Psychotherapy: How can it Help you

Psychotherapy: How it Works and How it Can Help

Psychotherapy (also known as talk therapy) can be an important part of treatment for depression or bipolar disorder (manic depression). A good therapist can help you cope with feelings and symptoms, and change behavior patterns that may contribute to your illness.
Talk therapy is not just “talking about your problems”; it is also working toward solutions. Some therapy may involve homework, such as tracking your moods, writing about your thoughts, or participating in social activities that have caused anxiety in the past. You might be encouraged to look at things in a different way or learn new ways to react to events or people.
Most of today’s psychotherapy is brief and focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future. You might see your therapist more often at the beginning of treatment, and later, as you learn to manage problems and avoid triggers, you might go to psychotherapy appointments less often.

Psychotherapy can help you:

• Understand your illness
• Define and reach wellness goals
• Overcome fears or insecurities
• Cope with stress
• Make sense of past traumatic experiences
• Separate your true personality from the mood swings caused by your illness
• Identify triggers that may worsen your symptoms
• Improve relationships with family and friends
• Establish a stable, dependable routine
• Develop a plan for coping with crises
• Understand why things bother you and what you can do about them
• End destructive habits such as drinking, using drugs, overspending or unhealthy sex. 

Who provides talk therapy?

Your therapist may be a psychiatrist (MD), psychologist (PhD, PsyD, EdD, MS), social worker (DSW, MSW, LCSW, LICSW, CCSW), counselor (MA, MS, LMFT, LCPC), or psychiatric nurse (APRN, PMHN). Your ability to talk honestly and openly with your therapist, set clear goals and make real progress is important. Think of your relationship with your therapist as a partnership. The two of you will work together to help you feel better. You do not need to feel ashamed or embarrassed about talking openly and honestly about your feelings and concerns.

How do I get started?

Make a list of the things that are bothering you and the issues you would like help with. Bring it with you to your first appointment. You might include:

• Issues in your family or other relationships
• Symptoms like changes in eating or sleeping habits
• Anger, anxiety, irritability or troubling feelings
• Thoughts of hurting yourself

In your first few sessions, you will probably do most of the talking. You should tell the therapist why you are there and what you would like to get from therapy. Make a list of short- and long-term goals with your therapist at the beginning of treatment. After a few sessions, your therapist may be able to give you an idea of how long therapy will take and when you can expect to see changes in your moods.

How will I know if I’m making progress?

After some time has passed, check the list and see if you’re closer to reaching your goals. It may be helpful to track how you feel each day and how you cope with difficult situations. Review your progress with your therapist. Improvement won’t happen overnight, but you should see some change, even if it’s just a better understanding of your own thoughts and feelings. It is also helpful to learn everything you can about depression and bipolar disorder and their treatments. Check your local library for other books and reference materials.

What if I’m not making progress?

If, after some time, you don’t begin to feel some relief, you have a right to seek a second opinion (as you would with any illness) from another therapist or mental health professional. You have a right to have the best treatment possible, and you can feel better.

What type of therapy is best for me?

There are many types of talk therapy and most therapists use a combination of approaches. Behavioral therapy concentrates on your actions; cognitive therapy focuses on your thoughts; and interpersonal therapy looks at your relationships with others. Your loved ones may join you in sessions of family or couples therapy. Group therapy involves several, usually unrelated people working with the same therapist and each other. One approach is not necessarily better than another the best choice is the one that works best for you.

What are some therapies commonly used for depression or bipolar disorder?

Interpersonal therapy (IPT) was originally developed to treat depression. It has since been adapted for bipolar and other disorders. It is time-limited and goal-oriented, and addresses a person’s symptoms, social relationships and roles. IPT focuses on what is happening “here and now” and attempts to help a person change, rather than just understand his or her actions and reactions. The patient and therapist examine current and past relationships. IPT does not focus on unconscious or subconscious motivations, wishes or dreams. It looks at conscious, outward action and social adjustment. It does not try to change the personality, but rather to teach new skills that can lessen symptoms.

An IPT therapist is an active supporter of the patient on the wellness journey. The therapist does not assign homework, but may encourage a patient to engage in social activities. The therapist helps the patient review his or her symptoms and relate these symptoms to one of four things: grief over a loss, conflicts with others, changes in life status such as moving or changing jobs or isolation/ lack of social skills. The therapist and patient then work through specific situations, one by one, to relieve symptoms and stress.

