THE CASE OF MARIA: A RATIONAL EMOTIVE BEHAVIOR THERAPY APPROACH
Following the O'Kelly, DiMattia, and Vernon model, the REBT counselor or therapist first asks Maria to describe the problem she would like to work on, using active listening skills and conveying genuine interest in her by asking pertinent questions to help focus the interview. Then the counselor or therapist asks Maria for a specific example to help clarify the target issue. During this time, the counselor or therapist is empathic, conveying interest in helping Maria resolve the issues that are troubling her. Next, the counselor or therapist asks Maria to identify the emotional and behavioral consequences – how she felt in relation to the example she identified, if she experienced any bodily sensations associated with these emotions, and how she behaved in response. In this case, Maria indicates that she is depressed and anxious. She has also had some thoughts about suicide but feels so guilty because of her children and her religious beliefs that she stops herself from following through with this. In terms of a behavioral consequence, Maria also shares that she has difficulty concentrating, that she has been absent from work, and that her depression is negatively affecting her job performance.
After assessing emotional and behavioral consequences, the counselor or therapist may want to determine if there are any relevant secondary emotions. At this point, the counselor or therapist may help Maria identify the irrational beliefs she has about being depressed and anxious. Based on Maria's disclosure that she should not feel this way, that she should be able to handle her problems, the counselor or therapist helps Maria dispute her irrational beliefs by asking how it helps her deal with her depression by feeling guilty and challenging her to think about what good it does to put herself down for feeling depressed and anxious. It is hoped that helping Maria see that she is human and that humans sometimes have strong negative reactions to upsetting life events will help her understand that it does no good to put herself down for feeling as she does, and that if she can reduce her guilt, she will have more energy to deal with her depression and anxiety.
After the secondary emotions have been dealt with, the next step is to assess the client's irrational beliefs. The counselor or therapist can do this by asking Maria what thoughts she has when she feels so depressed, anxious, or guilty (it is helpful to take each emotion separately, first working on the one that is most troublesome to her). For example, if Maria identifies depression, she may be thinking that her life will never get better, that there is no use in living, that she is a rotten person because she has created all these problems for her children and family of origin. Next, the counselor or therapist may help Maria see that it is not the events themselves that create her negative feelings and behaviors. For example, the counselor or therapist can ask Maria if she thinks every woman in her situation would feel as depressed and anxious as she does, and if they don't, what might they be thinking? After dealing with this in some detail so that the counselor or therapist is certain that Maria understands the connection between what she is thinking and feeling/behaving, the counselor or therapist may ask Maria if she would like to work on changing her thoughts so that she can feel better. In this manner, the counselor or therapist and Maria establish the therapeutic goal.
Next, the REBT counselor or therapist may use a combination of logical, empirical, and functional disputes (D) to help Maria replace her irrational beliefs with rational alternatives. For example, the counselor or therapist may ask: "Where is the evidence that you have nothing to live for just because things have been difficult for you lately?" "How logical is it for you to assume that you alone have ruined the lives of two families just because you are divorced?" "What sense does it make to think that you are to blame for the disunity in your family?" "How logical is it for you to think that you should have stayed with an abusive husband?" The counselor or therapist will continue to help Maria dispute her irrational beliefs with the goal of helping her adopt a more effective rational philosophy (E) and reduce the intensity of the negative emotions (F), which in turn will help her gain more emotional and behavioral control.
In addition to disputing, the REBT counselor or therapist can help Maria by using a combination of other techniques. For example, they can teach her how to use rational coping self-statements to reduce her guilt. Bibliotherapy can help her learn more about selfforgiveness. And the counselor or therapist can work with Maria to establish a stress management plan that includes exercise and healthy eating.
The counselor or therapist can also help Maria deepen her conviction in rational thinking by having her describe how life could be different if she endorses these new beliefs. Maria is encouraged to practice her new learnings by completing homework assignments, which will be checked each session.
Although REBT counselors or therapists will not deal with a lot of family-of-origin issues, they will help Maria deal with her guilt and self-downing relative to her family's feelings about her decision to marry and her guilt about the divorce. Homework assignments such as writing letters to family members or learning how to communicate with them in a more assertive manner can be helpful.
The goal of counseling or therapy is to help Maria learn more effective ways of thinking, feeling, and behaving that will enable her to deal not only with present problems but also with future issues. The REBT counselor or therapist supports, challenges, educates, and empowers Maria by using a variety of cognitive, emotive, and behavioral strategies.