HOWARD YOUNG: RATIONAL THERAPIST Seminal Papers in Rational- Emotive Therapy Edited by Windy Dryden GALE CENTRE PUBLICATIONSPublished by Gale Centre Publications Whitakers Way Loughton, Essex 1G101SQ © Michele Young, 1989. British Library Cataloguing in Publication Data Young, Howard Howard Young: rational therapist: seminal papers in rational - emo- tive therapy. 1. Psychology. Rational - emotive therapy I. Title II. Dryden, Windy 616.89°14 ISBN 1870258 10 X No part of this publication may be used or reproduced in any way with- out the publishers’ written permission, except in the case of brief quo- tations embodied in critical articles or reviews. Printed in Great Britain by BPCC Wheatons Ltd, Exeter CONTENTS PREFACE INTRODUCTION Albert Ellis CHAPTER ONE: Is it RET? CHAPTER TWO: Counseling Strategies With Working Class Adolescents CHAPTER THREE: Practising RET With Lower - Class Clients CHAPTER FOUR: Practising RET With Bible - Belt Christians CHAPTER FIVE: Teaching Rational Self- Value Concepts To Tough Customers page 39 97PREFACE I first encountered Howard Young at the Third National Conference on Rational-Emotive Therapy in New York in June 1980, where I heard him de- liver a paper entitled "Teaching Self-Value Concepts to Difficult Clients". This paper (reprinted in this volume) was full of good clinical sense and was a model of clarity and conciseness. I wrote to Howard soon after for copies of this and his other unpublished papers and was very much struck by his inventiveness as a clinician. On his death, I resolved to bring his papers to a wider readership and this volume represents the best of Howard Young’s work. I wish to thank Michele Young for giving me permission to edit Howard’s papers and to in- clude them in this volume and Albert Ellis for writing the introduction. Windy Dryden, London, September, 1989. INTRODUCTION Albert Ellis Howard Young’s contributions to rational-emotive therapy (RET) are unique and outstanding in several ways but to one of them] particulary respond: He epitomized its scientific outlook. The scientific method, as I view it, has two notable aspects which at first blush may seem somewhat contradictory: First, it starts with a distinct theory (or hypothesis) - and with a theory about its theory (or metatheory). Its metatheory is that none of its theories (or hypotheses) are sacrosanct or inviolable and that all of them are (and preferably should be) sub- ject to revision and possible abandonment. Its theory is that this or that principle seems to explain certain observed situations, so let us state it in precise terms so that we can test our formulation - and in some way render it liable to falsifi- cation (Bartley, 1968; Mahoney, 1976; Popper, 1972). The essence of this first aspect of science is flexibility, lack of dogmatism and anti-absolutism (Ellis, 1983). Second, after setting up precise and falsifiable theories (or hypotheses), science tries to be rigorous about testing these theories, and therefore favours empirical and logical methods of examining and (tentatively) validating or fals- ifying them (Ellis, 1962, 1973; Reigl, 1945, Reichenbach, 1953; Russell, 1961; Wittgenstein, 1958). Science encourages experimentation, measurement, quan- tification, precision and is therefore often accused of being overly restrictive and rigid in its outlook (Ferguson, 1980). This is sometimes true - since science can be turned into scientism (a form of dogmatism) by some of its unwary and fanatical advocates (which merely tends to substantiate the RET hypothesis that humans - yes virtually all of them - easily and naturally are prone to irrational thinking!). According to my views, however, the two seemingly inconsistent aspects of the scientific method - flexible theorizing and rigorous, logico-empirical testing of hypotheses - intrinsically go together and are part and parcel of one process of open-mindedness (which I believe is the essence of scientific thinking). For to keep revising our theories, we require some degree of precision in stating them (Korzybski, 1933); and the best (though perhaps not the only) method we 1have found of testing them is to subject them to empirical and logical analysis (Popper, 1972; Russell, 1961). Otherwise they would tend to remain irrefutable and inviolate. RET particulary embraces the scientific method in several ways: (1) Ittries to set up its theories of human behavior and personality change in precise, te- stable form (2) It encourages controlled studies of its hypotheses to see if they are falsifiable. To date, for example, there have been about 500 published studies checking the main RET hypotheses - that irrational beliefs or cognitions lead to emotional and behavioral disturbances and that changing these beliefs alleviates these disturbances (DiGiuseppe, Miller, and Trexler, 1979; Ellis 1979a). (3) RET sees each therapeutic session as an experiment to test its hy- potheses, to check on the client’s diagnosis, prognosis, and improvement, and to validate or invalidate the therapist’s manner of using rational- emotive ther- apy. (4) RET makes a serious attempt to teach many of its clients how to think scientifically and unabsolutistically, so that in the present and future they will be able to recognise their self-defeating assumptions and use logicol-empirical methods of modifying them (Ellis, 1979b). What has all this to do with Howard Young? A great deal! For Howard, as I could see when I first supervised his therapy in the early 1970s, was a distinct conceptualizer and theoretician, He thought deeply about and quarreled with the psychoanalytic and other theories he had been taught at Smith College School of Social Work and independently arrived at some of the main theories of RET. Once he studied and experimentally used RET, with his clients and in his own personal life, he solidly adopted its theoretical structure and, as far as I know, did not significantly deviate from it for the rest of his life. Thus, as his papers in this book show, he strongly subscribed to these key RET theories: 1. Emotions abet and enhance human existence but had better be clearly differentiated into appropriate (self- preserving) and inappropriate (self-de- feating) feelings. 2. Emotional disturbance (C) doesn’t only stem from activating "traumatic" events (A) in people’s lives but also, and very importantly, from their irrational Beliefs (B) about these events. 3. People with disturbances had better work at changing their beliefs or thinking that largely lead to and perpetuate their disturbed feelings and beha- viors. 4. Once people disturb themselves and develop primary symptoms of anxiety, depression and self-downing, they frequently make themselves anxious about their anxiety, depressed about their depression, and self-downing about their self-downing; and their creation of these secondary symptoms exacerbates their primary disturbances, RET particularly helps them to work against both their secondary and their primary disturbances. 5. People can legitimately and helpfully rate or evaluate their deeds, acts, and traits but they had better forego all forms of self-rating and uncondition- ally accept themselves no matter how badly they behave. 6. People had better be strongly self-interested without being immorally antisocial, revengeful and vindictive. 7. RET practitioners are preferably active-directive, encouraging, open and risk-taking. 8. Elegant rational-emotive therapy teaches clients how to be independent, unabsolutistic thinkers, and to prefer but not to need the approval of others. It often encourages clients to deliberately make themselves uncomfortable before they then become comfortable with and finally often enjoy new behaviors. 9. Both cognitive and behavioral homework assignments are heavily stress- ed and monitored, especially with difficult clients. Inthese and many other ways Howard Young followed the basic principles of RET and thereby based his therapy upon a clearly delineated set of theories (rather than upon random eclecticism). But like all good scientists he contin- ually tested these theories and creatively adapted them to different kinds of clients. Much of his life he worked with lower class individuals, many of whom had their own biased values and customs; and he realistically saw that elegant RET would hardly reach many of them. So instead of abandoning rational- emo- tive philosophies altogether (which a less scientifically- minded therapist might easily have done), he cleverly used them in unique ways that made them quite appropriate for some of these clients. Thus, in reading the chapters in this book, you will find Howard using these fascinating variations of RET.1. He emphasized building a trusting relationship with adolescents before teaching them some of the main RET principles. 2. He specialized in simplifying the RET messages, so that even his toughest clients could understand them. He stressed simple, effective language and often pioneered in the devising of audio- visual aids (Young, 1974; Young & Young, 1978). 3. He taught clients to accept themselves in inelegant, ego - oriented ways when it seemed clear that they would not adopt more elegant RET solutions of unconditional acceptance. 4. He sometimes showed recalcitrant adolescents how to avoid getting into trouble instead of changing their disturbed feelings. 5. He made great use of his authority and reputation as a therapist when this seemed beneficial. 6. He sometimes assigned a problem for clients to work at solving, 7. He emphasized practical problem solving with clients who resisted changing their ideas. 8. He sometimes used clients’ bigotries to help them behave less self-de- featingly and more ethically with others. Some RET purists, in reading the pages of this volume, may cavil at Ho- ward’s use of some "irrational" ideas to help people behave more "rationally." Not me! For I have always held that irrationality mainly consists of thoughts, feelings, and behaviors that sabotage the main interests or values of the individ- ual and of his or her social group (Ellis, 1962, 1971, 1973, 1979b; Ellis & Becker, 1982; Ellis & Harper, 1975). It also consists of unrealistic (antiempirical) be- liefs (e.g., "Ihave a fairy godmother who will help me and protect me") and of illogical ideas (¢.g., "Because I am good at tennis, I am a noble person whom other people should love and for whom they should sacrifice themselves."). Al- though unrealistic beliefs and illogical ideas are often self-defeating and society sabotaging, they aren’t necessarily so; and occasionally, they may lead to more good than harm, Thus, if I believe that I have a fairy godmother who will help and protect me I will probably do little to help myself and will irrationally suf- fer, But I may use this unrealistic belief to give myself false confidence that I can do daring things; may thereby accomplish many projects I wouldn’t other- wise achieve; and may lead a happier life than I otherwise would. RET hypothesizes, then, that many unrealistic or illogical beliefs often or usually are self defeating but that, just because ideas so profoundly affect human behavior, some "crazy" beliefs may help and some "sensible" beliefs may sometimes sabotage happiness. Follow this RET theory, I distinctly endorse some of Howard Young’s use of religious dogmas that I personally consider "irrational" but that, especially when employed with devout religionists, will often do more good than harm. In this regard, I have often used the Christian doctrine of grace to help people unconditionally accept themselves in spite of their poor behavior, and I have advocated this doctrine in my talks and workshops (some of which I gave a de- cade before Howard joined the RET ranks). In its usual form, this doctrine hypothesizes that (1) Jesus exists, (2) that He is a Son of God, (3) that He died to save humans, and (4) that if people accept Jesus and ask forgiveness for even their worst sins, Jesus and God will forgive them and give them grace. As an at- heist, I strongly believe that all these hypotheses are invalid. I therefore show most of my clients that they choose to believe these assumptions and therefore to accept themselves. Since the assumptions are all unprovable (and most prob- ably based on wishful-thinking), they can more elegantly choose to accept themselves directly, without any intervening assumptions, just because they choose to do so. This is a more elegant (and less hypocritical) solution to their problem of self-acceptance, because they then can choose to unconditionally accept themselves whether or not Jesus or God exists and whether or not Jesus or God decides to give them grace. If, however, Lam seeing a highly religious person who won't accept secular humanism, I often do exactly what Howard often did: use their own (unpro- vable and unfalsifiable) assumptions to help them accept themselves. And although I personally dislike this kind of inelegant solution, I quite agree with Howard that many uneducated, religious, and economically deprived clients will not listen to elegant RET formulations and therefore half a therapeutic loaf, with these clients, is better than none. Howard Young had many unusual attributes that enabled him to make dis- tinct contributions to RET. He was exceptionally creative, inventive, and original - as every good scientist, again, had better be. He took the same kindsof risks that he encouraged many clients to take - and thereby often stood up to the disapproval of others. He was exceptionally clear and concrete - and out- lined his methods in such detail that almost any therapist could understand and use them, He pioneered in the educational aspects of therapy in general and of RET in particular and realized that getting across to clients is most important in therapy. He was forceful and energetic, and could be helpfully charismatic with individual clients and with large audiences. He was as enthusiastic and en- couraging as any therapist I have known among the hundreds I have supervised. Asa person, Howard was highly intelligent but hardly your typical "intel- lectual." His wife, Michele, with whom he had a remarkably close and happy relationship, will attest that he was profoundly kind, loving, generous, patient, and unhostile. He noted, in his biographical material in A Rational Counseling Primer (Young, 1974) that RET helped release him "from a generous supply of depression, anger, and self - blame." I am delighted that it did. But, as he so often pointed out to his own clients the Activating Event (A) or RET did not exactly cause the consequence (C) of the happy life he led for the decade be- fore his death. His own beliefs (B) did. Howard was a truly remarkable person with many unique ideas of his own. His untimely death in his late forties is a grave loss to himself, to Michele, to his clients, and to RET. But his works, as nicely epitomized in this book will long be remembered. Read them carefully. ‘They will add to your knowledge and your life. REFERENCES Bartley, W.W. (1968). Theories of demarcation between science and meta- physics, In I. Lakatos & A. Musgrave (Eds.), Problems in the philosophy of science. Amsterdam: North Holland Publishing company. DiGiuseppe, R.A., Miller, NJ., & Trexler, L.D. (1979). A review of rational - emotive psychotherapy outcome studies. In A. Ellis & J.M. Whiteley (Eds.), Theoretical and empirical foundations of rational - emotive therapy (pp. 218 - 235). Monterey, CA: Brooks/Cole. Ellis, A. (1962) Reason and emotion in psychotherapy. New York: Lyle Stuart. Ellis, A. (1971) Growth through reason. North Hollywood, CA: Wilshire Books. Ellis, A. (1973) Humanistic psychotherapy: The rational- emotive approach. New York: McGraw-Hill. Ellis, A. (1979a) Rational-emotive therapy: Research data that support the clinical and personality hypotheses of RET and other modes of cognitive- be- havior therapy. In A. Ellis & J.M. Whiteley (Eds.), Theoretical and empirical foundations of rational- emotive therapy (pp. 101 - 173). Monterey, CA: Brooks/ Cole. Ellis, A. (1979b). The theory of*rational-emotive therapy. In A. Ellis & J.M. Whiteley, (Eds.), Theoretical and empirical foundations of rational- emotive ther- apy (pp. 33-60). Monterey, CA: Brooks/Cole. Ellis, A. (1983). The case against religiosity. New York: Institute for Rational Living. Flllis A., & Becker, I. (1982).-A guide to personal happiness. North Hollywood, CA: Wilshire Books. Ellis A., & Harper, R.A. (1975). new guide to rational living. North Holly- wood, CA: Wilshire Books. Feigl, H. (1945). Operationism and scientific method. Psychological Review, 52, 250-259. Ferguson, M. (1980). The acquarian conspiracy. Los Angeles: Tarcher. Korzybski, A. (1933). Science and sanity. San Francisco: International Society of General Semantics. Mahoney, M. (1976). Scientist as subject. Cambridge, MA: Ballinger. Popper K. (1972). Objective Knowledge. London: Oxford. Reichenbach, H. (1953). The verifiability theory in meaning. In H. Feigl & M. Brodbeck (Eds.), Readings in the philosophy of science. New York: Appleton- Century- Crofts. Russell, B, (1961). The basic writings of Bertrand Russell. New York: Simon and Schuster. Wittgenstein, L. (1958). Philosophical investigations. New York: Macmillan. Young, H. (1974). rational counseling primer. New York: Institute for Rational ving. Young, H., & Young M. (1978). Understanding and overcoming emotional upset. Videocassette and slide carousel. New York: Institute for Rational Liv- ing.CHAPTER 1 IS IT RET? Over the last few years I have heard and read many criticisms of the prin- ciples and philosophies of rational-emotive therapy (RET). Almost invariably these criticisms have proven to be based on misconceptions and Albert Ellis challenged and corrected them - actions one might expect from the founder of RET. Also as one might expect, in spite of Dr. Ellis’s spirited and untiring ef- forts, the misconceptions have continued. As an active advocate of RET in both theory and practice, I have decided to join in countering misconceptions about RET. The inspiration of this deci- sion was a letter that appeared in a recent copy of a popular psychology magazine. An individual wrote to the magazine’s editors, complaining that after brief exposure to RET, he had abandoned the system because it "smacked of complacency, self-centeredness and cop-outs." Since I have dealt with these particular criticisms on more than one occasion, I will share some of the expla- nations I offer to those who honestly believe that RET turns people into emotionless, uncaring robots who feel perfectly justified in exploiting others - without a hint of conscience. THE COMPLACENCY CRITICISM The complacency criticism seems to rest on what many believe is an RET dictum that one’s hardships and adversities should be faced with complete un- concern and indifference. The goal of rational thinking, according to such critics, is to learn to face disappointment, no matter how serious, in such a way that you end up feeling either carefree or calm. If, for example, you catch your spouse in bed with your best friend, or perhaps discover your house has just burned to the ground, you are to shrug off these unfortunate events and go about your business in a matter- of- fact way. As a confirmed RETer, you are to look upon such situations in a thoroughly objective, dispassionate manner. It is no small wonder, therefore, that RET is reputed to produce rational, but emotion- less, robots: people able to feel detached and aloof from any and all of life’s problems. seater cee Is this true? Does RET promote this kind of complacency? Does RET ac- tually teach the client to face problems without emotion? No! Although complacency and emotional indifference might well be preferred modes of be- havior in some circumstances, in most cases RET therapists are working hard to help their clients face and solve their problems in an energetic, emotion-di- rected way. It is true, however, that the RET system places first priority on instructing clients to think about disappointment objectively and sensibly. When clients view their problems in an exaggerated, negative, absolutistic way, they usually feel extremely disturbed. After learning to challenge and correct such thinking patterns (that is, learning to think rationally), they are usually able to overcome or avoid emotional upset. It is here that critics usually misunderstand RET theory. They believe that to overcome or avoid emotional upset means to avoid emotions. In order to cor- rect this misconception, let me approach the subject in the same way that I explain the emotional facts of life to clients. I often ask clients why they have come to see me. Usually they admit they are feeling emotional pain about a particular problem and want relief. I then advise them I can teach them a method of handling their problem so that they will feel unhappy. This generally brings an immediate response such as "Hell, I don’t need you for that! I can feel unhappy on my own.” Another popular reply is "Why should I pay someone good money to help me do what I’m already doing?" Very quickly I contradict such responses, pointing out that feelings of un- happiness are probably not what brings the client to me, but rather feelings of misery and upset. I further explain that there is a considerable difference be- tween the two. Unhappiness usually describes feelings that are unpleasant, but manageable and probably quite appropriate under the circumstances. Emo- tional misery or upset, however, describes feelings that are agonizing and extremely distracting. Such feelings are often beyond the individual’s control and frequently force him or her to behave in self-destructive, undesirable ways. After a few illustrations, clients recognize the difference between feeling un- happy and feeling upset or miserable and readily admit that they are seeking therapy because they feel quite miserable. 9__ After establishing this frame of reference, I ask a series of questions to help clients understand further the kind of emotional help rational thinking can give them. First I ask if they can honestly feel happy about their problem. I’ve yet to meet someone who believes this can be accomplished, Next, I ask if they can feel calm about their problem. Although at first many clients express a desire to feel calm, they usually realize such a feeling would be unlikely under the pres- ent circumstances. Finally, I suggest that they have two choices remaining - two ways they might feel about their problem: unhappy or upset. Most clients will declare that neither is their first choice, but when it comes to deciding between the lesser of the two evils, “unhappy’ is probably the more realistic and appropriate way to feel about their problem. In fact, most clients will admit that feeling merely unhappy would probably be an improvement over the anxiety, depression, or other disturbing feelings they have been experien- cing. Once the client will accept that negative feelings, as opposed to passivity or indifference, will likely result from rational thinking about a disappointment, therapy can begin. : RET, therefore, encourages one to interpret disappointment as a disap- pointment and, usually, to feel appropriately unhappy or displeased. Rational thinking does not change noxious reality; it merely puts it into objective per- spective. When this happens, when one refuses to mentally convert a disappointment into a disaster, the feelings that follow still are negative. Al- though unpleasant, however, such negative feelings will not be so strong or so intense as to be disrupting, overwhelming, or preoccupying. The negative feel- ings that logically follow from reality-based thinking about disappointments would fit the criteria for rational behavior. They do not produce needless suf- fering, nor do they interfere with the kind of problem solving and goal striving bay ee tomaximum happiness or minimum unhappiness (Ellis, 1973; Maults- yy, 1976). If this approach is used, emotional indifference or apathy is unlikely to occur, since such feelings logically follow from the belief that a perceived situ- ation is relatively neutral; that is, without significant positive or negative meaning. Probably the only way one could feel indifferent about a disappoint- ment is to define (or perhaps redefine) the disappointment as a nondisap- pointment - a situation that is neither good nor bad. Once a situation is evalu- ated as a disappointment (a negative evaluation) negative feelings may be expected. The degree or intensity of these negative feelings, of course, depends on the degree or intensity of negative appraisal. 10 When RETers claim that rational thinking avoids emotional upset, there- fore, they do not mean that rational thinking eliminates emotions. The rational evaluation of a disappointment does not wipe out emotions in general or nega- tive emotions in particular (Young, 1975). Clients who are shown how to face unpleasant situations rationally are far from complacent or emotionless. On the contrary, such individuals will still experience emotions, and sometimes these emotions will be quite strong and bothersome. Even though unpleasant, how- ever, such feelings would not be considered upsetting or disturbing; they will not cause or create, accordingly to the individuals experiencing them, extreme or excessive suffering and will not interrupt the individuals’ continued strivings for survival and happiness. What I am discussing has implications beyond proving that RET enhances emotional responsiveness. Another issue is one that is rather unclear and vague in the field of psychological help; namely, how one is supposed to feel after suc- cessful psychotherapy. In other words, what kind of results might one expect from a counseling endeavor? As far as clients are concerned, the results are al- most always centered on feelings. It is feelings, particularly confusing, painful, and otherwise upsetting emotions, that usually bring people to therapy in the first place. Even though most systems of psychotherapy promise that a change in such feelings will occur if their practices are followed, very few therapists make clear exactly what kind of change in feelings might realistically be ex- pected. It is my experience that most clients (and therapists as well) are looking for far more of a change of feelings from therapy than can actually be delivered. I know that when I first became interested in practicing therapy, even up to and including my introduction to RET, I still believed that the therapy ex- perience would solve the riddle of human happiness. To be honest, I think that what first attracted me to RET was certainly not its promise of hard work and effort; somehow I conveniently missed the point. Rather, my faith in RET was placed in what I believed was a simplified, common-sense method of achieving a mental health paradise that would allow for enjoyable disappointments and comfortable suffering. Accordingly to the way I saw it, all you had to do was change your irrational thinking and you would be quickly and easily blessed with a problem-free existence and would live happily ever after. Needless to say, I learned the hard way that probably no system of therapy, regardless of claims, can legitimately deliver an emotional utopia - at least not on this planet. Iwould like to again emphasize that, in my opinion, the actual application of RET theory to a problem situation rarely involves feelings of happiness or 1even indifference. This would be particulary true if the problem constitutes a serious adversity, such as the death of a loved one or the sudden loss of a job. Under such circumstances, RET might help one feel sadness, regret, sorrow, annoyance, and the like. The practice of rational thinking, therefore, offers a method of facing reality that enables individuals to reduce the intensity or de- gree of emotional discomfort - not necessarily to eliminate it. Once an unpleasant emotional state is achieved, the accompanying feelings might help one to take whatever action is necessary to resolve or accept the problem. It is important to realize, in this regard, that achieving a more moderate, though de- cidedly negative, emotional state is not an end in itself. Though the individuals may feel more comfortable, it is expected that their feelings will be strong or bothersome enough to motivate or inspire them toward problem solving and change when appropriate. In other words, the direct application of rational thinking usually involves facing and reacting to disappointment. For the majority of people, this is rare- ly a fun situation. The process is disagreeable to most, requires considerable effort and practice, and likely involves some degree of manageable suffering. As I frequently tell my clients, "RET will help you solve your problems without getting too bent out of shape emotionally. You're still going to get a little bit bent, but not as much!" THE SELF-CENTEREDNESS CRITICISM The self-centeredness criticism exposes what many believe is a critical shortcoming in the RET system: a self-serving morality. It is claimed that RET teaches clients to think of themselves and only of themselves. Critics seize on the words of Albert Ellis (1965, 1969), whose writings clearly suggest that a ra- tional approach to morality would better be based on the ethics of self- interest; that is, consider yourself first. This means, according to many critics, that RET preaches a "me first" morality: you can do your own thing, no matter whom it hurts, and as long as you are making yourself happy, everything is okay. As a result of such ideas, hard-core RETers, therapists and clients alike, are accused of ignoring established ethical standards in favor of their own self- ish desires. If these selfish pleasure-seekers admit to wronging another along the way, they are excused from responsibility because they acted according to. RET scripture: they put themselves first. As long as you are looking out for yourself, critics claim that you have a ready- made RET excuse for exploiting others and that RET promises you a clear conscience. 