Bernard, Michael E. School Psychology Review; 1990, Vol. 19 Issue 3, p294, 10p
RET TREATMENT PERSPECTIVES
A brief overview of the RET model of childhood maladjustment will help to make clearer the rationale for the methods RET prescribes in treating the social, emotional, behavioral, and learning problems of school-age children (see Bernard & Joyce, 1984). RET takes extreme cognizance of the wide individual differences observed in the way students in school (and elsewhere) react to the same event. Whether the event be teasing, performance failure, criticism, parental rejection, unfair treatment, or frustrating and difficult tasks, children and adolescents of the same age experience different degrees of adaptive and maladaptive emotions and behavior. This is especially the case after children have entered the concrete operational period of thinking as defined by Piaget and begin to actively mediate their environment. AS children enter this stage of development, they are less influenced by events in their immediate perceptual environment. They begin to be more independent in their thinking and, in particular, think much more about things which have happened in the past or might happen in the future. From a RET perspective, the belief system and the logical reasoning processes of children determine in a fundamental way the extent to which they react adaptively to particular bad events they encounter. RET accepts the findings of the cognitive-developmental literature which point to a progressive differentiation and sophistication of perceptual, symbolic-representational and information-processing abilities. However, RET has a particular theory as to why certain children bring with them to their immediate environments irrational belief systems and faulty reasoning processes which are atypical for their cognitive-developmental level.
RET incorporates the findings of Chess and Thomas (1985) and other researchers who have found that children are born with reliable and consistent patterns of behavior which they label temperament (activity level, regularity, adaptability, approach/withdrawal, physical sensitivity, intensity of reaction, distractibility, positive/negative mood, persistence). RET theorists (e.g., DiGiuseppe,1988) have argued that all children are born with NFT or no frustration tolerance. Additionally, RET theorists have for many years (e.g., Ellis, Moseley, & Wolfe, 1966) described differences in parenting styles and how parenting style along with parent emotions influence the development of children. For example, Hauck (1967) identified the "unkind and firm" pattern ("unquestioning obedience to authority combined with a kick in the ego") as contributing in certain children to low self-esteem, insecurity, and guilt as well as avoidant, overly dependent, and submissive behavior. "Not firm" patterns of parenting which involve parents setting few rules and limits has been linked in the RET literature with children who manifest low frustration tolerance and an inability to delay gratification. Bernard and Joyce (1984) argued that child psychopathology results from an interaction of child temperament with parenting style and, in particular, that adaptive development occurs because of a good match between parent child-raising approach and child temperament. Clinically, the RET practitioner is "on the look out" for children with age-inappropriate low frustration tolerance and who have "egorelated" problems and, in particular, "self-downing" thinking tendencies (e.g., Knaus, 1985). In understanding why these children think, feel, and behave the way they do, RET gives attention to their temperament and the way their parents think, feel, and behave towards them.
TREATMENT GOALS: MODIFY NEGATIVE AND INAPPROPRIATE EMOTIONS
The goals in the RET treatment of school-age populations are similar to those in adult treatment although the means vary depending on the cognitive-developmental status and intelligence level of the student. That is, RET is directed at bringing about a reduction in the intensity of inappropriate, negative emotions of students which are seen to be causing misery as well as making it harder for students to solve current problems and achieve future goals. RET is not designed to help the young client solve current presenting practical problems, but rather to reduce extreme levels of anger (rage), anxiety, and feeling down (depression) which prevent the young person -- or make it harder -- from figuring out how to overcome a specific problem. Extreme emotional upset disrupts the thinking process. The RET practitioner does not ignore practical, manipulative, or behavioral problems. While using RET with a student to solve emotional problems, the RET practitioner will frequently employ different cognitive-behavioral techniques such as interpersonal cognitive problem solving (Spivack & Shure, 1974); self-instructional training (Meichenbaum, 1977; Kendall & Finch, 1979); cognitive social skills training (Halford, 1983) to help the student acquire skills to modify aversive events in the environment and to solve practical problems.
Take the example of Andrew in Grade 7 who has been referred to his school's psychologist because of being very scared and depressed about the amount of teasing he receives. From a RET assessment perspective, Andrew might be assessed as experiencing a high level of depression and anxiety surrounding being teased. (He may as well have a deficit in social skills or an inhibition of his social skills due to his anxiety as well as experience other emotions like extreme anger.) The RET treatment goal for Andrew would be to reduce the intensity of his depression and anxiety so that not only would he be happier with his friends at school, but also through greater emotional self-control, be more effective behaviorally to decrease the frequency of teasing. Once Andrew's depression and anxiety is reduced, his high level of anger may also be targeted for change.
In RET, the modification of emotional problems is primarily accomplished via the modification of the young person's assumptions, inferences, evaluations, expectations, and beliefs which are either anti-empirical or irrational. "Errors" of inference refers to faulty conclusions (e.g., "Everyone is teasing me.") and predictions (e.g., "Everyone will always tease me.") a student makes about past, present, or future external events as well as misattributions of cause-effect relationships (e.g., "The reason my classmates tease me is because they hate me."). Irrational evaluations refer to the manner in which the student appraises the significance of the initial interpretation or inference of reality and typically are manifested in "absolutistic statements" (e.g., "I need my classmates' approval."), "awfulizing" statements (e.g., "It's terrible to be teased."), "I can't stand-it-itis" statements (e.g., "I can't put up with teasing any longer.") and "global rating" statements (e.g., "I'm hopeless.").
Said another way, when a student is assessed as having an emotional problem, according to RET theory, one can anticipate a number of different cognitions which are causing and/or concurrent with emotional problems. Erroneous and irrational cognitions are seen as exacerbating bad external circumstances. In the case of Andrew, Andrew's ideas that "No one likes me," "Ill never have any friends," "Everyone is teasing me," "I can't stand being teased," and "I'm hopeless" are seen as leading to inappropriately strong negative emotions. A student with a more rational attitude towards teasing would feel appropriately negative (disappointed, irritated, concerned), but would not be as upset as Andrew. To reduce Andrew's depression and anxiety, RET would employ a number of different techniques to modify Andrew's way of thinking about being teased.
RET COGNITIVE CHANGE METHODS FOR USE WITH STUDENTS
Once the RET practitioner has identified specific erroneous inferences and irrational evaluations, he/she then decides which cognitions he/she will attempt to modify and which change methods to employ. These decisions are based partly on the cognitions themselves and also on the cognitive maturity of the young client. To begin with, those cognitions which are erroneous and irrational are targeted for potential change --sometimes with the help of the young client. That is, the practitioner is careful not to change negative cognitions which might be true. For example, in the case of severe child abuse on the part of a rejecting parent, you would not target the cognition "My daddy doesn't love me" for change to "Daddy loves me" if the overwhelming amount of evidence points to the conclusion that the parent doesn't love the child. For a more detailed discussion of this idea and how RET differs from Beckian cognitive therapy, see DiGiuseppe (1989).
