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Rational Emotive Behavior Therapy (REBT / CBT) is a comprehensive approach to psychological treatment that deals not only with the emotional and behavioral aspects of human disturbance, it places a great deal of stress on the thinking component of distress. Human beings are exceptionally complex, and there doesn't seem to be any simple way in which people become "emotionally disturbed," nor is there a single way in which they can be helped to be less-defeating. Our psychological problems arise from misperceptions and mistaken cognitions about what we perceive; from our emotional under reactions or overreactions to normal and unusual stimuli; and from our habitually dysfunctional behavior patterns, which enable us to keep repeating nonadjustive responses even when we “know” that we are behaving poorly or even foolishly.

HEALING BY CHANGING ONE'S LIFE PHILOSOPHY

REBT is based on the assumption that what we label our “emotional” reactions are largely caused by our conscious and unconscious evaluations, interpretations, and philosophies. Thus, we feel anxious or depressed because we strongly convince ourselves that it is terrible when we fail at something or that we can’t stand the pain of being rejected. We feel hostile because we vigorously believe that people who behave unfairly to us absolutely should not act the way they indubitably do, and that it is utterly insufferable when they frustrate us.

Like stoicism, a school of philosophy that existed some two thousand years ago, rational emotive behavior therapy holds that there are virtually no good reasons why human beings have to make themselves very neurotic, no matter what kind of negative stimuli impinge on them. It gives them full leeway to feel strong negative emotions, such as sorrow, regret, displeasure, annoyance, rebellion, and determination to change social conditions. It believes, however, that when they experience certain self-defeating and unhealthy emotions (such as panic, depression, worthlessness, or rage), they are usually adding an unrealistic and illogical hypothesis to their empirically-based view that their own acts or those of others are reprehensible or inefficient and that something would better be done about changing them.

Rational emotive behavior therapists — often within the first session or two of seeing a client — can almost always put their finger on a few central irrational philosophies of life which this client vehemently believes. They can show clients how these ideas inevitably lead to emotional problems and hence to presenting clinical symptoms, can demonstrate ex actly how they forthrightly question and challenge these ideas, and can often induce them to work to uproot them and to replace them with scientifically testable hypotheses about themselves and the world which are not likely to get them into future neurotic difficulties.

12 IRRATIONAL IDEAS THAT CAUSE AND SUSTAIN EMOTIONAL PROBLEMS

Rational Emotive / Cognitive Behavioral Therapy Demonstrates that a Person's Beliefs is the Fundamental Cause of Distress

They are:

1. The idea that it is a dire necessity for adults to be loved by significant others for almost everything they do — instead of their concentrating on their own self-respect, on winning approval for practical purposes, and on loving rather than on being loved.
2. The idea that certain acts are awful or wicked, and that people who perform such acts should be severely damned — instead of the idea that certain acts are self-defeating or antisocial, and that people who perform such acts are behaving stupidly, ignorantly, or neurotically, and would be better helped to change. People’s poor behaviors do not make them rotten individuals.
3. The idea that it is horrible when things are not the way we like them to be — instead of the idea that it is too bad, that we would better try to change or control bad conditions so that they become more satisfactory, and, if that is not possible, we had better temporarily accept and gracefully lump their existence.
4. The idea that human misery is invariably externally caused and is forced on us by outside people and events — instead of the idea that neurosis is largely caused by the view that we take of unfortunate conditions.
5. The idea that if something is or may be dangerous or fearsome we should be terribly upset and endlessly obsess about it — instead of the idea that one would better frankly face it and render it non-dangerous and, when that is not possible, accept the inevitable.
6. The idea that it is easier to avoid than to face life difficulties and self-responsibilities — instead of the idea that the so-called easy way is usually much harder in the long run.
7. The idea that we absolutely need something other or stronger or greater than ourselves on which to rely — instead of the idea that it is better to take the risks of thinking and acting less dependently.
8. The idea that we should be thoroughly competent, intelligent, and achieving in all possible respects — instead of the idea that we would better do rather than always need to do well and accept ourselves as a quite imperfect creature, who has general human limitations and specific fallibilities.
9. The idea that because something once strongly affected our life, it should indefinitely affect it — instead of the idea that we can learn from our past experiences but not be overly-attached to or prejudiced by them.
10. The idea that we must have certain and perfect control over things — instead of the idea that the world is full of probability and chance and that we can still enjoy life despite this.
11. The idea that human happiness can be achieved by inertia and inaction — instead of the idea that we tend to be happiest when we are vitally absorbed in creative pursuits, or when we are devoting ourselves to people or projects outside ourselves.
12. The idea that we have virtually no control over our emotions and that we cannot help feeling disturbed about things — instead of the idea that we have real control over our destructive emotions if we choose to work at changing the musturbatory hypotheses which we often employ to create them.

