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Practical Applications of Rational Emotive Therapy
10 CEUs Practical Applications of Rational Emotive Therapy

Section 25
REBT Successes and Failures: Personal Expert Perspectives

Question 25 | Test | Table of Contents | RET CEU Courses
Psychology CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs, Nurse CEUs

Revealed Perspectives: Commonalities and Differences
There is considerable emotional energy found in many of the narratives. These are not the narratives of individuals with very low or flat affect. To the contrary, some of the experts displayed considerable anger and frustration in those areas where they failed to apply REBT to themselves as well as satisfaction and contentment where they succeeded. The experts used many of the same words and phrases common to REBT. They actively talked to themselves both rationally and irrationally. It is interesting that none cited verbatim, or even close to verbatim, the well-known irrational beliefs that are found in most standard counseling theory textbooks. An example is "It is a dire necessity for adult humans to be loved or approved by virtually every significant other person in their community" (Ellis, 1994, p. xx). Rather, the experts, who presumably have been practicing REBT on themselves for many years, have adapted the standard irrational beliefs to fit their own idiosyncratic belief systems or just shortened them for the sake of convenience. Understandably, there were far more shoulds, oughts, musts and have to's in the narratives in which the experts described when they failed to use REBT than in those describing when they succeeded. Rational self-talk was more prevalent in the examples of how the experts succeeded in using REBT--the type of rational self-talk that contributes to positive counseling outcomes.

There are several themes that are found in both the narratives in which the experts succeeded in applying REBT to themselves and those in which they failed. One expert's area of success was often another expert's area of failure. For example, Weinrach succeeded in using REBT to manage his anxiety, whereas Vernon failed to manage hers. Ellis and Wolfe succeeded in using REBT in the area of unconditional other-acceptance, yet Malkinson and Weinrach failed in managing their issues of unconditional self-acceptance. DiGiuseppe cited low frustration tolerance (LFT) as an example of how he succeeded (and also failed), whereas Ellis and Wolfe cited LFT as an area where they both failed. Backx's narrative about how he was successful in applying REBT to himself was not classified because of its general nature. The assignment of narratives into specific themes was not precise because some of the narratives could have been assigned to more than one theme. The classification of narratives by theme was made primarily on the basis of self-talk as opposed to the experts' description of the surrounding circumstances.

Walen, DiGiuseppe, and Dryden (1992) subsumed Ellis's irrational beliefs into four categories, which they referred to as "core irrational beliefs." The categories are "demands, awfulizing, low frustration tolerance, and global evaluations of human worth" (p. 17). This four-category model was applied only to the narratives in which the experts described their failures at applying REBT to themselves. (It was not applied to the narratives wherein the experts succeeded because there was considerably less evidence of irrational thinking in these examples.) Two of the experts (Weinrach and Malkinson) dealt primarily with issues of global evaluations of human worth, and three of the experts (Ellis, DiGiuseppe, and Wolfe) experienced LFT, primarily. MacLaren's narrative about depression was not classified because its origin seems to have fallen primarily outside of REBT's sphere. It serves as a cogent reminder that relying solely on one approach, in this case REBT, may not always be in the client's best interest.

Finally, more than one core irrational belief was found within most of the narratives, which is often the case with clients. For example, Weinrach dealt with both global evaluations of (his) human worth and the demand that his colleague offer greater respect for the importance of his work. Ellis displayed classic LFT and demanded that the airline treat him better. DiGiuseppe experienced LFT (by displaying an intolerance for discomfort) and demanded that he should not have to use an appointment book. Vernon demanded a certainty of the outcome of her husband's surgery as well as "awfulized" about what life would be like for her son if her husband were to die. Wolfe displayed LFF along with global evaluations of human worth of her employees; Malkinson dealt with global evaluation of (her) human worth and demanded that she be treated better.

Successes in Applying REBT
In the following section, the experts provided examples of how they succeeded in applying REBT to themselves.

Anxiety Reduction (Stephen G. Weinrach)
In August of 1998 1 had coronary bypass surgery. It is common for bypass surgery patients to complain more about all of the tubes in their mouth and nose than about pain from the surgery itself. The tubes and oxygen mask are suffocating. Although the surgery went well, there were serious problems with my respiration immediately thereafter. Pulmonary therapists have this funny habit of wanting their patients to breathe on their own, and I was not doing a very good job of it. At one point, my pulmonary therapist, whom I shall call Debbie, after trying to motivate me to breathe more independently, calmly informed me that if my output did not improve significantly within the next hour, she would have no choice but to insert a nasotracheal tube. The tube is inserted in one's nose and wends its way down to one's lungs. Once in place, mucous is suctioned out of the lungs.

I fully understood Debbie's directions about inhaling and exhaling, and I was willing but unable to comply. There was a cognitive disconnect between comprehending and acting. For example, I was unable to imitate someone showing me how to cough. Debbie, in her own charming and nonthreatening way, calmly made it clear to me that I was not following her directions. I fully understood the implications of her threat to insert the tube--something I did not want to take place. I was not particularly frightened that I was not breathing adequately because I was unaware of its serious implications. I was frightened that inserting the tube would be very painful.

