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A SOLUTION-FOCUSED APPROACH
TO RATIONAL-EMOTIVE BEHAVIOR
THERAPY: TOWARD A THEORETICAL
INTEGRATION
Jeffrey T. Guterman
James Rudes
Barry University, USA
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CLINICAL THEORIES
Rational Emotive Behavior Therapy
Ellis (1988) has suggested that you can figure out by sheer logic
that if you were onlyto stay with your desires and preferences, and
if you were neverto stray into unrealistic demands that your
desires have to be fulfilled, you could very rarely disturbyourself
about anything (p. 21). From this thought flows REBTs most fundamental principle, namely, that emotional and behavioral disturbance
is largely caused by demandingness (Ellis, 1962, 1988, 1996, 2001).
REBTs theory describes the processes whereby humans create
irrational (i.e., self-defeating) philosophies and then indoctrinate
themselves with these ideas. In addition, REBT contends that
humans are taught irrational philosophies and frequently internalize
these ideas through persistent self-indoctrinations. According to
REBT, humans make themselves disturbed by thenceforth bringing
irrational philosophies to situations in their lives.
REBT theory is specified further by way of its distinction between
rational beliefs and irrational beliefs. According to REBT, rational
beliefs are evaluative cognitions that are nonabsolute and take the
form of preferences, desires, and wishes (Ellis, 1962, 1996; Ellis &
Dryden, 1990). Ellis and Dryden (1990) have suggested that rational
beliefs are relative and do not interfere with the attainment of basic
goals. Irrational beliefs, on the other hand, tend to be absolute,
dogmatic, and demanding and take the form of musts, shoulds, and
oughts (Ellis, 1962, 1996). When humans hold irrational beliefs
about negative events in their lives, these generally correspond to
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self-defeating (also referred to as inappropriate) emotions and behaviors (e.g., depression, anxiety, addiction) that usually block one from
working toward their goals (Ellis, 1996). Rational beliefs about negative events tend to result in self-helping (also referred to as appropriate) emotions and behaviors (e.g., sadness, concern, annoyance) that
aids one in working toward their goals (Ellis, 1996).
Ellis (1962) originally identified twelve irrational beliefs, which, he
theorized, are mainly responsible for creating disturbances. Subsequently, Ellis (1999) has condensed this original list to comprise
three core irrational beliefs:
(a) I must achieve outstandingly well in one or more important
respects or I am an inadequate person! (b) Other people must
treat me fairly and well or they are bad people! (c) Conditions
must be favorable or else my life is rotten and I cant stand it!
(p. 155)
REBTs ABC theory explains quite simply the processes whereby humans become emotionally and behaviorally disturbed (Ellis, 1962,
1988, 1996). A stands for Activating events. B stands for Beliefs. C
stands for emotional and behavioral Consequences. REBT holds that
Activating events (A) do not directly cause emotional and behavioral
Consequences (C). Instead, it is ones Beliefs (B) about Activating
events (A) that contribute most to emotional and behavioral Consequences (C). REBTs ABC theory posits that appropriate emotional and
behavioral Consequences (C) are largely caused by rational Beliefs (B)
about Activating events (A). Conversely, inappropriate emotional and
behavioral Consequences (C) are mainly caused by irrational Beliefs
(B) about Activating events (A). REBTs main clinical goal is to help
individuals dispute irrational beliefs and, in turn, eradicate emotional
and behavioral problems so that they can work toward their goals in an
effective and efficient manner (Ellis, 1996). The course of REBT includes introducing to clients the principles of REBT, and helping them
use various cognitive, emotive, and behavioral techniques aimed at
disputing irrational beliefs and modifying dysfunctional feelings and
behaviors. The disputation method, REBTs principal technique, has
been defined as any process where a clients irrational beliefs and
cognitive distortions are challenged and restructured (Ellis, Sichel,
Yeager, DiMattia, & DiGiuseppe, 1989, p. 34). REBT also employs a
variety of behavioral and emotive technique aimed at helping clients
change their self-defeating thoughts, feelings, and behaviors.
