before many dients can show significant shifts in their thinking. Susan Walen raised the gener• al issues of how effective RET can be in the treatment of biologically driven affective disorders. Windy Dryden spoke of the importance of the thera• peutic relationship and taking into account dient expectations in determin• ing how to bring out the best in RET and in the dient. It became obvious to me before I even read the chapters that RET practitioners were doing as much "outside" traditional RET as "inside" RET to help dients to use RET to make changes in their lives. The organization of the chapters flows from general considerations in improving RET's effectiveness to using RET with specific populations and problems. In Chapter 1, summarizes why RET is an effective and efficient form of therapy and indudes many do's and don'ts in using RET effectively. The second half of the chapter contains the transcript of an

vii viii PREFACE interview I conducted with EIlis covering the dient, therapist, and therapy characteristics that he takes into account when he practices RET. In Chapter 2, Russell Grieger, weIl-known RET author and practitioner (Rational-Emotive Therapy: A Skills-Based Approach, with John Boyd; Handbook of Rational-Emotive Therapy, with EIlis) presents a guide he uses with his dients to ensure that they will understand and follow the basic RET steps to change, beginning with Step 1, "Committing Oneself to Change," and ending with Step 6, "Going Forward." He argues that educating dients in a structured way about the theory and practice of RET tremendously en• hances most dients' ability to use RET effectively. He also views as an important therapeutic task the education of dients about the concept of personal responsibility. In my opinion, Paul Woods, coeditor (with Russell Grieger) of the Journal of Rational-Emotive and Cognitive Behavior Therapy, has made tremen• dous advances in the teaching methods that he uses with his clients to bring about RET-induced change. In Chapter 3, Woods presents the im• pressive array of RET visual-graphic aids that he uses with his dients and the introductory RET explanations that he uses with his dients. Robert Dawson is one of Australia's foremost RET practitioners and trainers. In Chapter 4, Dawson presents a model he calls "REGIME," which he designed to improve RET's effectiveness. Rejecting what he terms the "mad-dog disputing" model, Dawson illustrates the importance of using basic microcounseling skills (e.g., empathy) in the relationship• building phase of RET. He goes on to discuss the importance of therapist• dient goal setting as aprerequisite to disputation and of using Arnold Lazarus's multimodal theory to ensure that the dinician will not overlook important assessment information. Windy Dryden continues to be a prolific generator not only of books on RET and aIlied cognitive-behavioral approaches, but also of creative and innovative ideas. In Chapter 5, using dinical ca se material, Dryden offers advice on the importance of the therapeutic aIliance and of being prepared to make compromises with dients in order to bring about change. One of RET's most prodigious thinkers is Raymond DiGiuseppe, au• thor of countIess thought-provoking pieces on aspects of the philosophy, theory, and practice of RET. In Chapter 6, he presents for the first time his view of RET's unique hypothesis-driven form of assessment as weIl as different methods for assessing dient irrationality. In Chapter 7, Di• Giuseppe discusses the nature of cognitive disputation and, again, offers the practitioner new techniques for identifying, challenging, and changing clients' irrational thinking. Paul Hauck has been writing books on RET for three decades (e.g., The Rational Management of Children, 1967; Overcoming Worry and Fear, 1975; Brief Counseling with RET, 1980; The Three Faces of Love, 1984). Always thinking of and offering the RET practitioner new perspectives, in Chapter 8 he ad- PREFACE ix dresses the issue of how RET can be used by a dient to solve interpersonal as distinct from intra personal problems and, specificaIly, how RET can help dients get what they want from others. Susan Walen is regarded by her contemporaries as a leading RET prac• titioner-theoretician who is stimulated by model building, likes to write on sex and women's issues, and is most weIl known as the senior author of the popular RET training text The Practitioner's Guide to Rational-Emotive Therapy (coauthored by Richard Wessler and Raymond DiGiuseppe). Chapter 9, cowritten with Mary Rader, is the most moving and powerful of all the chapters in this collection. It is affectively moving and at the same time therapeutically challenging. Walen and Rader write poignantly of their own experiences of severe depression and offer illuminating insights into the phenomenology of the "disease" and the care with which RET needs to be offered to severely depressed dients. Janet Wolfe has for many years been responsible for taiIoring RET to the particular characteristics of women. As early as 1975, when she pre• sented RET as an effective , she has been a driving force behind the development of RET for women. In Chapter 10, coauthored with Hedwin Naimark, the latest advances in the application of RET to the understanding and amelioration of "women's problems" are presented. The person most responsible for the current increase in interest in the use of RET in organizational settings is Dominic DiMattia. In Chapter 11, he outlines ways in which rational effectiveness training can be used to boost the performance of individuals working in organizations and in sales training. He points out ways in which RET can be made more "user friend• ly" to big business. Finally, in Chapter 12, Marie Joyce and I update our insights into how to use RET with younger populations, which we presented in our 1984 book Rational-Emotive Therapy with Children and Adolescents: Theory, Treat• ment, Preventative Methods. Let me now try to summarize briefly some of the major condusions about how to improve the way in which RET is practiced. The generalizations that folIoware based on a simple observation: Certain clients require prerequisite work before they can profit from cognitive dis• putation and the allied RET change techniques. There are many reasons for this phenomenon, most of which have to do largely with dient characteristics. Perhaps the most relevant of these to the practice of RET has to do with dients' entering level of preparedness to change. Prochaska and DiCle• mente (1986) pointed out that, whereas some dients are "ready for action," others are in a "precontemplation" stage. RET may weIl be best suited to dients in the contemplation and action stages: 1. RET is best practiced when the practitioner has an in-depth under• standing of the current RET theory of mental health problems, for it is this theory that drives RET assessment and intervention procedures (see Ber- x PREFACE nard, 1991; Bemard & DiGiuseppe, 1989; EHis, 1988; EIlis & Dryden, 1987, 1990). 