CLS 6805.01

1. CLS 6805.01 Chapters 14,15 & 16

2. Rational Emotive Behavior Therapy • Started by Albert Ellis in 1955-grandfather of Cognitive Behavior Therapy; father of REBT • Combination of Humanistic & Behavioral Therapy to help deal with issues from past http://rebtnetwork.org/

3. Rational Emotive Behavioral Therapy (REBT) • Stresses thinking,judging, deciding, analyzing, and doing • Assumesthat cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship • Is highly didactic,very directive, and concerned as much with thinking as with feeling • Teachesthat our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations • Is based on the premise that the way to bring about lasting emotional and behavioral change is for members to change their thinking • Stresses action in the real world as a way to change

4. The Therapeutic Process Group therapy is seen as an educational process • Group members learn • To identify and dispute irrational beliefs that are maintained by self-indoctrination • That events do not cause our problems, but our interpretation of these events do • To replace ineffective ways of thinking with effective and rational cognitions • To stop absolutistic thinking, blaming, and repeating false beliefs • Members are expected to be active and to put into practice into everyday life what they are learning in the group

5. View of Human Nature • We are born with a potential for both rational and irrational thinking • We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves • We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk • We need to acknowledge that we are mainly responsible for our own disturbed thoughts, emotions, and actions • We have the capacity to change by using a combination of cognitive, emotive, and behavioral methods

6. Emotional Disturbance • Through autosuggestion & self-repetition we install & maintain self-defeating beliefs-irrational dogmas & superstitions self-created plus irrational beliefs from significant others • Blame is core of emotional disturbance, so to recover--stop blaming self & others • We escalate desires & preferences into dogmatic & absolutist “shoulds, musts, oughts, demands, commands-which are irrational beliefs that need to be changed

7. Irrational Ideas • Irrational ideas lead to self-defeating behaviors • Absolute “shoulds,” “oughts,” and “musts” result in our becoming and remaining emotionally disturbed • Some examples of irrational beliefs: • “I must have love or approval from all the significant people in my life.” • “I must perform important tasks competently and perfectly.” • “If I don’t get what I want, it’s terrible, and I can’t stand it.”

8. A-B-C Theory of Personality • When we have an emotional reaction at point C (the emotional Consequence), after some activating event at point A, it is not the event itself (A) that causes the emotional state (C), although it may contribute to it. It is the Belief system (B) or the beliefs that we have about the event that mainly creates the C.

9. Confronting Irrational Beliefs • Cognitive restructuring is a central technique of REBT • Group members learn how to identify and dispute their faulty ways of thinking • The process of disputing (D) faulty thinking involves: • Detecting irrational beliefs and seeing them as unrealistic • Debating these beliefs • Discriminating between irrational thinking and rational thinking

10. REBT Process • A = existence of fact, event, behavior, attitude of individual • B = person’s belief • C = emotional & behavioral consequence or reaction of individual • D = disputing intervention-challenge beliefs • E = effective philosophy after disputing • F = new set of feelings • Human beings are largely responsible for creating their own emotional reactions & disturbances • Goal: show people how to change irrational beliefs that directly “cause” disturbed emotional consequences

11. The A-B-C theory

12. Role of REBT Group Leader • REBT leader teaches members how to challenge their assumptions • Leader challenges members’ faulty thinking and teaches them how to apply realistic and constructive thinking to cope with current problems and with future problems • Leader uses a variety of cognitive, behavioral, and emotive methods to assist members in modifying their dysfunctional patterns • REBT leader assumes the role of teacher and mentor • Leader employs a directive role in getting members to commit themselves to practicing in daily life what they learn in the group

13. Cognitive Methods in REBT Groups • From a cognitive perspective, REBT demonstrates to group members that their beliefs and self-talk keep them disturbed • In group there is an emphasis on thinking, disputing, debating, interpreting, explaining, and teaching • Some cognitive techniques that are used in an REBT group: • Teaching the A-B-Cs of REBT • Active disputation of faulty beliefs • Teaching coping self-statements • Psychoeducational methods • Cognitive homework (Ex. REBT Self-help form)