The main cognitive change method employed in RET is called disputation. Disputing is based on the scientific method and involves a close examination of specific thoughts and beliefs of a student to determine the extent to which they are true (there is factual evidence to support them), sensible (logical) and helpful (leading to goal directed feelings and emotions). Once uncovered and identified, the practitioner uses a variety of questioning, didactic, and socratic techniques that the student can be provided with the evidence and justification for why some of the ideas he/she holds are irrational and untrue. The disputing process ends with the practitioner helping the student to reformulate his/her irrational evaluations and beliefs to more rational ones and to acquire a set of rational self-statements which the student can employ in the problematic situation. The amount and degree of disputing depends on client maturity.
RET is distinguished by its concern for the philosophical belief system of the client as this system is seen to contain the basic "trait" attitudes which are responsible for the consistencies in the adaptive or maladaptive functioning of clients. The older the client -- especially above the age of 12 or 13 -- the more the belief system is seen to be at the core of the emotional difficulties of the client.
With certain bright and older students -- those who have achieved the capacity for formal operational thought (see Bernard & Joyce, 1984, Chapter 4) -- one can use abstract, philosophical disputation in an attempt to modify the basic belief system. Termed "preferential/elegant RET" (Ellis, 1980), this method engages the client in a consideration of the logicality, empirical basis, and semantic meanings of irrational beliefs expressed as broad generalities and not tied to specific situations. For example, if Andrew who was very depressed and anxious about being teased was older, one could have disputed some of his more general beliefs such as "I need people to approve of me," "People should treat me fairly," "I'm hopeless when people reject me." Methods for philosophical/general disputation of beliefs have been described in many texts (e.g., Walen, Wessler, & DiGiuseppe, 1980) and more recently in DiGiuseppe (1990).
Disputation of Irrational Beliefs in Specific Situations
With younger students, it is almost always the case that disputing of irrational beliefs occurs in a specific, concrete context. Disputing at this level involves identifying "should/ought/need" statements, "awfulizing" statements, "I can't-stand-it-itis" statements, and "self-worth" statements as they are manifested in specific situations (for a discussion of these types of irrational statements, see Walen et al., 1980).
For example, in the example of Andrew, the RET practitioner would dispute his irrational idea that "I'm hopeless" by examining the belief as it arises with a specific person. "So, when George calls you 'Stupid', you think you are hopeless. Is that right?" Once Andrew agrees, the practitioner establishes a basis for disputing his irrational self-statement dealing with self-worth by asking Andrew to complete a "Self-Concept Circle" (see Knaus, 1974) which has students (with practitioner help) writing down positive and negative characteristics of themselves (e.g., negative: getting teased a lot, not good at math, bad at playing the recorder; positive: fixing my bike, looking after my pet, help mom and dad with chores). The practitioner is then in a position to pose basic disputational questions to dispute self-downing: "Does George calling you 'Stupid' take away all of the positive things about you? Do you lose all your good things? Does it make you totally stupid?" One could also dispute Andrew's idea "I'm hopeless" semantically by defining "I'm hopeless" as meaning hopeless at everything he does. One then asks him on the basis of his self-concept circle whether he is hopeless at everything. This disputing results in a rational self-statement, 'While I'm not good at making friends with George, there are other good things about me."
Other irrational evaluations expressed by Andrew in specific situations which could be disputed are: "It's awful to be teased by George when I arrive at school"; "I can't stand it when George teases me at recess." Disputing "awfulizing" irrational self-statements involves helping students to keep "bad" events like teasing in perspective. One very effective way RET disputes "awfulizing," is through the use of a "catastrophe scale." To use this scale, a vertical line is drawn and at various levels on the scale the following percentages are entered along the vertical line: 100% (at the top), 90%, 50%, 10%, and 0% (bottom of scale). In beginning the dispute, Andrew would be asked "When you get very, very down about being teased, on a scale of 1 to 100, where 100 is the worst thing which could happen to you, 50 is medium bad, and 10 is a little bad, how 'bad' is being teased?" Once having elicited a rating which tends almost always to be above 90, Andrew would fill out the catastrophe scale beginning with events in the world which could happen which would be catastrophes (events with a rating between 90-100) such as earthquake, parents dying, permanent injury, etc. Andrew would then complete the scale for more moderate "catastrophes" in the 80-90 range from house burning down and broken leg to trivial bad things with rating of 10 or less such as forgetting lunch, losing 20 cents, etc. The ratings of specific events will vary a little across students and age. The dispute finishes with Andrew being asked: "On this (completed) catastrophe scale, how bad is being teased by George when you come to school?" In lowering his initial rating of the badness of being teased from above 90 to somewhere in the more moderate range of bad things which could happen, Andrew will experience a restructuring of his cognition that "teasing is awful" and a reduction in the intensity of his anxiety and discomfort. The rational self-statement which could be substituted now would be something like "Teasing is bad, but it isn't the worst thing which could happen."
The irrational statement "I can't stand George teasing me" would be disputed with questions such as: "You mean it kills you? Where is the evidence that you can't stand it? Have you ever fainted? Have your eyeballs fallen out?" A rational counter self-statement might be "While I don't like being teased, I can stand it."
Disputing of Inferences
The other main category of cognitions along with irrational evaluations which is disputed in RET are "errors of inference." Given their lack of experience and knowledge, school-age children are even more likely than adults to hold erroneous conclusions and make faulty predictions about reality. Indeed, one of the prerequisite insights we teach students in RET is the difference between an "assumption" and a "fact" and that just because they might think something, does not necessarily make it true. In the case of Andrew, he might subscribe to a number of errors of inference including: "Everyone is teasing me," "Because I'm being teased, no one likes me," "I'm teased all the time," and "I'll always be teased."
The main RET technique for disputing faulty inferences is called "empirical disputation" or "empirical analysis" (e.g., DiGiuseppe, 1981; DiGiuseppe &Bernard, 1983). In empirical disputation, the practitioner teases out with the student whether there is objective evidence to support their conclusions or predictions or whether they are distorting reality. For example, to empirically dispute the thought "Everyone is teasing me," a class list could be employed and Andrew could go down the list of names and place a check next to any who do not tease him. This empirical analysis would help him to modify his conclusions to something more accurate and which he would find easier to accept (e.g., "Only four or five kids are teasing me.").