2. RET practitioners need to pay more attention to the nature of the therapeutic relationship and how to go about forging a relationship with dients that will minimize dient anxieties about the practitioner and RET. In particular, it is important to discard the "patient uniformity" myth and to recognize that different dient characteristics, induding gender, sex role, culture, personality, problems, and previous experience in therapy, require and lead to different types of practitioner-dient relationships. 3. In building a therapeutic relationship, it is vital that the RET practi• tioner be able to successfully use basic microcounseling skills such as em• pathy and listening (e.g., Egan, 1990), as weIl as be supportive and caring when required. That is, simply showing dients how RET conceptualizes problems, "teHing" them what they are thinking (advanced accurate empa• thy), and providing them with a minilecture on the ABCs of RET are not enough for many dients, who either require trust and understanding and/or may not be ready for RET action. 4. Multimodal assessment techniques (e.g., Lazarus, 1981, 1986) can be extremely useful adjuncts to the basic RET assessment regime. Concep• tualizing dient problems by using the BASIC ID framework can help to isolate the noncognitive aspects of problems surrounding dysfunctional thought-feeling links that may prevent RET from being used effectively. For example, the treatment of painful sensations through relaxation meth• ods can dear the way for cognitive disputation. Further, a careful and thorough assessment of sensation may lead more quickly to the discovery of biologically driven emotional disorders, which, when discovered, will have a direct bearing on the way RET is introduced in therapy. 5. RET assessment effectiveness is enhanced by the practitioner's knowledge of RET and of the hypotheses that RET offers conceming the nature of the irrational beliefs that underlie different dient problems. RET assessment techniques can also be augmented by a directive and active style of hypothesis testing. Using this approach, the RET practitioner not only permits the full force of RET theoretical schemata to direct the assess• ment process but also frequently offers hypotheses to the dient conceming relationships among events, irrational beliefs, and feelings. The dient's reaction (acceptance or rejection) to RET hypotheses helps to guide the practitioner's assessment interview. 6. RET attempts to empower dients by providing them with disputa• tional skills that will enable them to modify their own emotional states and behaviors. RET also provides dients with a set of rational values (e.g., self• acceptance, other-acceptance, and involvement in creative pursuits; see EIlis & Bemard, 1985) that RET hypothesizes will lead to increased hap• piness. The use of disputational methods by dients as weIl as the adoption of new values would appear to demand from dients a sense of personal PREFACE xi responsibility, that is, a belief that it is possible, through their own efforts, to do something about their problems. A fair proportion of dients arrive in therapy with low personal responsibility, feeling helpless to change them• selves or their circumstances. It is therefore vital for RET practitioners to provide their dients with an awareness of the importance of the attitude of personal responsibility and to provide their dients with experiences that will start to combat dients' attitudes of helplessness. 7. For some, but not aIl, dients, spending time explaining the theory of RET as weIl as the role and nature of disputation can be extremely helpful. For those who are experiencing extreme emotional pain, however, the exposition of the RET model, especially during initial treatment sessions, can do more harm than good by both alienating the dient from the practi• tioner and increasing the emotional pain for dients who find themselves unable to be rational. This is especially the case for dients experiencing biologically driven affective disorders. However, for those dients who ar• rive in therapy ready for action, a dear discussion of RET will be helpful. 8. In attempting to modify irrational thinking through disputation, the RET practitioner needs to be aware that what leads dients to generate irrational thoughts in particular situations are frequently nonspoken, im• plicit irrational beliefs, which are collectively referred to as an assumptive framework or a personal paradigm. To produce changes in dient thinking beyond specific environmental circumstances, it is necessary for the dient to dispute and modify these more implicit irrational beliefs. 9. RET practitioners should not be exdusive in their use of traditional RET methods. RET also regularly employs many cognitive, emotive, and behavioral methods that are sometimes used in non-RET therapies. It particularlY emphasizes forceful, emotive methods such as forceful coping statements, rational-emotive imagery, and shame• attacking exercises; and it gives its practitioners fullleeway to use, especially with difficult and resistant clients, some nonrational and "irrational" meth• ods, such as Pollyannaism, religious conversion, extreme active listening, and unusual and tricky paradoxical interventions. It also regularly uses practical problem solving, interventions, relaxation meth• ods, and other useful techniques but adds to them the revealing and active disputing of dients' basic musturbatory philosophies. Arnold Lazarus (1989) illustrated how "time tripping" and certain imagery techniques can emotionally "unblock" dients concerning past events, freeing them to con• sider here-and-now issues by using RET. I have tried to ensure that the material contained in this book will be useful to practitioners. As a rough guess, the practitioners who are contrib• utors to this book have over 225 years of collective experience in using RET with dients. I am very pleased with the quality of the contributions and hope that readers will find many ideas that will help either reinforce some of the ways they have been working with their dients or introduce some xii PREFACE