14. Emotive Methods in REBT Groups • REBT is a multimodal approach to change • Members experience a variety of cognitive, emotive, and behavioral techniques • Some emotive methods include • Unconditional acceptance: group leaders model an accepting attitude • Rational emotive imagery: members vividly imagine the worst thing that could happen and are encourage to change feelings & respond differently • Use of humor: laugh at self-defeating beliefs • Shame-attacking exercises: teaches clients to accept themselves in spite of reactions from others • Role playing involving a cognitive evaluation

15. Behavioral Methods in REBT Groups • REBT group leaders use the entire range of cognitive behavioral techniques • Some behavioral methods often used include • Self-management methods • Behavioral role playing and role rehearsal • Homework assignments (Ex. Read a book, visualization, practice behaviors outside the group) • Reinforcement and penalties (Ex. Reward yourself with a movie, or penalize yourself by donating $100 to an unworthy organization • Skills training (in group or outside of group by taking a workshop)

16. Self-Talk of Group Leaders • Group leaders can use REBT as a way to identify and challenge their internal dialogue that can get in their way of effectively leading a group • Some examples of group leader’s self-talk that can be examined: • I must have the approval of all the members of my group • I must be the perfect role model at all times • I must always perform perfectly • I must have the right technique for every problem • I must always be in control in my group • If I make a mistake, that means I am a failure

17. REBT with Multicultural Populations • Some advantage of REBT groups as applied to working with multicultural populations: • A sensitive leader can challenge members to question messages from their culture • Members can learn new ways of thinking and behaving • Some limitations to consider: • REBT leader needs to use caution in confronting members too forcefully about their beliefs and behaviors • Important for leaders to understand and respect cultural differences and not judge these differences • Leaders need to be careful to avoid imposing their beliefs and values

18. Evaluation of REBT in Groups • Contributions and strengths of the approach • Can be applied to working with wide range of problems in groups • Groups useful in helping members to learn about their self-defeating beliefs and how this influences their current way of acting and feeling • The approach stresses the need to put into action newly acquired insights • Can be used as a basis for psychoeducation in groups • Limitations of the approach • Dangers of leader being inappropriately confrontive • Possibility of leader deciding for members what is “faulty thinking” • Concern about the misuse of leader’s power to pressure members and to persuade them to adopt the leader’s views and values

19. Reality Therapy • William Glasser 1925- • Became disenchanted with Freudian Psychology • Created Reality Therapy by 1962- we are all responsible for what we choose to do • Developed Choice Theory – everything we do is chosen and we can learn to make better choices • Reality Therapy is the methodology for implementing the key concepts of Choice Theory

20. Assumptions of Reality Therapy • Emphasis is on responsibility • We may be the product of our past, but not the victims of our past • Leader’s function is to keep therapy focused on the present • We often mistakenly choose misery in our best attempt to meet our needs • We can only control what we are presently doing • Reality therapy is active, directive, structured, psychoeducational, and focuses on doing and action plans

21. Underlying Problem for all Clients • They are either involved in a present unsatisfying relationship or lack of what could even be called a relationship • If therapy is to be successful, the therapist must guide the client to a satisfying relationship & teach client to behave in more effective ways • Clients find out their problems are the way they chose to behave

22. Basic Needs • All internally motivated behavior is geared toward meeting one or more of our basic human needs • Love and belonging – need to be involved with others • Power – need for achievement and accomplishment • Freedom – need to make choices • Fun – need to enjoy life • Survival (Physiological needs) • Choice theory posits that all our behavior is an attempt to control the world around us for the purpose of satisfying these 5 basic needs • Choice theory isbased on assumption that all behavior is purposeful and originates from within the individual • Choice theory and reality therapy • Choice theory provides an explanation of our human nature • Reality therapy offers a method for getting the relationships we need

23. Quality World • We possess these basic needs in differing degrees and fulfill them in various ways • We develop a quality world and choose to behave in a way that gives us the most effective control over our lives and satisfies our view of our quality world

24. Key Concepts of Choice Theory • Existential and phenomenological orientation • We perceive the world in the context of our own needs • The focus of choice theory is on internal control and the subjective world • We choose our own goals and are responsible for the kind of world we create • Total behavior • Includes four inseparable components: acting, thinking, feeling, and physiology • We have most control over our acting and thinking • Axiom of choice theory • Although the past may have contributed to a current problem the past is never the problem

25. Total Behavior • Total behavior is our best attempt to satisfy our needs • Components of total behavior • Acting—behaviors such as talking, jogging • Thinking—thoughts, self-statements • Feelings—anger, joy, pain, anxiety • Physiology—bodily reactions such as headaches If we choose to change what we are doing, the thinking, feeling, and physiological components will change, as well.