An effective empirical disputational method is to design an "experiment" where the student collects data over a short period of time (a week) and compares the results of data collection with his/her original conclusion or prediction. In Andrew's case, the practitioner could design a chart for him to collect the number of times he is actually/eased along with their time of occurrence to help him dispute some of his distortions of what is happening. (You have to be somewhat careful in anticipating the likely results of empirical data collection in case the environment is so filled with negative events that the student's inference turns out not only to be true, but strongly reinforced by the results!)
With students younger than 7, the practitioner provides the student with a list of rational self-statements which he/she can employ in the problematic situation (e.g., DiGiuseppe, 1981). Rational self-statements differ somewhat from coping self-statements, positive self-statements, attributional self-statements, and self-efficacy self-statements in that they encapsulate a rational idea. RET practitioners use all varieties of self-statements when working with school-age children. The point here is that some, but not all, self-statements designed to modify emotions and behavior are rational Some derive from other therapeutic traditions. When used with students with whom you have done some disputing, rational self-statements are the result of the dispute; a new rational belief which counters the previously disputed irrational belief. With children less than 7, little if any disputing takes place. Instead, these young children are given extensive practice in "what to think." The RET practitioner models aloud a rational self-statement expressed in very simple language (e.g., "It's not so bad to be teased. I can stand it."). The young child is then given practice in thinking aloud the rational self-statement in a role play situation and slowly, over time, practices saying the rational self-statement silently. If the young child can read, it is generally a good idea to write the statements down on a card and have them practice thinking the statements at home during the week.
In the case of Andrew, the rational self-statements which could be generated to not only to replace his previous irrational beliefs, but also which he could practice and employ when he is being teased include: "Just because I'm being teased doesn't mean all kids don't like me," "I can stand being teased," and "There are lots of good things about me."
KEYS TO SUCCESSFUL RET CHILD TREATMENT
The following points are based on the collective experience of over 2 decades of working in schools with a wide variety of school-age children and problems (from Bernard & Joyce, 1990).
- Have "on-hand" as many concrete-educational teaching aids as possible. RET, when applied to younger populations, frequently incorporates a variety of structured learning didactic teaching activities. It is important that the student be provided with visual aids to represent the different ideas being described including "thought clouds," "self-concept drawings," "Happening-Thought-Feeling-Reaction Diagrams."
- Target one child emotion-behavior for change in a specific situation. A common problem is to work on a variety of emotional problems such as anger and anxiety along with associated cognitions at the same time. It is best if you work on one problem at a time.
- For children older than 7, it is generally a good idea to illustrate the relationship among activating events, thoughts, feelings, and behavior with diagrams. A commonly used method is to employ the "Happening-Thought-Feeling-Reaction Chart" where each category of event is written on a piece of paper or on the board and specific examples are listed below.
- Assess the student for multiple cognitive errors. It is important to "get out" and write down several errors of inference and evaluations before beginning to dispute.
- Allow the student the first opportunity to dispute cognitive errors. This provides the student with the important insight that what he/she is thinking may be false and, importantly, that one can change one's thinking.
- Always tie the disputes with the student to the specific situation or event of concern. That is, make sure the student is considering whether his/her thoughts are sensible and true in terms of a specific situation. Not "Where is the evidence you can't stand teasing?", but rather, "Where is the evidence that you can't stand being teased by George when you arrive at school at 8:44 am.?"
- For students who are older than 7, make sure the student explains the relationship between change in thinking and changes in feelings. It is important that the students learn that they way in which they can reduce their emotional upsets and feel good is by changing their thinking. This step can be by-passed for less intelligent, less articulate older students.
- Be animated when disputing. It is important that the student is stimulated to recognize and change irrational thinking. One way to do this is to modify your verbal behavior (e.g., change voice tone, volume, speed, accent) and non-verbal behavior (e.g., getting out of your seat; walking around the room).
- Repeat the same disputational argument if the student does not seem to understand the dispute and if he/she still believes the erroneous/irrational idea. Many students will require repetition of arguments and evidence to dispute inferences and beliefs they have held for an extended period of time and which they strongly believe.
- Project the same difficult situation into the future. With the student, generate coping and rational self-statements which the student can employ to modify his/her emotions and behavior in the future.
- Focusing on the same difficult situation, use role play and modeling of rational self-statements. Then, have the student overtly and then covertly rehearse rational self-statements and practice appropriate behavior with the practitioner role playing aspects of the difficult situation. That is, have the student observe you while you think aloud in a difficult situation. The student could play the role of an antagonist or help create the atmosphere of the difficult situation. Then exchange roles.
- Assign homework. During the time between sessions, the student should be involved in employing some RET or other skill presented in the counseling session (e.g., self-observation of emotional upset; using rational self-statements which have been written down; putting up with things the student thinks he/she can't stand).
WORKING WITH PARENTS
As indicated earlier, parents can play an important role in the development of different problems of childhood. As well, they are vital adjuncts in bringing about an amelioration of the problem. RET has for many years recognized the importance of parental behavioral/child management skills in the socializing and disciplining of children. There is plenty of research attesting to the lack of parenting skills in parents of conduct disordered children (e.g., Forehand, King, Peed, & Yoder, 1975; Patterson, 1981, 1982). RET practitioners routinely assess parenting skill assets and deficits and teach 'parenting" skills (e.g., Hauck, 1983).
The area in which RET has made the greatest contribution to the improvement in parent-child interaction, however, is that of parent emotions. RET has as one of its basic assumptions when working with parents that when parents become overly upset about their child's behavior, their behavior ceases to be effective at best and often can bring about a negative result in the child.
When interviewing parents, the RET practitioner is on the look-out for extreme emotional reactions on the part of parents when they observe their child misbehaving or experiencing a social, emotional, or learning problem. Typical parental emotions which impede effective child raising and problem solving are as follows.
When parents feel guilty, they are likely to believe that (a) they attribute their child's problem to themselves, and (b) they often condemn themselves for being responsible.
Extreme anger (not just annoyance) is frequently encountered with the parents of children with conduct disorders. Parental anger is motivated by the expectation that anger is an effective punishment tool and the irrational belief that "Children should always behave well and do as I say."
Parental anxiety frequently is encountered in the parents of children who experience "internalizing disorders" and learning difficulties. These parents believe that "It is awful that my child has c problem" and "My child cannot stand having the problem" (projected discomfort anxiety).
Low Frustration Tolerance
Many parents of children who experience difficulties of adjustment in growing up have a low tolerance for the frustrations of bringing up children. They irrationally believe that "Parenting shouldn't be so hard" and that "It is too hard to solve my child's problems."