new approaches that will have a significant impact on their professional functioning. There is little doubt that RET continues to be adynamie and extremely effective therapy that offers challenges to the practitioner and the dient alike.

MICHAEL E. BERNARD Melbourne, Australia

REFERENCES

Bemard, M. E. (1991). Staying rational in an irrational world: Albert El/is and rational-emotive therapy. New York: Carol Publishing. Bemard, M. E., & DiGiuseppe, R. (Eds.). (1989). Inside rational-emotive therapy: A critical analysis o{ the theory and practice o{ Albert Ellis. New York: Academic Press. Egan, G. (1990). The skilled helper (4th ed.). Pacific Grove, CA: Brooks/Cole. Ellis, A (1988). How to stubbornly refuse to make yoursel{ miserable about anything-Yes anything! New York: Lyle Stuart. Ellis, A, & Bemard, M. E. (Eds.). (1985). Clinical applications o{ rational-emotive therapy. New York: Plenum Press. Ellis, A., & Dryden, W. (1987). The practice o{ rational-emotive therapy. New York: Springer. Ellis, A, & Dryden, W. (1990). The essential Albert El/is. New York: Springer. Lazarus, A (1981). The practice o{ multi-modal therapy. New York: McGraw-Hill. Lazarus, A. (1986). . In J. C. Norcross (Ed.), Handbook o{ ec/ectic psycho• therapy (pp. 65-93). New York: Brunner/Mazel. Lazarus, A. (1989). The practice of rational-emotive therapy. In M. E. Bemard & R. Di• Giuseppe (Eds.), Inside rational-emotive therapy: A critical analysis o{ the theory and practice o{ Albert El/is (pp. 66-94). New York: Academic Press. Prochaska, J. 0., & DiClemente, C. C. (1986). The transtheoretical approach. In J. C. Norcross (Ed.), Handbook o{ (pp. 163-2(0). New York: Brunner/Mazel. Contents

Clulpter 1. Using RET Effectively: Reflections and Interview 1

ALBERT ELLIS How RET Can Be Effectively Brief ...... 2 How RET Can Be Effectively Elegant and Long-Lasting ...... 8 Interview ...... 11 References ...... 32

Clulpter 2. Keys to Effective RET 35

RUSSELL M. GRIEGER Organizing and Guiding the Client ...... 36 Helping Clients Take Responsibility ...... 53 Therapist Checklist for RET Effectiveness ...... 62 Summary...... 66 References ...... 66