Cognitive-behavioral therapy (CBT) combines cognitive therapy, which involves examining how thoughts affect emotions, and behavioral therapy, which involves changing a person’s reactions to challenging situations. CBT is goal-oriented and works best when the patient takes an active role. One aspect of CBT helps a person recognize the automatic thoughts or core beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don’t make sense and helps the person change them. Types of automatic thoughts may include focusing on one negative idea (an unkind person) and applying the negative quality to everything (the human race in general); viewing things as “all good” or “all bad”; or applying labels such as “loser,” “no good,” or “worthless.” Types of core beliefs may include, “I have to succeed at everything”; “Everyone has to love me”; “It’s a disaster if things don’t go the way I plan or expect”; or “I can’t change the miserable way I am.”

The behavioral aspect of CBT takes place after a person has a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things or people that cause fear or panic. Through practice, a person learns new, healthier behaviors.

With CBT, the therapist assigns homework. It may include journaling, reviewing notes or tapes of the therapy session, or trying a new approach to an old problem. There may also be exercises to make a person more aware of his or her own thoughts and actions without judging them.

The most important parts of any type of therapy are partnership, communication, goals, collaboration, trust, understanding and action. Successful therapy can help a person change thoughts, beliefs, perceptions, actions and moods for the better. 

Psychotherapy the Basics

Wikipedia

Psychotherapy is a set of techniques intended to improve mental health, emotional or behavioral issues in individuals, who are often called "clients". These issues often make it hard for people to manage their lives and achieve their goals. Psychotherapy is aimed at these problems, and solves them via a number of different approaches and techniques; commonly psychotherapy involves a therapist and client(s), who discuss their issues in an effort to discover what they are and how they can manage them. Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect patient privacy and client confidentiality.
General description

Given that psychotherapy is a kind of treatment restricted mostly to verbal exchanges, practitioners do not have to be medically qualified. In most countries, however, psychotherapists must be trained, certified and licensed with a range of different licensing schemes and qualification requirements in place around the world. Psychotherapists may be psychologists, social workers, trained nurses, psychiatrists, psychoanalysts, or professionals of other mental health disciplines. Psychiatrists' training focuses on the prescription of medicines, with some training in psychotherapy. Psychologists have special training in mental health assessment and research in addition to psychotherapy. Social workers have special training in mental health assessment and treatment as well as linking patients to community and institutional resources.

Recent trends in drug development to treat chemical imbalances have led to a more wide spread use of pharmaceuticals in conjunction with psychotherapy by medically qualified mental health nurse practitioners, psychiatrists, and in some states prescribing psychologists . While having benefits for patients with ailments such as bipolar disorder, impulse problems, schizophrenia and obsessive compulsive disorder, drugs of late have begun to be used as a 'quick fix' and are gaining less favor in the therapeutic community.

There are at least five main systems of psychotherapy:
psychodynamic,
cognitive
humanistic/supportive
behaviorism
Brief counseling

History

For a comprehensive view of the different kinds of psychotherapies, see the List of psychotherapies. For a view of the development of psychotherapy see the Timeline of Psychotherapy history Most psychotherapies are either direct descendants of psychoanalysis, or their founders started out in areas of psychoanalysis before developing their own theories. Therefore, when describing the history of psychotherapy, most traditionally start with Freud.
Psychoanalysis

Although there are some bodies of thought in psychology without Sigmund Freud in their legacy, most can be traced back to his work starting in the 1880s in Vienna. Trained as a neurologist, Freud began noticing neurological problems in patients that had no biological basis. Seeing blindness, paralysis and anorexia with no apparent physical cause, he looked towards the mind for answers. Finding some evidence that those who were mentally ill could exhibit physical symptoms, he discovered colleagues and teachers who were equally perplexed and interested in such matters like Josef Breuer and Jean-Martin Charcot.