In working with parents, the RET practitioner spends a great deal of time helping parents modify their emotions using standard RET disputational techniques. Clinical experience has shown that behavioral interventions with parents are not employed effectively by parents because of their own intervening emotional reactions to their child's problems. RET teaches parents the importance of accepting themselves in the face of problems their children experience, of disciplining without anger, that "awfulizing" about children's problems only aggravates the problem and distorts the severity of the problem, and to develop high frustration tolerance to better manage the hassles of child raising. (See article in this mini-series by Joyce for a case study on the use of RET with parents.)
RET TREATMENT LEVELS
There are a number of levels at which. the RET practitioner can involve the parents and student in a RET intervention.
Level 1. Practitioner-Student. This is the most traditional form of mental health service delivery and involves the practitioner seeing the student and using RET directly without seeing the parents of the student.
Level 2. Practitioner-Student-Parent/Teacher. At this level, the RET practitioner works directly with the student. The parent (or both parents) or teacher of the student are present and the goal at this level is to both help the student modify his/her problems and teach the l parent/teacher basic RET methods which they can then use with the student outside of the session (see Waters, 1990).
Level 3. Practitioner-Parent/Teacher-Student. Just as behavioral approaches are taught to parents and teachers for them to manage the specific problems of a child, so, too, do RET practitioners work with parents and teachers to help them to manage the problems of a child without the direct intervention of the practitioner. While RET practitioners teach parents a variety of practical problem-solving skills and child management approaches, what differentiates RET from behavioral approaches is that it also assesses and modifies parental emotions which are presumed to be interfering with effective management of a child's problem (see McInerney, 1990).
Level 4. Practitioner-Parent/Teacher. It is sometimes the case that the RET practitioner focuses on the improvement of the mental health and reduction of stress as an end in itself when working with a parent or teacher (e.g., Bernard, Rosewarne, & Joyce, 1983; Forman, 1990; Joyce, 1990).
Level 5. Practitioner-Student-Family Members. Some RET practitioners prefer to have the total family involved during part or the complete sessions with a student with the goal of modifying emotional and behavioral patterns of responding among family members using RET and allied techniques (e.g., Woulff, 1983).
Level 6. Practitioner-Couple. While RET practitioners operate from the belief that child problems can be the cause rather than the effect of marriage/ relationship problems, it is sometimes the case that the RET practitioner, with the cooperation of the child's parents, will spend some time helping to rid the couple (without the child being present) of emotional disturbance. Improvement of the marital relationship can bring about a beneficial change in the child and enable the partners to manage their child's problems more effectively (e.g., DiGiuseppe & Zeeve, 1983).
Level 7. Group Therapy. In recent years, there has been a growing recognitions of the importance of working with students in groups and RET can be readily modified for such purposes (e.g., Elkin, 1983).
In conclusion, the use of RET treatment methods with students in schools and their significant others has over a 20 year history. And as RET itself continues to evolve its important and basic insights, skills and attitudes can be used by people to produce beneficial changes in their lives, so, too, the use of RET in schools by psychologists continues to be refined. While the basic model of change in RET is a relatively simple one, the reality of trying to help improve the thinking and attitudes of school-age children is not straightforward. RET offers the school psychologist an impressive array of methods and techniques to be used to solve childhood problems. The challenge for the school psychologist is to maximize their effectiveness. This we have found over the years to be a stimulating and rewarding experience.
Rational-emotive parent consultation. Joyce, Marie R., School Psychology Review, 02796015, 1990, Vol. 19, Issue 3
RET AS PARENT CONSULTATION
RET parent consultation can be applied at one of two levels: indirect service to a child or parent mental health consultation; indirect service to the child where the parent is the consultee and the child is the client aims to increase parents' ability to solve practical problems of their children (e.g., behavioral, emotional, learning) and achieve the goals of parenting as a consequence of parents acquiring emotional self-control skills. This first level, which parallels Meyers' Level 2, Indirect Service to the Child, identifies the child as the client and main beneficiary of RET parent consultation. While parents themselves will, as a consequence of learning rational-emotive self-control skills, experience an improvement in mental health through a lessening of emotional stress, this outcome facilitates the parents' solving of child problems and fosters the social, emotional, and educational development of the children.
Parent mental health consultation where the parent is the client is the second level which parallels Meyers' Level 3, Mental Health Consultation. It recognizes the improvement of parent mental health as an end in itself. Within this context, the client who is the recipient of RET parent consultation is the parent. (The child is seen, indirectly, as benefiting from a reduction in parent stress.) If, therefore, there is a need in your parent population for stress management programs, you could consider the present RET approach.
In assessing and remediating parenting problems, RET employs a dual analysis--of parents' emotional problems and of parents' practical problems. This distinction is crucial to understanding how RET is applied to parenting issues. Practical problems of parents refer to problems parents encounter with their children and are often resolved by parents through the learning and application of specific parenting skills (e.g., discipline skills, communication, tutoring). Emotional problems of parents occur when parents experience disturbed negative emotions about a practical problem they have with their children. These disturbed emotions (e.g., rage, anxiety, guilt) are seen in RET as not only exacerbating parent stress, but also as making it much harder for parents to solve their practical problems. For example, a parent may experience feelings of high anxiety when the child's developmental rate is apparently slower than other children's, or feelings of inadequacy, depression, or anger when their discipline methods are failing. RET parent consultation differs from behavioral consultation in targeting parent emotions for change.
RET proposes that high intensity negative emotions of parents (a) derive from irrational beliefs about themselves and their parenting, and (b) are inappropriate and self-defeating, primarily because they produce emotional distress in the parent, undermining mental health, (c) interfere with effective practical problem solving, (d) can occasion further emotional problems in their child (e.g., anxiety, guilt, resentment, self-pity, or anger), and (e) can lead to a deterioration in the parent-child relationship.
RET AND PARENTING
RET has concerned itself with issues of parenting over several decades. More than 20 years ago Ellis, Moseley, and Wolfe (1966) in their book "How to Raise an Emotionally Healthy, Happy Child" presented rational-emotive ideas to help parents understand common child problems and ways they might be alleviated. Problems dealt with included fears, anxiety, hostility, sex, and conduct problems and lack of self-discipline. Ellis et al. (1966) focused on the importance of the parents" emotional state while interacting with the child. For example, they recommend to parents who are helping their child overcome fears: "Calmness in dealing with a child's fears is one of the prime requisites for helping them to overcome them" (p. 65). In teaching parents about lack of self-discipline in a child, they suggest "In most cases where a child refuses to accept any discipline . . . it is his parents, rather, who won't accept any wrestling with him and who weakly refuse to take the consequences of forcing him to discipline himself. This is often an outcome of their own feelings of inadequacy, their fears and guilt at acting 'hostilely' toward a child" (p. 129).
