Rational Emotive Behaviour Therapy In a Nutshell.
Behavioral health care
|Publication:||Name: Existential Analysis Publisher: Society for Existential Analysis Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 Society for Existential Analysis ISSN: 1752-5616|
|Issue:||Date: July, 2010 Source Volume: 21 Source Issue: 2|
|Topic:||Canadian Subject Form: Behaviour therapy; Behavioural medicine|
Rational Emotive Behaviour Therapy In a Nutshell
Michael Neenan and Windy Dryden (2006). London: Sage
The heart has its reasons of which reason knows nothing.
Blaise Pascal (1623-1662).
The book opens with the well-known quote from Epictetus, a much earlier philosophical source than that quoted above: 'People are disturbed not by things but by the view they take of them'.
As agreeable as this latter proposal may be (especially for those of the existential persuasion), it is the only reference to philosophical tenets in the book: in spite of this paucity of allusions, the authors and the founding practitioner Albert Ellis both insist that clients need to take on a 'philosophical' outlook about their distress. It is unclear as to which philosophical school they are referring (one might infer the Stoics).
It is proposed that this statement demonstrates the '... cornerstone' of the REBT (CBT) model: one's current situation is not a product of intrapsychic conflict over unacceptable historical antecedents, but ('largely') a result of one's attitude towards any given experience (one can only speculate as to what reservations are being held here).
Laudable as this statement might seem, a single epithet from a philosopher's oeuvre does not suffice as a description of the human condition.
This text fulfils its stated aim: '... to cover all of the key elements of REBT theory and practice in as few words as possible' (p.1). This is the very reason this reader would recommend it to anyone looking to review or clarify the model in question. The authors use one case example throughout the book to demonstrate the method, which assists in the clear and concise discussion. The language is simple and devoid of psychotherapeutic jargon.
At regular junctures, and in the final bibliography, references are recommended for those who would wish to read further on the subject of the paradigm.
By virtue of these qualities, I think the book would appeal to practitioners and lay people alike: anyone who has an interest in familiarising themselves with the basics of the various CBT approaches now in use.
The 'Counselling in a Nutshell series seeks to ... provide concise introductions to the key elements of theory and practice underpinning major therapeutic approaches. The current portfolio includes psychodynamic counselling and person-centred counselling.
As to the content of the book: Albert Einstein once reportedly commented: 'everything should be made as simple as possible, but no simpler'. The simplicity of the format of this book is not a problem: the simplistic view of (all) the CBT models IS very much a problem.
The CBT approach is woefully reistic: human beings are represented as somewhat mechanistic entities. If their 'faulty thinking' can be corrected, they can enjoy the benefits of a 'rational' perspective that can modify (with a lot of 'trying' and 'hard work') their emotional experience as well as their behaviour (and possibly their 'philosophy'). In this perspective, there is no acknowledgement of the wonderful ambivalences or contradictions that qualify human existence as perceived by other philosophies and psychotherapy models.
Furthermore, some concerns may be raised as to the proposed definitions of what qualifies as 'irrational': there are many religious beliefs, as well as cultural norms, that might fall into this category as it is outlined here. From an existential perspective, there are many aspects with which one might take issue in the CBT paradigm.
It is fundamentally Cartesian: the 'mind', 'inside' the person, is invested with the power (and justification) for ruling the emotions and behaviour of the individual. With respect to this very fallacy, Cohn comments: 'In Western thinking, reason and feelings have been considered predominantly as separate functions ... Heidegger views this as another dualism to be challenged: reason and feelings are both aspects of existence and cannot be separate'" (Cohn, p.61, 2002).
There are further distinctions between existential thinking and the theory of emotions as stated by REBT. According to the Dryden and Neenan text, 'Rational thinking leads to a reduction in the intensity, frequency, and duration of emotional disturbance' (p.7). The 'disturbing' emotions are then categorised as unhealthy or inappropriate.
There is no sign of the appreciation that emotions, as well as perception, cognition, feelings and intuition are disclosive: they reveal to us how we find ourselves in the world. Heidegger discusses this 'attunement', as it is translated, in Being and Time (Heidegger, 1962). This disclosiveness, this attunement, is valuable information in recognising how we are being, how we rare conducting ourselves, how we are with others and how others are with us.
It might be suggested therefore, as does Rollo May (May, 1969), that there are no emotions that are inappropriate, or unhealthy. All emotions are indicative of an aspect of one's world-view, and should be regarded as an inroad to the meaning and value constructions held by the existent. This surely must be the appropriate exploration, well before one even begins to consider changing the emotional response(s).