Freud opened up a private practice in 1886 until 1896 that mostly treated women who showed symptoms of hysteria (which, at that time, was very loosely defined). Using such techniques as dream interpretation, free association, transference and analysis of the id, ego and superego, his colleagues developed a system of psychotherapy termed 'psychoanalysis'. Students and colleagues of his such as Alfred Adler, Otto Rank and Carl Jung became psychoanalysts themselves, and formed their own differentiating systems of psychotherapy. These were all later termed under a more broad label of 'psychodynamic', meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self. Psychodynamic psychotherapy and psychoanalysis are considered to be particularly effective at treating certain mental disorders, such as personality disorders and mood disorders.
Current psychodynamic approaches continue to develop and change. Contemporary Freudian approaches usually retain Freud's emphasis on sexuality, aggression, and mental conflict, and often prefer insight-oriented, uncovering psychotherapy to more supportive techniques. Contemporary Freudians, for the most part, continue to believe that psychotherapy is most effective when it leads to increased self-knowledge on the part of the patient. Other current psychodynamic approaches -such as object-relational and self-psychological approaches- prefer techniques designed to change the patient's habitual patterns of living by building an especially authentic or supportive relationship with the analyst that is believed to help the patient learn new ways of relating to others and to life in general.

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Workplace Stress an insight

Stress in the workplace is becoming a major concern for employers, managers and government agencies, owing to the Occupational Health and Safety legislations requiring employers to practice 'duty of care' by providing employees with safe working environments which also cover the psychological wellbeing of their staff.

One of the costs, for employers, of work place stress is absenteeism, with the A.C.T.U. reporting that owing to stress, nearly fifty per cent of employees surveyed had taken time off work. Other negative effects were reductions in productivity, reduced profits, accidents, high rates of sickness, increased workers' compensation claims and high staff turnover, requiring recruiting and training of replacement staff.

While a certain amount of stress is needed to motivate individuals into action, prolonged stress can have a huge impact on overall health. More than two-thirds of visits to doctors' surgeries are for stress-related illnesses. Stress has been linked to headaches, backaches, insomnia, anger, cramps, elevated blood pressure, chronic fatigue syndrome, fibromyalgia and lowered resistance to infection. For women, stress is a key factor in hormonal imbalances resulting in menstrual irregularities, PMS, fibroids, endometriosis and fertility problems. Stress can also be a factor in the development of almost all disease states including cancer and heart disease.

Each profession has its own unique factors that may cause stress; below are some causes of stress that cross many professions:
Increased workload
Organizational changes
Lack of recognition
High demands
Lack of support
Personal and family issues
Poor work organization
Lack of training
Long or difficult hours
Inadequate staff numbers and resources
Poor management communication
Lack of control or input

So what can be done to effectively manage workplace stress?
Organizations can:
Educate their employees to recognise the signs of stress.
Where possible, give their employees the chance to be involved in decisions and actions that affect their jobs.
Improve employer-employee communications.
Provide employees with opportunities to socialise together.
Be understanding of employees' personal and family responsibilities.
Ensure employee workloads suit their capabilities and resources (provide more training and resources if not).
Provide support (internal) for employees who have complex stress issues.
Employees can reduce their overall stress by:
Regularly exercising, as this releases 'happy hormones'.
Eating a healthy diet, as stress depletes vital nutrients.
Getting adequate rest.
Being more organized. Get up earlier to have more time.
Delegating responsibility where possible. Say no!

Avoiding caffeine and sugar. Although this may provide an instant lift it later depletes the body of energy and nutrients.

Taking time to do things that bring enjoyment and pleasure.
Making the work environment pleasurable. Taking care of their overall health and wellbeing by practising good self-care.

Sometimes trying to implement change (even for the better) can itself cause stress and prevent a person remaining motivated. In this case it's important to get support for your stress from a counsellor, doctor, naturopath, friend, peer or life coach who specializes in stress issues.

The benefits of a systematic and joint approach to reducing work stress are:

Increased productivity
Decrease in absenteeism
Improved morale
Decrease in workers' compensation claims
Reduction in workplace accidents

The most important benefit of reducing workplace stress is that it will promote a healthy, happy and pleasant work environment for all.

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Cognitive Behavioural Therapy CBT

CBT is a short-term talking treatment that has a highly practical approach to problem-solving. It aims to change patterns of thinking or behaviour that are behind people’s difficulties, and so change the way they feel. This booklet is for anyone interested in knowing more about CBT. It explains who and what it's for, and how to find a therapist.

