REBT approach in practice
(All clients are profiled from scenarios in Laureate Education books. The clients are fictitious for the purpose of practice.)
Aaron is a 17-year-old male who comes into counseling by a physician’s referral. He is a single, Jewish, Syrian-American adolescent who shows symptoms of anxiety, obsessive-compulsive disorder, and anorexia. He is a 5’10, 120 pound track star who obsessively monitors and keeps track of his food intake, work outs, steps, possessions he owns, and the people he talks to each day. He does not use any drugs or alcohol, and lives in a divorced household. His father is remarried, and his mother is a hard-worker with his standards and expectations (Taylor, 2012).
The goal of rational emotive behavior therapy (REBT) is to help clients get rid of self-defeating outlooks on their life and helps replace those thoughts with a more rational view (Corey, 2009). Aaron is in need of REBT because he has flawed thinking of who he is and what he should be. He believes he needs to lose weight in order to be a good athlete, and he also must keep obsessive lists of the friends he talks to each day and possessions he owns. REBT encourages Aaron to overcome feelings of anxiety, loss of self-worth, hatred, and hurt by experiencing healthy feelings of sadness over being unaccepted (Corey, 2009). Aaron must learn to fully accept himself, including his imperfections.
REBT uses the A-B-C model as its central framework. In Aaron’s first sessions, the therapist must identify what is the activating event (A) that causes his self-defeating beliefs (B) so that he has emotional and behavioral consequences (C) of eating disorders and his obsessive behaviors. After discovering these parts of the A-B-C model, the therapist can use disputing interventions (D) to create an effect (E) and finally Aaron can experience new emotions and feelings (F) (Corey, 2009). Strengths of REBT with Aaron would be that there are a wide range of active and practical procedures and techniques that could be used to fit Aaron’s needs. Also, REBT would help relieve his active symptoms and get him some immediate relief from his obsessive behaviors (Laureate, 2012). Albert Ellis developed REBT to be a more efficient and brief form of individual, couples, family, and group therapy (Corey, 2009). REBT is also a great therapy to use with Aaron because it can include his parents in the process. Aaron seems like a self-directed and motivated young man; therefore, REBT would work well for him because its focus is on “teaching clients ways to carry on their own therapy without the direct intervention of a therapist” (Corey, 2009, p. 305). Aaron would not have to be dependent on the therapist for his changes.
Some emotive techniques that could be used on Aaron would be telling himself to repeat rational coping statements like: “I do not need to be 110 pounds to be a good athlete, although I would certainly prefer to be” (Corey, 2009). He could also participate in rational emotive imagery, in which he would imagine the worst thing happening to him (gaining weight and not keeping track of his possessions and/or friends) and work on changing his unhealthy feelings of self-downing and horror to healthy negative feelings of sorrow and regret (Corey, 2009). Some behavioral techniques of REBT could include performing vivo desensitization assignments like talking to his coach or parents about what he is afraid to do, like gaining weight (Corey, 2009).
There are also some limitations and criticisms of REBT. First, Ellis did not believe that a client’s past would help change their flawed thinking and behaviors. Some therapists believe there is a great deal of therapeutic power in identifying the past traumas in order to understand how the client presently functions (Corey, 2009). Second, a therapist could misuse their power by imposing their own ideas of rational thinking instead of allowing the client to identify their own values and goals (Corey, 2009). Third, because REBT is a confrontational and forceful therapy, some therapists must find ways to adjust their own personalities to fit REBT in order for it to be a successful method (Corey, 2009). And finally, because Ellis was not a religious man while developing REBT and believed that religion imposed a guilt that is irrational on a client, it leaves little room for religious clients to incorporate it into their healing process (Corey, 2009). However, there are many modern REBT therapists that are sensitive to these cultural differences and make concerted efforts to help the client choose a value system that fits their journey (Corey, 2009).
Lastly, there are some legal, ethical, cultural, gender, and age issues that must be addressed with Aaron in therapy. In the first few sessions, the therapist must address how much his Syrian/Jewish culture and belief system affects his thoughts and behaviors (Laureate, 2012). He must also be assessed for issues relating to his own male body image (Laureate, 2012). Similarly, he should also be assessed for some age issues, including the long term effects that his behavior may have on his body that he may feel impenetrable to its affects (Laureate, 2012). Finally, confidentiality is a major issue when dealing with adolescents in therapy. Because Aaron is 17, his parents hold rights to his privacy. Therefore, in the first few sessions, the limits of confidentiality must be addressed, such as reporting abuse and/or harm to self or others (Laureate, 2012).
References
Corey, G. (2009). Case approach to Cognitive Behavior Therapy. In Case approach to counseling and psychotherapy (7th ed., ).
Corey, G. (2010). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Brooks/Cole.
Laureate Education. (2012). Client Profile 2: Aaron. Baltimore, MD.
Taylor, M. (2012). Cognitive Behavioral Therapy application: discussion. Retrieved from http://www.waldenu.edu