12 Does RET promote self-centeredness? Is a rational approach to morality mere selfishness? The answer is both "yes" and "no". Yes, RET promotes or, more precisely, accepts self-centeredness as natural in human interaction, but no, RET is not in favor of selfishness. RET, first of all, adopts the position that self-centeredness, whether desir- able or not, is inescapable; it is part of the human condition. Albert Ellis has remarked on many occasions that it seems to be in the nature of humans to think mainly of themselves and to be devoted to their own interest above those of others. There are, according to Ellis, strong innate biological roots to our self- centeredness. It is worth considering, in this regard, that altruism and martyrdom may be more self-serving than they at first appear. The neurotic mother, for example, who presents the picture of gratuitous self-sacrifice, is often behaving in such a manner not so much for the sake of her children, but in order to be able to think of herself as a good mother. Her real consideration is not the best interests of her children, but rather self- glorification. Even the authentic Albert Schweit- zers and Florence Nightingales among us serve others because it is likely, in the final analysis, that their own principles and standards are satisfied by their doing so. Perhaps our presumed nobility in humanitarian pursuits may well be, under objective scrutiny, nothing more nor less than egoism. Although RET accepts such self-centeredness as an unavoidable biologi- cal given, this does not mean that RET at the same time supports or encourages selfishness in interpersonal relationships. This seems to be the point at which critics misinterpret the RET approach to morality and self-interest. Selfishness, one method of expressing self-interest, almost always describes behavior that reflects an exlusive, almost fanatical self-regard, plus a deliberate or intentional disregard for the welfare of others. This approach to self-interest is distinctly different from that proposed by RET. How does RET morality differ from selfishness? First, Ellis does maintain that self-interest practiced along the lines of what he calls moral sanity consists of a primary axiom: To thine own self be true; that is, consider yourself above others. Ellis supports this position by pointing out that considering yourself first is probably the only way you can be sure that at least one person in the world will be truly looking out for your interests. If we lived in an "other- centered" world in which everyone were devoted to the welfare of his or her neighbor, a "me first" morality would be unnecessary. Unfortunately, this is not the case, for as Ellis puts it, "Whether we like it or not, literally millions of people are stupid, 13ignorant, or emotionally disturbed, and definitely could not be relied upon to act charmingly or caringly toward us". Even though both rational self-interest and selfishness put the individual first, the similarity ends there. The basic principle supporting RET morality adds an important dimension: a sincere concern for the welfare of others. This seeming paradox has its logic. By treating others properly, justly, and fairly, we are trying to insure, as far as is humanly possible, that these others will treat us ina like manner. In other words, we behave properly toward others so that we can help create the kind of society that is safe and beneficial for us to live in. The RET approach to morality, therefore, first advises that we strive pri- marily on behalf of our own welfare, but it also recognizes that we almost invariably live in a social group and that many of our satisfactions and annoy- ances are bound up with such group living. It would, therefore, follow that we had better refrain from unduly interfering with the welfare of others so that we will not run into serious social conflict. In the final analysis, then, RET morality is based on the golden rule; we try to do unto others as we would like for them to do unto us. A rational "me first" morality must, in order to be truly rational (i.e. to maximize happiness and minimize unhappiness), include, as a necessary corol- lary consideration of others. The important point here is that you treat others well not primarily for their sake, but for yours. You behave morally or ethically because doing so will likely contribute to your own happiness and satisfaction and not just because fairness, kindness, or cooperation are desirable in and of themselves, When you are good to others, you are, in effect, trying to be good to yourself. What then is rational self-centeredness? Very simply; you consider your- self first and others a close second. You avoid deliberate, direct, or needless harm to others, not for their benefit alone, but because such actions might well bring reprisals that would interfere with your own happiness. The RETer who is attuned to the principles of rational morality, therefore, practices what might accurately be labelled authentic or enlightened altruism: social conduct that demonstrates a genuine concern for the rights and privileges of others but, at the same time, is based on highly rational self-interested motives. I think that even the most adamant critic might agree that such a system of ethics, far from being selfish and socially unjust, is, rather, founded on princi- ples that are quite moral and humane. Specific rules of conduct derived from 14 this approach have been developed, and if you are interested in a more thor- ough exposure to self-interest morality, I suggest you consult the writings of Albert Ellis in this area. It may come as a surprise that a system of psychotherapy proposes and en- dorses a moral philosophy in the first place. Traditionally, psychotherapy has been viewed as a value-free enterprise in which the therapist cured the mind without directly considerably ethical or moral concerns. The implication was that the curative powers of psychotherapy not only relieved the clients’ emo- tional ills but also produced in the client a sense of social responsibility that would lead to law-abiding, morally correct behavior. One might ask, therefore, whether a therapist should discuss right and wrong behavior with a client. Is such discussion not best left to the minister, the attorney, or the philosopher? Although I cannot answer for all systems of psy- chotherapy, I do believe that morality has its place in RET. In fact, I doubt if a competent RET therapist would consider any subject, moral or otherwise, off limits to therapeutic intervention. Even more to the point, however, the main thrust of an RET approach is the questioning of one’s beliefs and values, and as such an analysis would necessarily include and examine those moral princi- ples or standards that scem to contribute to the problem or to its solution. Perhaps an example might better illustrate how the issue of morality could be handled in a counseling endeavor. The case concerns the basic principle of considering oneself first as applied to an overworked middle-aged woman hospitalized for severe depression. Like many of my clients, the woman is a fundamentalist Christian (Young, 1977) who believes that as a woman, she has no choice but to oblige others. In this case, the woman’s grown children make unfair demands on her. They expect her to baby-sit at any time, to allow them to drop in for coffee, to listen to their prob- lems over the phone for hours on end, and to entertain them every Sunday, when they expect to receive a full-course meal without themselves offering any help in the preparation or cleanup. The woman is afraid to say no to her children, because she believes she has to give completely of herself without question, since, accordingly to her, such behavior is mandated by Scripture.Therapist: I fell quite honored to be talking to you, P’ve never met anyone so religious. Client: I’m not that religious. T: You have to be. C: What do you mean? T: You're obviously one of Christ’s disciples - the thirteenth, I guess. C: (She gives me a puzzled look). T: You see, it is my understanding that Christ only expected such extreme self-sacrifice from his disciples. He asked them to give up everything - their jobs, family, money, and to devote themselves entirely to Him. C: Tm not that way. T: You sure are! You devote yourself completely to your family because you believe it’s your Christian duty. You don’t dare tell them no or ask them to leave you alone once in a while, because you believe God says you have to do everything for them. You get no rest, right? C: Well, God comes first, my family second, and me last - it’s in the Bible. T: Yes, that’s what God says to do, but you go to extremes. I agree that you are supposed to worship God first, to take care of your family second, and finally to look after yourself. But you’re only doing the first two. You’re not looking after yourself at all. And do you see what’s happening? You end up in the hospital, where you can’t go to church and where you can’t take care of your family at all. You really can’t take care of God and your family unless you also take care of yourself. This theme was reiterated until the woman realized that she would have to think more of herself and consider her own feelings and desires in order to truly behave in a Christian manner. This is an attempt to foster in the woman rational self-interest so that she would consider herself first and others a close second. It was not put to her in this way, because such a concept may smack of selfish- ness to many Christians. However, by showing her that she would actually be a better self-sacrificer in the long run by considering her own self in the short run, Iwas able to make the message more acceptable. It is important to realize that moral behavior like any other kind of beha- vior, can be subjected to the rules of rational analysis. In other words, RET principles need not be limited merely to helping people overcome their emo- 16 tional or psychological disorders. Such principles can also be used effectively to help people establish a humanistic code of conduct with regard to their treat- ment of others. This does not mean that RET can provide a set of moral standards that would guarantee world harmony and peace on earth. Rather, I am suggesting that RET might offer a more reasonable and practical, though hardly perfect, system of ethics better suited to unavoidable human limitations and inevitable societal change. THE COP-OUT CRITICISM The cop-out criticism is usually directed at the very foundation of RET the- ory: the relationship between cognitions and emotions. According to critics, those that follow the ABC theory of emotional disturbance have a sanctioned excuse to exploit others. You could, for example, take advantage of someone in word or deed and then absolve yourself of any responsibility for this person’s resulting emotional misery by shielding yourself with RET theory: it is not what you do to others, but rather what they think about what you do, their irrational evaluation, that causes their upset. RET, therefore, affords its followers a the- oretical cop- out in social relationship conflicts. You can do whatever you want to others, and if they don’t like it, if they feel disturbed, and if they go and jump offa bridge, you are faultless for their actions. Since, according to the ABC the- ory, their upset and resulting behavior are their own fault, you need not hold yourself accountable and suffer the pangs of guilt. Is this true? Can one treat another harshly or unfairly and, in keeping with the ABC theory of emotional disturbance, legitimately disavow responsibility for the subsequent upset suffered by this other person? Does RET free one of liability, providing a sanctioned cop-out, so to speak, in such circumstances? The answer is no! Although in most forms of emotional upset the finger of re- sponsibility is pointed directly at the sufferer, RET also acknowledges there is, a "responsible contributor" in the majority of interpersonal conflicts. ‘An example of the ABC paradigm as it is applied to interpersonal conflict goes like this: Let’s say a husband criticizes his wife, calling her a "lazy slob" be- cause she failed to make the bed. This criticism, represented by the words "lazy slob" is considered A - the Activating Event. The wife’s response (Iet’s say she feels humiliated and cries) would be labelled C - the Emotional Consequence. 14In typical RET fashion we would then discover what went on in the wife’s thinking process, her B - Belief System, to determine why criticism resulted in feelings of humiliation and in crying. In other words, we would not assume that the criticism caused the upset but rather that the wife’s own peculiar way of thinking about the criticism is what produced her distress. Let’s further assume that her B’s went something like this: "He’s criticizing me. That’s unfair! I had other things to do today, and I had no time to make the bed. Calling me a lazy slob means that he doesn’t love me, and that makes me a worthless, unlovable nobody." We can see why this woman feels the way she does when we discover her private reasoning, and it is this reasoning that RET holds accountable for her upset. You will notice in this example that I am still sticking very carefully to the premise that it is a person’s evaluation of an event (in this case, criticism), rather than the event itself, that creates emotional upset. You might wonder at this point if this isn’t just what the "cop-out" critics are saying: that RET frees one of responsibility in interpersonal conflicts because, according to the ABC way of analyzing things, nothing was done overtly to cause the conflict - the other person’s thinking is at fault. A closer examination of the ABC’s will, however, show that the issue of responsibility is not nearly so one-sided. The ABC paradigm, when used to depict situations in social relationships, represents an interdependent equation: A plus B equals C. A alone does not produce C nor, in such cases, does B alone cause C. In interpersonal conflicts, Bis always dependent on A - what someone else says or does. A plays a "re- sponsible” part in influencing, provoking, triggering, or otherwise activating the kinds of thoughts at B that do produce the upset at C. Put more simply, in in- terpersonal problems A contributes, B evaluates the contribution, and the combination of the two processes produces C, an emotional consequence. A, therefore, plays an integral role in contributing to the emotional upset in social conflict situations. Getting back to the example of the husband who criticized his wife for not making the bed, let’s assume that he came in for a counseling session in what he sang the praises of RET. At one time he felt extremely guilty about criticiz~ ing his wife’s housekeeping standards, because he believed his comments hurt her feelings. Now he claimed that he was free of guilt and, according to him, he owed it all to RET. He’d learned his lesson well: it was his wife’s fault that she 18 became upset. All he had done was to call her a name: it was she who made a big deal out of it - so she deserves her tears and suffering! Such a misapplication of the principles of RET is not unusual in the early stages of counseling. I would probably handle this case by first agreeing with the man that it was his wife’s faulty evaluation and not the name-calling that caused the emotional upset. However, I would likely add, "0.K., your wife is re- sponsible for her emotional distress. However, you are responsible for the name-calling. If you're really a student of the ABC’s, you'd realize that it takes a combination of both your name calling and your wife’s interpretation to pro- duce upset. Your wife did not dream up your comment about her housekeeping standards. You're a contributor, and even though your wife made herself upset, you’re responsible for helping her feel so miserable. She didn’t do it all on her own!" I would then explain further, "If you're of at least average intelligence and have survived in a social world up to this point, you know that when you call someone a name, especially a name that implies discredit, such as "lazy slob", you'lllikely get a negative reaction from most people. It seems that people nor- mally react poorly to disapproval from others, especially from those close to them. Apparently it’s part of our nature to take the opinions of others too seri- ously. In addition, I suspect you know that the particular remark you made is almost always viewed as extremely disparaging by your wife, because practically every other time you called her that name she ended up feeling very upset. In offering more explanation, I would tell the man, "I, therefore, hold you responsible for behaving in an unfair and unnecessary way toward your wife. Even though her upset is her fault, I find you also at fault because you took ad- vantage of both your wife’s human tendency to upset herself when confronted with disapproval and her learned habit to disturb herself over your particular brand of criticism.” Iwould also advise the client, "If you really wanted to point out to your wife that you did not appreciate her bed-making deficiencies, you might have done so without resorting to name- calling. In other words, in the ABC scheme of things, you could have been a better A. This might have helped your wife im- prove her bed-making, Instead, it appears you helped her only to feel quite upset." In the midst of such discussions, clients sometimes add another tactic to avoid responsibility when their actions have influenced others to upset. The hus- 19band in this illustration might inform me that he was more than fair to his wife and actually did try to help her to overcome her distress. After all, he would say, even though he criticized his wife’s bed-making efforts, the minute she looked upset, he explained the ABC’s to help her and made every effort to show her that it was her thinking and not what he said that was the problem. As.is often the case, he might report that his distraught partner acted even more upset after hearing the wisdom of RET theory. The husband is convinced he is off the hook, because even though he sup- plied the criticism, he generously made every effort to straighten things out by thoughtfully providing his wife with RET insights. If his wife refused to listen toreason and wouldn't apply the ABC’s tc her emotional problem, there is noth- ing more he can do, and he might as well wash his hands of the affair. This attempt to evade responsibility by providing therapy is another misuse of the ABC principle common to many beginning RETers. It is something like shooting someone with a gun but claiming innocence in the act because you called for an ambulance. I usually take great pains to show how this is just an- other cop-out, one that provides an excuse rather than a cure. For cases such as the husband in the example I’ve been using, I would also advise that the ABC’s are best used on oneself in these circumstances. In fact, in most interpersonal disagreements, RET works best when you apply it first directly to your own thinking and your own part in the problem. To try as the husband did to help his wife overcome her upset by playing psychologist is usually viewed by the sufferer as adding insult to injury. This kind of help is seen as just another form of criticism and almost always makes mat- ters worse instead of better. I would probably suggest to the husband, after making sure he was aware of his part in the conflict (as contributor to his wife’s upset in the role of both critic and therapist), that the easiest way to get a frying pan over the head is to tell people you’ve just criticized that their emotional upset is entirely their fault and that you are just an innocent by- stander. Of course, if I explained things in this way to the husband, he would prob- ably go right back to feeling guilty. In this case, counseling efforts could be directed toward helping him to overcome his guilt by teaching him to challenge self-blame, rather than to conveniently deny responsibility. The immediate point I would try to make with the critical husband is that the ABC’s are not a tool to be used to avoid one’s own responsibility in inter- personal problem situations. The ABC theory was designed to explain human 20 behavior, particularly behavior of emotionally disturbed individuals. It does not explain away or excuse the mistreatment of others. If anything, the ABC’s clear- ly demonstrate that the responsibility in relationship conflicts is often a two-way street. RET theory, therefore, as applied to interpersonal problems, does not ex- cuse either party from his or her part in the conflict. Granted, RET places considerable responsibility for emotional upset on the thinking of the person suffering the distress, but it also recognizes that another person may well have influenced or contributed to such thinking in the first place. In other words, the ABC principle provides a model in which there is a shared responsibility for the emotional outcome of a relationship disagreement. By using such an ap- proach, both contributor and evaluator can be helped to understand their respective roles in such situations, and, through the use of rational thinking and responsible communication skills, they can usually either eliminate the prob- lem or at least make it less stressful. SUMMARY What then, do confirmed RETers do when they hear that RET promotes complacency, self-centeredness and cop-outs? First, they recognize that these criticisms are obvious misconceptions that usually result from casual acquaint- ance with RET theory and practice. They also realize that a better understanding and true mastery of RET principles would easily show these ob- jections to be false. Would these same RETers feel upset because RET is being unfairly criticized? Hardly! They would look at the criticism, no matter how inaccurate and misleading, as disappointing, but not disastrous; as difficult, but not im- possible, to tolerate; as something they might desire, but not demand, to be different; and finally, they would view the critic as someone who deserves cor- recting, rather than punishing. Would such a rational outlook lead to indifference and passivity on the part of the RETers? On the contrary, such an approach would likely produce ap- propriate emotional irritation which could easily be translated into determined action to straighten out the situation. In other words, the RETers would find the critic’s comments quite bothersome, as opposed to disturbing, and might strongly desire to correct the critic’s misunderstandings and perhaps win the person over to the RET way of doing things. 21Would this be self-centered? After all, trying to win the critic over to RET would be trying to get one’s own way. Yes, the primary motive might well be self-serving, since the RETers would be interested in achieving satisfaction from winning an argument and gaining a convert. However, at the same time, their goal would definitely include helping someone else. The RETers, there- fore, would honestly and unashamedly view their helping behavior as having a strong self-interest motivation, Suppose that the critic, upon hearing the RET facts of life presented in per- suasive and forthright manner, begins to feel intimidated, angry, or otherwise upset. Would the RETers conveniently hide behind theory and excuse them- selves from any part of the critic’s distress? Of course not! Although the RETers would know that it was the critic’s own thinking that was the main source of the upset, they would also recognize that what they said also played a part in the emotional problem. As a result, they would be quite sensitive to the critic’s feel- ings and might show genuine concern and empathy to the critic. They might then try to soften the message in such a way that it would prove more accept- able. In other words, the RETers would not cop out; they would realize their responsibility and make necessary adjustments in their approach to order to help the critic both lessen and gain an appreciation of the principles and prac- tices of RET. REFERENCES Ellis, A. The case for sexual liberty, Vol.1 Tucson: Seymour Press, 1965. ae A. Rationality in sexual morality. The Humanist. September/October, Ellis, A. Healthy and unhealthy aggression. Paper presented before the Ameri- can Psychological Association 8ist Annual Convention, Montreal, August 27,1973. Manlisy, M. Help yourself to happiness. New York: Institute for Rational Liv- ing, 1976. ‘Young, H.S. Rational thinkers and robots. Rational Living, 1975, 10(2), 29 - 31. Young, H.S. RET with Bible-belt Christians. Paper presented at the Second National Conference on Rational-Emotive Therapy, Chicago, June 5, 1977. (re- printed in this volume as chapter 4) CHAPTER 2 COUNSELING STRATEGIES WITH WORKING CLASS ADOLESCENTS Inthis paper, I will be discussing counseling strategies with adolescents who come from working class backgrounds. This category of teenagers include those who possess average or less than average intelligence, read very little (if at all), are school dropouts or terminal high school students, usually obtain employ- ment in the unskilled labor market, come from lower middle- income or welfare-supported families, and are frequently unmotivated for psychotherapy. Most of my suggestions can also be applied, with appropriate modifications, to normal, neurotic, delinquent, or psychotic adolescents. Further information on a behaviorally orientated approach to differential diagnosis is available in Maultsby’s (1975) excellent article. Although I do not deny the existence of such developmental issues as struggles with independence, sex role identity confusion or parental separation problems, I shall not be discussing such general issues in this paper; for I be- lieve that it is not the developmental struggles themselves which are the central issue, but rather the adolescents’ attitudes about these problems which are the main concern, particularly when these attitudes are exaggerated, distorted, and otherwise inaccurate. In more simple terms, the primary problem in adoles- cence is cognitive misconceptions, and the task of therapy is correcting these misconceptions (Young, 1975). With this introduction in mind, let me move directly into specific counsel- ing tactics and strategies. Because adolescents are a difficult client group capable of a wide variety of resistant behaviors, perhaps the most sensible place to start is the establishment of a systematic, well-structured framework. I generally follow these steps: (1) developing a relationship, (2) defining the problem, (3) teaching the principles of rational thinking, (4) encouraging change. 