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Solution-focused Therapy
The clinical theory of solution-focused counseling is informed by a
social constructionist position that holds that there are no clinical
problems independent of the social interchange that occurs between
clinicians and clients (de Shazer, 1991). Accordingly, clinical problems are co-created in language between therapists and clients. De
Shazer (1991) has noted, however, that the notion of problem necessarily implies the existence of non-problem or exception, that is,
times when theproblem does not happen even though the client
has reason to expect it to happen, and, of course, the space between problem and non-problem or the areas of life in which the
problem/non-problem is not an issue and is not of concern to the
client. (p. 83)
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It follows that disturbance is to be understood in terms of the coexistence of rational beliefs and irrational beliefs. The change process
entails helping the client replace irrational beliefs with rational beliefs by identifying and amplifying rational exceptions: instances
when, in the context of clinical disturbances, the client retains their
preference (rational belief), yet does not escalate that desire into a
demand (irrational belief). We recognize that there are also always
general exceptions to clinical problems; that is, any instance when the
client has experienced some improvement in their self-defeating
thoughts, feelings and/or behaviors, and all other aspects of their life
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in which the problem is less severe or not of concern. The identification and amplification of general exceptions does not necessarily imply that the client is not holding irrational beliefs. We have found,
however, that identifying and amplifying both rational exceptions
and general exceptions often contributes to more effective problemsolving and symptom relief.
The clinical process of our integrative model (described in the next
section) often includes both an educative phase and an application
phase. During the educative phase, the client is introduced to the
principles of REBT and is encouraged to begin conceptualizing clinical problems in terms of the ABC theory. During this phase, the client is also provided with instruction in disputing irrational beliefs
and various other cognitive, emotive, and behavioral techniques. The
application phase includes helping clients to identify and amplify
both rational exceptions and general exceptions. We have set forth a
reformulated expansion of the ABC theory, denoted as ABCDE, to account for the change process where D refers to Disputing irrational
beliefs and E refers to identifying and amplifying Exceptions (rational and general).
We now briefly describe Elliss (1977, 1980, 1996, 2001) distinction
between preferential REBT and general REBT in order to offer a
rationale for our use of various techniques and goals of treatment
within the integrative model. According to Ellis (1977), preferential
REBT (also referred to as elegant REBT) involves helping clients
make a profound philosophic change whereby core irrational beliefs
are replaced with rational beliefs. This approach is considered preferential because it prepares clients to deal effectively with both current
and future events by ascribing rational, rather than irrational, beliefs
and thereby avert self-defeating emotions and behaviors. General
REBT, on the other hand, refers to the use of alternatives to the disputation method, including many of the techniques used in Becks
(1976) cognitive therapy and Meichenbaums (1977) cognitive-behavior therapy. Ellis (1996) has pointed out that although his first choice
is to use preferential REBT, he does not rigidly hold to this treatment in cases where it is assessed that the client is not amenable to
such an approach; where there is significant resistance to such methods; or where such an application might otherwise impede progress.
Ellis (1999) has also advocated the use, in some cases, of techniques
that run counter to some of REBTs main principles:
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REBTincludes a reserve of other cognitive, emotive, and behavioral methods that may be useful for particular clients when its
most popular methods are resisted by the client, therapist, or
both. REBT practitioners are free to experiment with a wide variety of techniques, some of which may seem irrationalWhen all
else fails, REBT therapists can use various techniques from other
forms of therapy, including even some irrational techniques, to
help clients who resist employing the best methods. (pp. 157
158)
In a similar vein, we understand our integrative model as including aspects of preferential REBT, general REBT, solution-focused
conceptualizations and interventions, and virtually any other techniques that bring about effective change. We have found that a flexible clinical approach speaks to Pauls (1967) cogent point that
therapy is to be deemed as effective in relation to how it addresses
the question of what treatment by whom, is most effective for this
individual, under what set of circumstances (p. 117).
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Since cognition, emotion, and behavior are interactive and reciprocally related, we also encourage clients to dispute irrational beliefs in
conjunction with various cognitive, emotive, and behavioral techniques. Ellis & Dryden (1990) have suggested that cognitive change
is often facilitated by behavioral change (p. 173). Along similar lines,
Ellis (1980) has suggested that if people force themselves to actdifferently, they frequently will bring about cognitive modification (p.
332). Cognitive techniques include the use of coping self-statements
where clients are encouraged to write down and repeat to themselves
rational beliefs to supplement their disputation of irrational beliefs. A
variety of psycho-educational are also used, including encouraging
clients to read REBT self-help books and use REBT self-help forms.