HOW CBT/REBT DIFFERS FROM OTHER PSYCHOTHERAPY APPROACHES

1. The de-emphasis of early childhood is paramount. While CBT/REBT accepts the fact that dysfunctional emotional states are sometimes originally learned or aggravated by early teaching or irrational beliefs taught during development.  It proposes that these early-acquired irrationalities are not automatically sustained over the years by themselves.  Instead, people must actively and creatively re-instill them t. Consequently the CB/REBT usually spends very little time on the clients’ parents or family upbringing; but is fully able to them to bring about significant changes in their problems with life. The therapist demonstrates that no matter what the clients’ basic irrational philosophy of life, nor when and how they acquired it, they are presently disturbed because they still believe this self-defeating world- and self-view. If they will observe exactly what they are irrationally thinking in the present, and will challenge and question these self-statements they will usually improve significantly.
2. Emphasis on deep philosophical change and scientific thinking. Because of its belief that human neurotic disturbance is largely ideologically or philosophically based, CBT/REBT strives for a thorough-going philosophic reorientation of a people’s outlook on life, rather than for a mere removal of any of their mental or psychosomatic symptoms. It teaches the clients, for ex ample, that human adults do not need to be accepted or loved, even though it is highly desirable that they be. REBT encourages individuals to be healthily sad or regretful when they are rejected, frustrated, or deprived. But it tries to teach them how to overcome feelings of intense hurt, self-deprecation, and depression. As in science, clients are shown how to question the dubious hypotheses that they construct about themselves and others. If they believe (as alas, millions of us do), that they are worthless because they perform certain acts badly, they are not merely taught to ask, “What is really bad about my acts?” and “Where is the evidence that they are wrong or unethical?” More importantly, they are shown how to ask themselves, “Granted that my acts may be mistaken, why am I a totally bad person for performing them? Where is the evidence that I must always be right in order to consider my-self worthy? Assuming that it is preferable for me to act well rather than badly, why do I have to do what is preferable?”
   
   Similarly, when people perceive (let us suppose, correctly) the erroneous and unjust acts of others, and become enraged at these others, they are shown how to stop and ask themselves, “Why is my hypothesis that the people who committed these errors and injustices are no damned good a true hypothesis? Granted that it would be better if they acted more competently or fairly, why should they have to do what would be better?” CBT/
3. CBT/REBT teaches that to be human is to be fallible, and that if we are to get on in life with minimal upset and discomfort, we would better accept this reality — and then unanxiously work hard to become a little less fallible.
4. Use of psychological homework. CBT/ REBT agrees with most Freudian, neo-Freudian, Adlerian, and Jungian schools that acquiring insight, especially so-called emotional insight, into the source of their neurosis is a most important part of people’s corrective teaching. It distinguishes sharply, however, between so-called intellectual and emotional insight, and operationally defines emotional insight as individuals’ knowing or seeing the cause of their problems and working, in a determined and energetic manner, to apply this knowledge to the solution of these problems. The rational emotive behavior therapist helps clients to acknowledge that there is usually no other way for him to get better but by their continually observing, questioning, and challenging their own belief-systems, and by their working and practicing to change their own irrational beliefs by verbal and behavioral counter-propagandizing activity. In REBT, actual homework assignments are frequently agreed upon in individual and group therapy. Assignments may include dating a person whom the client is afraid to ask for a date; looking for a new job; experimentally returning to live with a husband with whom one has previously continually quarrelled; etc. The therapist quite actively tries to encourage clients to undertake such assignments as an integral part of the therapeutic process.
   
   The REBT/CBT practitioner is able to give clients unconditional rather than conditional positive regard because the REBT philosophy holds that no humans are to be damned for anything, no matter how execrable their acts may be. Because of the therapist’s unconditional acceptance of them as a human, and actively teaching clients how to fully accept themselves, clients are able to express their feelings more openly and to stop rating themselves even when they acknowledge the inefficiency or immorality of some of their acts.
   
   In many highly important ways, then, rational emotive behavior therapy utilizes expressive-experimental methods and behavioral techniques. It is not, however, primarily interested in helping people ventilate emotion and feel better, but in showing them how they can truly get better, and lead to happier, non-self-defeating, self-actualized lives.

Approaches to Couples Counseling

One of the most common mistakes of therapists treating couple in crisis is a function of the often exaggerated self-important self-image of many practitioners.  Specifically, some therapists presume that a couple that has had failing communications, deception, romantic or sexual infidelity (to name a few of problems that bring people to couple's counseling) will suddenly sit side by side in front of the all-powerful therapist and the facades, lies, deceptions, miscommunications, et al will come to abrupt halt.  Why on earth should people suddenly come clean and bare their soul in front of some stranger.  Au contraire  (pardon my French) but they will more often redouble their efforts out of shame, fear, or simple recalcitrance.  Imagine how you would feel after you have been withholding from or even deceiving  the person closet to you when you are suddenly confronted by a complete stranger to reveal all.  Tell the truth.... you would tell him to f__k off in eloquent and calm terms but continue the lies and deception.  If you lie to someone you love, or supposedly love but have come to resent, why the hell should you prostrate yourself in front of a stranger with couple of degrees and do an veracity dump??