23Ofcourse, one need not necessarily hold to this particular order; itis under- stood that there may be overlapping. For instance, one could be developing a relationship while defining a problem or vice versa. Additionally, the therapist might want to concentrate on one area more than another. Nevertheless, I have found reliance on such a stuctured approach to be extremely productive in maintaining a therapeutic direction with adolescent clients. DEVELOPING A RELATIONSHIP Although the importance of relationship-building is not necessarily em- phasized in RET theory, I view it as a primary consideration in any attempt to practice RET with young people. The average adolescent often approaches counseling, if he approaches it at all, with anxiety, apathy, or defiance. Add this to what appears to be an almost universal distrust in adults, and you have a situ- ation that is hardly conducive to the development of a therapeutic alliance. Itis, therefore, desirable and beneficial when working with an adolescent, to use various expressive techniques that will encourage a trusting, accepting interpersonal relationship. Though I place importance on relationship build- ing, I do not view the relationship as the therapy itself, but rather as the medium in which growth and change can best take place. It is on this point that RET appears to differ from many other systems of psychotherapy. For example, in a recent article (Lechnyr, 1975) student effec- tiveness in clinical training was determined by the therapist’s abilities to establish empathy, warmth, and congruence with their clients. Nowhere in the article was any other goal, such as specific change, suggested. The implication was that students would receive a passing grade and treatment outcome would be positive if, and only if, a proper relationship was established. Relationship development as a goal in and of itself represents gross thera- peutic misdirection. It is a little like a salesman who judges his performances according to how well liked he is by his customers, with little regard to sales out- come. Such a salesman would either be reprimanded by his employer for confusing means with ends, or fired. A therapeutic relationship is no different or no more unique than any other form of human contact which aims at changing people. When we help our clients overcome their problems, we are using the same techniques that have been de- veloped over thousands of years in law, politics, religion, education, commerce and advertising. 24 In more simple terms, the purpose of a therapeutic relationship is to estab- lish a position of authority and influence over a client. If such persuasive powers can be enhanced through empathy, caring, and concern, then we would better take advantage of such techniques. However, at the same time, we would bet- ter realize that a therapeutic relationship is a means toward an end - not an end itself. Here are some techniques and strategies I recommend for developing are- sponsive relationship with adolescents. Allow long periods of uninterrupted listening. This is perhaps a departure from the more active, interventionist approach usually employed in RET. How- ever, I have found that many adolescents have not had the opportunity to talk with an adult without some kind of admonishment or interruption. As a result, I tend to sometimes allow chatting or rapping in the interest of encouraging ease and comfort in the therapeutic situation. Avoid silences. Especially with teenagers, silences are not particularly pro- ductive. With the exception of a client who is collecting his thoughts or pausing to come up with an answer to a question, I make every attempt to keep the con- versation going. I find that most teenagers get very uncomfortable and self- conscious when silences are deliberately allowed to last. Accept their reality perspective regardless of how distorted or limited it may be. If, for example, a young person decides his parents are "always on his back" (even though I know in many cases this is not true), I usually accept his conviction as fact. This is especially important with delinquent or anti- estab- lishment adolescents. Instead of talking the client out of his faulty opinion right away, I allow it and proceed from there. This indicates that I am an ally rather than an opponent and often decreases defensiveness. Discuss openly your own opinions and attitudes. I try to answer all ques- tions casually and directly, including questions about my marriage, sexual attitudes, personal problems, and counseling experiences. I have found that I tend to be asked more personal questions by teenagers, and this is under- standable since many of them are trying to find out what adulthood is all about. ‘They usually do not have this opportunity with other adults, such as parents or teachers, who are often hidden behind moral or idealistic roles. 25ee eae Allow a companion to sit in on the session. Quite often, letting a young per- son bring along a friend seems to relax the situation and pave the way for future Progress. In fact, sometimes I use the companion to make a point or two. On more than one occasion, I have found that the companion picked up the mess- age quite clearly and was able to repeat it back to the primary client, thus facilitating the therapy. I have also used this same approach with good results by allowing a pet to join us for a session or two. I have shared encounters with dogs, hamsters, cats, mice, turtles, birds, and ants (but turned down a pony). Ask questions that can be easily answered. I usually begin the interview with a biographical data sheet. This includes the usual name, age, school, grade, and parents’ occupation type of information. Often the client feels more com- fortable when I begin with questions that can be easily answered. Along the same lines, I will ask questions about their favourite movies, T.V. shows, ham- burger hangouts, friends and enemies. Since parents and teachers often concentrate on what’s wrong with these interests, many young people will open up and talk more easily when I show positive regard for their activities. See the adolescent first. When a teenager is brought in by his parents, and they are registering the complaint and asking for therapy, I very frequently see the teenager first. This can sometimes give the impression I am willing to listen to him and respect his point of view, and helps lessen his concern that I am col- laborating with his parents. Get the parents to make an initial concession. With strict or overprotec- tive parents, I sometimes make an effort to get them to give in on some of their demands. Increasing an allowance, extending curfews, or reducing house or yardwork commitments are good examples. This gives the teenager the idea that I have influence over the parents, a previously unthought of idea, and often paves the way to a more responsive relationship. Make the youngster feel he is special. With certain teenagers I make a de- liberate but prearranged point to forcefully tell my secretary, "Absolutely no phone calls while so-and-so is in my office", or words to that effect. Such a tech- nique, when used appropriately, can go far in encouraging a young client to think what he has to say is very important. Show positive regard for the young person. Although many other variables, both planned and unplanned, could rightfully be included in successful rela- tionship building, it is my opinion that a positive interest in young people is very important in developing a trusting relationship with an adolescent. 26 DEFINING THE PROBLEM With an adult client, "problem defining” might not necessarily receive spe- cial or undue attention. RET is a problem-orientated approach anyway, and most adults are able to focus fairly quickly on what or who is bothering them. I have not found this to be the case with adolescents - especially those who are unmotivated because they have come for counseling against their wishes. It is not unusual to find young clients to be vague, evasive, defensive, or downright defiant when asked why they have come for help. Even after a problem area has been successfully defined, adolescents seem to wander off easily into tangents, get wrapped up in the details of their volatile life experiences, or become lost in meaningless philosophy - of - life excursions. Sometimes I permit such wanderings in the interest of relationship building, but usually I make an effort to encourage young people to become problem focused. Sometimes matters can get complicated. Often the young | client is referred and brought to the counseling session by someone other than himself. The refer- ral source and the young person often see a different problem area. For instance, a parent might see smoking marijuana as a problem; the school might see under- achievement as the problem; and the client might see difficulties with aboy or girl friend as the problem. When confronted with this kind of situation, Imake every effort to get the adolescent’s agreement on exactly what needs at- tention. If this means initially concentrating on a problem unrelated to the serious concerns of others, then I usually proceed with this problem, hoping to get back to the "serious concerns" later. I might again emphasize that it it incredibly easy to get lost with bray Despite what I think is a very admirable ability to "get down to business," Toften find myself lost, wondering how the hell I got into talking about UFO’s, ESP, the SLA, Vietnam, Billy Jack, and a host of other interesting but therapeutically irrelevant subjects. It is for this reason that I find the framework I outlined help- ful in maintaining my own problem- focused direction, and often in the middle of a fascinating discusson of ancient astronauts, I will interject, "Now let’s get back to that history test you are afraid to take." Some of the principles I have found helpful in locating and maintaining a problem-focused direction are: Define the problem. As I mentioned, in many cases young people who come to my attention are initially referred by parents, schools, or police. Usually I have some knowledge of their difficulties beforehand, and a simple statement 27like, "I understand that you are here because you ran away," leads to a lively problem-focused discussion. Give a representative example out of the life of another young person. By discussing a problem of another teenager I’m able to illustrate what I am look- ing for. This not only provides a sense of ‘at least I’m not the only one with problems," but offers a concrete example of the kind of subject matter discussed in counseling. Give a problem example out of your own life. This is especially effective if it deals with criticism, rejection, and failure - all common adolescent over-con- cerns. Not only do such admissions humanize the therapist, they also help the young person discover that such problems are inherent in human living. Encourage a discussion about the problems of other people. With a par- ticularly anxious young person, I sometimes find it helpful to focus on the problems of friends, parents, or anyone else she or he cares to mention. Usually these problems are self-related and at least allow me to maintain a problem- solving direction. Use visual aids. I have found that the most effective tactic with the evasive or "problem-free" young person is to use wall posters that contain all the irra- tional ideas and many of their corollaries. I have the young person look at this list and see if he or she believes any of the ideas. This is a quick way to get a di- agnostic impression of an adolescent’s thinking, and can serve as a stepping stone to identifying a specific problem area. Simplify the definition of a problem. Many times young clients are afraid to reveal a problem because they feel they are supposed to tell their innermost fears, or that anyone with a problem is crazy. In order to overcome this attitude, Treduce a problem to one of three possibilities: not getting your own ‘way, some- one on your back, or any kind of hassle. Since I have yet to meet a teenager who doesn’t complain about such areas, this technique usually gets a problem-fac- ing process started. Discuss bad feelings. I will frequently tell a teenager client that a problem is "feeling bad." Although this is oversimplified, it often serves to encourage talk about emotions, upset, and the like. End the interview. I have found the unmotivated adolescents who have forced to come in against their wishes, that once I feel I have established a posi- tive relationship with them, I can suddenly end the interview by saying, "Well, I 28 guess it’s silly to continue. You don’t have anything I can help you with." Then, with much sorrow and regret, I tell them that although I enjoyed rapping with them, I really have other things to do. In the majority of cases I get about a half- hour of uninterrupted problems. In fact, some of the best problem-defining has taken place on the way to the front door. TEACHING THE PRINCIPLES OF RATIONAL THINKING A primary goal in RET is to help people recognize, challenge, and correct irrational attitudes that can lead to emotional unhappiness and self-defeating behavior. This remains so with the adolescent, but it is, I find, a more arduous task than with the adult. This might be explained by the fact that the average adolescent has just reached (or is still in the process of reaching) mature cognitive development. In other words, adolescents are only beginners when it comes to manipulating thought and applying abstract concepts as principles with which to direct one’s life (Piaget and Inhelder, 1969). It is also probably safe to assume there has been little attention, past or present, to the training or encouragement of the rational capacity toward logical and independent thinking. Thus, although rationality might now be available for service, it lacks adequate training and experience. In my view, the primary role of the therapist in such circumstances is that of a teacher whose goal is to provide the emotional facts of life within a frame- work of reason and common sense. This might, at first, seem like an extremely difficult task, Let me assure you it is! However, I usually get somewhere when L observe the following guidelines: Keep things as simple as possible. Because young people have difficulty with abstract philosophical concepts, I have found that it is wise to simplify, even oversimplify, in the interest of getting a point across. A simple but familiar state- ment such as "sticks and stones will break my bones, but words can never hurt me - unless I believe they can,” or "happenings plus thoughts equal feelings," is an example of this approach. Make liberal use of the A-B-C principle of understanding emotional upset. Luse a poster to illustrate the A-B-C paradigm. The most successful poster de- sign I have used to date is one that begins with a cartoon character who is wakened in the middle of the night by a loud noise. I have a series of posters that show how this noise could produce three separate reactions (calmness, fear, and joy), depending upon three different interpretations of the noise. 29Use visual aids. I have charts, drawings, and posters on the wall of my of- fice. Often these get across a concept that verbal dialogue is unable to clarify. In addition, I have a small black- board that I can hold on my lap. I will write or draw on the blackboard and get various points across in this way. This seems to make a greater impact on an adolescent than a straight talk session. Many times in subsequent interviews they will admit to remembering a point and applying it successfully because it was made more vivid through a visual experience. Keep the instructive experience brief, dramatic, and full of impact. Though RET can be introduced in different ways, | find that a Socratic dialogue is often beyond the grasp of average adolescents. When they cannot answer questions effectively they often begin to feel inferior and tend to become less responsive. Asa result, I find it very effective to stop the interview at a certain point and in- dicate that I would like to teach an idea or two that might be helpful. Thus, I will then take a few minutes out to teach some of the rational-thinking princi- ples, and then refer back to them, occasionally pointing out how to apply these principles as complaints or problems are brought up throughout the rest of the session. Confront and explain the concepts of "should," “awful,” and "can’t stand.” Since most adolescent problems stem from their demandingness and exagger- ation of disappointments, I try to sensitize them to their use of "should," ‘awful’, and "can’t stand." Since understanding these words is a key to understanding rational thinking, I have used a number of techniques to help teenagers grasp their meaning. Some of the best ways I have found to explain the meaning of "should" are : 1. Use "must" or "gotta" in place of "should". Teenagers use the word "should" so frequently and indiscriminately that sometimes just getting them to change the word to "must" gets the imperative quality across. "I should get a A," makes sense to a lot of teenagers, but "I gotta get an A" often encourages them to see the error of believing in absolutes. 2. Change the "should" concept to.a"no right" concept. Another method of get- ting across the absolutistic meaning of "should," especially with angry teenagers, is to change the "he shouldn’t do that" to "he’s got no right to do that." Explain. ing the irrationality of "he’s got no right" is often easier for some teenagers to understand, 30 3. Use the "want-need" concept. Another way of getting teenagers to recognize and challenge their absolutes without using a "should" is to teach them the dif- ference between wanting and needing. I have found that some of the most resistant and stubborn young people, especially those who are engaged in be- havioral excesses, are quite capable of understanding the critical distinction between desires and necessities, and of using this insight productively. 4. Teach that "should" equals "unbreakable law". It is sometimes helpful with young clients who have difficulty understanding the absolutistic meaning of "shoulds” and "musts," to suggest that when they are upset in their tummy, they are making up unbreakable laws in their heads. "Debbie’s Commandments," Tom’s turn to be God," or "Time for Bill to play judge and jury in his head" are examples of this apporoach. Once they understand what it means to be unre- alistically demanding, I proceed to show them there is probably no such thing as unbreakable law that can be applied to human beings. Now let me suggest some ways to get across the concept of "awful" to teenagers. 1. Substitute the words "disaster," "castastrophe," or tragedy" for "awful," "terrible', or "horrible". The words "awful," "terrible," and "horrible" are so much part of the average teenager’s working vocabulary, and have such a variety: of meanings, that I have found it extremely difficult to define these words according to the bad, all bad, and more than all bad | RET model. Instead I will ask an emo- tionally distressed adolescent, "Well, was it a disaster?" This word has a more precise, concrete meaning and can be more easily confuted than "awful." 2. Use the phrase "end of the world" in place of “awful” . Again I find that asking "Would it be the end of the world” usually gets an eye-rolling, "Of course not" from most adolescents, and allows the next question, "Then exactly what would it be?” The answer is almost always in the realm of realistic disadvantage and begins to teach a method of anti-awfulizing. 3. Use the phrase, "A fate worse than death". Once more, by substituting a more meaningful term, I find that adolescents can sometimes begin to understand that the excessive, disturbing feeling in their gut comes from an exaggerated nutty idea in their heads. 4. Ask them, "What's the worst that could really happen?" For anxiety-ridden teenagers, I avoid the word awful by getting them to focus on the most prob- able but worst outcome they can imagine. This forces them to stay away from 31possibilities and concentrate on actualities. In essence, they are learnii with the hassle and not the horror. a ee NeD Se Ask them, "Could it be any worse?" Often they will exaggerate an i a situation totally bad. By encouraging them ees ei oe could make it even worse, they sometimes see it as highly unlikely that any dis- advantage is one hundred per cent bad. Helping teenagers realize that something could be a lot worse often gets them to turn disasters back into dis- appointments. Finally, I will mention a few methods I use to hel Siang val ew Ip teenagers comprehend the "Can’t stand concept. This idea is ubiquitous in adolescent belief systems, but my experience shows that, for some reason, adolescents seem to grasp this concept and understand why it is irrational more quickly than other RET con- cepts. However, when I run into difficulty, I find the following usually gets results: 1. Substitute "unbearable" or "intolerable" for "can’t stand." Often I am able to en- courage a young adolescent to realize how pernicious the "can’t stand” concept is by getting him to realize it means the same as "unbearable." Many teenagers, - hearing it put this way will say, "Well, it’s not that bad. I mean, I can bear it, 2. Ask them if they will curl up and die." Sometimes, asking if a problem is so bad that it will literally cause them to "curl up and die” gets the point across and shows them they are making matters worse than need be. a Substitute "won't" for "can’t." Frequently when I hear the word "can’t" I quick- lysubstitute “won't.” This is an immediate way of showing that it is one’s attitude, which is under the individual's control, and not the situation, that is overwhelm- ing. 4. Explain "difficult" versus "impossible." Often the "can’t stand" concept can be better understood by asking if a particular problem situation is impossible, or Just difficult to tolerate. Even some of the most resistant teenagers can see this point and realize that just because something is a pain in the neck doesn’t + they can’t put up with it. : Gags eats 5. Give three "can’t stand" situations. 1 will sometimes ask, "Suppose you were allowed to eliminate three of the biggest, most unbearable hassles of your life? Which three would you pick?" Often the answer fails to include the present problem and helps demonstrate that the young client can indeed stand the dif- ficulty. Show the client that overcoming emotional upset does not mean eliminat- ing emotions. Teenagers, after hearing a little of the wisdom of RET, often become dismayed because they think rational thinking will convert them into robots or zombies. They are afraid if they learn to overcome emotional dis- tress they will be left without any feelings or emotions. I usually handle this problem in the following ways: 1. Ask them if they know anyone who is without emotions, who never, ‘feelsany- thing. I point out I am not talking about holding feelings inside or pretending not to feel certain emotions, but do they really know someone who literally can- not feel anything inside his gut? I’ve yet to get a yes on this. 2. Use myself as an example. 1 will ask if 1 look like I don’t have any feelings. T point out that I’m a rational thinker a good part of the time, but add a variety of examples of different kinds of emotions I feel. I especially reveal those times I still get myself emotionally upset. 3, Explain that rational thinking helps you get less angry and less worried. Some- times just using the word "less" in front of upsetting feelings helps some teenagers realize that I’m talking about a very reasonable goal. I let them know that the more they work at rational thinking, the less upset they will become; but they will probably never eliminate emotions 4. Explain that bad emotions do not always equal upsetting emotions. Along the same lines, I point out that when a disappointment occurs, rational thinking will probably still produce bad feelings, but not disturbing feelings. With some what brighter youngsters, I usually explain that upsetting feelings produce great pain, may overwhelm one, and lead one into trouble and away from problem solving, I further explain that a bad but appropriate feeling produces tolerable pain, is controllable, and leads one away from trouble and towards the attain- ment of one’s goals and desires.5. Use a visual aid. The best way I have found to teach young clients that over- coming upset does not mean eliminating emotions is to use a feeling continuum. I will draw a vertical line on the blackboard and put "calm" at the bottom and "upset" at the top. In the middle I put annoyance, irritation, or some word de- scribing emotional discomfort. I then tell them the goal of rational thinking is to get to the middle of the line, because this will help them produce manageable emotions that they can use to solve their problem. Make every effort to teach the concept of self- acceptance. Self- accept- ance, as you are probably aware, is unique to RET, and I consider it a concept that is most effective in helping overcoming emotional upset. Unfortunately I find this one of the most difficult ideas to get across to teenagers, and I might add, to working class adults as well (see chapter 5). Some of the explanations I have found successful include the following: 1. Use a visual aid. 1 draw a circle which I label "self." Next I put a series of smaller circles inside the self circle. These represent the traits, characteristics, and performances of the individual client. I pick out the particular trait area that is in question and put in even smaller circles to indicate specifics within that trait area. I use plusses and minuses to show success and failure. From here I try to show that, when one area of one trait goes bad, it does not make the entire circle (self) bad. 2. The flat tire example. Although there are a lot of examples that illustrate the illogic of overgeneralizing from act to personhood, I have found that the flat tire example is the best for teenagers. This is the one where you ask if they would junk the whole car if they found it had a flat tire. They key word seems tobe "junk." Once they pick up on this word-image, I use it when they put them- selves down for mistakes or criticism by saying, "there you go again, junking yourself because you ....” 3. Show that although you are responsible for what you do, you are not the same as what you do. This is sometimes a tricky concept to get adolescents to under- stand. They frequently argue that if they do something bad, they are bad. I use a cow example. If you go around town mooing like a cow, does that make you a cow? [usually get a "no." Then I say, "but you did it, you're the one who is mooing." After a few examples like this they usually get to the point and begin to learn how to separate what they do from who they are. 34 wn “it" rather than "me." Sometimes I get very good results by sugges- Pho tilcaigen when they fail at something or get criticized to forcefully tell themselves. "It’s too bad," rather than the more pernicious T m bad." This simple devices often serves as a shortcut for getting adolescent clients to con- centrate on problem-solving instead of self-rating. 