A number of other RET writers have addressed the problems of parents. Hauck (1967), in his book "The Rational Management of Children," analyzed some of the irrational attitudes commonly held by parents in relation to their children and detailed some of the common "parenting styles" and the consequences of these for children. Grieger and Boyd (1983) described six disturbed parenting styles associated with anxiety, fears, and phobias in children. The parenting styles described by Hauck and by Grieger and Boyd are discussed below in relation to child mental health.
Several RET theorists have been concerned with the application of RET to parents of particular populations of children. For example, DiGiuseppe (1983,1988) dealt with the parents of conduct disorder children and McInerney (1983) addressed problems encountered by parents of handicapped children. Other published RET literature on parenting includes Barrish and Barrish's work (1986) on the RET treatment of parental anger, and Woulff (1983) who integrated RET with family therapy.
RET hypothesizes (e.g., Bernard & Joyce, 1984) that the child's parents create the most important environmental conditions by their style of parenting Parents not only teach behavioral patterns, but also contribute to parent-child interactions emotional elements that react with the child's inborn tendency to think irrationally and self-centeredly. Such tendencies can be modified or reinforced by parental attitudes and practices. Children with "difficult" temperaments (Chess, Thomas, & Birch, 1966) are particularly at risk when exposed to the styles of parenting discussed below. RET has made a contribution to understanding some of the maladaptive habits parents (and children) manifest and how they can be overcome.
Hauck (1967) presented a RET rationale of parenting styles in which he discussed two dimensions of parenting: kindness and firmness. He identified the "kind and firm" approach as being consistent with RET and the philosophy of rational parenting It involves the parent frequently discussing behavior with the child, helping the child build up tolerance for the inevitable frustrations of life by setting limits, and thinking well of the child, even when he or she is misbehaving. Each of the other three styles of parenting Hauck presents ("kind and not firm," "unkind and firm," and "unkind and not firm"), is shown to have destructive effects. Kind and not firm parents are loving but indulgent towards their child and likely to produce "the spoiled brats, the weak and dependent, and the emotionally infantile" (Hauck 1967, p.43). Unkind and not firm parents are cold, critical, and inconsistent towards their child, leading to confusion and inconsistency in the child, because whatever he or she does seems to be wrong. Thus, RET hypothesizes a link between lack of firmness by the parent with poor self-discipline in the child.
A further link is proposed between parental unkindness and low self-esteem in the child and so the unkind and not firm regime is seriously lacking in both aspects. The unkind but firm style has the beneficial feature of helping to develop habits of responsibility and self-discipline, but at a high cost to the mental health of the children who frequently suffer anxiety and depression associated with blame and guilt.
In an account of parenting styles associated with anxiety, fears, and phobias in childhood, the RET practitioners Grieger and Boyd (1983) identified six disturbed styles: (a) the criticism trap, the most common style, is characterized by excessive criticism, nagging, blaming, correcting, ridiculing, and putting down the child; (b) the perfectionism trap, in which parents place excessive pressure on the child to always achieve highly and do well; when the child performs poorly they criticize and get angry, and when the child performs well they let the child know that he/she could have done better; (c) in the scared rabbit trap parents communicate excessive fear of danger and discomfort with uncertainty; (d) the false positive trap and (e) the guilt trap are styles which provide excessive and indiscriminate positive affection for the child, with little or no limit setting; and (f) the inconsistency trap is characterized by parents either dealing with the child according to their mood, or criticizing the child strongly and frequently but without setting rules. All of these styles are associated with irrational beliefs-and disturbed negative emotions in the parent and with undesirable consequences for the child's mental health.
Irrationality and Emotional Distress
From a RET perspective, psychological stress in parents is manifested in intense and enduring levels of parent emotionality including excessive anger, guilt, anxiety, and self downing. A RET view off parent emotional stress focuses on parents' beliefs especially about themselves and their parenting, and about their child and their child's behavior. Recent research (e.g., Joyce, 1989) has found irrational beliefs about parenting to be correlated with emotional stress in parents. Examples of irrational beliefs which RET hypotheses underlie parent extreme emotional upset are as follows:
Parental anger. In this area three common irrational beliefs are: (a) There are bad and wicked people in the world, and the only way to make bad people into good people is by being very severe with them, beating them, and telling them how worthless they are (Hauck, 1983); (b) Children should always and unequivocally do well (e.g., be motivated, achieve, etc.) and behave correctly (e.g., be kind, considerate, interested) (Grieger & Boyd, 1983); and (c) A child and his behavior are the same and thus children who act badly are bad (Grieger & Boyd, 1983).
Parental depression and self-downing. In these areas four common irrational beliefs are: (a) If you are not loved and approved of by important people in your life, you are worthless. Rejection is painful and almost devastating and you cannot avoid being upset when rejected (Hauck, 1983); (b) If my child misbehaves frequently, it is awful and I am a failure as a parent (Bernard & Joyce, 1984); (c) My self-worth is tied to how I do as a parent so I had better not make mistakes (Grieger & Boyd, 1983); and (d) I am worthless because my child has so many problems (Woulff, 1983).
Parental ego anxiety. Two common irrational beliefs in this area are: (a) I must have the love and approval of my child at all times (Bernard & Joyce, 1984); and (b) My child must do well in everything (Bernard & Joyce, 1984).
Parental generalized anxiety. An example of an irrational belief that can be characterized as generalized anxiety is: I must worry about my child at all times and help him/her overcome problems (Grieger & Boyd, 1983).
Parental low frustration tolerance. Four common irrational beliefs that characterize low frustration tolerance are: (a) Difficult issues in life are best handled if they are avoided as long as possible (Hauck, 1983); (b) If something is frustrating, it must be avoided at all costs (Grieger & Boyd, 1983); (c) I cannot stand my child's behavior (DiGiuseppe, 1983); and (d) My child shouldn't be so difficult to help (Woulff, 1983).
Parental guilt. In this final category, four common irrational beliefs are illustrated as: (a) I am the sole cause of my child's problems (DiGiuseppe, 1983); (b) If I make a mistake, it will always affect my child (McMullin, Assafi, & Chapman, 1978); (c) It is awful for my child to suffer and I must therefore prevent it at all costs (Grieger & Boyd, 1983); and (d) I must never do the wrong thing with my child. If I do, I am a failure (Bernard & Joyce, 1990). These examples provide a selection of the irrational ideas which RET practitioners work on, to help parents eradicate them from their thinking.