What is cognitive behaviour therapy?

Cognitive behaviour therapy (CBT) describes a number of therapies that all have a similar approach to solving problems, which can range from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people's attitudes and their behaviour. The therapies focus on the thoughts, images, beliefs and attitudes that we hold (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems.

An important advantage of CBT is that it tends to be short, taking three to six months for most emotional problems. Clients attend a session a week, each session lasting either 50 minutes or an hour. During this time, the client and therapist are working together to understand what the problems are and to develop a new strategy for tackling them. CBT introduces them to a set of principles that they can apply whenever they need to, and which will stand them in good stead throughout their lives.

CBT is a combination of psychotherapy and behavioural therapy. Psychotherapy emphasises the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioural therapy pays close attention to the relationship between our problems, our behaviour and our thoughts.

What's the history of CBT?

In the 1960s, a US psychiatrist and psychotherapist called Aaron T. Beck observed that, during his analytical sessions, his patients tended to have an 'internal dialogue' going on in their minds, almost as if they were talking to themselves. But they would only report a fraction of this kind of thinking to him. For example, in a therapy session the client might be thinking to him- or herself: 'He (the therapist) hasn't said much today. I wonder if he's annoyed with me?' These thoughts might make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this thought with a further thought: 'He's probably tired, or perhaps I haven't been talking about the most important things'. The second thought might change how the client was feeling.
Beck realised that the link between thoughts and feelings was very important. He invented the term 'automatic thoughts' to describe emotion-filled or 'hot' thoughts that might pop up in the mind. Beck found that people weren't always fully aware of such thoughts, but could learn to identify and report them. If a person was feeling upset in some way, the thoughts were usually negative and neither realistic nor helpful. Beck found that identifying these thoughts was the key to the client understanding and overcoming his or her difficulties.

Beck called it cognitive therapy because of the importance it places on thinking. It's now known as CBT because the therapy employs behavioural techniques as well. The balance between the cognitive and the behavioural elements varies among the different therapies of this type, but all come under the umbrella term cognitive behaviour therapy. CBT has since undergone scientific trials in many places by different teams, and has been applied to a wide variety of problems.

What's so important about negative thoughts?

CBT is based on a 'model' or theory that it's not events themselves that upset us, but the meanings we give them. Our thoughts can block us seeing things that don't fit with what we believe is true. In other words, we continue to hold on to the same old thoughts and fail to learn anything new.

For example, a depressed woman may think, 'I can't face going into work today: I can't do it. Nothing will go right. I'll feel awful.' As a result of having these thoughts – and of believing them – she may well ring in sick. By behaving like this, she won't have the chance to find out that her prediction was wrong. She might have found some things she could do, and at least some things that were OK. But, instead, she stays at home, brooding about her failure to go in and ends up thinking: 'I've let everyone down. They will be angry with me. Why can't I do what everyone else does? I'm so weak and useless.' So, that woman probably ends up feeling worse, and has even more difficulty going in to work the next day. Thinking, behaving and feeling like this may start a downward spiral. This vicious circle can apply to many different kinds of problems.

How does this kind of problem start?

Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn't get much open affection from their parents but was praised for school work, might come to think, 'I have to do well all the time. If I don't, people will reject me'. Such a rule for living (known as a 'dysfunctional assumption') may do well for the person a lot of the time and help them to work hard. But if something happens that's beyond their control and they experience failure, then the dysfunctional thought pattern may be triggered. The person may then begin to have 'automatic' thoughts like, 'I've completely failed. No one will like me. I can't face them'.

CBT acts to help the person understand that this is what's going on. It helps him or her to step outside their automatic thoughts and test them out. CBT would encourage the depressed woman mentioned earlier to examine real-life experiences to see what happens to her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be able to take the chance of testing out what other people think, by revealing something of her difficulties to friends.

Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may be basing our predictions and interpretations on a biased view of the situation, making the difficulty that we face seem much worse. CBT helps people to correct these misinterpretations.

What form does treatment take?