5. Teach the RET pleasure principle. Lately I have been using a technique that has been quite successful in helping young people learn to separate intrinsic value from extrinsic accomplishment. I point out that success and approval are, in the final analysis, nothing more or less than pleasure. Seeking these plea- sures is both sane and rational. However, using these same pleasures as ego boosters or for the sake of self-value is both sane and rational. However, using these same pleasures as ego boosters or for the sake of self-value is both insane and irrational. I use the following example to get the point across: Ifyou gointo an ice cream store, buy an ice cream cone, and eat it, you will feel pleasure. However, you wouldn’t also conclude that because you had this pleasure you can now hold your head up high, you are a good person, and have self-respect. This would be idiotic because all that occurred is that you experienced the plea- sure you desired. I then suggest that the client put the problem in place of Er ice cream. Or I will suggest (when he or she does not get success or approv. I) that an appropriate statement would be: "So, I didn’t get my ice cream cone - too bad!" ENCOURAGING CHANGE It comes as no secret that client change and growth are. dependent ee ively putting knowledge learned in therapy into practice in concrete esite Tinuaticie This requires conscious effort and hard work. Sea: ly, these requirements are not high on the list of adolescent ee ae people are notoriously reluctant to apply themselves to any task that does not promise immediate results. This is understandable, since most Sac have only recently emerged from a well-conditioned period of ae _ pendency and security. Recognizing this as an unfortunate but unavoidable reality is the first step, not only in understanding young people but in recogniz- ing that behavior change may be a slow, frustrating process. i inki inciples on Although some adolescents learn and apply rational thinking princip! their own, “ae do not. As a result, additional efforts are usually necessary to encourage self-benefiting behavioral change. I have found these approaches and techniques helpful in promotion such change: 35Develop an attitude of "total tolerance." The therapist would best view his own "shoulds" and "oughts" and remember realistically that an adolescent does not have to improve, change for the best, or follow a rational constructive life- style. Another important therapist requirement is to avoid exaggerating or “awfulizing" adolescent complaints. Young people are able, seemingly quite easily, to get themselves into the most difficult situations, It is more productive for the adolescent to be able to discuss his harrowing experiences within the confines of a responsive but reality-oriented relationship. Recognize that not all adolescent emotional complaints have a cognitive basis. Adolescence is a period of rapid physiological change that can some- times bring about extreme bodily urges and sensations. Such feelings, if uncomfortable and intense, can be exacerbated by thinking the source is body tissue, and not shoulds, awfuls, and can’t stands. Perhaps the best way to avoid chasing irrelevant emotional complaints is to tell the client that in all likelihood heis suffering from temporary "growing pains," and then to guide him into more appropriate emotional concerns. Write out an A-B-C homework assignment. Although I am frequently suc- cessful in getting adolescents to understand why their thinking is irrational, I findit difficult to get them to practice challenging and correcting their irrational ideation outside the therapy session. The hard work involved in changing cog- nitions usually begins and ends in the office. As a result I try to outline their problems on a blackboard or sheets of paper. Ttry to take them through at least one A-B-C paradigm per session. I also have them take their assignments home with them and refer to them during the week between sessions if the problem comes up again. I have not been particu- larly successful in encouraging adolescents to read the RET literature; no doubt reading and writing assignments are too closely associated with unpleasant school duties. I thus put more effort into the therapy session, and rely less on bibliotherapy, than I would with an adult client. Combine thought change with behavior change. I almost always try, when- ever appropriate, to combine rational thinking with assertive or goal-striving actions. For example, I not only help a shy adolescent boy understand the cog- nitive source of his shyness, but also get him to do something assertive like go toa party, ask a girl out, or maybe say'no" to someone he usually accommodates 36 with a "yes." I found that young people are more likely to accept some of the ideas of rational thinking after they have tested out emotionally provoking ex- periences in social situations. In this regard, it is important to remember that rational thinking is not necessarily an end in itself, but rather a means towards the end of problem solving and goal striving. Tell adolescents what to think. I have found that, despite heroic or some adolescents are simply not going to learn how to "reason things ot Either they lack intelligence or are unwilling to put in the effort. In this case, simply give them the correct sentences to tell themselves. Fon ansianeeed might say, "Next time someone calls you an asshole, tell yourself: "If they i mea finger it doesn’t make me a finger, so why get upset over being called an ass- hole?" Teach the client to use a dictionary. Name-calling is a particular problem with young people. I have suggested that they stop each time they are a a name, and look up the name in a pocket dictionary. If they can prove they are the name, then they can feel miserable. If not, the name-calling proves nothing about them, but might just tell them something about the name-caller. Tell the youngster what to do. Some adolescents do not respond stan to directly change their thinking, no matter what method Luse or how ne e make things, In cases like these I concentrate on telling them howto do Ul Se in such a way they can enjoy themselves and yet keep out of trouble. This coul include such things as how to creatively lie to their parents, how to cheat suc- cesfully in school, and how to handle the police. For instance, I suggested to a teenage girl on parole who consistently broke the rules of parole ie a on the verge of being sent to a correctional school, that she cry in front o ae role officer. Her parole officer did not like the girl because she was defiant. The girl did cry, continued to break the rules, but was not incarcerated pane she gained the good graces of her parole officer, who now thought te a " nally gotten through to the girl. I recognize that when we correct oe avior al the expense of appropriate cognitions, people often change, but for the wrong reasons. Unfortunately, we cannot always obtain the most elegant solution to emotional problems; and very often, especially when counseling teenagers, we would sometimes better take what we can get - as long as it relieves suffering and does not cause further difficulties. I might add that a lot of my RET coun- seling with teenagers follows this philosophy. 37Go for the reduction of behavior rather than its elimination. Sometimes with certain teenagers I am able to modify their behavior by getting them to cut down rather than cut out. In other words, I try to get them to pass just one of four subjects they are failing, or maybe to get them to smoke only outside the home. Sometimes a minor alteration will serve to satisfy parental or school Pressures. (This, of course, will not work with drugs.) Recommend the use of an appointment book. I try to encourage teena- gers to buy an appointment book and get them to organize their time. This includes responsibilities like school work and household duties, and also their recreational activities. Teenagers are notoriously unorganized and forgetful. I have had considerable success with some school underachievers by just getting them to make a list of tests, papers, and other school requirements. Make use of the relationship to encourage change. I find that, at least in- itially, many young people change because they want to please me. This is often enough to keep them working until they can experience the rewards of their own efforts, which replace the relationship as a motivating factor. As I men- tioned earlier, relationship development with adolescents is an integral part of RET and may be the most significant Positive outcome. Although I could list a number of ways to use "friendship power" to encourage change, the most ob- vious is to tell them, "Do it for me!" Use supportive coaching and positive reinforcement. I have found simple encouragement extremely helpful with young people. Counteracting their re- sistance and sense of hopelessness with, "Yes, you can, you just keep trying,” "It will come after a while," and similar behavior-shaping comments can be highly useful. Many adolescents are accustomed to having their faults overemphasized and as a result are quite receptive to positive feedback when appropriate and not overdone. REFERENCES Lechnyr, R. Evaluation of student effectiveness. Social Work, 1975, 20, 148-150. Maultsby, M.C,, Jnr. Rational behavior therapy for acting-out adolescents, Journal of Social Casework, 1975, 56, 35-43. Piaget, J., and Inhelder, B. The psychology of the child. New York: Basic Books, 1969, ‘Young, H. Rational casework with adolescents. Journal of School Social Work, 1975, 1, 15-20. 38 CHAPTER 3 PRACTISING RET WITH LOWER-CLASS CLIENTS would appear that psychotherapy has long been the province of the oat and maa econ classes. According to Halleck Mell the lower-class individual was usually viewed as too impulsive, too eager for a mediate gratification, and too simple- minded for such a pbs endeavor. These shortcomings were assumed to interfere with the kind of in- tense verbal interaction and expansion of awareness that makes psychotherapy a successful enterprise. The same author concludes that, as a result, the ae tal health needs of the lower-class person have been largely rene er, even when helped, such clients tended to be labeled as hopelessly distur ee and their treatment tended to be managed with less prestigious, non-ver! measures such as drug or shock therapies. Despite such pessimism on the part of the mental health establishment os ward the treatment potential of the lower classes, it has been my Seen that such individuals can respond to and benefit from Rational- Emotive TI a. This conclusion results from the application | of a structured system of clinical strategies that follow from the theoretical principles of RET. Itis the purpose of this paper to outline some of the approaches and detail some of the techniques that have enabled me to use this system with lower-class clients who suffer from a wide range of psychological symptoms and disturban- ces. THE LOWER CLASSES Since the ‘lower class’ can conjure a variety of meanings, I would. oe define this social group more precisely. The most widely used ees - determining socioeconomic status in psychotherapy research (Hollings fe and Redlich, 1958) separates the lower classes into two groups, the a # class and the poor, and measures each group according to occupational level, educational background, and family structure. 39The working classes typically are employed in skilled and semi- skilled jobs and belong to unionized trades or industries. Although some fall below the tenth-grade level in education, most have completed high school or technical training. Their family relationships are usually stable though perhaps less so than those of the upper classes. Coal miners, car workers, truckers, carpenters, and the like are most commonly included in this group. The poor are usually involved in those non-unionized, semi- skilled, and unskilled occupations in which irregular employment is common. Education beyond the eighth grade is rare, and family life is marked by frequent separ- ation and divorce. Examples would be individuals who are farm workers, housekeepers, ghetto dwellers, and those supported exclusively by welfare or other marginal subsidy programs. In addition to research findings, actual contacts with the lower classes have revealed other endemic characteristics. The most frequently observed include a tendency on the part of the lower- class individual to adhere to strict or ex- tremist religious views; to use alcohol (especially among males) as an exclusive leisure or recreational activity; to express anger and Tage spontaneously; to re- sort to physical punishment or combat to resolve conflicts; and to follow rigid sex-role stereotypes in interpersonal relationships. ‘The following examples are typical illustrations of the kinds of individuals that might be labeled lower class: The first is a 33-year-old man who sought therapy for periods of panic, as he called them. He is a high school graduate with some technical school train- ing and is employed as an air conditioner repairman. He has a family of four, including his wife and two young daughters whom he vows will remain virgins until the day they marry. In a recent argument with a neighbor, he used a loaded gun to get his point across. His goal is to make just enough money so that he can retire amd move his family to a cabin deep in the woods, far away from hip- pies, atheists, and homosexuals. His weekends are often spent hunting and fishing with close friends, but he actually uses these occasions as an excuse to drink all day and night. He calls himself a redneck hillbilly and says he is proud of it. The second example is that of a 26-year-old mother of six children who is supported by welfare assistance. She can neither read nor write. She lives in a three bedroom trailer which is her third home. Her first was destroyed by a flood and her second by a series of shotgun blasts from irate neighbors. who claimed this woman had stolen one of the children’s bicycles. The husband in this situation claims to suffer from a bad back. He does not receive disability compensation because doctors do not believe there is anything wrong with him. He physically and verbally abuses his wife, but she is a fundamentalist Christian and was told by her minister that her husband is a cross she must bear. She firm- lybelieves that the more she suffers in this world, the greater will be her reward in the next. She requested therapy for severe depression. THE STRUCTURED APPROACH Having introduced the clients, I would like now to move on to the method, that is, the procedures I have found most effective in applying RET to such in- dividuals. Of primary concern is the realization that RET can be practised in a variety of ways. Although basically a cognitive-semantic theory of psychother- apy, RET is multidimensional in application and approach. The creative RET therapist, therefore, can make liberal and appropriate use of empathy, imagery, role-playing, emotional ventilation, operant conditioning, assertiveness train- ing, and other well-established clinical procedures and can consider them an integral part of the total treatment program. Recognizing that RET can be put into practice ina broad spectrum fashion is of particular value if a therapist is attempting to work with the lower classes. Individuals of these strata have been described as the most psychiatrically im- paired segment of society (Srole et al., 1962) and often prove extremely difficult to engage and sustain in a therapeutic process. Under these circumstances, an approach is required which will allow for flexibility and diversity while, at the same time, staying within the bounds of a structured, well-directed plan of ac- tion. After considerable trial and error, I have developed such an approach, which focuses attention on what I have found to be the most relevant areas of clinical concern with the lower-class client. This framework includes (1) develo- ping a relationship, (2) defining a problem, (3) solving the problem, and (4) encouraging change. 4These approaches are interdependent and interactive and each is directed toward a particular goal and follows a specialized set of clinical strategies. The remainder of this paper will be devoted to discussing the methods and tech- niques involved. DEVELOPING A RELATIONSHIP It is my opinion that the purpose of relationship developement in RET is to establish the therapist in a position of power and influence over the client. Once such a position has been achieved, the therapist can encourage or per- suade the client to change his behavior. Put another way, the role of the therapist is that of manipulator, and he uses the interpersonal relationship to maneuver the client to act in positive and beneficial ways. Some clinicians may feel uncomfortable about being identified as manipu- lators. They prefer to view their client contacts in more benign and egalitarian terms. However, I agree strongly with Gillis (1974), who claims that nearly all therapists, whether they want to admit it or not, engage in tactics and strategies that add to their power and influence over their clients. Gillis points out that no matter how benevolent or non-directive one’s approach may be, a situation in which one person is allowed to comment on the performance of another pres- umes a position of control. It is quite possible, therefore, that the relationship concept so revered in psychotherapy is not, in actual practice, the esoteric sacred entity that some be- lieve itto be. It is more likely that the partnership that exists between therapist and client is no more unique or different than any other kind of social interac- tion in which one party is influenced to undergo change. When we help our clients, therefore, we are using the same tactics that have been developed over thousands of years in business, law, politics, religion, and advertising. The techniques used to obtain such relationship power may be classified as two main approaches: those aimed at developing command and those aimed at developing friendship. __Command power results when the therapist gains ascendancy in the rela- tionship through the use of authority, expertise, and prestige (importance). The client accepts the therapist’s insights, and he changes because he believes the 42 therapist is an expert and knows what is best. The client is influenced by com- petency and credibility. As you are aware, people will perform previously unthinkable acts if they are ordered to do so by respected authorities. Friendship power, onthe other hand, results when the therapist gains lever- age over the client through the use of non-possessive warmth, positive regard, amd empathy. The client is influenced by trust and kindness. He accepts the therapist’s interpretations, and he changes because he likes the therapist and values the relationship. Your own observations show that people will go to ex- tremes to do things to please someone whose friendship they esteem and want to keep. Although the use of friendship power is probably more popular among therapists, it has been my experience that command power is the more effec- tive method of relationship manipulation with the lower classes. Such clients tend to be uneasy with and wary of an egalitarian approach because they do not consider themselves the equals of the therapist. Lower-class clients expect the therapist to be an authority and to act like one. There is a high expectation that the therapist be someone who knows what he is doing and is sure of himself. It is important, however, that an authoritative role not be confused with an authoritarian role. The therapist presents himself as forceful but not demand- ing and directive but not dictatorial. Although I am recommending that the therapist establish a position of command with the lower-class client, I am not suggesting that the position be carried to extremes, such as conveying the im- pression of omnipotence and God-like domination. In other words, I am advocating that the therapist maintain a strong position of leadership in the re- lationship while at the same time remaining empathetic and responsive. There are a number of techniques that can be used to accomplish this end. Command power, for example, may be attained in the following ways: Use a loud voice. One of the most effective ways to gain attention and respect of the lower-class client is through the use of aloud, forceful voice. The lowered or soft voice, although helpful at certain times, is usually non-productive when used on a regular basis to establish authoritative influence over such clients. hese individuals tend to lack faith in someone who presumes to be an authority yet sounds unsure of himself. They usually expect an authority to speak in a forthright powerful, loud-sounding manner. I am not suggesting the therapist 43yell at the client, but the volume of the voice should be of sufficient intensity and the tone of sufficient quality that the client will listen and, more important, believe what is being said. By modulating one’s voice and emphasizing certain points with increased or decreased volume, the therapist can lend authority to his interpretations and insights. The loud, forceful voice connotes a very im- Portant message to the lower-class client: I am an expert and I am sure of myself. Use commanding gestures. Another effective way to imply you are an authority is to use commanding gestures during the counseling session to indicate that you are boss. Gestures such as pointing your finger or clenching your fists are effective as long as they are done to imply assurance and not to intimidate the client. For example, while making a point you could hit the desk a few times for emphasis. Such a move would lend drama and impact to your message because only someone that really knows what he is doing usually acts in this manner. Another method that is especially effective when leading groups is to forcefully underline a point made in writing or to tap loudly on a blackboard to. emphasize a particular idea or insight. There are, of course, a number of gestures or even postures that imply command and authority, and I suggest that the therapist capitalize on them to convey to the client the distinct impression that he is indeed a person who is in charge of things. Touch the client. Along the same lines, another useful way to gain the upper hand in the relationship is to touch clients in some kind of forceful, determined way. I realize that touching usually suggests some kind of intimacy, but this is not what I am referring to here. What I have in mind, for example, is making a Point while at the same time vigorously tapping the client’s shoe or maybe reaching over and tightly grabbing a bicep muscle. Such a move is not intended to encourage closeness but to underscore a message in a dramatic way. [believe there is some evidence that touching is a sign of domination, that the "toucher" is the superior and the "touche", the subordinate. My experience seems to suggest that, when done appropriately, touching increases the therapist’s authority and influence over the client. Of course, itis important that judgment be exercised and the frequency of such behavior as well as the sex, age of the client, and the area touched, be taken into consideration. Establish and exploit a reputation. In addition to using loudness, gesturing, and touching to assert influence over a client, I would also suggest that the therapist deliberately define himself as an expert. Such a maneuver can often go far in giving the therapist powerful advantage with the client. Probably the 44 most common ploy in this regard is a display of diplomas and certificates that attest to one’s training and competency. It is, for example, very impressive if you have the title "doctor" before your name. I see many lower-class clients he think I am a doctor because they first come in contact with me in a doctor’s office. I rarely correct this misconception initially, since it often serves the purpose of convincing them that I am an expert. Other tactics that can enhance the therapist’s reputation as an expert in- clude talking to the public on mental health subjects, writing articles for the local newspaper and appearing on radio and television. | appear ona television show monthly, and this has greatly enhanced my reputation as an authority with many clients and would be clients. Along the same lines, I suggest authoring a brief pamphlet or audio-tape about some mental health subject. Such an gael need not be a great work of literature or published commercially, but it shoul be given to the client as one means of establishing your expertise. Tan constant- ly amazed at the influence of A Rational Counseling Primer (Young, 1974) in establishing my credibility with clients. In my opinion, this booklet is as effec- tive in earning me a reputation as an expert as it has been effective in teaching some of the basic principles of RET. I realize that some of these approaches may not be feasible for all of you, so let me mention one sure-fire tactic for establishing yourself as a knowled- geable authority. Simply announce in a firm, loud, self-assured voice that you are indeed an expert, and you get results. I clearly state that not only do I know what I am doing, but I am good at it. I have yet to be challenged on this state- ment, and it often has a profound effect on some clients. For example, I will deliberately tell a client that I teach in a university, publish papers in profes- sional journals, and appear on television. In other words, I advertise my achievements and give myself credit for being an expert, Clients usually respond to such a forthright approach by allowing me to say things and suggest changes in their lives that would probably not be allowed to someone of. lesser stature and importance. This kind of power is extremely useful in a learning situation where there is considerable resistance to change. superior wisdom and knowledge. Another way to attain interpersonal pine i display superior wisdom and knowledge. The therapist can accomplish this end through the use of powerful ‘common sense’ arguments, esoteric interpretations, psychological jargon, diagnostic labels, and the Be ‘Throwing in some research findings on the topic under consideration can also 45help the therapist to boost the client’s confidence in the therapist’s intellectual abilities. Lower-class individuals are often impressed with such tactics and tend to view their therapist as someone who possesses profound wisdom. This same goal is often achieved when the therapist directly relates to the client the ideational source of his disturbance. Since the monitoring of one’s own thought processes is new to most lower-class clients, they are often unable to state readily the ideas that are causing their emotional problems. When this is done easily and effortlessly by the therapist, it can have a striking effect on the client. Such a maneuver often encourages respect and admiration for the therapist as a person of extraordinary knowledge. It is my opinion that it is not just the insights that are presented but the way in which the client views the pres- enter that plays a major role in the therapeutic change process. 1 will now comment on some of the techniques that can be used to gain friendship power. Acknowledge reality constraints. A first step in promoting oneself with lower-class clients as an understanding caring person is for the therapist to become keenly aware of the reality constraints with which many of these people must deal. The therapist who demonstrates an understanding of authentic environmental pressures will go far in establishing a responsive empathic relationship. For example, ignoring the reality demands of an eviction notice and showing more eagerness to examine underlying or more dynamic issues not only impairs the relationship but probably the course of therapy itself. Substantial efforts, therefore, would best be directed to exploring fully the current life situation of the client and, where appropriate, to demonstrating genuine interest and concern in reality-based pressures, Tolerate value differences. Another requirement in establishing a friendship bond in the relationship involves careful attention to value differences.Often the basic values of the therapist and lower- class client will be different and in conflict. Under such circumstances, it is of paramount importance that the therapist maintain a non-judgmental, objective attitude toward the client’s value orientation. The client who beats his children and steals from his employer, for example, may be acting according to established cultural norms and not necessarily demonstrating psychopathology. What the therapist assumes to be deviant behavior may well represent an ingrained way of life acceptable within 46 a lower-class context. I strongly suggest, therefore, that the therapist become well acquainted with the lower-class client’s convictions regarding child-rearing, religion, marriage, and the like. Even more important, I suggest that an understanding and acceptance of such values be communicated to the client. Demonstrate unconditional positive regard. Closely related to accepting value differences as a method of gaining likableness, is to convince the client that the therapist accepts him unconditionally. This is usually accomplished by maintaining an understanding facial expression and commenting in a non-judg- mental manner when a client mentions objectional behavior. However, since RET is a confronting, directive type of therapy, clients sometimes gather the impression that the therapist is attacking or disapproving of them as people. In order to get the point across that itis behavior or ideas that are under scrutiny and not the whole person, I usually tell the client the following: ' ‘You and ag going to get together and form a partnership. This partnership is going to hel Pp you to solve your problems, Sometimes we’re going to have to get tough with your ideas and some of the things you do, but no matter what we find wrong, it will still be a partnership." In other words, I try to show him we are going to join forces against ’it’ and not against him. Understand language differences. Another good method for establishing F trusting relationship with the lower-class client is to gain an Saas ef language differences. Many lower-class clients, especially those from eae ghetto areas, tend to rely heavily on conversational idioms and regionalize jargon to express themselves. It is wise for the therapist to be alert for these language differences, to learn their meaning, and to use them in the tare interchange. Such efforts often improve understanding and communications by helping resistant or threatened clients to identify with the therapist. Closely related to the use of words familiar to the client is avoiding bea of words or expressions that are taboo to lower- class clients. For eats abe cannot think of the last time I used the word "fuck" with lower-class adults. "Shit is close behind, and I once used the word "ass" and a client walked out on me. Some words possess extremely negative connotations to many lower-class clients, and they will not tolerate their use. In order to enhance Sonnac and facilitate a responsive relationship, therefore, Thave learned to avoid the use of words that are objectionable to lower-class clients. 