As the hour elapsed, I found myself remarkably and uncharacteristically calm about the prospect of the tube being inserted. I was alert enough to talk to myself rationally. I told myself that "I was powerless to change whatever the ultimate outcome was" (tube or no tube) and that "were the tube to be inserted, it would take only a minute or two and that I could stand a lot of pain for that short amount of time. That was the worst thing that could realistically happen." The prospect of dying had never occurred to me. Throughout the hour, Debbie coached and encouraged me to inhale and exhale to no avail. At the appointed hour, she told me to swallow once she got the tube halfway down. I relaxed, swallowed, and the tube was painlessly inserted. I was very excited that I could invoke REBT under the circumstances. Its use helped me handle a situation that I had found very threatening. At the time, I remember being more elated that I could rely on invoking REBT while lying in the cardiothoracic intensive care unit than I was upset with the necessity to insert the tube. I may have forgotten how to breathe, but I did not forget my REBT.

A month after my initial discharge from the hospital I was readmitted for 2 more weeks, during which time I had two additional surgeries and the temporary insertion of a port in my arm so that intravenous antibiotics could be self-administered 3 times a day for the next 45 days at home. For this procedure, I was not sedated and was even more anxious than before, with some justification. Then, every few weeks, I had to have blood tests to determine if the antibiotics were damaging my liver. The blood needed to be drawn from the top of my hands because I had an artery removed from my left arm for the bypass surgery and I had the temporary port in my right arm. These blood tests were far more painful than anything I had experienced previously and at times I would cry afterwards. In all three situations, I was successful in calming myself down to the point where I was merely appropriately apprehensive. I was able to tell myself "I may not like it, but I can stand it. I have stood it before so I know that I can stand it again."

Unconditional Other-Acceptance (Albert Ellis)
I used to be quite angry at people who acted stupidly or immorally and at horrible world conditions. My use of REBT on myself, when I started to apply it to others in January 1955, convinced me that my angry feelings were largely created by my absolutistic demands that people must treat me fairly and considerately and were rotten people when they did not. I taught many of my clients unconditional other-acceptance (UOA), to accept the sinner and not his or her sins, and thereby refuse to feel angry.

I got a good chance to put my unconditional other acceptance into practice in 1993, when I was celebrating my 80th birthday. For several years before that, I had been collaborating on a Dictionary of Sexological Terms with B., with whom I had maintained a close friendship since our college days. I gave him considerable material that I had already gathered for the Dictionary, and he promised to complete it in, at most, a year and by doing so get some credit on his PhD in philology. B. did little work on the Dictionary, kept lying to me and our publisher, and completed the work he had to do on his PhD. The publisher rightly canceled the contract for the book after 3 years of B.'s abysmal procrastination; the Dictionary was never published.

Under ordinary conditions, before I began to use REBT on myself, I would have been incensed for several reasons: (a) B. was slothfully procrastinating, (b) he kept lying about the work he was doing, (c) he had me write a special letter to his Philology Department saying that he was working , hard on the Dictionary, and (d) I had agreed to forgive him $8,000 he owed me when he would finish his work on the Dictionary. But after the publisher canceled our contract, he invented an outrageous lie to the effect that I had forgiven the debt just for his starting to work on the Dictionary. So he canceled the debt.

Instead of making myself incensed at B., I used REBT to make myself feel very displeased with his behavior but not angry with him. How? By telling myself, 'Too bad that B. has lied, cheated, and procrastinated, but that rotten behavior doesn't make him a bad person. "I no longer viewed him as a dose friend but was not angry at him. I invited him to my 80th birthday party in 1993, and we talked in a pleasant manner, reminisced about some of our mutual experiences over the years, and semihumorously mentioned our monetary differences. No, no feelings of anger, rancor, or resentment on my part. Using REBT and its philosophy and practice on myself, I accepted B. with his poor behavior and I rarely think any more of the highly immoral way he treated me.

It should come as no surprise that several experienced REBT experts have both succeeded and failed in applying REBT to themselves. The implication for practitioners who use REBT with their clients and perhaps on themselves, as well, is clear: The successful use of REBT requires considerable and continuous hard work. REBT is not easy. REBT is not applicable to every situation. Nor is it realistic to expect REBT, or any other approach, to work 100% of the time. That said, it has been used successfully in the personal lives of those experts who contributed to this article. It could be argued that in those cases in which the experts failed, it may have been a function of their fallibility as human beings. For example, those who struggle with LFT probably get frustrated trying to reduce their LFT. In the final analysis, Paul (1967) got it right. The ultimate question is, of course, "What treatment, by whom is most effective for this individual with that specific problem under which set of circumstances?" (p. 111).
- Weinrach, Stephen G. et. Al.; Rational Emotive Behavior Therapy Successes and Failures: Eight Personal Perspectives; Journal of Counseling & Development, Summer 2001, Vol. 79, Issue 3.

Personal Reflection Exercise #11
The preceding section contained information about personal expert perspectives on successes and failures with REBT. Write three case study examples regarding how you might use the content of this section in your practice.

What technique did Ellis use to accept the sinner and not his or her sins, and thereby refuse to feel angry? Record the letter of the correct answer the Test.

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