Research evidence is inclusive from four studies encountered in the literature (Hultgren, 1977; Bruner, 1979; El-Din, 1982; Berger, 1983) which have employed RET with parents. Changes in parent irrationality were found in the Bruner and Berger studies, but not in Hultgren's. Berger failed to obtain changes in parent emotionality, whereas El-Din found changes in child behavior as a consequence of RET. Lack of detailed descriptions of and comparability between independent treatments and dependent measures employed makes findings difficult to interpret and summarize.
The Rational Parenting Program to be described later in this article was evaluated by the present author (Joyce, 1989) with a sample of 48 nonclinical parents. The study examined the effect of the Rational Parenting Program on four groups of dependent variables: parent irrationality, parent emotionality, parent perceptions of child problems, and the perception of participants' parenting by their spouses. Parent emotions studied were trait anxiety, state anxiety, self-downing, anger, guilt, discomfort, and well-being. Validation evidence was established for the Belief Scale (Berger, 1983), which was used to measure parent irrational beliefs, by means of factor analysis of the scale on a separate sample.
Results of the study showed that the program was effective in reducing parent irrationality, both overall and for each subscale of the revised scale. Significant changes in the Low Frustration Tolerance subscale were the strongest followed by changes in Self-Worth and Demandingness. In the area of emotionality, results showed the Rational Parenting Program was effective in significantly reducing guilt in experimental group subjects and, for those parents with moderate to high entering levels of anger and state anxiety, the program was effective in reducing levels of those negative emotions. No differences in intervention effects were found for two experienced leaders. Further analysis of effects, for experimental subjects only, found that changes in parent irrationality were correlated with changes in emotions, namely guilt, self-downing, and trait anxiety, these being associated with cognitive changes in Self-Worth and Low Frustration Tolerance. Exploratory findings from a 10-month follow-up showed that both the changes in irrationality and the changes in emotions were maintained. Of particular interest in this follow-up was the finding that reduction of perceived child behavior problems in the long-term is associated with changes in parents' beliefs about their own self-worth. It appears that parents who lessened their global self-rating then experienced fewer child behavior problems. This supports the RET view that the detrimental effect of irrational beliefs of parents can be alleviated by education in rational parenting and that child behavior problems as perceived by the parent can be reduced in this way.
INDIRECT SERVICE TO THE CHILD
This type of consultation is usually done with an individual parent or two parents. When it has been assessed that parental emotional problems are contributing to or exacerbating their child's problems--or when the practitioner detects that it is the parent who owns the problem and that the child's presenting problem is developmentally "normal"--RET is an appropriate treatment of choice for use by a school psychologist. The central treatment goal when using RET parent counseling techniques with an individual parent or parents is helping them to reduce their emotional problems about their parenting and their child. The main RET technique employed involves identifying and disputing their irrational beliefs. All of the disputational methods employed in RET can be adapted to parent problems--cognitive disputation, emotional disputation, and behavioral disputation (Walen, DiGiuseppe, & Wessler, 1980). Cognitive disputation is most often done by teaching the ABC model (Ellis, 1962) in concrete examples relevant to the current problems. For example, the child's aggressive verbal behavior may be the Antecedent (the "A") or activating agent for the parent's intense angry feelings and behavior, which includes yelling and threatening the child and blaming her for her faults. These feelings and behavior are the Consequences or "C." The ABC model stresses the role of the parent's rational and irrational beliefs (the "B") in bringing about the "C," namely the particular feelings the parent experiences about the event "A." Irrational beliefs that parents hold will most likely combine "shoulds"/ "demands" (e.g., "she shouldn't behave like this; she should behave properly" and "she must do what I want and stop all this nonsense"), "awfulizing" (e.g., "It's awful for a child to treat her parent this way"), and low frustration tolerance (e.g., "I can't stand being treated this way!"), and global rating (e.g., "She's a rotten little kid for acting this way"). Parents can be helped to see the link between their irrational ideas and their (ineffective) ways of feeling and responding. They can learn to dispute these by being asked and learning to ask themselves challenging questions -- Where is the evidence for that idea? Is that a logical thought? Is the thought really true? Is hoIding the belief helping me or hurting me? Is it helping or hurting my child?
There are a number of basic steps in teaching the ABCs of RET to parents. These include:
Parents learn emotional awareness by focusing on emotions and learning to accept them. They learn that emotions vary in intensity and can be appropriate or inappropriate.
The ability to discriminate among emotions and to label them is developed through building an emotional vocabulary.
Parents are taught to think consequentially about emotions and their effects. This can help to motivate them to change the way they feel, by changing some of the beliefs and thoughts that underlie their disturbed emotions.
The ABC model is taught as a structure for helping parents to identify their irrational beliefs.
Parents learn to use disputation methods to enable them to change their beliefs.
A variety of homework exercises provide opportunities for parents to engage in problem identification and assessment, and later to practice disputation.
The following are some suggested homework exercises for parents working on emotional problem solving. For angry parents:
Monitor angry feelings daily using the Feeling Thermometer or an anger scale of 0 to 100.
Record angry episodes and do an ABC analysis for each.
Listen to a tape of their previous RET session.
Practice Rational Emotive Imagery (REI) for their recurrent "A"s.
Make a list of possible reasons why the child is the way he/she is.
Write down their thoughts on any occasions when they managed to reduce their anger.
For self-downing parents:
Write a list of their positive characteristics as parents on a card and read it twice a day.
Use thought-stopping to interrupt self-downing self-talk
Write out ABC sheets for times when they feel most down (e.g., say, over 7 on the Feeling Thermometer).
Say aloud to the spouse or another adult rational self-statements such as "Even though my child's problem is continuing, I don't have to put myself down."
Have their spouse make rational self-acceptance statements to the parent and reinforce efforts to overcome downing. For example, a spouse could say "I can see that you are really working hard to accept yourself more. Well done! It was great when you came through that bad period this morning and kept on trying."
For anxious parents:
Daily rehearsal of anti-awfulizing thoughts (written down for them by the practitioner).
Make a list of possible events worse than the worrying ones.
Answer the "what if . . ." questions that underlie the anxiety.
Practice saying aloud to the child calming down thoughts when the child is anxious.
It will be clear that these procedures are a mixture of concrete and more sophisticated methods. It is the experience of this writer that while parents can function at an abstract, philosophical level when functioning at their best, much of the time (and perhaps especially when they are emotionally stressed), they can benefit from very simple concrete disputational methods.
The following case illustrates RET parent consultation in which parent emotional states played a part in maintaining the child's problem and provided an obstacle to alleviating the problem.