47Flatter the client, It is hard to imagine a technique more powerful in estab- lishing interpersonal power than flattery. I am not referring to positive reinforcement for improved or corrected behavior but to the actual compli- menting of the client in some way. For example, you might notice and comment favourably on a new hairdo, a new pair of shoes, and the like. However, the most effective method of flattery use with lower- class clients isto stress similarities between myself and the client. This is especially produc- tive when such similarities are personal shortcomings or faults. By my admitting that I not only have problems but that these problems are sometimes no differ- ent from his, the client often sees me as more approachable and feels more comfortable in my presence. Remember, there is a tendency on the part of clients to see their therapists as gods, as being far above the ordinary problems suffered by mere mortals like themselves. When it seems advisable, I destroy this myth by telling the client how upset I felt when my tire went flat on a high- way or how I slipped and fell while carrying out the garbage the night before. With other clients I might flatter them by telling them that I enjoy spending the session with them, that they seem to have a pretty good way of handling their problems. As long as the remarks are sincere and reflect an honest appraisal of the client’s behavior, they are usually effective. Write letters. A technique that is very effective in giving clients the impression that the therapist is a caring person is to write letters to them. For example, when a client misses an appointment, I will sometimes drop him a self-typed letter with a brief personal comment and a time for his next appointment, I believe I once read of a study that indicated that the files of successful therapists contained many such letters. Occasionally the therapist could send a card or some other kind of rememberance and accomplish the same purpose. This need only be done once in a great while, but the personal touch often gives the client the idea that the therapist is an understanding person who puts a little effort into remembering him. PROBLEM DEFINING The purpose of problem defining in RET is to obtain a diagnostic assess- ment of the client’s reality-based and psychologically induced complaints, This procedure helps the therapist and the client gain mutual understanding and 48 agreement about the problems to be discussed and resolved in the corrective process. this might seem an obvious step regardless of socioeconomic seengurneae eal emphasis in work with the lower classes. Such in- dividuals tend to be quite unsophisticated about the kind of problems suited to verbal therapy. It is not unusual for the lower-class client to request and ce demand services beyond the scope of a therapy endeavor. A young mother, for example, insisted that I spank her child because he was using ‘bathroom cuss words." She was convinced that this was my job for, as she put it, "If you don’t punish children, then how can you be of help?" Because, like this mother, many lower-class clients are often ignorant ao what takes place in therapy, it is advised that the client be offered some ae preliminary instruction about how therapy can work for him. Such an orienta- tion will help prevent misunderstanding and future disappointment. ue a my opinion that the closer therapy approximates what the client expects = pen in the experience, the more likely ts that the client will remain in treatment and the greater will be the chance of a positive outcome. Once the therapist is satisfied that the client has a general idea about Soe takes place in a therapy encounter, he can then proceed with an Soe 3 the kind of problem situation that will require such assistance. I ein aa a8 is best approached with the lower-class client bya diligent analysis of the pr : lem situation as a whole, in its broad aspects. I do not limit ‘this exploration 10 irrational thinking but expand it to an investigation of the client's environmen tal circumstances, the client’s value system, and, of course, the client’ Bh a and disturbances. In other words, I am interested ina thorough Pee ol the entire A-B-C spectrum and any additional information that appears is = to contribute to the problem or, even more important, to the solution of the problem. rapists might feel impatient with such an approach. They oes aati! fh first rafal " or "should" the client utters, ces that they have located and zeroed in on the core problems: the client? 's exagger- ated, absolutistic thinking. Although perhaps quite dramatic and certainly accurate from a theoretical point of view, such an approach might prove pre- mature and counterproductive with many lower-class clients. 49It has been my experience that lower-class clients disturb themselves with the same irrational thought patterns as does any other class of people. How- ever, the confronting and confuting of these attitudes usually requires a more extensive understanding of the client, his values, his cultural and familiar back- ground, resources available to him, and so on. Without such knowledge even the most brilliant insights will have little value in helping the lower-class client come to grips with his disturbances. I might add that problem defining is not limited to the first session but is applied to subsequent, on-going sessions as well. The therapist is urged to make each session with the lower-class client a problem-facing endeavor. Otherwise even though the session may have cathartic value and may help the client feel better, itis unlikely the session will encourage behavior change and actually help the client get better (Ellis, 1972). Problem defining with the lower-classes, therefore, usually follows a course of action which includes: (1) teaching the client the ground rules of psychother- apy, (2) helping the client identify a problem arca suitable to such assistance, and (3) obtaining the necessary details in order to prepare the problem for ther. apeutic intervention. These goals can be achieved in a number of ways. Use a biographical data sheet. One of the most effective and relatively simple ways to gain an idea of how much the client knows about psychotherapy is to have him fill out a brief, one-page, biographical data sheet. This includes the usual name, age, address kind of information, but has, as the last item, a few lines for the client touse to state the problem that brings him to therapy. I usually begin an interview with this questionnaire and use it primarily as an apportunity to explore the lower-class client’s understanding of therapy. This kind of approach usually provides a very good idea about what the client views as appropriate for counseling assistance. Ask the client what he expects from therapy. Another way to learn how much the client knows about therapy is to ask him what he expects from such an endeavor and in what way he believes counseling might help him, I am not asking what kind of problem the client sees as requiring help but rather what kind of help he thinks he can get. Often this can be quite revealing. I have had answers ranging from a prescription for nerve pills to the removal of warts. This approach usually lends itself to an understanding of the client’s misconceptions 50 and often gives a good indication of how much education the client will require before problem defining and problem solving can begin. Offer an example. When it is determined that the client does indeed require instruction about the therapeutic process, I have found the best tactic is to offer an example. This is especially effective if the example uses the life of another client. For example, I might say, "Yesterday, a woman came in to sceme borane she felt depressed - as if life no longer mattered. It seems all her cl ere ae grown, her husband works all the time, and she no longer feels me ied. ’m helping her figure out how to cope with the situation. Uenallys bee a whee and try to tailor the example to what I believe the client's own problem mig! be. Advise the client that therapy is primarily a thinking endeavor. oe ie 3 to help the client understand the ways and means of therapy is to a jain rte therapy helps you by showing you how to think differently. I tell the client ¢ a counseling teaches one to look at problems in another light. This is an a ly important concept for lower-class clients to understand, as they ee id want to forget or ignore their problems. I therefore emphasize one ie is : not to forget or try to get a problem out of one’s mind but rather to learn hoy to think about the problem in a different, more sensible way. Use a client-understood analogy. Another method I find helpful in raat to the client what takes place in therapy is to offer an analogy with which he es readily identify. Since , for example, many of. my clients are or ina housewives, I will frequently use a cooking illustration. I point out tha : particular cake recipe is followed and the cake turns out badly, then no bee . how many times that recipe is used, the same poor results will still be pro< wes This is because, I point out, the recipe is no good. However, the ae is di cs if a new recipe is tried, the result might be a delicious cake. Therapy, I a ~ the client, is like learning and using that new recipe-learning as a new way handle problems. client understand what therapy cannot provide. An important part of Eee the client to therapy is to tell him directly not only en a help him but also how therapy cannot help him. Lusually arora this ne oc by trying to advise the client that it is unlikely that therapy will cure es problems and fix it so he can live happily ever after. I point out that somet 51therapy makes it easier to bear the burden of a problem that cannot be solved. Sometimes I explain it in terms of therapy helping one choose the lesser of two evils and learning to live with the results, It is important that therapy be explained to lower-class clients in this way, as, in many cases, the solution to their problems involves choosing between negative alternatives, - Advise the client that therapy will help him feel less miserable. Along these same lines, I also try to explain the limitations of therapy by helping the client realize that therapy will help him feel less upset as opposed to feeling calm or content. This is another point that is especially important to stress with lower- class clients, as they often believe that "being normal" means feeling happy all the time or facing hardship and adversity in an indifferent or carefree manner. I try to explain that therapy will teach them a way to get their emotions under control, to feel less upset but still to have bad feelings, and to be able to solve problems or accept those things that cannot be solved. I usually tell the client that when you have problems you often feel bad but not so bad you cannot handle it. Sometimes I go over the Serenity Prayer with clients to get some of these points across. Begin each session with a request for a problem. Once the client has a general idea about the therapeutic process, I usually make a determined effort to get down to business as quickly as possible and to encourage problem defining in order to set the stage for problem-solving interventions. Probably the best way toachieve this goalis to begin each session with a request for aproblem. usually start the session by asking "What problem would you like to work on?" or "What kind of problem can I help you with today?" This approach immediately focuses attention on problem defining and also helps, when necessary, to guide the client back to problem facing when he wanders off into concerns unrelated to therapeutic assistance. Sometimes I might allow such meanderings in the interest of relationship building, but mostly I interrupt the client and say, "Now let’s get back to that problem you wanted help on" or "I see your point, but let’s get back and see if I can help you with that jealous husband of yours." Limit the session to one or two problems. Because lower-class clients often present themselves with a host of problems and disturbances, I suggest you limit the sessions to exploring fully only one or two problem areas and preferably one. Sometimes I will even end a session before the time is up in order to maintain this principle. It is important to bear in mind that it is not necessary to help clients solve every problem that troubles them (Beck, 1976). RET, 52 i i the client remedy the present blem-solving type of therapy that aims to help ‘ Sear es and, in addition, to learn a general method of handling problems so that future concerns can be resolved independently. ~~~ ha A ti in client agreement on the problem to be resolved. Most important with eheaaae chai is to allow him to choose the problem area to be dscns I mention what might seem an obvious point to those of you who follow i ic principle of client self-determination. However, I remind you that ee ass clients share a system of values and standards that usually differs markedly as that of their therapists. As a result, it is easy for the therapist unwittingly to on the client to work on problems that are maladapative only eerie ie is standards (which might be quite different from those followed by the lower- class client). For example, the religiously liberated therapist who eos ort a client’s stated concern regarding a religious problem in order to de oe issues the therapist considers more appropriate is probably missing the point and is offering assistance unrelated to the client’s primary concern. blem specificity. Once an A-B-C understanding of the problem Fi aus uatbeed peblshed Cavett the therapist help the cleat define the problem so that the core issue can be identified. What I am referring seid is reducing the problem to a basic concern. I usually find that the a bring lower-class clients into therapy can be reduced to the fo cod categories: (1) those that involve personal failure or shorteomings ( ) ua that involve interpersonal rejection or criticism; (3) those that invol —_ deprivation of some kind of major pleasure or satisfaction; and (4) those problems involving a realistic danger to life and limb. By conceptualizing a problem in this way I usually find am oy able to guide clients into a specific problem-defining framework. From there on a plore the problem in more detail and discover the ideational source of a disturbances or distress. For example, the client who complains about nak : problems might be questioned until it is learned that a critical spouse is the ne tral issue. Once criticism is established as the specific problem, the situatio n might be further reduced by suggesting that attention center on a ped cou sion when such criticism occurred. Further, the actual criticism coul a a 48 examined amd distilled to learn exactly what it is about the criticism that . eS client finds so upsetting. This approach not only helps screen out unimporta: 53and irrelevant material but, even more im, i pee " S portant, it better sets th 2 apeutic intervention and problem solving. seid a Assign a problem. In some cases, certain clients are so confused and believe themselves to be plagued by so many pressures that it is extremely difficult to gain agreement or single out a specific problem. It seems that no matter how much effort is put into problem defining, the client keeps finding more serious problems or is unable to settle on what to work on. The best method I have found to handle this kind of client is literally to assign him a problem. The strategy here is to assign the problem so that corrective measures can be initiated as soon as possible. Unless therapeutic measures are taken quickly these clients will regress and their problems become worse because the: ne convincing themselves that they are beyond help. : Tusually call a halt to this kind of situation by telling the client what the Bove is, how we are going to work on it, and that by solving this problem, his other concerns will seem very small by comparison. I then refuse to let him dis- sal aay else a encourage him to concentrate only on the problem at nd. This is quite et fective with chronic complainers and wit a pill for every little ache and pain. i eae PROBLEM SOLVING Problem solving is the basic goal of the therapeutic i i CAC oS Hn scien ralianietaecete tap an with the lower-class client usually involves two main areas of endeavor: the examination and remedying of practical problems and the examination and remedying of psychological problems. Practical problem solving includes those areas in which information, direct advice, referral, and similar measures are the most appropriate inter- ventions My experience has shown that counseling the lower-class client often involves such efforts and does not always require an investigation into the psychological aspects of his complaint. Sometimes merely informing a client of a specific re- source can go far toward alleviating his symptoms. I am well aware that, as clinicians, we usually expect our psychological interventions to serve as the pri- mary method of helping our clients. However, this is not always feasible or appropriate with the lower-class client, and it is sometimes better to offer in. struction and guidance rather than interpretation and insight. : [have found that a certain amount of letter writing, phone calling, agency contacting, form completing, and the like is almost always a part of the coun- seling process with the lower-class clients. This does not mean that if you decide to practice RET with the lower-classes you will have to abdicate your role as a clinician. What it usually means is that you had better be prepared to provide some additional assistance beyond the psychological explanations that normally take place within the clinical setting. Psychological problem solving, on the other hand, includes those areas in which cognitive insight, emotional ventilation, behavior modification, and the like are the appropriate interventions. The main thrust of RET approach is to correct conflict- causing misconceptions. This is usually accomplished byteach- ing the client to think about his thinking, to scan his own thought processes and pick out those ideas and beliefs that create his suffering and unhappiness. In addition to learning how to identify the ideas that cause his upset, the client is also shown how to challenge systematically and correct those ideas until they are more logical and less distress-producing. Itis casy to assume that such an intellectually sophisticated endeavor is be- yond the grasp of the average lower-class client. In fact, initial effort on the part of the client to understand and participate in cognitive restructuring usually does prove unrewarding and can give the impression that the individual is in- accessible to such a process. However, my experience demonstrates that this initial difficulty is usually due to inexperience rather than to incapaciity. The lower-class client is simply not accustomed to reflecting about his thoughts and fantasies in any kind of conscious way and then to expressing this information to someone else for analysis. It is not, therefore, that the lower-class client is in- capable or unequipped for insight therapy but rather that he lacks practice and experience. The lower-class client’s potential for psychotherapy, therefore, is as legit- imate as that of any other individual. The therapeutic methods employed, as Beck (1976) points out, are merely an extension and refinement of what people have been doing since the early stages of their intellectual development. The particular techniques such as labeling objects and situations, setting up hypo- theses, and weeding out and testing hypotheses are basic skills that people normally apply without realizing it. There is nothing about such procedures that would preclude their use by persons of low social standing. Practising RET with members of the lower-classes, therefore, is not a ques- tion of the client’s innate capacity to participate in a therapeutic process. 55Rather, itis a question of the therapist’s ability to present psychological infor- mation in such a way that it is intelligible within a client-understood frame of reference. There are a number of practice-proven, effective techniques in this regard, Maintain an active-directive dialogue. Probably the most general requirement for dealing with the psychological problems experienced by the lower-class clients is for the therapist to maintain an active-directive dialogue. Since these clients usually have initial difficulty with insightful self-exploration, it is unwise for the therapist to be passive or non-directive in expecting them to confront and confute their irrational ideation. An inactive approach on the therapist’s part often decreases client responsiveness because the client simply does not know what to do. Itis far better for the clinician to take charge of the interchange and deliberately to direct the client’s verbal activity. The more open, straighforward and informative the therapist, the better are his chances of stimulating a free flow of attitudes and ideas from the. client. Lower-class clients often respond very well to such an animated though directive approach and are sometimes surprising in their ability to provide therapeutic appropriate material. Teach the relationship between cognitions and reactions. An equally important requirement for handling psychological problem solving with lower-class clients is to introduce them to the relationship between cognitions and reactions. This is not always an easy task, as most lower-class clients typically externalize the source of their emotional problems and often have difficulty believing and accepting that they are responsible for creating and sustaining their own disturbances. I usually find that this information is acceptable to the client if presented in a somewhat simplified, carefully structured manner. For example, after I gain some idea about the nature of the client’s prob- lem, I pause and take time out to teach the A-B-C principle. Often I do this as a separate instructive experience using. examples unrelated to the client’s stated complaint. [ use this tactic because clients are sometimes too immersed in their own upset and are so convinced that their suffering is caused by outside forces, itis difficult for them to believe that their own thinking is at fault. Once I per- ceive that the client understands the A-B-C’s I will show him how to apply the principle to his own problem and upset. In order for this instructive period to be dramatic and full of impact, I have found the use of visual aids to be a most effective method. I have wall posters, 56 -B-C’s character on my for example, that demonstrate the A-B-C’s as well asa cartoon i _ wall aaa by thought bubbles that contain the typical irrational ideas that upset people. In addition, I use an artist’s sketch pad or blackboard and actually draw some illustrations that demonstrate the relationship between thinking and feel- ing. The therapist need not be an artist to use this tactic successfully. A few stick figures or merely circles in which you can sketch facial expressions will usually be more than adequate. This kind of teaching maneuver usually has more ef fect on the lower-class client than does trying to talk them into accepting responsibility for their emotional problems. Another successful way to demonstrate the A-B-C’s with those who believe that either someone can hurt their feelings or that they can hurt the feelings of others is to hand the client a rubber hammer. After he accepts the hanes I ask, "Who handed you the hammer?" He answers that c.d, and I next ask, ‘Sup- pose you hit yourself over the head with the hammer. Who makes you do i : the person who handed you the hammer or you?" The client usually admits tl . he is responsible in such a case. I then tailor the illustration to ie his particul i situation. Ifthe client is upset about criticism, for example, I ask "Who criticize you?" The client will tell me the name of the person, and,then I will ask, "Who hit you over the head with the criticism?" This kind of technique can be ee different ways, and clients are able to understand and remember the principle involved much better than with a strict verbal discussion no matter how clear concepts are made. ifference between rational thinking and positive thinking. One ma aging clarification among, lower-class clients is that rational thinking is often a form of moderate negative thinking and not necessarily ee thinking. Many clients will confidently declare, after a litle RET — know what you want me to do - just think positivly about | everything. I usually explain that in most cases they have decided they are facing a disappointment, and it would be inconsistent to expect them to tell themselves they like Be disappointment. I point out that I am trying to help them to be honest witl themselves and to think negatively when things do not go their way but not so negatively that they end up disturbed. is poit ini ‘believe some- Lusually elaborate on this point by explaining that when they n thing is had ley are not expected to tell themselves that it is good but to stick to what they really believe: the situation is bad. When they do this, I explain fur- 57ther, they will feel bad, and that is the way one is supposed to feel under such circumstances. I tell the client I have no argument with him when he thinks and feels like this. However, when he believes a situation is not just bad but very, very, very, very, very, very bad, then I suspect his thinking may be too negative, and this will result in his feeling upset. I tell the client that I am just trying to help them to cut out some of those "verys" and that is what rational thinking is all about. Inform about appropriate emotions. Along with teaching clients to differentiate among negative thinking, positive thinking, and extreme negative thinking, it is important to advise them about the kinds of feelings to be expected from rational thinking. Often lower-class clients will readily agree with the wisdom of rational thinking but will complain that I am suggesting they eliminate their feelings. They usually express this point by declaring that I am trying to make them uncaring about a certain problem or situation, The best way I have found to overcome this misconception is to draw a ver- tical line on a piece of paper or blackboard, labeling the top of the line "upset" and the bottom of the line "indifference" or "calm", I then explain that rational thinking will put the client somewhere in the middle of the continuum - a point which might be labeled "less upset". I usually stress the word "less" in front of the feeling that is disturbing the client rather than relabeling that feeling. This is usually less confusing and seems to present a more manageable goal to most lower-class clients. The client, for example, who feels anger is helped to feel "less angry" rather than to feel "annoyed" or “irritated”, Explain symptom formation. Another step in the psychological problem- solving process with lower-class clients involves helping them understand the nature of symptom formation. Many of the lower-class clients I see often display or complain about physical disturbances that accompany emotional upset. Sometimes these symptoms result in actual illness or diseases such as ulcers or colitis, but usually they are experienced as very distressing internal body changes. An accelerated heart beat, rapid breathing, difficulty in swallowing, stomach upset, cold hands, and headaches are common examples. Often the client has been told by a doctor that his symptoms are caused by his nerves or that "it’s all in his head". This kind of explanation, although true in a sense, usually means very little to the average lower-class client. As far as he is concerned, he has been told that he has imagined his aches and pains. Clients 58 usually react in a typical fashion, feeling angry, bewildered and anxious, and they frequently end up aggravating their symptoms even more. J usually help the client to understand the situation by explaining that the nervous system that allows him to feel an emotion also operates other import- ant parts of the body, such as the heart, lungs, stomach, and the blood vessels. These body parts are sort of on the same electrical circuit, I point out, so when a person "turns on" an emotion, he "turns on" other parts of the body as well. I further point out that when the emotions are in an uproar there is a good chance some other part of the body will also be in uproar. Provide insight. Since the confronting and confuting of irrational ideation is a primary goal in an RET endeavor, it is of utmost importance that sucha Process be introduced to the client in the most effective and efficient manner possible. It has been my experience that the most feasible method of helping the lower- class client to identify and remedy faulty thinking patterns is simply todo some of his thinking and reasoning for him. In this case, the therapist assumes the role of informed teacher and tells the client what the client is thinking, why his thinking will lead to problems, and how to adopt a more realistic point of view. Because the specific irrational attitudes that usually result in specific emotional disorders have been identified (Beck, 1976), the RET therapist has at his disposal an established method for quickly helping the client to locate the cognitive-semantic source of his disturbances. In addition, the therapist corrects these irrational aberrations according to the principles of rational analysis (Ellis, 1973, Maultsby, 1975). Contrary to what might be expected, clinical experience has shown that directly supplying lower- class clients with such insight actually encourages them eventually to do such reasoning and analyzing on their own, Use appropriate cognitive insights. Because the insight process with most lower-class clients is to be a therapist-directed activity, itis extremely ‘important that the therapist make sure the insights imparted to the client can be clearly and easily understood. One reason the lower-class client often gives the impression of being unable to benefit from verbal therapy is because such insight is presented in an unintelligible manner that is beyond the client’s ability to comprehend. This apparent obstacle can usually be overcome, however, if the therapist makes an effort to tailor psychological insights to the intellectual and educational level of the client. 