by William Taboas, M.A.
Friday Night Live (FNL) is offered twice monthly at the Albert Ellis Institute (dates:https://albertellis.org/friday-night-live/) and runs from 7:00PM to 8:30PM. The FNL sessions are a great opportunity for curious folks who wish to see how an REBT/CBT session would transpire. But what is great about FNL is that you get to see how therapist’s personalities and clinical judgment shape the implementation of REBT. Some are vigorous in disputing irrational beliefs, some emphasize didactic explanations to conceptualize a problem and intervention, others roll with the punches, and others will use the clients’ strengths to promote cognitive, emotive, and behavioral change. While all adept REBT clinicians carry on Albert Ellis’ teachings, the flexible, collaborative, and change focused nature is apparent in every session.
Last Friday night we got to see Michael Hickey, Ph.D., demonstrate how would a Rational Emotive Behavior Therapy (REBT) session would look like, in front of a live audience. Following the tradition of the grandfather of CBT and founder of REBT, Dr. Albert Ellis, Dr. Hickey invited volunteer participants from the audience to present a problem they would like to work with.
The first volunteer participant was a young woman. Dr. Hickey proceeded to ask, in traditional REBT fashion, what she wanted to work on during their time together. She shared that she has a long-term problem with compulsive skin picking. Dr. Hickey assessed for triggers, behavioral, emotional, and cognitive. Dr. Hickey expressed that behavioral treatments aside (namely Habit Reversal Training or HRT), that may take more time to teach and implement, they could agree on working on the emotions or emotional triggers surrounding this problem. The participant then expressed that she works with children that suffer from various skin conditions. “I feel like a hypocrite!”, she expresses. “And when you’re saying and thinking that, what emotion are you feeling?”. “Guilt”, she says. “What’s the cause of the guilt?”, he asks. “That I pick my skin and take it for granted, since I work with kids with skin conditions.” “Dr. Hickey then offers a hypothesis: “Are you telling yourself you shouldn’t be doing that?” “Yes. But then I rationalize later, and I don’t feel guilty.” Dr. Hickey highlights the difference between rationalizing and not feeling guilty, versus telling herself that she shouldn’t pick on her skin, and that it makes her a hypocrite and bad person. Highlighting this difference exemplifies the B-C connection to the participant. He then uses a functional dispute: “How is demanding that you shouldn’t do this helping you in feeling less guilty and picking your skin less”. “It’s not.” Dr. Hickey has driven his point home. The participant realizes that if she thinks rationally in the moment, she avoids disturbing herself with guilt, which ultimately doesn’t stop her from skin picking. Instead, she later mentions that she wants to feel prideful that she is helping children. Dr. Hickey highlighted that focusing on thinking about how she is helping, rather than demanding that she not pick her skin and putting herself down for it, may enhance her sense of pride.
The second volunteer participant of the evening was a young woman who lost a dear friend to gun violence in recent months. She expressed that she was experiencing fear and sadness. Dr. Hickey demonstrated empathy for the painful loss of a loved one. Her goal for the session was to be more at ease with her friend’s untimely passing. Dr. Hickey was careful in assessing and distinguishing between Unhealthy Negative Emotions (UNE) and Healthy Negative Emotions (HNE). He asked about her sadness, about how she goes about her day, and if she has any social support, such as friends and family that accompany her through the grieving. Dr. Hickey emphasized the importance of having friends and family around during difficult times of loss and change. He added that sadness is a natural part of loss, and that intervening with that process might do more harm than good. She wished to replace that fear with love. Dr. Hickey reinforced and agreed that Love is a desirable healthy emotion. Stating that they can work on reducing the fear to concern, Dr. Hickey and the participant worked on emphasizing the feelings of love for her friends while still thinking about the loss, albeit in a healthy and adaptive manner. By focusing on this strength, instead of her fear, she could then be concerned for her friends, while maintaining a deep connection with them.
The third and last participant of the evening was another young woman who wished to be more assertive with her roommate. She initially expressed that she is “fearful of confrontation”, and that her goal for the FNL session was to know what to do to be more assertive and be comfortable with confrontation. “Did you perceive her as angry? Is there evidence?”, Dr. Hickey asked. “No”, she responds. “But that’s not the part that’s making you angry at her. Let’s take it a step further and say that she was. What would make you angry about that?” She then reveals some of her own irrational demandingness: “She shouldn’t be mad at me. She must be responsible for her own actions.” However, she later revealed a rational belief: “I am not responsible for her emotions. She is!”. Dr. Hickey capitalized on this: “That’s a very rational thought. And if you thought about this in the moment, or before talking to her, do you think you would have been anxious or less worried?”. “No. Definitely less worried. But I can say that now!”. Both Dr. Hickey and the participant proceeded to emphasize that practicing the rational belief when anxiety becomes imminent will be fruitful in developing assertiveness over time.
Dr. Hickey’s approach appeared to be using the participant’s strengths to generate rational beliefs and adaptive behavior. With the first participant, Dr. Hickey, using the mechanics and structure of REBT, and collaborative nature embedded in the model, worked on shifting the focus of one dysfunctional emotion (i.e., guilt) to a more functional emotion and source of individual strength: the pride she has with her work. Not only the therapist emphasized the pride, but used it as an example of rational thinking and establishing the B-C connection. With the second participant, Dr. Hickey normalized the sadness as a natural part of loss, and highlighted the participant’s love for those who are close as a source of strength and comfort. With the third participant, Dr. Hickey only needed to compare and contrast the client’s own irrational beliefs with her own disputations, and the emotional consequences.
In all three sessions, the therapist’s intervention was simple, yet effective: work with and reinforce what the client is already doing well, and inspire hope by highlighting their own strengths. In clinical work, this can be a powerful tool for emotional, behavioral, and cognitive change.
Next FNL date:
January 23rd at 7pm, presented by John Viterito, LPC