John (aged 12 years) had been the victim of a sexual assault by a trusted babysitter 6 years previously. The parents came for consultation because they were concerned that John (a) had never discussed the experience with anyone and the parents believed that it may be having an ongoing bad effect on his mental health, (b) was soiling frequently at home and refusing to clean himself up immediately, (c) had outbursts of anger in the family -- in conflicts with father, mother, and younger brothers -- with occasional destruction of property, and (d) he was having difficulties with his schoolwork.
The goals of this initial session with the parents were to assess the nature of the child's problems, the desirability of direct intervention with the child, and the nature of the parents' role in the child's problem. Regarding the parents, assessment revealed the mother was experiencing high levels of anxiety in relation to John's problems and frequently felt completely "fed-up." The father was less involved with the day-to-day details of his son's life, but on occasions became very angry with John and engaged in verbal battles with him. Both parents also felt very guilty about the assault to which John had been subjected and this was intensified by John having said to the mother several times that she was to blame for what happened (because of leaving the children in the care of this person).
During the consultation, the therapist asked each parent about their negative feelings and helped them focus on and express how these feelings were affecting their own well-being, and their ongoing relationship with their son. They were helped to understand that these feelings, while not the cause of the problems, were contributing to "bad scenes" at home and poor handling of the child when he was experiencing his problems.
The common antecedents that occasioned the mother's guilt were: John's soiling, his blaming of her, her own thoughts about the assault, and memories of previous mistakes and accidents, including a fall the child experienced when in her care. The irrational beliefs the mother held were: "These bad things should not have happened. I am to blame for them happening and because of that I don't deserve any respect" (i.e., guilt and self-downing); "It's horrible and awful to have a child with a soiling problem. When he soils and won't clean it up it's unbearable. I can't stand it" (i.e., awfulizing and low frustration tolerance); "I must worry all the time about his school difficulties. They probably mean his future will be a disaster. He won't get a job" (i.e., anxiety).
Parental strengths included an over-riding warm and loving attitude to their children, a lively sense of humor, and a commitment to work towards their child's well-being. The father was firm in his discipline and supportive of his son, but had a tendency towards anger when the child's behavior was extreme, so there were occasional angry confrontations between father and son. The father's irrational beliefs included similar guilt-producing ones to the mother's, and additional beliefs that his son should not and must not behave in certain ways (i.e., lose his temper).
As the father was less available for attendance at sessions than the mother, the therapist worked with him at the first session, disputing his irrational demandingness towards his son and teaching him directly that continuing to get angry was getting in the way of helping John overcome his problems. Rational self-talk was modeled: "John is behaving this way at present. That is all he has learned so far," "If I get angry it'll only make things worse," "Even if I'm angry before I know it, I can then calm myself down to improve the situation."
The mother attended 6 fortnightly (i.e., every 2 weeks) sessions and worked on challenging her irrational beliefs. Examples of the challenges employed with the mother include: "Can a parent prevent every bad possibility for her child?" "Can a parent accept herself as a person, even when a mistake has been made in parenting?" "Given her knowledge at the time, could she have prevented the assault?"
Because of the severity of the child's problems, John was also seen separately for weekly RET sessions for some months. Contact was maintained with the mother by telephone after her sessions were finished to help her maintain her efforts and also to check John's reports about his behavior at home. Improvements were made in all problem areas: parents became calmer and dealt consistently with difficult situations; John overcame his angry outbursts and his soiling problem (he aimed for and achieved what he called "zero weeks"); and his schoolwork improved.
MENTAL HEALTH CONSULTATION FOR PARENTS
Based on the present author's experience in school settings, individual parents infrequently approach a school psychologist requesting mental health consultation to reduce their stress. When working on child problems, parent stress-related mental health problems sometimes emerge and individual mental health consultations may follow. The more usual form of Mental Health Consultation with parents however is in groups and this type of rational-emotive consultation is almost synonomous with Rational Parent Education.
RET consultation with parents in groups is not only a cost effective method, but is positively evaluated by parents as relevant and helpful. Groups can be run in schools or community centers in either day or evening settings, and parents can attend together, in different groups or singularly. Recruitment for groups run by school psychologists generally is done through school newsletters. Sometimes an introductory lecture is provided to give parents preliminary ideas and information about the groups.
Rational-emotive consultation with parents in groups is based on the principles of Rational-Emotive Education (REE) (Knaus, 1974). Rational parenting is to be distinguished from other approaches to parent education. These include behavioral programs which teach child behavior management (Forehand & McMahon, 1981; Patterson, 1971), Parent Effectiveness Training (PET) (Gordon, 1976, 1980) which is derived from reflective counseling approaches and teaches communication skills, and Systematic Training for Effective Parenting (S.T.E.P.) (Dinkmeyer & McKay, 1982, 1983) which draws on Adlerian principles. These parent education programs have sometimes been employed with clinical populations (e.g., behavioral/raining) and more often with nonclinical (PET and S.T.E.P.) groups. While the rational-emotive education of parents frequently is integrated with therapeutic techniques in clinical consultations, as described earlier in this article, the interest in this section is in its use with groups of nonclinical parents.
Rational-emotive parent education has been developed for use with groups of parents to reduce their everyday stress (as an end in itself) as well as to improve their parenting skills so that their children manifest fewer problems and enhanced adjustment (Joyce, 1989). Thus the main focus of this program is a mental health consultation but there is some overlap with indirect service to the child. The 9 week program of 1 1/2 hour weekly sessions teaches rational-emotive ideas to parents in four main areas: (a) management of their own emotional stress, (b) child discipline, (c) problem solving for child problems, and (d) the development of rational personality traits in children. These areas are dealt with in the following nine sessions:
Parents have feelings too!
Emotional stress in bringing up children.
Rational self acceptance for you and your child.
Rational coping in a crisis.
Understanding children's emotions.
Children's problems -- Rational problem solving I.
Children's problems -- Rational problem solving II.
Teaching rational attitudes to children.
Parents learn first to label feelings and monitor their intensity by the use of the Feeling Thermometer (Bernard & Joyce, 1984). They also learn that their disturbed negative emotions can interfere with their functioning as parents. Emotional responsibility, that is, taking charge of their own emotions rather than blaming other people or events for how they feel, is taught by means of the ABC model applied to parenting examples, enabling them to explore their irrational parent beliefs and to challenge and change these. This is the first step in achieving the goals of rational-emotive parent education which aims to teach parents to think more rationally, so that they with feel better (less distressed), be more effective problem solvers in every day difficulties, and provide healthier models for their children in dealing with difficult, disappointing or frustrating events.
In learning rational discipline, parents focus on any troublesome negative emotions that they may customarily feel when disciplining their child, especially in situations where the child is not readily compliant. For example, they explore the maladaptive role of anger, worry, and self-downing in discipline situations and practice disputing their underlying irrational beliefs before implementing their discipline strategies.