59For example, those lower-class clients who see their pr - strophes and feel upset often find it hard to understand RAT ea negative, grossly exaggerated point of view that is causing their disturbance. As far as the client is concerned the situation is awful, because itis awful! Intellee- tualized discussions which attempt to prove that it is unlikely their situation is a genuine catastrophe, or philosophical debates which challenge their belief that their problem is truly awful, usually fail to make an impact. , However, when their problems are framed in a simplified, visually struc- tured way, lower-class clients are better able to see the difference between authentic misfortune and imagined horrors. I usually accomplish this by using a sheet of paper on which I put two columns. One column I label "Pain-in-the- neck HASSLES" and the other col I "End- HOR tone, umn I label "End-of-the-World Next I encourage the client to tell me exactly what is wrong in hii Then, after we list all the disadvantages and Geeienes Dated eae | the client in which column the problem belongs - the hassle column or the hor- ror column. Clients almost always sce the point and admit that their problems belong in the hassle column. I ask them how they would feel if they could see their problem as a hassle instead of as a horror. Clients usually admit that they would feel much less upset. I then inform them that the job is constantly to tell themselves the truth - that the i in-i i Bae ee that the problem is a pain-in-the-neck, nothing more and A similar approach can be used to deal with the principle of self-accept- ance with lower-class clients. This has consistently proved to be a most frustrating task with this client group. I am often successful, however, by redi- recting the client’s attention from rating himself to a tolerating frustration. The strategy is to get away from the self-concept issue as much as possible and to avoid attempting to convince the client that self-blame sllogical and unnecess- ary. Again I use the two-column method on a pi ain piece of paper or blackboard. Only this time I label one column "It’s Bad" and the other column "I’m Bad". I then encourage a discussion of the problem and try to show the client how it can be understood asa manageable frustration and not as a blow to his pride 2 his cool en shift the emphasis to the "It’s Bad" column because this lows for the introduction of insights and semantic strategi i telligible to the lower-class client. Se ae For example, the disabled client who believes his inability to work proves he is worthless, totally incompetent individual and suffers accordingly is shown "It’s Bad’ that his handicap that prevents him from working. "It’s Bad" because he is unable to gain a sense of achievement. "It’s Bad" because he cannot earn as much money as before. "It’s Bad" because he cannot provide for his family as well as before. "It’s Bad" because he will have to settle for less satisfaction from life, and so on. The client is constantly directed to focus on the "It’s Bad” column rather than on "I’m Bad’, even when I recognize that the psychodyna- mics involved deal with lowered self-esteem. T emphasize to the client, then, that he is a person "with less" rather than the more pernicious concept that he is "less of a person". This maneuver allows for cognitive interventions that deal with frustration tolerance - an issue that is usually more amenable to therapeutic intervention with most lower-class clients than those involving self-value. Stick to accepted insights. Once a particular insight has been presented, understood, and accepted by the client, it is strongly suggested that this formation be repeated without significant change. In other words, stick to what seems to impress the client as the cognitive source of his distress and use the same words, analogies, visual examples, and the like to reinforce continually the message. Putting clarifications and interpretations into different words or using other but similar analogies may prove stimulating and creative to the therapist but confusing and bewildering to most lower-class clients. Although the repetition may be monotonous at times, it usually proves to be an effective approach in helping lower-class clients to understand and accept the rational concepts presented on their behalf. Modify self-statements. Another effective problem-solving tactic with lower- class clients involves the use of self-statement modification. Despite efforts on the part of the therapist, some lower-class clients do not respond to a rational analysis of their problems even when provided with accurate insight and interpretation. Sometimes detailed and even simplified explanations seem to fall on deaf ears and may be little more than wasted effort. Under these circumstances, it is better to teach the client to modify irrational attitudes and thought patterns through rote learning rather than through insight learning. In other words, instead of using reason and logic to rid the client of his faulty assumptions, the therapist presents him with a different, more realistic set of ideas which the client is told to memorize and to repeat to himself whenever he 61encounters the circumstances that he claims are upsetti i 5 psetting. Although this approach is often not as interesting and challenging f ist, i often 1 : ing for the therapist, it very productive with certain clients. “A mane Analyze upset about upset. One of the most common psychological problems experienced by lower-class clients occurs when they feel upset about feeling upset. In essence, they have become sensitized to their own symptoms and disturbances and are no longer concerned with the original subject of their as ie one words, they feel anxious about feeling anxious, depressed eli, 5 : é ae ne sonics anxious about feeling depressed, guilty about fecling __ It is important for the therapist to be alert to this condition or will be wasted on analyzing a situation and accompanying ideation omcelnnen have caused the initial upset, but that is now secondary to the actual or current disturbance. In A-B-C terms you might put this in an A-B-C-B-C perspective This is sometimes a chronic problem of long standing and is easy to identify, as the client will often not be able to indicate anything other than emotional upset as the complaint. Clients who state their probl " " poate problem as "bad nerves” are a good Tusually inform the client immediately that the sour i is hi own upset. I tell him that this is a fairly cal Se Sanat ee ant it is hardly fatal. Lower-class clients frequently believe the intensity of their symptoms means that something is drastically wrong with them, and they ma: feel nearly on the verge of a horrible death. I try to illustrate the aruleeaees of the situation by explaining that when they have toothache, they feel pain, sometimes even a lot of pain. I ask the client what would happen if they thought about the pain all the time. Would it get better or worse? Usually they see the point. I reinforce this by telling them it’s the same with their emotional prob- lems. The more they preoccupy themselves with their suffering, the worse it will seem, but it will never kill them or harm the: i ae m any more than will a bad Another intervention that can be used in situations of thi i in- forming the client that his upset will not drive him Hse As eee misconception among the lower-classes is that their emotional problems will cause them to lose their minds and that they will end up in mental hospitals. The most effective way I help clients cope with this idea is to ask, "How do a feel right now?" Usually they answer "Terrible!" Then, in true Gestalt fashion, 62 I advise them really to get in touch with their upset. They usually comply with- out much effort, and then I ask "Now how do you feel?", and they usually answer, "Worse!" Then I say in a convincing voice, "Well, that’s about it - that’s about as much of a nervous breakdown as you are going to have. You came through it. Congratulations." Next I shake their hands and ask them if I am shaking the hands of people who are suffering and who have emotional problems or of people who are crazy and who belong in state hospitals. By my pointing out that a nervous breakdown means suffering and not insanity, lower-class clients will often stop ruminating on their symptoms and allow other problems to be faced and resolved. For those clients who state that their problem is bad nerves, which is a com- mon presenting complaint among lower-class individuals, Tusually respond that they have good nerves. I point out if they had bad nerves they probably would not be able to feel good or bad. I further inform such clients that they probably have the best nerves in town - all they have to dois to tell themselves one "awful" or "terrible" and their nerves get right down to business and make them feel upset. I tell the client that only a very strong set off nerves could cause him so much misery. Coordinate behavior change with cognitive change. Although the goal in RET is to correct symptom-producing cognitions, overt behavior change is also encouraged as part of the problem-solving process. Such behavior change is sometimes sought for its own sake, but, in most cases, it is coordinated with basic efforts to correct the client’s disturbed thinking. In other words, whenever possible, behavior modification is used as an adjunct of cognitive restructuring. Lower-class clients tend to cling to certain prejudices and self-defeating attitudes even in the face of admitted contradictory evidence. However, they usually respond well when encouraged to act "as if" they believed therapist- dictated rationales. Persuading the client to act on rational insights despite his lack of conviction often makes it easier for him to convince himself to modify attitudinal distortions and to adopt more sensible thought patterns regarding this problems and conflicts. ‘Teach responsible assertive behaviors. In addition to my encouraging cognitive change by also encouraging related behavioral change, I find the lower-class client responds well to assertiveness training in problem solving. This approach does not necessarily make specific efforts to help the client locate and correct the cognitive source of his problems. What I am referring to here is to an 63emphasis on teaching the clients what to do - actual instruction for overt behavioral change with a minimum of effort put into corrective measures on behalf of the client’s thoughts or covert behaviors. I recognize that when behavior is corrected at the expense of rational and appropriate cognitions, people often change but for the wrong reasons. In many cases, they maintain their irrational belief systems in spite of their apparent pro- gress or improvement. Unfortunately, we are not always able to direct our clients to resolve their problems in the most elegant manner. Sometimes, with certain clients, especially those from the lower- classes, we had better take what we can get as long as it relieves suffering and does not cause further conflict. I think it is important that we bear in mind that our goal as therapists is to help our clients solve their problems, and we may not always be able to do this ac- cording to script. Tusually find that most assertiveness training with lower-class clients falls into two general arcas of endeavor. The first includes teaching clients to deal directly with the presenting problem. Usually thisis a one-shot deal, and gener- alization to other areas of concern is neither expected nor encouraged. An example would be a woman whose husband has retired and who moves here, against her silent protests to the contrary, to a trailer in the mountains, where he plans to spend the rest of his life fishing and watching television, The woman, however, wanted to remain in her community with her grown children and her close friends, whom she visited regularly. She ends up in the hospital with a di- agnosis of depression. The woman had not discussed the situation with her husband because, she says, he was not the type who either talked things over or listened. Instead of examining the cognitive-semantic roots of her depression and her inability to confront her husband, I instructed her on how to assert her- self with her spouse. She was rehearsed in exactly what to say to him, how to handle his silences if there were any, and so on. She followed her instructions, Her husband listened to her and agreed to move back to the community and only to "retire" on weekends. Asecond area in which assertiveness training with lower-class clients is the best problem-solving approach involves teaching such clients how to handle op- pressive interpersonal relationships where one partner in the relationship acts in an aggressive way. Married lower-class women are especially unfortunate in this respect, as they are frequently involved in Tarzan-Jane types of interactions. Such women are frequently berated by their husbands and usually require ther- apeutic assistance beyond an understanding of the cognitive source of their 64 distress. What is usually required is the learning of actual verbal behaviors that can be used to handle manipulative criticism. ‘The best approach I have found for this kind of situation follows the general pattern of the client’s first acknowledging that there may well be some truth to the critic’s point of view. This agreement is given regardless of whether the critic is actually right or wrong. Second, the client is told to express his. opinion and then to repeat these two steps until some kind of compromise opinion or action can be worked out. If the critic is dangerous, the client is instructed to work on agreement only and not to attempt to express his point of view, at least initially. For example, the woman who is unfairly called lazy by her husband is in- structed to inform him that he may well have a point. She is taught to tell her husband, in a sincere manner, that she, in fact, might be very lazy. The goal is to establish the husband in the position of boss and to allow him to believe he is right. In most cases the previous scenario was for the wife to argue the point and for the husband to go to whatever extremes he deemed necessary to prove his point, Usually this meant reducing the wife to tears or, in some cases, beat- ing her. The husband wants to be boss, so therefore the wife gives him the title with- out a struggle. Once this is accomplished, she can offer her opinion. She: might, in this case, disagree and inform her husband of the many tasks she did com- plete during the day. If the husband still disagrees and tells her she should be doing more, once again the wile agrees and accepts this opinion. She tells the husband he is probably correct again but expresses her opinion that she is doing about all she can. Usually the husband just wants to be considered lord and master and once this has been established, he acts more benevolently, is less demanding, and gets off his wife’s back. If the client follows these tactics and the husband remains critical or ag- ressive, there is a good chance the husband is quite disturbed and nothing will help the situation. In such a case, this is pointed out to the client and therapeutic endeavors shift to a discussion of the client’s motives for staying in such a situ- ation. This method has been justly criticized (Lange and Ji jakubowski, 1976) be- cause it does not allow for the true expression of one’s: feelings and, when | carried to extremes, may be countermanipulative and could discount valid criticism. It isimportant to realize that this tactic is not for use with a critic who is generally 65reasonable and honest but rather with someone who consistently acts in an ex- tremely aggressive, destructive, manipulative manner. ENCOURAGING EFFORT With the usual exceptions, in order to grow and to change, the client is ex- pected to put knowledge learned in therapy into practice in concrete and specific life situations. This usually requires hard work and effort on the part of the client and is rarely achieved through passive listening or insight osmosis. Clients who do best in therapy, therefore, are those that commit themselves to change and then work hard to bring this change about. Encouraging a client to understand and accept such a commitment and the hard work that follows is, of course, no easy task. The lower-class client, in par- ticular, presents a special problem in this area and often requires special help in understanding his part in the change process. This is probably explained by the difficulty the average lower-class person seems to experience in differen- tiating psychological assistance from general medical treatment. In the medical setting, the problem or illness is not considered the patient’s domain, and self- treatment is discouraged lest it interfere with the healing process. When the lower-class person presents himself for psychotherapy, therefore, he expects to be "doctored" - to have the emotional problem treated or cured with little or no participation on his part. In addition, the lower-class client shares the same myth about psychother- apy as do other client groups - that change will occur when the therapist uncovers some hidden insight or incites some kind of purifying emotional out- burst. In other words, something special is supposed to happen in therapy, and when it does a magical transformation will take place. The client will then have the answers to all his problems and will be able to live happily ever after. The lower-class clients that I see seem particularly prone to this misconception be- cause they are exposed to or believe in religious faiths that promise instant and everlasting happiness if they undergo a sort of spititual surrender to Christ. ae Unfortunately this myth about the magical powers of therapy is not always limited to clients. Even RET therapists could confuse the sometimes dramatic events that occur within the clinical setting as evidence that change has auto- matically taken place. It is sometimes easy to believe that a penetrating insight is sufficient to correct a client’s disturbances. It is important to bear in mind that what happens within a therapy session, even an RET session, is for the most part an intellectual endeavor. The wisdom ofthe therapist’s words, regardless of how accurate, will have little consequence unless the client translates those words into action in some way. If the therapist is effective during the session, then the client has probably gained intellectual understanding of his emotional problems. Even though such experience may appear quite intense, they are in the final analysis, only blueprints for change. Interpretation and insight about the client’s faulty thinking patterns, there- fore is not an end in itself but rather a means toward an end. More to the point, the RET therapist is responsible for more than tracking down and correcting the client’s distorted cognitions. The therapist must also direct his attention to the equally important but perhaps less glamorous task of informing and per- suading the client to overcome his disturbances by practising his insights in some kind of conscious, self-directed way. Although I view the client as responsible for putting in the practice and ef- fort to make change possible, I see the therapist as accountable for instructing the client that such effort is indeed required and then encouraging, persuading, and otherwise inspiring the client actually to attempt such efforts. I might men- tion in this regard that I am often told by my clients that they do not always feel good when they enter or leave my office. They frequently complain that I put pressure on them - that I seem to be pushing them, expecting something from them. When I hear this, in most cases, I know I am doing my job. My clients are quite correct: I do expect something from them and I do push them. I expect them to do their job, to work at change, and I push them to do this. Iwill now detail some of the ways in which I educate lower-class clients as to their part in the change process as well as some of the tecniques I use to mo- tivate such clients to expend effort and to practise. Explain that self-directed effort is required. Since direct instruction is already accepted, the first step toward encouraging the lower-class client to act on insights learned in therapy is simply to tell him that improvement will require work and effort on his part. A client can be given an explanation of the normal resistance that humans seem to experience when trying to change their actions. If he is advised that emotional and psychological problems are merely bad habits, that they are difficult though hardly impossible obstacles, the client is often willing to put forth the necessary effort to achieve change. Explaining emotional disturbance as a bad habit is an especially valuable tool for getting 67 Ssacross the importance of self-effort to lower-class clients. This kind of educational approach often takes the magic out of how psychotherapy is supposed to work and puts behavioral change within a framework the client understands - that of hard work, practice, and effort. Explain that progress will take time. In addition, it is important to advise the client that progress will take time and will not happen overnight. Because the lower- class client often confuses psychotherapy with medical care and faith healing, he often expects unrealistic results from his therapeutic experiences. Perhaps the most prevalent expectation is that psychotherapy will quickly and | permanently cure his emotional problems and that after a few sessions the client will no longer feel upset or experience distressing symptoms. Emphasizing to the client that behavioral change is almost always a long, slow, tedious process rather than a dramatic, sweeping, sudden affair (Harper, 1975) is best done as soon as possible. It is also better to inform the client that although improvement is likely, a permanent cure that will leave him carefree and unaffected by life’s frustrations is highly unlikely. He can be told that the lessons learned in therapy will take some time to put into practice, that progress will be gradual, and that his efforts will probably have to be made on an ongoing, regular basis for the best results to be achieved. Offer an explanation of what is normal. I also help clients gain a realistic expectation of therapeutic outcome by offering an explanation of what itis like to feel emotionally normal. A simple explanation is to tell the client that mental health means learning how to handle disappointments without feeling too upset - bad, but not too upset. I make the point that normal means feeling both good and bad, not just good all the time. Unfortunately, the expectation of feeling good constantly is common among lower-class clients who believe their therapy experiences are supposed to “heal’ them of all their suffering and leave them unaffected or comfortably calm about problems. In order to determine if this expectation exists, I will often ask clients how they believe they are supposed to feel if they think rationally about their problems and follow my suggestions. Often they will report they ex- pect to feel relieved or peaceful. One client whose mother was dying slowly from cancer told me that if she could think the way I had been advising, she could feel as if a huge weight had been lifted from her shoulders and her heart would 68 be full of joy. In other words, she would feel happy because her mother was dying. If this misconception goes by unchallenged, clients will usually drop out of therapy because the results cannot possibly equal expectations. Clients will be- lieve they have been shortchanged and will quickly lose faith in the therapy process. Once this occurs, even the most skillful interventions and the most brilliant insights will have little impact, because these maneuvers will not pro- vide the desired effect or produce enjoyable disappointments or comfortable suffering. Lusually attack this problem in two ways. First, I point out to the client that I follow the exact principles I am trying to teach him, and I have yet to feel good about disappointment. If I am unable to feel cheerful about disappointments, I ask how they expect to be able to do it. I also point out that people who smile or feel calm in the face of adversity are usually not called well-adjusted or nor- mal. They are usually called crazy. Secondly, I tell the client that the goal of our efforts is to help him feel un- happy rather than miserable. Sometimes I will use a continuum illustration to get this concept across. I show him that he belongs somewhere in the middle of the continuum between calm and miserable. I point out that feeling miserable usually prevents him from solving problems because it is a feeling so strong that it controls him. Unhappiness, I explain, is an unpleasant feeling, but it is one that can be controlled and used as a motivation to solve problems. ‘Teach suffer power. In addition to helping the client understand what to expect from therapy, [also teach him the principle of suffer power or struggle strength. | ‘This principle holds that progress in therapy initially requires that one put in effort while feeling upset. In other words, I instruct clients that they are to force | themselves to challenge an idea or change an action even though they feel | disturbed. This is an especially important tactic with lower- class clients as they almost always want to wait until they feel better before trying out new behaviors or trying to think things out. I tell them that they have literally got to do the opposite of how they feel, and that this is the secret of getting better - trying to change when they do not feel like changing. . Assign homework tasks. As you are aware, assigning reading, writing, and activity- oriented tasks outside the therapy session can enhance outcome because such efforts often encourage the client to realize that he is expected to 69use his own efforts to bring about change. Task assignments work well with the lower-class client as long as such assignments are problem-specific and well within the intellectual