Clulpter 3. Orthodox RET Taught Effectively with Graphics, Feedback on Irrational Beliefs, a Structured Homework Series, and Models of Disputation ...... 69

PAUL J. WOODS Introductory Minilectures ...... 70 Report Booklet on the Client's Irrational Beliefs: Homework ...... 83 Analyzing an Emotional Episode: Homework ...... 85 Examples of Irrational Beliefs (iBs) with Disputational Responses and Rational Alternatives: Homework ...... 95 Building Positive Self-Regard: An Inelegant Step along the Way to Unconditional Self-Acceptance ...... 103 Evidence of the Effectiveness of the Above Strategies ...... 104 References ...... 108

xiii xiv CONTENTS

Chapter 4. REGIME: A Counseling and Educational Model for Using RET Effectively ...... 111

ROBERT W. DAWSON REGIME: Objectives, Therapist Strategies, and Client Behaviors . . 112 REGIME: Stages of Therapeutic Process ...... 113 REGIME Intervention Matrix ...... 127 Transcript ...... 127 Conclusion ...... 131 References ...... 132

Chapter 5. Flexibility in RET: Forming Alliances and Making Compromises ...... 133

WINDY DRYDEN The Therapeutic Alliance ...... 133 Compromises in RET ...... 140 Conclusion ...... 148 References ...... 148

Chapter 6. A Rational-Emotive Model of Assessment 151

RAYMOND DIGIUSEPPE Overview of Rational-Emotive Assessment Procedures ...... 152 RET versus Traditional Models of Assessment ...... 153 Medical Model of Assessment ...... 154 Static versus Dynamic Assessment ...... 157 Therapeutic Relationships and Self-Disclosure ...... 157 Epistemology ...... 160 Hypothesis-Driven Assessment ...... 162 Assessing Irrational Beliefs ...... 165 References ...... 169

Chapter 7. Comprehensive Cognitive Disputing in RET 173

RAYMOND DIGIUSEPPE An Expanded Model...... 174 The Target of the Dispute ...... 176 The Nature of the Dispute ...... 177 Rhetorical Disputing Styles of Therapists ...... 182 Level of Abstraction ...... 186 CONTENTS XV

Multiple Irrational Belief Processes ...... 188 Comprehensive Cognitive Disputing in RET ...... 191 References ...... 194

Chapter 8. RET and the Assertive Process ...... 197

PAUL A. HAUCK Two Types of Problems ...... 197 The Two Principles of Human Interaction ...... 199 To Be or Not to Be Assertive: The JRC Principle ...... 201 The Three Rules of Assertion ...... 203 The Four Objections ...... 206 When RET Is Especially Called For ...... 208 The Four Options ...... 209 Making a Choice ...... 212 Wider Applications ...... 213 A Case Study ...... 217 References ...... 218

Chapter 9. Depression and RET: Perspectives from Wounded Healers ...... 219

SUSAN R. WALEN AND MARY W. RADER Overview ...... 219 The Self-Disdosure Part ...... 220 Depressive Illness: The Uniformity Myth ...... 232 Clinical and Treatment Implications ...... 240 Conclusion ...... 260 Some Recommended Books on Depression for Patients ...... 261 References ...... 261

Chapter 10. Psychological Messages and Social Context: Strategies for Increasing RET's Effectiveness with Women ...... 265

JANET L. WOLFE AND HEDWIN NAIMARK The Vicious Cyde of Sex-Role Stereotypes ...... 267 The Vicious Cyde and the RET Process ...... 275 Building Awareness of and Challenging Sex-Role Stereotypes .... 277 Case Study ...... 279 Strategies and Exercises That Challenge Sex-Role Stereotypes .... 283 Conclusion ...... 298 References ...... 299 xvi CONTENTS

Chapter 11. Using RET Effectively in the Workplace ...... 303

DOMINIC J. DIMATTIA Problems in the Workplace ...... 303 Applications of RET in the Workplace ...... 305 General Issues When Using RET in the Workplace ...... 314 CaseStudy ...... 314 Summary ...... 316 References ...... 317

Chapter 12. RET with Children and Adolescents ...... 319

MICHAEL E. BERNARD AND MARIE R. JOYCE Theoretical Perspectives ...... 319 RET Treatment Levels ...... 321 The RATE Model ...... 322 Keys to Successful RET Child Treatment ...... 336 Working with Parents ...... 337 Recommendations for Treating Specific Childhood Disorders . . . . . 341 Conclusion ...... 344 References ...... 345

Index...... 349