26. Reality Therapy in Groups • Leaders encourage members to move from talking about the past and their symptoms to discussing their present unhappy relationships • Because almost all symptoms are caused by unhappy relationships, members must do what they can to correct their present relationships

27. Questions in Reality Therapy • Group leaders challenge members with this question: “Is what you are now choosing to do getting you what you want?” • Skillful questioning is part of reality therapy and some questions include: • Do you want to change? • What do you want in your life that you do not have now? • If you changed, how would your life be different? • What do you have to do now to make the changes happen?

28. Role & Functions of Leader • Reality therapy group leaders strive to establish a therapeutic alliance that allows for the effective use of reality therapy • Reality therapy leaders assume an active and directive role in group • Some functions of the reality therapy group leader: • Teaches members they have some control over their feelings by choosing to act and think differently • Facilitates discussion of how members are currently behaving • Helps members make an evaluation of their present behavior • Teaches members to design and carry out plans to change what they are doing to get what they want • Helps members to evaluate the level of commitment to their action plans

29. Cycle of Counseling • Consists of two major components: • Counseling environment – consists of specific guidelines for implementing interventions and is the foundation from which procedures are built • Procedures – lead to changes in behavior – the WDEP system

30. The Counseling Environment • Personal involvement with the group members • Group leader aims to establish a safe climate as the basis for effectively implementing reality therapy procedures • For involvement to occur leaders need to have personal qualities: warmth, understanding, acceptance, care, respect for members, openness, and nondefensiveness • Counselor attitudes and behaviors that promote change • Group leaders strive to teach members to accept responsibility for their total behaviors • Leaders help members to see that reasonable consequences are necessary and useful • Leaders do not give up easily in members’ ability to find a more responsible way of living

31. Procedures in Reality Therapy The WDEP Framework – therapist & client join together to determine goals and plans W Wants—Well timed questions can get members to think about what they want and whether their behavior is leading them in the direction they want to go (Picture Album) Ex. What do you want? D Doing and Direction—members look at their behavior to determine if what they are doing is getting them what they want. Ex. What are you doing? EEvaluation—members evaluate the quality of their behavior, what may be contributing to their failures & what changes they can undertake. Ex. Does your present behavior have a reasonable chance of getting you what you want? PPlanning—the process enables people to gain effective control over their lives: “SAMIC”

32. Planning For Change - SAMIC S Simple—Easy to understand, specific and concrete A Attainable—Within the capacities and motivation of the group member M Measurable—Are the changes observable and helpful? IImmediate and Involved—What can be done today? What can you do? C Controlled—Can you do this by yourself or will you be dependent on others? Effective planning involves process-centered activities. Ex. Pay your child 3 compliments, jog 30 min a day, Volunteer 2 hrs a week, take a vacation

33. Multicultural Reality Therapy • Reality therapy can be modified to fit the cultural context • Reality therapy can be adapted to non-Western people • Group members are asked to determine what changes they may want to make • Leaders refrain from deciding what behavior should be changed • Group work can be cast in framework of a teaching and learning process • Many members will find the structure and focus on action plans appealing in a reality therapy group • A possible limitation is that this approach may not fully take into account environmental forces

34. Evaluation of Reality Therapy Group • Contributions and strengths of the approach • The emphasis on personal accountability • The stress given to members making their own evaluation of what they are currently doing • Emphasis on creating an action plan to get what members want • A straightforward and clear approach • Limitations of the approach • Some leaders might assume role of judge for members of what behavior to change • Not much attention is given to expressing and exploring feelings • The role of the past is given scant attention

