REBT encourages clients to seek adversity when carrying out homework assignments, but does so sensibly

REBT’s ABC model holds that people disturb themselves (at C) about adversities (at A) largely because they hold rigid and extreme attitudes (at B) towards these adversities (Dryden & Neenan, 2004b; Ellis, 1994). It follows, therefore, that if they want to handle these adversities more constructively, then they need to develop a set of flexible and non-extreme attitudes towards them. This suggests that, sooner or later, REB therapists need to encourage their clients to seek out adversity in order to practise thinking flexibly and in a nonextreme way about this adversity. This, of course, needs to be done sensibly and I discuss below the importance of helping clients to challenge themselves without overwhelming themselves.

Clients are generally ambivalent about facing adversity when carrying out homework assignments. They want to address their problems, but they would rather do this without facing adversity. This is akin to wanting to learn to swim without getting wet! Let us discuss one example where a client was happy with what he had achieved from a homework assignment, but where I, as therapist, knew that the client had not got as much out of the assignment as he thought because he had not faced adversity. Harry, the client, was anxious about speaking up in class because he was scared that his fellow students would disagree with him. As a result, he kept quiet. In our sessions, I helped him to identify, examine and change the ego-based rigid and extreme attitudes that underpinned his disturbance. He saw (but did not yet believe) that it would be preferable if his fellow students agreed with him, but that they did not have to do so, and he also saw that if they did not, he could accept himself in face of this disagreement. We discussed the importance of him putting these flexible and non-extreme attitudes into practice in the face of adversity and he agreed to speak up in class until three people had disagreed with his opinions; he would practise his newly developed flexible and non-extreme attitudes before speaking up and after getting the disagreements.

Harry came to the next therapy session in an upbeat frame of mind. I asked him to tell me how his homework assignment had gone and he said better than his wildest dreams. I was expecting him to tell me how much benefit he had got from rehearsing his flexible and non-extreme attitudes when other students disagreed and that he would be consequently more open to voicing his opinions in class. However, he told a very different story. He said that he spoke up on a number of occasions and was surprised and delighted to learn that everyone agreed with what he had to say and some even invited him for coffee afterwards, something that had never happened before.

As his therapist, I (WD) was pleased that he had spoken up, but I also knew that he had not really faced adversity (i.e. having others disagree with his views) while doing his homework assignment and thus had no real experience of thinking constructively in the face of adversity. Harry admitted that he played safe and only voiced views that he knew would be popular. As it happened, in the next week a few people did disagree with him as Harry, buoyed by false confidence, took more risks in saying what he really thought, and thus we returned to the theme of Harry helping himself by facing adversity.

REBT discourages gradualism

Another distinctive feature of REBT is its stance on the speed with which clients should ideally face adverse situations and practise thinking flexibly and in a non-extreme way in these situations. Many years ago, Joseph Wolpe (1958) developed a therapeutic technique, called systematic desensitization, based on the principle


of reciprocal inhibition. Focusing on anxiety, Wolpe argued that the best way of dealing with anxiety was to inhibit the anxiety response to a threat by replacing that response with one that was incompatible with anxiety; namely, a relaxation response. In order to do this, Wolpe argued that the therapist had to help the client to move up very gradually a sophisticated hierarchy of graded anxietyprovoking situations. In doing so, the client was to imagine each situation from a state of relaxation. At the first sign of anxiety, the client was to stop imagining the anxiety-provoking situation and return to the relaxation state before re-imagining the anxious scene. When the client could do this, they would then take one step up the hierarchy and repeat the procedure. Therapist and client would work very gradually up the hierarchy until the client could imagine the most anxiety-provoking scene in a state of relaxation.

Ellis (1983b) argued against the use of gradualism in the treatment of anxiety and other psychological disorders. He suggested instead that clients should be encouraged to face their fears as implosively as they could tolerate while practising thinking rationally in such situations. His argument was threefold.

First, a gradual approach to therapeutic change is not cost effective in terms of treatment sessions. It takes a very long time to help clients to work their way up hierarchies, particularly where these are complex and contain a lot of items.

Second, the process does not encourage client self-reliance. The process is normally heavily dependent on the presence of the therapist, although latterly more automated desensitization programmes were developed.

Third, and perhaps most crucially, a very gradual approach to the treatment of anxiety and other psychological disorders unwittingly has two main, related side-effects:

1. First, gradualism reinforces clients’ philosophy of discomfort intolerance. It implicitly teaches them that they must avoid feeling anxious or must only experience low levels of anxiety. They, then, may develop anxiety about anxiety and avoid situations in which they may feel anxious.

2. Second, gradualism may unwittingly encourage clients to view themselves as fragile, too weak to cope with anything that is stressful.

REBT tends to favour full exposure in vivo where clients practise thinking flexibly and in non-extreme ways while facing what they truly fear. If clients do this, then they can make a lot of progress quite quickly. However, many clients will not do this, at least initially, and therefore REB therapists need to encourage them to proceed according to a principle that I have called ‘challenging, but not overwhelming’ (Dryden, 1985) rather than falling back on the gradualism principle. Using the ‘challenging, but not overwhelming’ principle, once therapists have ascertained that their clients are not prepared to use the full exposure principle, they ask them if they are prepared to use rational thinking while facing situations that are challenging for them to face but not currently overwhelming for them. It can be seen that the ‘challenging, but not overwhelming’ principle is a flexible, pragmatic alternative to the ‘full exposure’ and ‘gradualism’ principles.

< Prev   CONTENTS   Source   Next >