CBT differs from other therapies because sessions have a structure, rather than the person talking freely about whatever comes to mind. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards. The problems may be troublesome symptoms, such as sleeping badly, not being able to socialise with friends, or difficulty concentrating on reading or work. Or they could be life problems, such as being unhappy at work, having trouble dealing with an adolescent child, or being in an unhappy marriage. These problems and goals then become the basis for planning the content of sessions and discussing how to deal with them.
Typically, at the beginning of a session, the client and therapist will jointly decide on the main topics they want to work on this week. They will also allow time for discussing the conclusions from the previous session. And they will look at the progress made with the 'homework' the client set for him- or herself last time. At the end of the session, they will plan another assignment to do outside the sessions.

Doing homework

Working on homework assignments between sessions, in this way, is a vital part of the process. What this may involve will vary. For example, at the start of the therapy, the therapist might ask the client to keep a diary of any incidents that provoke feelings of anxiety or depression, so that they can examine thoughts surrounding the incident. Later on in the therapy, another assignment might consist of exercises to cope with problem situations of a particular kind.

The importance of structure

The reason for having this structure is that it helps to use the therapeutic time most efficiently. It also makes sure that important information isn't missed out (the results of the homework, for instance) and that both therapist and client think about new assignments that naturally follow on from the session. The therapist takes an active part in structuring the sessions to begin with. As progress is made, and clients grasp the principles they find helpful, they take more and more responsibility for the content of sessions. So by the end, the client feels empowered to continue working independently.

Group sessions

CBT is usually a one-to-one therapy. But it's also well suited to working in groups, or families, particularly at the beginning of therapy. Many people find great benefit from sharing their difficulties with others who may have similar problems, even though this may seem daunting at first. The group can also be a source of specially valuable support and advice, because it comes from people with personal experience of a problem. Also, by seeing several people at once, service-providers can offer help to more people at the same time, so people get help sooner.

How else does it differ from other therapies?

CBT also differs from other therapies in the nature of the relationship that the therapist will try to establish. Some therapies encourage the client to be dependent on the therapist, as part of the treatment process. The client can then easily come to see the therapist as all-knowing and all-powerful. The relationship is different with CBT.

CBT favours a more equal relationship that is, perhaps, more business-like, being problem-focused and practical. The therapist will frequently ask the client for feedback and for their views about what is going on in therapy. Beck coined the term 'collaborative empiricism', which emphasises the importance of client and therapist working together to test out how the ideas behind CBT might apply to the client's individual situation and problems.

What kind of people benefit?

People who describe having particular problems are often the most suitable for CBT, because it works through having a specific focus and goals. It may be less suitable for someone who feels vaguely unhappy or unfulfilled, but who doesn't have troubling symptoms or a particular aspect of their life they want to work on. It's likely to be more helpful for anyone who can relate to CBT's ideas, its problem-solving approach and the need for practical self-assignments. People tend to prefer CBT if they want a more practical treatment, where gaining insight isn't the main aim.

CBT can be an effective therapy for a number of problems:

anger management
anxiety and panic attacks
child and adolescent problems
chronic fatigue syndrome
chronic pain
depression
drug or alcohol problems
eating problems
general health problems
habits, such as facial tics
mood swings
obsessive-compulsive disorder
phobias
post-traumatic stress disorder
sexual and relationship problems
sleep problems

CBT does not claim to be able to cure all of the above problems. For example, it does not claim to be able to cure chronic pain or disorders such as chronic fatigue syndrome. Rather, CBT might help people with, for example, arthritis or chronic fatigue syndrome, to find new ways of coping while living with the disorders.

There is a new and rapidly growing interest in using CBT (together with medication) with people who suffer from hallucinations and delusions, and those with long-term problems in relating to others. It's less easy to solve problems that are more severely disabling and more long-standing through short-term therapy. But people can often learn principles that improve their quality of life and increase their chances of making further progress. There is also a wide variety of self-help literature. It provides information about treatments for particular problems and ideas about what people can do on their own or with friends and family.

Why do I need to do homework?

People who are willing to do assignments at home seem to get the most benefit from CBT. For example, many people with depression say they don't want to take on social or work activities until they are feeling better. CBT may introduce them to an alternative viewpoint – that trying some activity of this kind, however small-scale to begin with, will help them feel better. If that individual is open to testing this out, they could agree to do a homework assignment (say to go to the cinema with a friend). They may make faster progress, as a result, than someone who feels unable to take this risk.

How effective is it?