35. Solution-Focused Brief Therapy • Steve de Shazer, Insoo Kim Berg – 1980’s • Solution-focused brief therapy (SFBT)—a future focused, goal-oriented therapeutic approach to group work • Shifts focus from problem-solving to solutions • SFBT looks at the strengths of a person and past successes • In a solution-focused group, the member, not the therapist, is the expert • Leader engages members in conversations about what is going well, their resources, and future possibilities • SFBT based on an optimistic assumption • Members are viewed as resilient, resourceful, competent, and able to construct solutions that can change their lives • The leader supplies optimism and recognizes resources members already possess

36. Key Concepts • Therapy grounded on a positive orientation—people are healthy and competent • Past is downplayed, while present and future are highlighted • Therapy is concerned with looking for what is working • Group leader assists members in finding exceptions to their problems – Ex. “Look back over your week & tell me what seemed to go slightly better for each of you.” • There is a shift from “problem-orientation” to “solution-focus” • Emphasis is on constructing solutions rather than problem solving

37. Basic Assumptions • People can create their own solutions • Small changes lead to large changes • It is not necessary to know the cause of a problem to solve it • The best therapy involves a collaborative partnership • A group leader’s not knowing stance affords the member an opportunity to construct a creative solution • Group members are empowered • Little attention given to diagnosis, history taking, analysis of problems, or exploration of problems

38. Role & Function of Leader • A not knowing position • Members think about their future and what they want to be different in their lives • Group leader has expertise, but is not an expert in how members should live • Members are experts on their own lives • Creating a therapeutic partnership • Leader prefers a collaborative or consultative stance • Emphasis is on leader creating a therapeutic partnership with members; empathy is more important than technique • Leader has task of keeping members on solution track rather than a problem track – Ex. “While we will discuss your reason for being here, we will shift the focus to what you want to accomplish.” • Leaders show members how they can use the strengths and resources they already have to construct solutions

39. Questions • One function of the leader is to ask questions of members, listen to answers, and generate further questions • Skillful questions allows people to utilize their resources • Asking “how questions” that imply change can be useful • Effective questions focus attention on solutions • Questions can get members to notice when things were better • Useful questions assist people in paying attention to what they are doing and what is working • Questions can open up possibilities for members to do something different • Ex. “What do you want from coming here?”, “How would that make a difference to you?”, “What might be some signs to you that the changes you want are happening?”

40. Process of Solution-Focused Group • Philosophical stance of accepting people where they are and assisting them in creating solutions • Steps in the change process • Setting the tone for the group • Assisting members in developing well-formulated goals • Searching for exceptions to the problem • Instilling hope and encouraging motivation • Assisting members in designing out of group tasks • Terminating • A key question is: “When the problem is solved, what will you be doing differently?” • Members are helped to identify barriers that could get in their way of maintaining the changes they made

41. Techniques and Procedures • Pre-therapy change – “What have you done since you made your appointment that has made a difference in your problem?” • Questioning – primary communication tool and main intervention • Exception questions – explore times when it was reasonable to have expected the problem to occur, but somehow it did not Ex. “Tell me about the times when things are going your way.” • Miracle question – “If a miracle happened and the problem you have was solved, what would be different?” • Scaling questions – “On a scale of 0-10, with 0 being how you felt when you first came to group and 10 being how you felt after your miracle occurs, how would you rate your anxiety now?” • Formula first session task (FFST) – homework using observation • Feedback – encouragement, suggestions for homework

42. SFBT in a Multicultural Context • Many characteristics of SFBT make it an ideal approach in group work • The approach stresses learning about the experiential world of the members • Some questions in understanding multicultural influence on members: • Talk about the influence that [some aspect of your culture] has played in your life • What challenges have you faced growing up in your culture? • How have you been able to draw on strengths and resources from your culture?

43. Evaluation of SFBT Group • Contributions and strengths of the approach • Rests on optimistic assumption that people are competent • Focuses on possibilities rather than limitations • Operates from a nonpathologizing stance • Use of questioning as centerpiece of this approach • Is a brief approach and makes each session count • Limitations of the approach • In a short time, leaders need to make assessments, assist members in formulating specific goals, and make effective interventions • Inexperienced leaders may be enamored by SFBT techniques and not give enough attention to creating a therapeutic alliance with members