and achievement level of the individual client. In the area of reading, I have found that Lembo’s (1974) book, Help Your- self, Hauck’s (1973) book, Overcoming Depression, and my booklet A Rational Counseling Primer are most effective. Other RET books do not seem to work as well with the lower-class clients because they prove too difficult for such clients to read. I might mention that the main purpose of using literature with the lower classes is not necessarily to teach the principles of RET but to estab- lish an expectation of benefit from therapy. Many clients fail to understand what they have read but will declare they are sure it will help them. It is this faith in therapy that I aim for in assigning initial reading experiences. Inthe area of writing assignments, I experience considerable difficulty with males. Most lower-class clients have little experience with the skills required for expressing themselves through written communication. I have been able to overcome this obstacle with lower-class females by suggesting they write me let- ters or keep a diary they can share with me. | will advise them to write about their problems, their thoughts, and their feelings, as well as about some solu- tions. Often this kind of approach helps the client look at his problems more objectively and sometimes can be quite potent in encouraging change. On some occasions I will return a letter and ask the client to rewrite it from a more ra- tional perspective. One tactic that usually gets good results is to direct the client to fill out or complete a form which monitors his behavioral change efforts. I usually design these forms for the client and then have him use them ina check-off fashion be- tween sessions. The forms can be used for simplified cognitive homework or activity homework assignments such as cleaning the house or going for a job in- terview. Often the completion of these tasks provides the client with evidence that change is actually taking place as a result of his therapy experience and tends to encourage even further improvement. The best method I have found to use the A-B-C homework form is to com- plete the assignment for the client. I have tried many approaches, including redesigning the form and using cartoon characters, but apparently this kind of endeavor is quite confusing to lower-class individuals. I found I was spending more time trying to explain the mechanics of filling out the form than on actual problem solving, so I have abandoned using this as an independent homework assignment. However, what I do is to fill it out while the client is talking and I 70 use his own language. I give the client the form after the session is over and tell him to study it between sessions. Along these same lines, I often write down on a piece of Paper rational thoughts or actions that can be followed until the client’s next session. I tell him to hang the paper in some prominent place such as the refrigerator door or bathroom mirror and to read it as often as possible. Another good technique is towrite the same message on a small piece of paper and to have the client place it inside the cellophane of his cigarette pack and to read it whenever he lights up. Finally, let me comment briefly on the kinds of activity assignments Tusually find most productive with the lower-class clients. As I have mentioned these tasks can complement attempts to restructure cognitions or can be used as at- tempts to solve problems without corresponding efforts to change thinking. In general, | find that activity assignments work best when they deal with the prob- lem itself rather than serving as exercises designed to build skills that can eventually be applied with the problem situation. The client who is afraid to say no to her mother-in-law, for example, is given direct instruction on how to handle this situation. This method is used in place of having her practice saying no to others until she is more comfortable with this kind of behavior and then applying it with the mother-in- law. Lower-class clients would view such skill training as creating a problem to solve a problem. Make liberal use of positive reinforcement. The principles of contingency reinforcements are well-established procedures that can be used by RET therapists to encourage change through effort and practice. Through the offering of various rewards or penalties, behavior can be manipulated to increase or decrease in frequency. It is strongly suggested that the RET therapist become familiar with these principles and use them to motivate the lower-class client to change his ways. Positive reinforcements, for example, can be used to increase behavior fre- quency through offering excited verbal praise, gold stars, and with extremely difficult clients, a free therapy session. This can be applied to already improved behaviors or as an anticipated reward. However, one area where such reinforce- ment is effective is with behavior that has not been changed, but the client is given credit for change. Sometimes this is called attribution reinforcement, and the principle is to tell the client he already exhibits traits or performs actions he has yet to demonstrate. For example, the client who complains of extreme shy- 71 og| 5 | ness and is afraid to speak up for himself can be told, "I really find that hard to believe. In last week’s session you gave me a tough time - you really stood up to me more than most people. You really came on as if you were sure of yourself and meant business. I was really impressed." | Use negative reinforcement or aversive control. Another method of | contingency reinforcement is to arrange negative consequences in order to | decrease unwanted behavior. This can be done by withdrawing a positive | outcome or, in some cases, seeing that a penalty follows certain objectionable behavior. Negative reinforcement can be used, for example, by ignoring or not offering interest in a particular subject or area you want stopped. For instance, the client who comes in week after week and merely complains and pays little attention to your interventions and efforts can be handled by remaining silent or perhaps appearing busy with something else while the client is talking. When | questioned you can reply, "Since you only want to complain I really can’t be of help to you." A more direct method is to tell the client you are not going to listen anymore, that you have decided you cannot help them. Often clients will begin to work on things if they realize they are not going to be able to use therapy as a confessional and will no longer receive the empathy and attention they want. Sometimes a client can be convinced to get on the ball and do something about his problems if some kind of penalty is arranged on his behalf. It is ad- vised that the therapist and the client decide together the kind of penalty to be used so that the arrangement will be viewed as a corrective measure instead of a punishment. For example, you might get the unemployed man who claims he is too anxious to sit through an interview to apply for two jobs or else he has to call and talk to his ex-wife who he claims to hate. However, one of the potent ploys you can employ to penalize a client for lack of progress is simply to im- press upon him that the natural outcome of one who does not work at change is to suffer, and this will continue until the change takes place. Sometimes this information has dramatic impact on clients, and they will begin to put in more effort outside the therapy. Combine both positive and negative reinforcements. One of the most effective methods of motivating behavioral change is to combine both positive and negative reinforcement. This is especially useful with depressed clients who week after week complain of depression and do nothing but sit on their behinds, I will first ask them if they really want to get over their depression. Usually they reply in the affirmative, Since they almost always tell me that the only highlight 72 of their miserable existence is the therapy session, I adhere to the following, plan of action: I write down a list of things to do. This list is not new, but includes those activities the client has failed to perform for quite some time. Then I tell the client that if he does all the things on the list, I will see him for the whole session and listen to his woes. However, if he does not do the items on the list, Iwill see him only for ten minutes, and all we can talk about is the weather. The charge, I point out, will be the same as for a full session. With selected clients, this tactic can sometimes produce immediate results. Haye clients listen to tapes of their sessions. Encouraging the clients to listen to audio and video recordings of their therapy sessions isa well-established method of motivating clients to put in effort in RET. This also works well with lower- class clients with some important modifications. ‘They usually donot own tape recorders, so they have to listen in the office immediately after their sessions. The best method I use is to have the client come in well in advance of his appointment. During the time before the session he is instructed to do some kind of written assignment pertaining to his problem. During the session he discusses the written assignment. After the session is over, he is directed toa separate office, where he listens to the recording. I have found this a good way to motivate clients, particularly those that have trouble understanding some of the insights being presented to them. Include family members in the counseling session. A very effective tactic that frequently encourages behavioral change is the participation of other family members in the counseling process. There is an expression in West Virginia: "Hit the bark, you hit the tree. Hit my family, you done hit me." Family ties are close, and this can be used to advantage in attempts to motivate clients to put forth the necessary effort to bring about change. I am not referring to family therapy per se but to choosing a particular member of the family and gaining his cooperation in helping the primary client. I have allowed, for example, an understanding and concerned husband to sit in on a few sessions with his wife so that he can see what I am trying to accomplish. Since the husband is not as disturbed as his wife, he usually understands more readily ‘what points are being made and repeats them back to the client between sessions at specific times when the client is having trouble. This can also be done very effectively with uncooperative family members. In this case such an approach has to be handled with care, lest the problem member of the family think you are faulting him or her for the client’s unhap- 73piness. For example, one very domineering and manipulative husband refused to allow his wife to leave the house unless she was in his company. He was jeal- ous and would fly into a rage if he suspected she was flirting in any way. I knew he resented me because I was a man and because his wife talked to me private- ly each week. It was important that his wife get out of the house and gain some independence, or she would remain depressed in spite of the cognitive efforts to the contrary. I talked with the husband and told him I knew he wanted his wife to get better. I further told him that after extensive studying of the prob- lem, it had been decided that she would get well if she could get out of the house during the day. Such activities as visiting her older children, shopping, and the like were presented as the kind of tasks that would be needed on a regular basis to cure her. Then I told the man I had tried everything to get her to do this, but, for some reason, I was unable to motivate her to change. I admitted I was fail- ing, and if he could help out and make his wife go out, he would be a better man than I. I also pointed out that the sooner the wife began to be more active, the sooner she could stop seeing me. She was allowed out the next day. Encourage weekly contacts. Although few systems of psychotherapy will dispute the value of weekly, or even more frequent client-therapist contacts, the lower classes are often unaccustomed to attending therapy on such a regular basis. They usually view such "doctoring" as a once-in-a-while, one shot deal. I have found simple instruction is the best policy for countering this kind of client attitude. If mental health care is described as an educational process involving the same kind of instruction and attendance as did school experiences, clients will usually feel more receptive to regular therapeutic contact. Use half-hour sessions. One method I have found that encourages change is to rely on the thirty-minute hour. The pressure of a shorter time period can often motivate the therapist to get down to business more quickly and to move the client toward change. Although I favor the half-hour session with clients of all socioeconomic levels, I have found it very productive with the lower-class client. Often therapy with these clients can prove non-productive because the counselor is trying to solve too many problems in a given session or is trying to approach a particular problem offering too many insights. This tends to confuse the client because it dilutes the potency and impact of the message that the therapist is trying to convey. For example, I once saw a coal miner for four sessions that totaled about fifty minutes. He was a chronic drinker since the time he claims to have caused 74 the death of a close friend in a mine accident. The first session lasted about seventeen minutes. I pointed out the ideation that usually results in guilt, got the client’s agreement that this was what he was thinking, and explained how to think more rationally. After I was sure the client understood what was being ex- plained, I wrote down the rational insights on a piece of paper, told him to study them, and promptly ended the session. The man had other problems, but this was his main concern. To discuss other problems or to allow him to ramble on about his guilt feelings would have proven less effective than a short, to-the- point session. The remaining three sessions were used to reinforce what had been learned in the first session. REFERENCES Beck, A.T. Cognitive therapy and the emotional disorders. New York: Interna- tional Universities Press, 1976. Ellis, A. Helping people get better rather than merely feel better. Rational Liv- ing, 1972, 7 (2), 2-9. Ellis, A. Humanistic psychotherapy: The rational-emotive approach. New York: Julian Press, 1973. Gillis, J.S. Social influence therapy: The therapist as a manipulator. Psychology Today, 1974, 8, 91-95. Halleck, S. The politics of therapy. New York: Science House, Inc., 1971. Harper, R. The new psychotherapies. Englewood Cliffs, N.J.: Prentice-Hall, 1975. Hauck, P. Overcoming depression. Philadelphia: The Westminster Press, 1973. Hollingshead, A., and Redlich, F. Social class and mental illness. New York: Wiley, 1958. Lange, A., and Jakubowski, P. Responsible assertive behavior. Champaign, Ill: Research Press, 1976. Lembo, J. Help yourself. Niles, Il: Argus Communications, 1974. Maultsby, M.C.Jr. Help yourself to happiness. New York: Institute for Rational Living, 1975. 75Srole, L., Langer, T., Michael, S., Opler, M. and Rennie, T. Mental health in the metropolis: The midtown Manhattan study. New York: McGraw-Hill, 1962. Young, H.S. A rational counseling primer. New York: Institute for Rational Liv- ing, 1974, . 76 CHAPTER 4 PRACTISING RET WITH BIBLE-BELT CHRISTIANS Not long ago, an earnest-looking young man handed me a pamphlet en- titled "Five Facts You Need To Know For Eternal Life’. Once he had my attention he thrust at me another pamphlet. This one was called "The Golden Rule Is Not Enough!" Before I could recover I was holding yet another tract, this one asking: "Heaven or Hell - What Is For You?" The scene was played out one Saturday afternoon in a grocery store parking lot while I was getting out of my car. I have learned to accept such literature, to thank the giver sincerely, and to go on my way. To protest or do otherwise is to invite a sermon that would put Billy Graham or Oral Roberts to shame. I once kiddingly told such an individ- ual that I followed the teachings of Satan and that I truly believed in the devil. That was a mistake. I was relentlessly tracked through a shopping center by a first-class maniac desperately trying to save my soul before it was too late. It was not until I convinced my soul- saver that I was really a Christian and a lover of Jesus with all my heart that I was finally left to my own resources. In Huntington, West Virginia, where I live, such religious zeal is common- place. As you may or may not be aware, Huntington is in the midst of the Bible Belt, a section of the country reputed to be the stronghold of extreme religious conservatism. Itis a place in which the Bible is the best-seller and prayer is con- sidered the answer to all problems. Revival meetings, religious bookstores, twenty-four hour Christian radio broadcasting, gospel singing, and faith heal- ing are the order of the day. Billboards, flashing neon road signs, and bumper stickers all proclaim the news that "Christ is the Answer" and "Only Jesus Saves’. Who are these God-seekers - these over-religious, devout believers? Al- though many are probably members of a Protestant church group such as the Southern Baptist or the United Fundamentalist Church, they really seem to care little about sectarianism. In fact, most Bible Belt Christians claim no main-line religious affiliation. They simply refer to themselves as Christians. Even though, at first glance, such individuals might appear unlikely candi- dates for psychotherapy - especially a logico- empirical system of psycho- therapy developed by a dyed-in-the-wool atheist named Albert Ellis- it has been 77my experience that RET can be applied very effectively with Bible Belt Chris- tians. It is the purpose of this paper to discuss some of the approaches and techniques I have developed to accomplish this goal. I am going to assume that many of youare unfamiliar with Bible Belt Christianity, and I will therefore offer a brief introduction. Individuals who profess to be Christians are often called Fundamentalists, but this label correctly applies only to a group of "God-fearers" who belong at the ultra-conservative end of the continuum. At the other end are the "God-lo- vers" - the Evangelicals. Although similar in their adherence to Biblical absolutism, the two groups are divided by important differences. The Fundamentalists focus attention on sin and damnation. They are best represented by the hell, fire and brimstone preachers who like to denounce the wicked world with the rhetoric of doom. Fundamentalists are usually opposed to drinking, gambling, dancing and public swimming, Most recently one of their ministers called for the abolition of rock music because all such music is "as- warm with adultery, fornication, uncleanliness, heresies, and revelings." Another minister put it this way: "If I don’t understand something, then it’s a sin, and I oppose it!" Their formula for family structure is a simple one: the man is the undisputed head of the house, and the woman is his obedient wife and servant. Probably the most noteworthy feature of this devout group is its preoccu- pation with the overwhelming fear of divine wrath. Fundamentalists might justly - though paradoxically - be called "Old Testament Christians". They believe the closer one comes to God through holy living, the more one can sense one’s sins in the eyes of God. Since the only result of sin is eternal damnation, this indi- vidual feels fear and guilt. These feelings may be relieved only through repentance. However, this repentance brings one still closer to God, reminds ‘one again of one’s sins, leads to further fear and guilt, demands additional re- pentance which in turn brings the sinner once again closer to God, and so on. According to Biblical scripture, no one is ever free of sin, so the Fundamental- ist believer is forever caught in a Catch 22 - a vicious circle in which the hope is that one’s dying words are a request for forgiveness. For reasons that must be obvious, Fundamentalist preachers are opposed to psychotherapy and often try to sabotage efforts on the part of their flock to seek and remain with such help. It is not unusual for my clients to confide that their ministers have threatened them with the fires of hell for coming to coun- seling sessions. Psychotherapy - and psychiatry in particular, as one client was 78 warned - is the work of the Devil and is not to be trusted. The Evangelicals, on the other hand, offer a theology that places emphasis on forgiveness and salvation. They are the God lovers and seek an ongoing per- sonal and intimate relationship with Christ. This is a kind of spiritual union in which the individual surrenders his will or independence to God and allows di- vine inspiration to guide his life. Evangelicals do this because they believe that man is a sinner and is weak and that he cannot overcome these handicaps with- out Christ’s love and guidance. Once Christ is accepted as a personal savior, all is possible - literally all. No problem is so large that it cannot be relieved or resolved with Christ’s help. The Evangelical message is one of hope, joy, and eternal happiness. Probably the most striking feature of this religious approach, however, is the phenomenon of "being born again". During the process of dedicating one’s life to Christ, it is claimed that a kind of mystical, intensely emotional experi- ence takes place. The individual who undergoes this spiritual initiation is considered reborn or saved, is relieved of all past sin, and is free to make a fresh start in life. Many converts explain their rebirth as a sensation similar to an elec- tric shock. Some say it is as though a lightening bolt has suddenly struck them and has traveled through their bodies. One "saved" Christian claimed his salva- tion felt as though a sudden flow of energy and joy had come over him - a sensation akin to nothing he had ever experienced before. After being saved, these joyful Christians are eager and willing to relate the scenarios of their ex- perience in great detail to anyone that will listen. It appears that the telling and retelling of their testimony strengthens and recharges their faith. It is Evangelicals that have captured the public attenton of the day. Cele- brities on television talk-shows rave about their conversions; books written by the reborn are beginning to appear on best-seller lists; and a recent Gallup poll indicates that 94 per cent of Americans now claim they believe in God or a Universal Spirit. However, it is probably the nomination and election of Jimmy Carter as President, that has given the Evangelicals their greatest recent pub- licity. Mr. Carter has admitted to being a "born-again" Christian, and he claims to read a chapter of the Bible daily. It would appear that Bible Belt Christianity, whether it surfaces as God- fearing Fundamentalism or God-loving Evangelicanism, is a religious form that is on the rise in the United States. The Southern Baptist, for example, claim a membership of 12.7 million with a growing rate of 250,000 per year. I might add athat the population increase in "that old-time religion’ is not limited to the Bible Belt; of even more interest is the change in social- class composition of conser- vative Christian churches. Some recent research indicated these churches are no longer the exclusive province of the stereotyped, uneducated red-neck from the Deep South but are now attracting a country-wide, predominantly well- edu- cated, middle- class participation. It was suggested that the economic reversals and social changes of the past decade so disrupted the traditional security of the middle-class that a search for new meaning lead to the certainties of the Bible and the Christian promise of eternal salvation. It is quite likely, therefore, that whether you practise RET in West Virgi- nia or not, and whether you like it or not, one of these days you will find yourself face-to-face with a confirmed fundamentalist Christian. Since it is the primary purpose of this paper to discuss the application of RET with this client group, let me get down to business and discuss some of the clinical issues involved. It might prove helpful to approach the subject of dealing with with some of the questions that might well be asked before engaging in such an endeavor. 1, How much religious education must a therapist have before he attempts to practise RET with fundamentalist Christians? My answer is very little! I am not well-versed on the Bible, Most of the re- ligious information I need for my work comes from the clients themselves or from my occasional viewing of the religious programs that fill the TV channels in my area. I watch Billy Graham, Oral Roberts, Rex Humbard, and other media ministers. Their message is repetitive, casily remembered, and extremely use- ful for therapeutic interventions. The way in which the preachers get their message across is especially note- worthy. I strongly suggest you listen to some of the evangelists on television or radio. Although they sometimes come across as dogmatic and authoritarian, they are nevertheless extremely effective speakers, and they have a remarkable ability to persuade listeners to accept what they have to say. I have borrowed much from their delivery and style, and I often use their methods to get my own therapeutic message across to both religious and non-religious clients. However, it is not necessary to put even this much effort into a religious education if you plan to practise RET with Bible Belt Christians. Merely become familiar with the principle of forgiveness as found in the New Testa- ment. It goes like this: when you sin, you confess your sin to God, you ask for God’s forgiveness, you receive God’s grace, and then, freed of guilt, you work 80 hard to avoid further sinning so that you can fulfill God’s purpose for you. In RET terms this principle might be expressed in the following way: you make a mistake, you assume responsibility for the mistake, you accept yourself as a fal- lible human being, and you the work hard to avoid further mistakes so that you can strive for maximum happiness. Both the Bible and RET, therefore, view self-blame as playing an import- ant role in human suffering, and both offer similar approaches to dealing with the problem. In fact, it might be said that teaching the principle of acceptance and the tactics employed to put this concept into practice is the goal of many RET encounters. The therapist who acquaints himself with the similarities be- tween Biblical forgiveness and rational acceptance has at his disposal an extremely effective cognitive-philosophic tool for dealing with most forms of emotional disturbance. 2. What about the therapist's religious convictions? Can an atheistic or non- religious therapist practise RET with Bible Belt Christians? Myanswer is a definite "Yes!" I do not believe the therapist need be a Chris- tian, Catholic, Jew, Buddhist, Hindu, or whatever to practise psychotherapy with clients. The question of whether the client and therapist must share the same religion in order to ensure an effective therapeutic outcome raises an issue that frequently comes up in therapy. Can the white therapist work with a black client? Can the male therapist work with a female client? Can the straight ther- apist work with the gay client, and so on? Numerous studies have addressed themselves to this issue. The answer is usually the same: in some cases, itis important that the therapist and client share certain common characteristics, but in most cases it is not. It would be practi- cally impossible for the average therapist who works with a varied clientele to possess traits similar to those of all his clients. For one thing, he would have to suffer their disturbances, After all, how could one expect a therapist to help a psychotic client, an alcoholic client, or a manic-depressive client unless he him- self suffered or, even better, was presently suffering from such disorders? It is important to bear in mind that there is nothing about psychotherapy that requires the therapist to be anything other than an educator or teacher. Our job as therapists is to teach clients that alternatives, cognitive or otherwise, exist, and that chances are very good that if they follow some of these alterna- tives, they can either resolve their problems or learn to live with them better. As long as this information is presented in a responsible, empathetic manner, 81there is no reason why therapy cannot take place between people of different religious, social, ethnic, and other varied cultural, intellectual, and emotional backgrounds. Although exceptions do exist, it is my opinion that the non-relig- ious therapist, therefore, can work effectively with the: extremely religious client. ‘The primary requirement for such an endeavoris that the therapist demonstrate an accepting understanding, non-judgmental attitude towards the client’s relig- ious values and beliefs. 