CBT can substantially reduce the symptoms of many emotional disorders – clinical trials have shown this. For some people it can work just as well as drug therapies at treating depression and anxiety disorders. And the benefits may last longer. All too often, when drug treatments finish, people relapse, and so practitioners may advise patients to continue using medication for longer. When patients are followed up for up to two years after therapy has ended, many studies have shown an advantage for CBT. This research suggests that CBT helps bring about a real change that goes beyond just feeling better while the patient stays in therapy. This has fuelled interest in CBT. The National Institute for Health and Clinical Excellence (NICE) recommends CBT via the NHS for common mental disorders, such as depression and anxiety. (NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.)

Comparisons with other types of short-term psychological therapy aren't clear-cut. Therapies such as inter-personal therapy and social skills training are also effective. The drive is now to make all these interventions as effective as possible, and also, perhaps, to establish who responds best to which type of therapy.

Limitations

CBT is not a miracle cure. The therapist needs to have considerable expertise – and the client must be prepared to be persistent, open and brave. Not everybody will benefit, at least not to full recovery, in a short space of time. It's unrealistic to expect too much.

At the moment, experts know quite a lot about people who have relatively clear-cut problems. They know much less about how the average person may do – somebody, perhaps, who has a number of problems that are less clearly defined. Sometimes, therapy may have to go on longer to do justice to the number of problems and to the length of time they've been around. One fact is also clear, though. CBT is rapidly developing. All the time, new ideas are being researched to deal with the more difficult aspects of people’s problems.

How does CBT work?

CBT is quite complex. There are several possible theories about how it works, and clients often have their own views. Perhaps there is no one explanation. But CBT probably works in a number of ways at the same time. Some it shares with other therapies, some are specific to CBT. The following illustrate the ways in which CBT can work.

Learning coping skills

CBT tries to teach people skills for dealing with their problems. Someone with anxiety may learn that avoiding situations helps to fan their fears. Confronting fears in a gradual and manageable way helps give the person faith in their own ability to cope. Someone who is depressed may learn to record their thoughts and look at them more realistically. This helps them to break the downward spiral of their mood. Someone with long-standing problems in relating to other people may learn to check out their assumptions about other people's motivation, rather than always assuming the worst.

Changing behaviours and beliefs

A new strategy for coping can lead to more lasting changes to basic attitudes and ways of behaving. The anxious client may learn to avoid avoiding things! He or she may also find that anxiety is not as dangerous as they assumed.
Someone who’s depressed may come to see themselves as an ordinary member of the human race, rather than inferior and fatally flawed. Even more basically, they may come to have a different attitude to their thoughts – that thoughts are just thoughts, and nothing more.

A new form of relationship

One-to-one CBT can bring the client into a kind of relationship they may not have had before. The 'collaborative' style means that they are actively involved in changing. The therapist seeks their views and reactions, which then shape the way the therapy progresses. The person may be able to reveal very personal matters, and to feel relieved, because no-one judges them. He or she arrives at decisions in an adult way, as issues are opened up and explained. Each individual is free to make his or her own way, without being directed. Some people will value this experience as the most important aspect of therapy.

Solving life problems

The methods of CBT may be useful because the client solves problems that may have been long-standing and stuck. Someone anxious may have been in a repetitive and boring job, lacking the confidence to change. A depressed person may have felt too inadequate to meet new people and improve their social life. Someone stuck in an unsatisfactory relationship may find new ways of resolving disputes. CBT may teach someone a new approach to dealing with problems that have their basis in an emotional disturbance.

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REBT- Rational Emotive Behavioural Therapy

WHAT IS REBT ?

REBT is a practical, action-oriented approach to coping with problems and enhancing personal growth. REBT places a good deal of its focus on the present: on currently-held attitudes, painful emotions and maladaptive behaviors that can sabotage a fuller experience of life. REBT also provides people with an individualized set of proven techniques for helping them to solve problems.

REBT practitioners work closely with people, seeking to help uncover their individual set of beliefs (attitudes, expectations and personal rules) that frequently lead to emotional distress.