Two sessions are devoted to rational problem solving of specific problems each parent wants to discuss. These frequently include such common difficulties as social shyness, bedtime problems, sibling rivalry, aggressive behavior, homework problems, temper tantrums, and emotional difficulties such as jealousy. In these sessions parents learn to apply what they have learned in understanding the role of their own beliefs and emotions, and so work out ways to calm themselves first, then help calm the child if necessary, and finally proceed to practical problem solving to alleviate the problem.
The fourth area, the development of rational personality traits, enables parents to begin exploration of ways they can model and reinforce in their children habits of rational thinking which will encourage the child to deal with life in ways that are flexible, non-demanding, non-exaggerating, and tolerant of themselves and others when mistakes are made, or people "do them in."
An illustration of a session may clarify how the program works. Take, for example, Session Five, "Rational Coping in a Crisis." Rational-emotive goals for this session are (a) to discuss with parents common antecedent events associated with anxiety in the parent (e.g., school failure, chronic illness in the child) and the emotional and behavioral consequences that frequently occur when the parent is very anxious (see Figure 1, "Can parents worry TOO MUCH?"); (b) to help parents identify common irrational beliefs underlying anxiety, and practice identifying their own irrational ideas; (c) to generate disputes for those beliefs. Figure 2, "The ABCs of Calm Parenting," is an example of the ABC model applied to this area of parenting problems. Parents fill out the sheet in the session as a basis for discussion and especially for generating a homework exercise tailored to their individual habits of (irrational) thought.
Meyers' et al. (1979) consultation model has been found useful in describing two types of rational-emotive parent consultation. Preliminary research findings on the use of RET with parents indicate that parent irrational beliefs are associated with parent emotional stress and that RET interventions can reduce this emotional stress and help parents become more effective problem solvers with their children. The scientific basis for employing RET with parents is yet to be firmly established. Schools would appear to be ideal settings in which the empirical utility of rational parenting programs can be assessed by school psychologists.
- Abrams, Michael & Albert Ellis; Rational Emotive Behavior Therapy in the Treatment of Stress; British Journal of Guidance & Counseling; Feb 1994, Vol. 22, Issue 1.
- Bernard, Michael E.; Rational-Emotive Therapy with Children and Adolescents: Treatment Strategies; School Psychology Review, 1990, Vol. 19, Issue 3.
- Bishop, Michler; Rational Emotive Behaivoral Therapy: A Non-A.A. option; Behavioral Health Management, Jan/Feb 1994, Vol. 14, Issue 1.
- Cohen, Elliot; The Use of Syllogism in Rational-Emotive Therapy; Journal of Counseling & Development; Sept 1987, Vol. 66.
- DiGiuseppe, Raymond, & Michael Bernard.; The Application of Rational-Emotive Theory and Therapy to School-Aged Children; School Psychology Review; 1990; Vol. 19, Issue 3.
-Ellis, Albert; The Humanism of Rational-Emotive Behavior Therapy and Other Cognitive Behavior Therapies; Journal of Humanistic Education & Development; Dec 1996; Vol. 35, Issue 2.
- Ellis, Albert ; Using Rational-Emotive Therapy (RET) as Crisis Intervention: A Single Session with a Suicidal Client; Individual Psychology, Mar/June 1989, Vol. 45.
- Gavita, Oana A.; Celin, Andreea. Retman Rational Stories verus Rational Parenting Program for the treatment of the Child Psychopathology: Efficacy of Two Formats of Rational-Emotive Behavior Therapy. Journal of Cognitive & Behavioral Psychotherapies. Mar2013, Vol. 13 Issue 1, p33-56.
- Harrington, Neil; Pickles, Charles; Mindfulness and Cognitive Behavioral Therapy: Are They Compatible Concepts?; Journal of Cognitive Psychotherapy, 2009, Vol 23 Issue 4, p315
- Hyland, Philip; Shevlin, Mark; Adamson, Gary; Boduszek, Daniel. The Organization of Irrational Beliefs in Posttraumatic Stress Symptomology: Testing the Predictions of REBT Theory Using Structural Equation Modelling. Journal of Clinical Psychology. Jan2014, Vol. 70 Issue 1, p48-59.
- Johnson, Kaprea F. Using the Rational Emotive Behavior Therapy Framework to Understand Belief Systems and Types of Awareness in Young Men Exposed to Chronic Community Violence. International Journal of Mental Health. Summer/Fall2013, Vol. 42 Issue 2/3, p115-129.
- Lynddon, William J.; A Rejoiner to Ellis: What Is and Is Not RET?; Journal of Counseling & Development; Jan/Feb 1992, Vol. 70, Issue 3.
- Ruini, Chiara; Fava, Giovanni A.; Well-being therapy for generalized anxiety disorder; Journal of Clinical Psychology; May 2009, Vol 65 Issue 5, p510
- Sava, Florin A.; Yates, Brian T.; Lupu, Viorel; Szentagotai, Aurora; David, Daniel; Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (prozac) in treating depression: a randomized clinical trial; Journal of Clinical Psychology, January 2009, Vol 65 Issue 1, p36
- Sklare, Gerald, Taylor, Julie, & Susan Hyland; An Emotional Control Card for Rational-Emotive Imagery; Journal of Counseling & Development; Oct 1985, Vol. 64.
- Sucala, Mădălina; Schnur, Julie; Greene, Paul; David, Daniel; Erblich, Joel; Montgomery, Guy. Cognitive-Emotional Equation: The Relationship Between Irrational Cognitive Processes, Cognitive contents and Specific Emotions. Evidence from a Sample of Breast Cancer Radiotherapy Patients. Journal of Cognitive & Behavioral Psychotherapies. Nov2013, Vol. 13 Issue 2a, p503-516.
- The REBT Super-Activity Guide 52 Weeks of REBT For Clients, Groups, Students, and You!, Kirkus Reviews. 2/1/2013, Vol. 81 Issue 3, p364-364.
- Velten, Emmett; The Rationality of Alcoholics Anonymous and the Spirituality of Rational-Emotive Behavior Therapy; Journal of Humanistic Education & Development; Dec 1996; Vol. 35, Issue 2.
- Weinrach, Stephen G.; Nine Experts Describe the Essence of Rational-Emotive Therapy While Standing on One Foot; Journal of Counseling & Development; Mar/Apr 1996, Vol. 74, Issue 4.
- Weinrach, Stephen G. et. Al.; Rational Emotive Behavior Therapy Successes and Failures: Eight Personal Perspectives; Journal of Counseling & Development, Summer 2001, Vol. 79, Issue 3.
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