Emotive techniques include rational-emotive imagery and encouraging clients to dispute irrational beliefs in forceful, evocative, and dramatic ways (Ellis, 1985). Behavioral techniques include in vivo
desensitization or exposure, and implosion (Ellis, 1985, 1999; Ellis &
Dryden, 1990).
We also employ a variety of practical methods aimed at helping clients change negative conditions in their lives; that is, Activating
events (A). These methods might include teaching clients specific
skills, such as parenting, budget planning, and problem-solving.
These techniques, however, are usually employed along with the
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disputation method. Although we strive to help clients change negative Activating events (A), we often encourage them to first change
their irrational beliefs about these circumstances since, it is assumed,
that once clients are less emotionally and behaviorally disturbed,
they will very often then be more adept in their problem-solving
strategies (cf., Ellis, 1980; Ellis & Dryden, 1990).
Identifying and Amplifying Exceptions
If we have previously employed an REBT conceptualization when
defining the problem, we usually begin this part of the clinical process by first seeking to identify rational exceptions, rather than general exceptions. It is reminded that rational exceptions refer to
instances when, in the context of clinical disturbances, the client retains their preference (rational belief), yet does not escalate the preference into a demand (irrational belief). For example, the therapist
might ask the client, When has there been a time when you felt sad,
but not depressed, about this situation? This question is aimed at
identifying those times when the client experienced an appropriate
emotional Consequence (C) about a negative Activating event (A). In
keeping with REBT theory, it is assumed that such instances are occasioned by rational beliefs, rather than irrational beliefs. Accordingly, the client would then be asked to recall their Belief (B) during
the time when they felt sad, rather than depressed. Thus, the client
might be asked a line of questioning in the direction of identifying
corresponding rational beliefs; for example, What were you telling
yourself about the Activating event (A) when you felt only sad, but
not depressed? (and so on). In other cases, the therapist might first
focus on identifying incidences of rational beliefs, rather than initially attempting to identify appropriate emotional and behavioral
Consequences (C). So, the therapist might ask the client, When has
there been a time when you thought rationally about this situation?
and then proceed to identify the corresponding appropriate emotional
and behavioral Consequences (C). In either case, the incidence of rational Beliefs (B) and corresponding appropriate emotional and
behavioral Consequences (C) signify rational exceptions that are to be
amplified (described below).
A rule of thumb when asking such questions is to use language
that creates a context for identifying exceptions. For example, it is
important to ask, When has there been a time when you felt sad,
but not depressed, about this situation? rather than Has there been
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a time when you felt sad, but not depressed, about this situation?
The latter is a yes-or-no question that leaves room for the client to
respond negatively. The former carries with it a sense of expectancy
that indeed there have been exceptions. Often there is a silent response because many clients are not accustomed to being asked at
such an early stage in treatment about times when things are going
better. This questioning is interventive as it produces a sudden shift
in the clients problem focus. The therapist should be comfortable
with the silence and give the client time to digest this line of questioning.
If the client identifies exceptions, then proceed to amplify them. If
the client states that there have been no exceptions, however, encourage the client to consider small differences. Clients can frequently recall exceptions when asked to consider small changes that have
occurred. It has also been found that small changes often lead to bigger changes (cf., Erickson, 1980). Although it is difficult to imagine
being less demandingthat is, you are either placing a demand (on
yourself, someone else, or life conditions) or you are notthere are
instances when small changes might represent rational exceptions.
Consider, for example, that a client might be able to identify a time
when they still felt significantly upset, but nevertheless less disturbed than usual. Further inquiry might reveal that in such cases
the client did not hold an irrational belief and, as a result, was experiencing an appropriate, rather than inappropriate, emotional Consequence (C).