REBT then provides a variety of methods to help people reformulate their dysfunctional beliefs into more sensible, realistic and helpful ones by employing the powerful REBT technique called "disputing." Ultimately, REBT helps people to develop a philosophy and approach to living that can increase their effectiveness and happiness at work, in living successfully with others, in parenting and educational settings, in making our community and environment healthier, and in enhancing their own health and personal welfare.

But don't you need to uncover the past in order to really understand people's problems?

Contrary to what some people erroneously believe, REBT does recognize that we may be strongly influenced by events in early life. Much of our philosophy of life—what we think about ourselves and our values—is learned from past experiences. But the past is with us in the form of beliefs that we carry in our head in the present. REBT homes in on the beliefs that are harmful in our current emotional life and behavior—whether those beliefs arose in the distant reaches of our youth or within the past few weeks.

REBT believes that the "nuttiness" of our past exerts its influence in our current-day thinking patterns and beliefs. Although we cannot change the past, we can change how we let the past influence the way we are today and the way we want to be tomorrow. In this sense, REBT is an optimistic approach to living and to solving problems.

I've heard that REBT tries to do away with negative emotions altogether by making people think logically and objectively. Is that true?

This is a fundamental misconception of REBT. Perhaps more so than any other approach, REBT emphasizes the involvement of emotions in just about every aspect of our thinking and actions. REBT proposes that when our negative emotions become too intense (e.g., rage, panic, or depression), not only do we feel very unhappy, but our ability to manage our lives begins to deteriorate. At these times, the quality of our thinking changes and we begin to take things over-personally, blow things out of perspective, condemn others for their transgressions and generally become less tolerant of life's hassles and hardships. REBT helps restore the emotional balance in an individual's life by providing methods for thinking more realistically and level-headedly about ourselves, other people, and the world.

But aren't feelings such as anger and anxiety normal and appropriate?

Of course! But it is the quality of feelings that is important. Experiencing intense irritation and displeasure when things go wrong can motivate you to change frustrating conditions. Feelings of rage, on the other hand, often land you in a smoldering stew, where you're likely not to take any action at all, or to act in ways that are impulsive and self-defeating. A bit of anxiety or some degree of concern about facing the boss can add an edge of excitement that sharpens performance; excessive anxiety, however, can interfere with thinking and action. While REBT tries to minimize debilitating emotions, that does not mean that it's unhealthy to experience keen feelings of sorrow or displeasure when you experience misfortune.

With REBT's emphasis on reducing emotional upsets in the face of unfairness or misfortune, doesn't it encourage the preservation of the status quo? (Not to mention take away energy to make things better?)

One of REBT's favorite maxims (first expressed by Reinhold Neibuhr) is: "Grant me the courage to change the things I can change, the serenity to accept those that I cannot change, and the wisdom to know the difference." REBT seeks to empower individuals both by helping them more effectively handle their own painful emotions, and by enabling them to change their own behavior and improve their world where possible. When you get too upset, it is much more difficult to behave in constructive ways. By gaining better control over upsetting emotions, you become far more able to act assertively to change bad outside circumstances.

With all this emphasis on "me," doesn't REBT encourage selfishness?
Don't we already have too much selfishness in this world?

A very good question. Yes, many people are too selfish for their own and others' good. REBT provides people with the skills and attitudes to become less selfish. Selfishness is often motivated by ego-gratification. Many selfish people tend to be very needy and demanding and are intent on getting what they want at any cost in order to feel good about themselves. REBT helps people to reduce their own neediness and specifically their need to prove themselves to others. To discourage selfishness, REBT teaches what Albert Ellis calls the value of rational self-acceptance. According to Ellis, healthy people are usually glad to be alive and accept themselves just because they are alive and have some capacity to enjoy themselves. They refuse to measure their intrinsic worth by their extrinsic accomplishments, materialistic possessions and by what others think of them. They frankly choose to accept themselves unconditionally; and then try to completely avoid globally rating themselves—meaning their totality or their "essence." They attempt to enjoy rather than prove themselves. Thus, rather than acting out of selfishness, they learn to operate from responsible self-interest.

Isn't REBT just about intellectual disputing?

REBT does help people by teaching them to recognize and change those aspects of their thinking which are not sensible, accurate or useful. This is probably what is meant by intellectual disputing. However, it also uses a host of other emotional and behavioral methods designed to reduce upset feelings and increase personal effectiveness. These include rational-emotive imagery; assertiveness, self nurturance, risk-taking, and other behavioral homework assignments; communication skill training; and "shame-attacking" exercises.