Dr. Mike Abrams was personally trained by sex therapy founder, Dr. Albert Ellis, in couples therapy and marriage counseling.  His approach is to see each member of the couple separately (while both are present in the office) assuring complete confidentiality for all content conveyed in  the partial-session to each.  Dr. Abrams then formulates -- using the the two perspectives he would now have apprehended -- a model relationship from the participant's points of view.  From this he has a clear idea of the difficulties the relationship faces to survive and the specific actions required of each participant to achieve a working and loving relationship.

He then meets with them together and has each recapitulate that portion of what was disclosed in confidence that he or she is willing to reveal in the presence of his/her partner.  From this point on the couple is asked to view themselves, the partner, and relationship itself in a new light with renewed goals, expectations, and demands.

How to Select a Psychologist, Therapist, or Counselor

In nost major cities there exists an abundance of people seeking to provide you with mental health services.  The first thing to         check for is a license.  This may seem unnecessary but unfortunately there is a significant number of people who are not licensed to provide professional services and circumvent the licensing laws by using terms that do not fall under the license laws, terms like life coach, or professional advisor are among those that are not regulated.  A Google search for licensees in each field should separate this type of wheat from the chaff.  One you have found an individual with a license you will want to ascertain the amount of training or experience they have in the problem you are having.  Have they taken courses?  Have they taught in the field? Have they published in the area? are key questions for determining competence.  Related to the previous, determine what they have done to keep up with the field.  Find out what they do to learn the latest evidenced based treatments.  In general, an educated integrative approach is best.  Here the therapist has developed  some competence in several treatment methods and have specific criteria for selecting the one most appropriate for your problem.  A major and often overlooked requirement of quality healthcare is the measure the therapist uses to support his or her own diagnosis, progress, and hypotheses about you.  You would not see a physician who uses no testing to confirm his/her diagnosis.  Why would you expect less of a therapist?  In fact, some authors have found that therapists that do no have an objective measure of their client's mental status tend to improve minimally with experience.  Finally determine how they bill, how they work with insurance, and how their rates compare with others providing similar services.  The very best people do not necessarily charge the highest fees.     

Irrational Thinking and Sexual Problems

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Half a century ago Albert Ellis noted that a typically intelligent person would often act in ways that seem self-defeating or foolish.  His explanation for this phenomenon became the basis of all psychotherapies that are called any of cognitive behavioral, cognitive, interpersonal, or Rational Emotive.  In contrast to both the psychotherapeutic dogma of his time and his clinical education Ellis came to a novel explanation of emotional dysfunction.  His epiphany was that it was not unconscious forces or conflicts that led to adversities that fall within the realm of mental health.  Based on a pattern observed among clients, he concluded that all dysfunctions that can be ameliorated by psychotherapy are a result of two factors.  The first is a function innate constitutional propensities; the second is the inevitable tendency towards and irrational thinking (ref). Importantly, he observed that people are fully aware of most of their irrational beliefs yet tend to tenaciously maintain them despite their leading to despair and dysfunctional behavior.  These conclusions, the product of his early clinical work, and his work as a sex therapist led in 1953 his break with psychoanalysis. Once this break was complete he commenced calling himself a rational therapist through which he advocated psychological interventions with goal of changing peoples irrational thinking and behavior.

Early in the process of developing an new therapeutic paradigm Ellis also noted that people with sexual and intimacy problems were also victims of the same type of irrational thinking.  Specifically, the preponderance of sexual difficulties were spawned by rigid inflexible thinking, obsessive demands on people – including oneself.  In essence irrational thinking and acting in sexual affairs led to disruptions of relationships, difficulty in achieving stable bonds, and emotional distress in encounters. Sexual intimacy in the best of circumstances can be difficult – especially enduring intimacy. In any cases sexual passion lasts just long enough for copulation, occasionally it endures long enough to wean a child, and in rare and uniquely romantic cases love and sex and remain intimately connected for the lifetime of one of the partners. 

Sadly, the third case is rare. The dismal reality, based on the high rate of divorce and relationship dissolution, is that the transition from romantic love to an enduring conjugal love commonly fails to manifest.  Although, divorce rates remained fairly constant in the last two decades, there has been a trend towards fewer couples marrying.  For example, approximately 85% of people born from 1940 to 1944 were married by the age of 30 in contrast to the 65% of people born from 1970 to 1974.  Estimated divorce and separation rates range from 40% to higher rates as those found by Martin and Bumpass  who concluded that when allowing for underreporting the actual rate is closer to 66%.  Whatever the precise rate of divorce, it likely understates the rate of relationship dissolution, as many relationships fail before marriage is achieved. 