Innumerable case studies (and personal experience) reveal that people are often ambiguous with reference to what they purport to be a desirable change in their behaviour, thought, emotions and/or experience: 'I want to and I don't' is the frequent report. The enquiry here would probably be with respect to what IS being chosen, and experienced, and what is the possible loss in terms of values (including the value placed on self-concept) that might be incurred if things were to change. This query demands some investigation before the benefits of the intended change are exalted as the 'rational' and solely appropriate basis for the modification. In the REBT model, equivocation on the part of the client, for example, the neglect of homework assignments or a 'relapse' into previous behaviour is seen as a lack of commitment to the work on the client's part. Nowhere in this text is there a consideration of the how the efficacy of the practitioner might be evaluated, and how the incompetence of the therapist might be an impediment to the client in their pursuit of the desired modifications.
Furthermore, in the event of a lack of progress as defined by the model, the client is exhorted to work harder in their efforts at self-indoctrination: there is no query as to why the client might be drawn to former modes of behaviour, especially in light of the notion that their new 'rational' perspectives are providing them with a more satisfactory experience. The existential perspective proposes that all behaviour is purposeful (see the various vignettes in Sartre, 1991): this concept has no currency in the REBT model. If this proposal was recognised, one would be inclined if not obliged to investigate this aspect of the world-view (as one would explore emotional engagement in the manner described previously).
There is one other essential omission in the REBT paradigm that must not escape scrutiny: the co-constructive relationship of Self and Other.
It is understandable that CBT/REBT was popularised by American practitioners: it is very much in keeping with American cultural traditions of individualism (see May et al, 1969). The individual in this milieu is expected to be self-defining and self-sufficient. This perspective is very much in antipathy with the concept of human existence as inter-subjective and contextual.
Dryden and Neenan write in the chapter on 'Regular Psychological Workouts' (post-therapy): ..[a].. client who believes he no longer needs the approval of others and wishes to prove this to himself might seek out situations where he might be criticized ... to keep at bay his approval-seeking tendencies ... ("I don't want or need to be ... told I'm a nice person in order to justify my existence or please others to my own detriment") (p.77).
Such unilateral self-definition is unsupportable in existential thought. Furthermore, the idea of self-sacrifice in order to serve the wants or needs of others is one that is applauded in secular and religious circles alike. In stark contrast to the idea espoused in Dryden and Neenan, Sartre states "... he who sees me causes me to be; I am as he sees me ..." (Sartre, quoted in Friedman, 1991, p.189).
There are innumerable such expositions in the works of existential writers, stating quite clearly the implications for 'being-with' that are fundamental to the process of knowing oneself. It is a concept that cannot rest well with that of a REBT model.
This concept of inter-subjectivity does not, however, suggest that one can be totalised, finally or ultimately known; not by others, not even by one self.
This notion of contextualised existence would extend as well to our assumptions, perceptions, emotions and cognitions: all aspects of human being are thus implicated. As Cohn writes: 'The individual living in a 'with-world' can never be understood in isolation--s/he has to be seen in the context of her/his 'with-being'. As the context is in constant flux, the image of a fixed' internal' psychic structure is a construction' (Cohn, 2002, p. 40).
Finally, the aims of existential psychotherapy and REBT are incompatible: the latter focuses on the alleviation of distress via a form of re-education, and the former model aims for a greater understanding and appreciation of the human predicament, which may result in an understanding of personal suffering, if not a mitigation of the same. The process of existential psychotherapy, by virtue of its premises, requires a dialogical engagement; the treatment program of REBT requires primarily an instructor. This last proposal raises the question: what is it that qualifies a process as psychotherapy, as opposed to 'psychological treatment'?
Cohn, H.W. (2002). Heidegger and the Roots of Existential Therapy. London: Continuum.
Friedman, M. (ed) (1992). The Worlds of Existentialism. New Jersey, London: Humanities Press Intl.
Heidegger, M. (1993). Trans. Macquarrie, J. and Robinson, E. Being and Time. Oxford: Blackwell.
May, R. (1989). Love and Will. NY: Dell Publishing.
May, R. (ed) (1969). Existential Psychology. USA: McGraw-Hill.
Sartre, J.P. (1993). Trans. Barnes, H. Being and Nothingness. London: Routledge.
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