If rational exceptions are identified, the client is helped through
various lines of questioning to amplify these exceptions. One of the
main functions of amplifying exceptions is to help clients to identify
the differences between the times when they have the problem and
the times when they do not. An example of such questioning might
be, How did you make that happen? OHanlon & Weiner-Davis
(1989) have stated that verbalizing [differences] produces clarity
both for us and for our clients. Once our clients identify how they get
good things to happen, they will know what it will take to continue
in this vein (p. 86). Questioning aimed at identifying such differences also reinforces REBT principles, including the differences between rational beliefs and irrational beliefs. Another purpose of the
amplification process is to empower clients with a sense of self-efficacy. Questions aimed toward this end include, What does this [i.e.,
the rational exceptions] say about you and your ability to deal with
the problem? and What are the possibilities? The former is aimed
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and the goal. In some cases, the therapist and/or the client might
consider that further sessions are not required to achieve the goal. In
other cases, the goal might not have been fully reached, but it is
agreed that the client has displayed sufficient movement in direction
of the goal, making further sessions unnecessary. At this point in the
process, therapists proceed to the stage of re-evaluating the problem
and goal (described below). During the first session, however, it is
usually agreed that further sessions are needed because more progress is required. This is particularly relevant to the most important
insight that REBT emphasizes:
Because you naturally and easily think crookedly and behave defeatingly, because you have a strong biological as well as sociological tendency to disturb yourselfthere is normally no way, but
hard work and practice to change yourself and to keep yourself
less miserable and more functional. (Ellis, 1987, p. 111)
When REBT principles have been used in previous stages of treatment, homework and tasks are designed to help the client practice
disputing irrational beliefs, and identify and amplify both rational
exceptions and general exceptions. If REBT principles have not been
used, then this stage aims to help clients identify and amplify general exceptions. In either case, at the outset of this stage, the therapist can help carry the momentum by summarizing what has been
discussed thus far. The summary should include reviewing with the
client the problem, goal, and exceptions that have been identified. It
is also helpful to compliment the client at this time for taking the initiative to seek help and for his or her willingness to make positive
changes.
If the client is able to identify exceptions (rational or general), then
tasks are usually organized around encouraging the client to do more
of the same. If the client is not able to identify exceptions, then tasks
are designed to observe and build on the incidences of exceptions.
Following is a list of three tasks that we most often use with clients
and the corresponding criterion that generally guides our selection of
the task. These tasks have been adapted from those developed from
Molnar and de Shazer (1987) and address instances when the clinical
focus is on rational exceptions, general exceptions, or both.
Task 1. Client is told, Between now and the next time, I would like
you to continue to do more of the exceptions. (If the client is able
to define a problem and goal, and is able to identify exceptions.)
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Task 2. Client is told, Between now and the next time, I would like
you to observe for those times when it happens in your life (i.e.,
exceptions). (If the client is able to define a problem and goal, is
able to identify potential exceptions, but is not able to identify
exceptions.)
Task 3. Client is told, Between now and the next time, I would like
you to think about what you will be doing differently when the
problem is improved. (If the client is able to define a problem,
and is not able to define a goal.)
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aim to identify small changes. If the client maintains that there were
no exceptions, it may be necessary to discuss or reconstruct the problem which, in turn, might provoke the identification of exceptions.
Often exceptions come out later in the session (i.e., the client might
recall exceptions after he or she stated that there was none). In some
cases, clients will be very problem focused at the start of the next
session. They might assert that things got worse or they might have
recently experienced a severely problematic situation (perhaps just
before the session). When this happens, therapists can suggest to the
client, I am very interested in hearing about this, but I would first like
to check on the task that we discussed at the end of the last session.
Most of the time, clients will agree to this. After inquiring about the
task (and hopefully identifying and amplifying exceptions), the problem can be re-evaluated and, if needed reconstructed.
Re-evaluating the Problem and Goal
After evaluating the effectiveness of tasks, the problem and the
goal are re-evaluated and, if necessary, redefined. During this stage,
the client is helped to consider the extent to which progress or the results of homework and tasks amount to an attainment of the goal. If
the treatment goal has been reached or the client has made significant progress in the direction of the goal, then it might be appropriate for the therapist to ask the client whether he or she thinks that
further treatment is needed at this time. Discussing whether further
treatment is needed maintains a focused approach and helps to curtail the incidence of drop outs. It is apparent that a large number of
clients drop out of treatment after just a few sessions either by canceling or not showing for appointments. Ideally, we strive to reach a
consensus with clients regarding the issue of when treatment is (and
is no longer) needed.
If the client reports that the goal has been reached or sufficient
progress has been made, yet additional sessions are needed, then
subsequent treatment might be organized around building on the clients gains. If the client has made significant progress and also
claims that further treatment is needed, then perhaps the problem or
goal has not yet been satisfactorily defined. The client may also indicate that the goal has been reached and that there is now a new
problem and goal. In such cases, it is important to help the client
reconstruct the problem and goal. It could be said that talking about
a problem at different times necessarily produces a change in its defi-
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nition (i.e., the words used and hence the meaning ascribed changes).