Given high rate of divorce, relationship instability, and the range of negative emotions that arise from disrupted relationships it would seem to beg the question is there evidence that the same type of distorted thinking that is addressed in all modern therapies the foundation of despair in love and intimacy.  This was studied at this center utilizing  two survey's of total of 550 people it was found that those people who most strongly endorsed the irrational beliefs detailed by Ellis had the greatest degree of sexual difficulties. 

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Evolution of Human Sexuality

In 1895 Breuer and Freud published a book titled Studies in Hysteria that paved the way for a century of psychoanalytic explanations of human behavior.  The theme of the explanations is that expressed or repressed sexuality and aggression underlie and direct all human behavior. Indeed, even the most creative acts are viewed as resulting from disguised sexual intentions in the form of sublimation. Although, psychoanalytic theory has largely failed to meet research support , it seems to have stumbled onto a key principle of today’s zeitgeist, evolutionary psychology.  Evolutionary psychology supports the idea that sex does permeate most every aspect of our lives.  A man does not buy the expensive sports car only because he wants to drive fast.  A woman does not dye her hair or buy a snug fitting dress because she wants to look good for herself.  Even someone cramming for college entrance exams might be trying to bring his or her grades up for reasons other than college admissions.  Entrance into a better school leads to increased income and consequently better access to a mate. 

Supporting this perspective, psychologist David Buss theorized that virtually all male violence has a sexual basis.  This point was compellingly detailed by authors Malcolm Potts and Thomas Hayden  who cogently argue that most wars can be traced to innate sexual competition.  This evolutionary perspective of violence is based on both direct and indirect sexual jealousy.  Direct sexual jealousy usually involves a male guarding his mate, whereas indirect jealousy extends to encounters that are tangential to the love relationship.  For example, the rage a man feels when slighted is abstractly sexual, as it may result in his losing prestige or social standing.  Since all men are potential sexual competitors, loss of face typically leads to a diminution in a man’s access to females.  Indeed, many evolutionary psychologists opine that homicidal jealousy is an evolutionary adaption since killing a direct or indirect sexual competitor was an efficient solution during human evolution.  Why not?  There were no jails, lawsuits, or any consequences save for revenge by the slain man’s kin.  Killing one’s sexual competitor smoothed the path towards passing one’s genes to future generations.  In short, evolution may have made it more adaptive to kill than be cuckolded. The need to take an evolutionary view of sex is emphasized by Dobzhansky , who said “nothing in biology makes sense except in the light of evolution.”   By logical extension it follows that nothing in sexuality makes sense except in light of evolution.  Psychologists who attempt to understand and treat couples in distress must at least make an attempt to understand human social behavior in terms of our evolutionary past.

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Understanding Anxiety

Many psychotherapists still treat anxiety based on the theories of a 19th century Vienna physician who along with collaborator Josef Breuer proposed that anxiety arises when unconsciously repressed sexual and aggressive impulses begin to force their way into consciousness.  Despite more than a century of discredit people with anxiety spend hours with therapists who futilely seek to uncover these secret urges as a means to mitigate the anxious anguish of their client.  This is a sad waste of time and money.  Anxiety is a natural adaptive emotion that arises primarily from a brain module called the amygdala.  This part of the brain mediates fear, aggression, and many other survival related affects.  Importantly, in some people it is far more active than in others.  That is, some people feel fear more intensely and pervasively than others.  Indeed, there are a few people who have been documented to never experience fear or anxiety at all.  And sadly, their are others who are plagued with dread or even terror with the most minor or provocations. 

People with anxiety of the kind described above are bi necessarily deficient. Instead they may very well be adapted for dangerous environments in which fearfulness and the associated vigilance would enhance their survival chances.  However, too much of a good (or adaptive) thing can be problematic.  When someone's amygdala interprets too many events as dangers - and these events include the person's own thoughts -- then fear will be handicapping or even disabling.  Such a person needs to first understand the nature of his or her fears, the circumstances in which they become worse and unique way in which they manifest.  Anxiety is not always perceived as dread but can be experienced as dizziness, fatigue, irritability, and a range of other physical expressions.  One reason for this is one of the many connection sites of the amygdala is the insular cortex that can link bodily sensations to emotions.  An understanding of the multifaceted expressions of anxiety can act to reduce the secondary fears that often accompany it.  The sufferer must then learn to identify the triggers of the the anxiety -- and this is often not readily accomplished.. Joseph LeDoux of New York University has experimentally demonstrated that there are at least two fear pathways one largely conscious and the other unconscious.  Consequently, a person can experience fear or anxiety after being exposed to a thing or event that unconsciously represents danger without any awareness of the anxiety trigger.