I've heard that REBT is only really useful with very intelligent people.

REBT can work very well with very bright people. Good brain power can help certain people analyze more quickly the ways in which their thinking is illogical when they are upset. However, just because you have the potential to quickly see the irrational qualities of your thinking, doesn't mean you will use your potential to help yourself. Many very bright people are more motivated to argue the "rightness" of their beliefs than to consider they might be wrong.

Over the years, REBT methods have been adopted for children as young as five or six years old, and even for the learning-impaired. Rational emotive behavior therapists are trained to tailor REBT to meet the wide variety of intellectual, cognitive-developmental and other personal characteristics of clients.I've heard that REBT therapists do a lot of confronting. This doesn't sound very empathic or supportive.

REBT practitioners are very concerned about establishing a helpful, supportive, and facilitative alliance with people. They realize that not all people come to therapy ready for action and change, and that some people—because of their personalities and problems—require a great deal of support and empathy before they are ready to change. At the same time, REBT practitioners tend to take an active role with their clients. They help provide people as quickly as possible with the tools to help them change their beliefs leading to disturbing emotions, thus freeing them to confront their everyday problems with all their resources.

By being so active, aren't REBT therapists "controlling" the client?

REBT practitioners have excellent insight into the nature of problems in living and how to help clients free themselves from their emotional misery about them. They are conscious that many clients find it difficult to address the main problems in their lives and their own inner obstacles to happiness. Rational emotive behavior therapists work collaboratively with clients to clarify existing problems, and to identify important general problems to work on together. And yes, REBT practitioners are active in teaching clients new methods for changing their thinking, feelings and behavior. However, REBT does not control the client. Rather, it empowers people to manage their own emotional problems more effectively and to take control of their own behavior in order to try to obtain more of what they want in life.

Does REBT force its own beliefs about what's rational on people?

REBT defines rational beliefs as those which help people live satisfying, healthy, and fulfilled lives. Over the years, Albert Ellis has identified a set of rational beliefs or values which abet a person's happiness and survival. For example, rational self-acceptance—which involves people giving up the self-rating game—seems to help people significantly reduce anxiety and increase feelings of self-acceptance.

High frustration tolerance, which encourages people to accept (not like) life's hardships and other people's imperfections, leads to greater perseverance, patience, and the ability to get along with others. REBT practitioners are careful, however, not to impose "rational" beliefs. REBT accepts that there are also other "non-rational" belief systems that can help people achieve happiness. REBT accepts the value system of the client and works within that framework to facilitate the client's goals.By emphasizing the individual's beliefs and values and eliminating "shoulds," isn't REBT incompatible with religious values?
REBT has discovered that when people impose rigid expectations on themselves, other people, and the world they are likely to experience unnecessary emotional distress.

In REBT, these expectations are expressed as absolutistic "shoulds," "oughts," and "musts." For example, "I should be successful in important things I do at work" can get you into emotional hot water when you make mistakes or fail. REBT affirms the value of achievement, but helps clients give up their demandingness for total success at all times. REBT advocates instead a more preferential system of values: one which encourages people to work toward their professional goals, but never to condemn and damn themselves when they fail to achieve them. In a similar way, REBT is useful in helping people from diverse religious backgrounds to be more self-accepting, as well as more accepting of other people who may not share their particular values.

REBT makes sense, but I can't seem to apply it to myself—I understand it "intellectually," but not "emotionally."

When you think about it, what REBT sets out to accomplish sounds pretty ambitious: its goal is no less than changing core irrational beliefs that you've spent your whole life rehearsing, living, and "feeling." For many people, it takes some time before the emotional "gut" follows what their head already "knows." Learning new ways of thinking and new beliefs can be compared to a horse-driven carriage which has had the same driver and horse for years. The horse knows where to go without having to be told by the driver. Once you change the driver (new ways of thinking), the horse still goes in the same direction (old emotions and behaviors), but the driver has to strain at the reins to produce a change in direction (new emotions and behaviors). The positive aspect of the strain you may experience in using REBT is that it shows you are learning new ways of feeling and behaving and that you are taking charge of your own direction in life.