The therapist can use this inevitability to work toward reconstructing
more solvable problems. The goal might need to be more attainable,
more general, more specific, or more relevant to the clients problem.
CASE EXAMPLE
A 73 year old married man presented with the problem of depression. He stated that he had been diagnosed with major depression
two years ago following a myocardial infarction. He stated that he
experienced limited improvement after trying several antidepressants. The client stated that since becoming depressed he seldom engaged in recreational or social activities and was anhedonic. The
client stated that his goal was to become his old self again. The
therapist considered that the clients depression was, to some degree,
endogenous insofar as it related to the myocardial infarction. The
therapist also presumed, however, that psychological factors were
related to the depression. In particular, the client reported feeling
significantly guilty about his depressive condition. In REBT, the term
secondary disturbance has been used to refer to the emotional disturbances that clients sometimes experience about their principal inappropriate emotional and behavioral Consequences (C) (Walen et al.,
1992). In this case, the therapist understood the clients secondary
disturbance as an irrational Belief (B) about his depression (which
was conceptualized as an Activating event [A] in itself) that in turn,
resulted in an emotional Consequence (C) of guilt. The therapist provided REBT education to the client, including the ABC theory, and
encouraged the client to conceptualize his problems accordingly. It
was agreed that the client had secondary disturbance and, moreover,
that his guilt feelings about his depression exacerbated his condition.
The client was also asked to describe, in behavioral terms, what
being his old self was like. He stated that when he was his old self,
he was very active, socialized frequently, and enjoyed activities of
daily living. The client was able to identify an instance in the recent
past when he did not feel guilty upon thinking about his depression
but, instead, felt concerned (rational exception). The client also identified a few rare instances when he found that he was being his old
self (general exception). The client maintained, however, that these
exceptions were not significant. The client was then taught how to
identify and dispute the irrational belief that was contributing to his
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CONCLUSIONS
Many questions remain regarding the theory, research, and practice of this integrative model. It could be argued that at times the
clinical applications are ostensibly similar to each of the models from
which the integration has been developed. This is especially pertinent
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upon considering that Ellis (1996) has acknowledged that his clinical
model allows for the inclusion of solution-focused techniques in cases
when REBTs preferred approaches are ineffective. We affirm, however, that our integration of REBT and solution-focused therapy is
valuable because it affords therapists with a basis from which to
combine these two models with conceptual clarity and consistency.
It is reaffirmed that integrating REBT and solution-focused therapy addresses the limitations of each model while enhancing their
respective strengths. In the case example, the therapist used REBT
principles to help the client dispute an irrational belief that was presumed to be significantly contributing to the problem. In addition,
the therapist helped the client to identify and amplify general exceptions in keeping with a solution-focused approach. It follows that the
integrative model is comprehensive in that it strives for both (a)
REBTs large scope of change and educative approach, and (b) solution-focused therapys emphasis on using the clients language and
striving for minimalist goals. In the case example, the therapist used
the clients language (i.e., old self) as an organizing metaphor. Using
the clients unique frame of reference is a hallmark of solutionfocused therapys cooperative approach (de Shazer, 1984). Conversely,
the therapist taught REBT principles to the client, which enhanced
the change process.
The use of REBT principles within the integrative model also provides much needed content that is missing from the solution-focused
approach. Like other models informed by a social constructionist perspective (e.g., Anderson & Goolishian, 1988), solution-focused therapy
is to be considered a process model because its theory of problem
formation and change, unlike traditional models, avoids imposing
predetermined content (e.g., irrational beliefs) during the change process (Held, 1992). It is reminded that in solution-focused therapy,
problems are conceptualized as the clients languaging about problem/exception. Solution-focused therapy does not, however, specify
what the problem/exception shall be. Process models like solutionfocused therapy, as a result of their positing such general theories of
problem formation, allow for the use of virtually any content that clients might bring to treatment. This preference to avert imposing predetermined content, however, can result in the therapist feeling less
than grounded during the change process (Held, 1986). The integrative model addresses this limitation of process models by allowing for
the use of REBT principles.
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