3. How do you handle questions about your own religious beliefs, or lack of them, if you know that the information may create a serious problem for the client and might possibly result in termination of therapy? It is my suggestion that you answer such questions very carefully! Although Tam usually a strong believer in answering the personal questions posed by most clients in a direct and honest manner, I have found that this is not always advis- able with religious clients. If you are asked a question about your religious convictions, and you believe that an honest but negative reply could interfere with therapy, then I suggest you evade the issue. Try to answer the client and leave the impression you are a believer without really stating things as such. Ifyou are backed into a corner and nothing less than a straight "yes" or "no" answer is acceptable, I strongly suggest you lie and tell the client you are a firm believer. In my opinion, honesty is not always the best policy in these cases, and if the client is really in need of help, and a more acceptable counselor is not available, it is better to free the client of any doubt he may have about your mo- tives and to tell him what he wants to hear. Otherwise, many clients will suspect you are the Devil himself trying to seduce them away from God. Very little ther- apy could take place under such circumstances. 4, Are there any Christian religious beliefs that are off-limits to RET interven- tions? Yes, there are a few. I strongly suggest, for example, that you avoid con- fronting and confuting (1) the existence of God, Christ or the Holy Spirit; (2) the existence of the Devil, Demons, or the Forces of Evil; (3) the infallibility of the Bible; (4) the existence of a heaven that is somewhere in the sky; (5) the ex- istence of hell, a place of unbearable suffering, somewhere down inside the earth; and, of course, (6) life after death. For our purposes, these absolutes will have to remain inviolate and beyond the province of psychotherapeutic investigation. To do otherwise - to contra- dict such notions - will usually bring the therapeutic endeavor to a quick end. 82 Surprisingly, however, the inviolability of these concepts need not interfere with cognitive and linguistic efforts to convince Bible Belt Christians to change their thinking and overcome their disturbances. In fact, it is the very source of these absolutes, the Bible itself, that can provide the ideology for successful RET therapy. Itis important to realize that the Bible contains many sane and rational pas- sages that can easily lend themselves to sound therapeutic interventions. I have already described the similarity between the Biblical principle of divine forgive- ness and the RET concept of self-forgiveness. It is hard to imagine an emotionally disturbed client who could not use some assistance in overcoming the tendency to condemn himself and others. In addition, the Bible offers many other ethical principles that are consistent with the tenets of RET and that can be applied very effectively to most forms of emotional disturbance. However, the method I use most frequently to skirt fundamentalist abso- lutes and to encourage clients to surrender upset-producing, irrational ideas involves the interpretation and definition of the Scriptures themselves. I usually follow a procedure that first accepts a particular passage as literal truth, then changes the meaning of that passage so that it proves more rational and help- ful to the client. Since there is little agreement among Bible Belt theologians as to the exact meaning of Scripture, this tactic is rarely challenged. Clients often respond dramatically to this approach because my interpretations appear to have the sanction of God himself. ‘An example may help to illustrate this method more clearly. A fifty-year- old coal miner suffered an accident that was caused by the coal company’s neglect of proper safety precautions. He was extremely angry and depressed because the company would neither recognize its liability in the matter nor offer him compensation. Since the accident had left him permanently disabled, I asked why he had not sued the company for restitution. The man told me he was a Christian and that the Bible said you are not allowed "to law against your neighbor." I accepted this stricture without question but offered the man a different interpretation. I explained that the passage meant you were not supposed to bring legal action against someone for selfish reasons. I agreed that it was wrong tosue someone so that you could get rich - you are supposed to love your neigh- bor, not cause him trouble. However, I pointed out that if the man sued the company, he would not be doing it only for himself. Such legal action might be used as a way to force the company to improve its safety standards and might 83thus save lives. I informed the man that if he used the law against the company, he would likely be helping his neighbors. In other words, I redefined legal ac- tion as a virtue and not a sin. In addition, I asked the man if he believed, as a Christian, that he was the head of his house. He nodded his agreement, and I admonished him for not ful- filling his Christian duty in this regard. I pointed out to him that his failure to sue the company left his wife and family with scant economic support and sub- jected them to unnecessary hardship. By taking the necessary legal action, I told my client, he would not only be helping his neighbors but his family as well, and that, I emphasized, is what God wants him to do. It’s in the Bible! This proved to be the clincher: the man’s anger and depression subsided as soon as he learned that he had alternatives that were in keeping with Biblical law. I under- stand that he later obtained the services of an attorney. Rather than arguing with the Scripture, I interpreted it differently and showed this client that he was looking at things in the wrong way. I tried to offer an explanation that would allow for the most rational course of action under the circumstances. Combining this strategy with the principles of forgiveness has proved consistently the most effective way of intervening in the disturban- ces suffered by Bible Belt Christians. I have received remarkable results using this approach and have been able to convince some of the most rigidly narrow Christians to change their thinking and actions. I might add that I am not interested in whether or not I am Biblically ac- curate, nor am I the least bit interested in checking up and finding out if what Thave to say or even what the client has to say is actually found in the Bible. In many cases, I take considerable liberty with a particular passage or verse, and it is quite possible that my interpretation would not stand up to ecclesiastical review. My goal is not to provide pastoral counseling consistent with accepted religious dogma but rather to provide a therapeutic experience that follows the rules of rational analysis. In short, I present the Bible according to RET. Mysuggested approach can probably best be illustrated by the use of exam- ples. Let us therefore look at some clinical situations that demonstrate those cognitive strategies that I have found most effective with Christian clients. FORGIVENESS PLOYS This first example is that of a young woman who had to be hospitalized be- cause of extreme guilt and depression. It seems that she had borne a child by a 84 man other than her husband. Her husband was unaware of the situation, and the woman claimed to be so distraught that she could not look the child in the face. Although she was not a regular churchgoer, she was raised in a fundamen- talist family and had undoubtedly absorbed their beliefs. When I met her for the first time, I asked her why she felt so guilty. She claimed she had broken one of God’s sacred rules: she had committed adultery and was sure she would end up in hell. I asked her if she knew who Jesus was. She gave me an incredulous look and said, "Of course I do!" I said with great conviction, "I doubt that. You may know the name, but you certainly don’t know anything about what he had to say." Now that I had her undivided attention, I told her the story about how Jesus handled this kind of sin. I related that he was once confronted by some religious leaders with a woman who had been charged with adultery. The religious leaders wanted the woman severely punished, and I asked my client, "What do you suppose Jesus recommended?" My client looked blank. I told her that Jesus directed that the woman be forgiven and allowed to go her way. He offered her his grace and an opportunity for a new life. Ithen confronted the woman. I asked, "What do you think Jesus would rec- ommend for you? Do you think he would want you to feel miserable and be shut up in a hospital, or would he want you forgiven so you could be at home taking care of your family and raising that child of yours in a proper Christian man- ner? The woman scemed visibly relieved. I gave her the homework assignment of getting down on her knees and asking Jesus to forgive her. I told her all she had to do was to be sincere and to promise Jesus she would try not to commit adultery again and that her sin would be forgiven. The woman received some additional counseling along the same lines and showed marked improvement at the time of her discharge from the hospital. Here is another example that uses the same approach. This case involves a young woman who felt extremely guilty over a recent abortion. According to the woman, her act had brought God’s wrath upon her and she was undeserv- ing of any happiness. Therapist: Let me see if I understand you. You killed someone Client: No, I didn’t do it, but I’m responsible. I arranged for the abortion and I went through with it. T: Okay, I got that, and the reason you are so upset and haven’t been back to church since the abortion is that you know God hates you? 85C: That's right. I just couldn't go into the church and walk down the aisle knowing what I did and knowing God would judge me. T: But, why won't he forgive you? I thought Christ was a forgiver. Did you forget that? C: For an abortion! That’s murder! The Bible says thou shalt not kill! T: But, it also says that no matter what the sin - you can be forgiven. You can gain grace through Jesus. C: But this is serious; it’s not a minor sin. It’s killing a person - an unborn child. T: In other words, you really did it this time. You committed the biggest sin of all - you killed an unborn, innocent child, C: Well, what do you think? That it’s okay? That I’m not responsible? T: I think you've been reading the wrong Bible. I thought you said you were a Christian, but I guess you skipped over the part of the Bible I’m thinking about. It’s from the new Testament - the Christian part! C: What part? T: Well, let me put it this way. You said you were responsible for killing a person, right? You consider that an unforgivable sin. You think it’s the worst thing in the world - the biggest sin of all - and you can’t live with yourself because of it. C: Yes, T: Well, I can think of a killing, a death that is worse, and it’s in the Bible. C: What do you mean? T: Who died on the cross? C: Jesus. T: Let me ask you this. Do you really believe your sin, your responsibility in the killing of your unborn child is a bigger sin or worse than the killing of Christ? That the world will suffer more from the death of your unborn child than it did from the death of Christ? C:No, I guess not. T: Let me ask you something else. What did Christ say to the people responsible for crucifying him? What did he recommend for them? Did he get angry and hate them? Did he want them punished? What were his last words on the cross? C: He said to forgive them. T: Let me see if I have this right. You can kill Christ, the son of God, and you can not even ask for forgiveness and still be forgiven. But if you have an abortion in an over-populated, crowded world, you have to go straight to hell. C: I never thought of it that way. T: I know. If] could just get you Christians to practise what’s in the Bible, you'd be okay. I proceeded to use similar arguments and made considerable headway. However, this young woman was in a way testing me to learn what my approach would be, and the next interview revealed some additional information. C: I thought about what you said, and I really feel like a load has been taken off my chest, but I really didn’t tell you everything. T: Well, fill me in, and maybe we can put the Bible to work again and clear it up. C: Well - that abortion I told you about wasn’t the first. T: You've had another. C: Three more. I’ve four altogether. T: You're certainly fertile, but what’s the problem? C: I can understand about forgiveness for one abortion, but what about four? I should have learned my lesson. T: You mean you can get one pardon from God, but if you make the same mistake more than once, you're scheduled for a trip to hell. C: Well, there’s got to be a limit. T: Really? There you go again! Reading the wrong Bible! Iremember something about Christ saying that you can be forgiven seventy-times-seven. That means you could have four hundred and ninety abortions and still be forgiven. God would still have love for you. C: You mean I can do whatever I want? I can get pregnant, get an abortion, and just keep going on and on, four hundred and ninety times and I’m still forgiven + it’s okay in God’s eyes? T: Yes and No! Yes, you can have four hundred and ninety abortions and still be forgiven. But no, it’s not okay. It’s still a sin in God’s eyes. Jesus would be disappointed in your actions, but he would not condemn you. When you ask for 87forgiveness you are first of all admitting that you did something wrong, and God expects you to feel sorry and unhappy about breaking the rules. However, instead of blaming yourself, he wants you to accept yourself as someone who made a mistake - just an ordinary human being. God wants you to feel responsible and unhappy but not condemned and guilty. You see, Jesus allows you more than one mistake because he knows you are human and that try as hard as you may, you will still make some mistakes. He offers forgiveness so that you can stop blaming yourself and get to work on trying harder to do things right, He still wants you to feel bad but not so bad that you end up making more mistakes. That’s what happened to you. You made one mistake and felt so upset that you stopped going to church and kept right on making the same mistake over and over again. As you can see, I attempted to blend the RET concept of acceptance with the Biblical principle of forgiveness. My goal was to help the client realize that acceptance or forgiveness does not condone wrongdoing or sinning but rather encourages the individual to assume responsibility for the error and to work to take corrective measures in the future. Some Christian clients, however, are so influenced by the Fundamentalist doctrine of punishment that they will not accept forgiveness, no matter what the Bible says, As far as they are concerned, they must suffer some kind of severe penalty for their sin. Left to their own devices, such Christians will torture them- selves as much as possible and still believe they have not suffered enough. This example involves a coal miner who got in a fight in a bar. His brother- in-law came to his defense and, unfortunately, was shot and killed, leaving a wife (the client's sister) and four young children. The coal miner began to drink heav- ily in order, as he put it, to drown his guilt, a practice he continued for more than two years. At the time I saw him he had been out of work for some time as a result of physical problems caused by his drinking. I explained the principle of forgiveness, but the man insisted his "crime" deserved punishment, not forgiveness. My approach in this case was to suggest that the man had already suffered enough. I pointed out that the penalty for his crime was that he had saddened his sister, had deprived her of a father, had felt extremely guilty for the past few years, and was presently in the hospital facing an operation necessitated by his drinking. I said, "Suppose God had punished you- could he have come up with anything worse?" This started the client think- ing. I further pointed out that not even prison, a beating, or some kind of painful torture could equal the suffering the man had already endured. I asked him if 88 he ever stopped to think that maybe God had called forth all of his misery, and the eh he was talking to me now might be God’s way of telling him he had suffered enough for his sins. This concept seemed to make sense to the man, and I reinforced it with other, similar arguments. He stopped drinking and re- turned to work in the mines. Here is an example in which the client applies forgiveness not to himself but to someone else. This is a particularly difficult requirement for many ‘Chris- tians. When someone wrongs them, they are supposed to be forgiving and love that person. Unfortunately, their human tendency is to feel anger and resent- ment. What usually happens is that the individual suppresses the anger that makes him feel guilty for violating a Biblical injunction. ‘The client in this case was an elementary school teacher who was having problems with a critical manipulative teaching assistant assigned to her room. Apparently, the teaching assistant would try to take over the class by denigrat- ing my client and the students would laugh at the whole thing. My client did nothing about the situation. Extremely angry, she would have liked to have con- fronted the woman, but she believed her anger was sinful and felt guilty about it. She therefore withdrew from making any attempt to correct the situation. The teaching assistant took advantage of the client’s passivity, and the situation worsened. Finally the client’s hospitalization became necessary. My first goal was to convince the woman that her anger was not a sin and that standing up to her tormentor would actually be a Christian virtue. Therapist: When God is in your heart and is directing your life, what happens to you? Client: You are happy and do good things. T: I agree, but what about when you are unhappy and do bad things? Who's directing your life then - God or the Devil? C: The Devil, I guess. T: Okay, now let’s see how this applies to your situation, When this woman tries to take over your class and gets the kids to laugh at you, when she does evil things, who is influencing her to act in this way - God or the Devil? C: It’s the Devil. T: Good, we've got that important part established. Now, what have you been doing about it?C: Nothing. T: And what are you supposed to do about evil and sin? What’s a Christian supposed to do about the Devil? S You're supposed to fight sin and evil. You're not supposed to give in to the Devil’s temptation. T: Yes, and up to now you’ve been backing away and letting the Devil have his way. The Devil is not only making this woman do bad things, but he’s making life miserable for you. And you, a Christian, have been letting things go bad without so much as a word. C: But what can I do? T: You can forgive the woman - she’s not in her right mind. It’s not alll her fault that she treats you the way she does. It is because the Devil is tempting her and is winning. You can be angry and hate what the Devil is making her do. You can become determined to do your Christian duty and fight the Devil. In other words, when she treats you badly, you can understand the situation and actually feel sorry for the woman, but instead of backing off, you can stand up to her. It’s not really the woman you are mad at and standing up to, but the things she is doing because of the Devil. You have to feel angry, but it’s not the woman you feel angry toward, but the Devil in her that’s making her treat you badly. C: When you put it that way, everything seems different. I couldn't forgive her when I thought she was doing these things because she really wanted to hurt me. I just never thought she was possessed by the Devil. T: So you can love and forgive the woman but not her sin. The sin is the work of Satan, and you'd better get tough and try to stop the sin. i You may recognise this as a crude method of separating the person from his actions and deploring the action but accepting or forgiving the person. Once the situation was put in this perspective, the woman was receptive to assertive- ness training. In addition, I told the teacher to pray for the woman - to help the woman recognize that the Devil was guiding her life. These case illustrations give you a general idea of how I rely on the forgive- ness principle as a major interventional tactic in practising RET with Christian clients. Now I will offer some other cognitive techniques that demonstrate other rational approaches to Christian dogma. a ee ee SELF SACRIFICE STRATEGIES One of the main and most pernicious tenets of Bible Belt Christianity is the demand for total self-sacrifice, especially from women (see Chapter 1, pp. 15- 16). However, one case with a male client concerned a Baptist minister who used the self- sacrifice doctrine to protect and bolster his self-esteem. He would say yes to practically any request made of him, claiming this was the Christian way. The outcome was predictable. The man was overwhelmed by demands for all kinds of assistance - to the extent that he neglected his own family and his own health. After a number of sessions, it was apparent that his self-sacrifice was motivated primarily by his fear of lowered self-esteem if he refused to help someone and that person were disappointed with him. He claimed that he was aman of God and, as such, could not turn people down in their time of need. Most recently he loaned a very unreliable teenager $750 to buy a car, knowing the money would never be repaid. After a responsive relationship had been es- tablished between us, I confronted him with the following argument: "I think you use being a Christian as a cop-out. It seems to me that you bend over backwards to give everyone what they want because you are really afraid that if you turn someone down they will dislike you. When this happens, you make yourself feel crummy because you think you are less of a person - a nobody. You’re not giving to others for their sakes, but so that you can think well of yourself. Your motive is not Christian self-sacrifice ut good old-fashioned pride. In other words, it seems to me that you do good unto others to glorify yourself, not God." "Let me tell you what I believe Jesus would have done with the young man who wanted to borrow $750. First, he would have viewed the situation as an opportunity to teach a lesson in Christian living instead of as a threat to his pride. In this case I'll bet he would have figured that merely giving money to someone so young and so unreliable would be quite foolish. He would think this way because he would know that performing your Christian duty is not always pleasant and that not everyone is going to agree with your decisions. Jesus might have suggested that the young man work and save his money or perhaps arrange for a bank loan. Either way, however, he would still feel confident even ‘if the young man hated him because he wouldn't be aiming for the man’s approval but rather for the man’s spiritual enrichment." My goal was to encourage the client, in typical RET fashion, to concentrate on performance and duty rather than on self-rating or pride. Although my ex- 91pansion might not satisfy some theologians, it nevertheless had a - peal to my client. I often find that Christian clients who penal ei with self- conceptualization and assertiveness repond well if told to emulate Jesus. I usually describe Jesus as a rational, assertive, liberated individual who was not afraid to stand up for what he believed, regardless of the circumstan- ces. Using J lesus as a model in this way is an extremely effective tactic that inspires many clients to make immediate changes in their behavior because they believe they will be doing what God wants them to do. i PRAY FOR STRENGTH A recently divorced woman was going through the trials and tribulations that frequently accompany a broken marriage. She was a very pious Christian and the situation was a particularly difficult ordeal for her. In addition to the moral problem, her husband, a disturbed alcoholic and the one that initiated oe dares ee no call her frequently. He blamed her for the entire situ- ation, he lied to their children, and he withhel i approach proved most effective: payee Client: I just don’t think I can take another minute of it. P’'ve tri i . Pve tried everything. I prayed to God and asked him to help, and not even he ai Now I'm losing faith in God!" en Therapist: That sounds pretty serious, C: I've asked him to relieve me of the burden. P've sincer: i 3 ‘ ely put the probl his hands. I don’t even think he’s listening, Ocean T: Let me see if I have this right. You prayed that your husband would start acting rationally, that he would stop bothering you, would tel the children the truth, would give you enough money, and would make you feel better. You prayed to have this awful weight lifted from your shoulders. : C: Yes, that’s it exactly, but the Lord has given up on me. I think it’s because of the divorce. He’s making me suffer because of the divorce. T: No, he isn’t. You didn’t get the divorce. Your husband did. You're not responsible, so God won't punish you for something that’s not your fault. That’s not your problem, I'll tell you what your problem is - you don’t know how to pray. C: What do you mean? T: You're making the same mistake that many Christians make. You're asking 92 God for a miracle, for him to do all the work, for him to simply snap his fingers and make all the bad go away and make everything all good. You want God to do everything with no effort on your part. That's not his job. I'll tell you what to pray for. C: What? T: The strength to bear the burden. That’s what to pray for! Ask God to help you bear things - put up with things exactly as they are. Pray for the strength to handle the struggle better. I'll bet if you change the words of your prayer you'd feel a lot different. Try this: go home tonight and pray. Only this time ask God to help you merely put up with a disturbed, mixed up former husband, and see if things wor’t get better for you. With the Lord’s help, you'll begin to handle things as they really are instead of praying to make them the way you think they ought to be. I hate to say it, but the Lord helps those who help themselves. Since it is unlikely that the woman’s disturbed husband will stop his harass- ment, the client is far better learning to accept things as they are rather than demanding they be different. By my putting this concept into a religious frame- work, it became more intelligible and acceptable to the client. I saw her a few more times, but she claims my advice on praying was the key to her recovery. ‘Another client, a minister, expected to be granted immunity from life’s problems and frustrations. He believed his faith was supposed to give him per- fect control over his emotions and to protect him from upset of any kind. Up to the point when I saw him, he had been rather fortunate and had not experienced any serious problems. As far as he was concerned, there was nothing in life he could not manage with Christ’s help. Suddenly, however, within a two-month period his house burned down, one of his children almost died of an illness, his wife was stricken with a paralyzing disease, and he was unjustly accused of em- bezzling a large sum of money. Not surprisingly, he found his way into a psychiatric hospital. The main source of the minister’s distress was his inability to handle his problems alone. He constantly made matters worse by downing himself for not being able to view his situation with indifference or with Chris- tian cheer. He responded however, when I portrayed matters in the following way: "For a minister you've got a funny attitude about suffering. You think you're immune to it - that because you’re a man of God you don’t have to suffer. I’ve got news for you: the son of God, Christ himself, did a lot of suffering. You remember that trip to the cross - do you think that was fun, that he 93