The basics of REBT
The backbone of REBT is the ‘ABCD’ schema, which helps clients to see and understand how their thinking processes affect their emotions (Corey, 2000; Walen et al., 1992). The ‘A’ stands for the activating event that brought the client to see the counselor. The ‘C’ stands for the emotional consequences suffered by the client after ‘A’ has taken place. The key to REBT is the ‘B’. While most clients firmly believe that ‘A’ causes ‘C’, clients learn through REBT that ‘B’, their belief system, is actually what is responsible for their feelings ('C'). The ‘D’ in the ABCD schema stands for disputation, which is where much of the therapy actually takes place (Walen et al., 1992). Disputation of irrational beliefs is implemented through cognitive, emotive, and behavioral counseling techniques.
The ‘ABCD’ schema appears to provide a heuristic and germane framework in conceptualizing the psychological processing of a workaholic client. In the workaholic context, an individual is preoccupied by an overwhelming workload that is perceived as the only content of his/her life. This person, who has been suffering from an experience of extreme distress and burnout in many aspects of his/her life ('C'), may believe that the symptom is simply caused by unpleasant feelings and events ('A'). What the individual will learn through REBT, however, is that his/her irrational beliefs ('B'), are the actual cause of ‘C’ (his/her emotional distress).
This is because one's workaholic schema is the root for both the workaholic behavior and its related emotive disturbances. An example of a workaholic-rooted irrational belief may be negative self-talk such as: ‘If I do not spend all my time at work, I'll never be able to finish my assignments and I won't do as good a job as others’.
To correct irrational aspects that form the workaholic schema, the function of disputation ('D') will come into play during the counseling process. In helping the client understand the irrational nature of the workaholic schema, disputation aims to alter the irrational beliefs in the workaholic client through a potent, consistent, and persuasive educational intervention. This intervention highlights a helping process that integrates cognitive, emotive, and behavioral modifications relevant to workaholism.
Case illustration and analysis
The case study in this section attempts to illustrate how REBT can be used to assist a workaholic client. Following a brief case presentation, specific counseling techniques will be outlined to focus on helping the client cope with the workaholic issue through cognitive, emotive, and behavioral changes.
The case of a workaholic
Darlene has been working at a community employment agency for the past 2 years. Her work has been becoming increasingly stressful due to the fact that her performance on the job is now partially determined by the number of her clients that find and maintain a job. This isn't an easy task considering that most of her clients have significant barriers to employment. She feels that her job is next to impossible but she wants to succeed in the field, so she keeps working harder and putting in longer hours.
Darlene has a particular interest in working with clients with disabilities, so she is currently taking two night courses related to this field. Between her homework and her long working hours, she only has about 4 hours of leisure time per week. Even during this time she finds it hard to relax. She hasn't spent time with any of her friends in over a month.
A few weeks ago, Darlene started to feel tightness in her stomach that just wouldn't go away. More recently she has started having panic attacks on the subway, and even had to jump off one day because she was so anxious. She is aware that her life feels out of control and she would like to let something go, but she doesn't want to fail in her career. Darlene's parents are both very successful professionals, and there has always been pressure on her to rise to the top of her chosen field.
Recently, Darlene's stress hit an all time high. She now has panic attacks every day, and finds it difficult to get into any enclosed space, including a car. She visits her doctor, who urges her to give up some of her work, but Darlene is reluctant to do this. She wonders how she will ever get to be successful if she can't handle a heavy workload.
The first way that counselors can help their clients to dispute their irrational beliefs is through cognitive counseling techniques. Such techniques show clients that giving up perfectionism and absolute thinking can help them to lead happier, less anxiety-ridden lives (Ellis, 2000). Through cognitive techniques, irrational beliefs are brought out into the open so that they can be forcefully disputed (Ellis and Bernard, 1985; Ellis and Dryden, 1997). Questioning is a method that is often used by counselors to help their clients challenge their irrational beliefs. Examples of such questions are: ‘Is that good logic?’; ‘Is that true?’; ‘Where is that written?’; ‘What's the proof?’; and ‘Can you stand it?’ (Walen et al., 1992).
The counselor can vigorously dispute the common irrational beliefs that might be held by the workaholic client. Some of the irrational workaholic beliefs may include the following:
a. ‘If I delegate my work, it won't get done properly’;
b. ‘People will think I'm slacking off if I start to work fewer hours’; and
c. ‘If I don't work hard than I might lose my job and I may be too old to get hired by anyone else’.
Many of these irrational beliefs negatively affect the client's self-perception. Such misperceptions often derive from and reflect the lack of self-confidence within the person, reinforcing a sense of low self-esteem.
With regards to the present case, Darlene might hold the following irrational beliefs:
a. ‘I should be able to carry a full workload without becoming completely anxiety-ridden. I'm a total loser’;
b. ‘I must get an ‘A’ in all of my courses or I won't be able to pursue further education’;
c. ‘If my boss gives me a bad performance appraisal then I'll know for sure that I'm in the wrong field of work’; and
d. ‘I should be able to ride on the subway without having a panic attack. Why can't I just be normal like everyone else?’.
To help Darlene confront her irrational beliefs, the counselor can help Darlene first question the logic behind these beliefs. With a trustful and respectful counselor-client work alliance, the counselor should not hesitate to assume the role of a proactive and effective educator. That is, the counselor leads Darlene to become aware of the irrational nature of her thoughts regarding the role of work in her life. A series of direct and explicit questions focusing on attaching the client's misperceptions may be initiated.
‘Why should you burden yourself with an extreme overload of work without feeling anxiety?’, ‘Why should you become a total loser if you reduce your workload?’, ‘What is the rationale that you must get an “A” in all of your coursework otherwise you cannot pursue further education?’, ‘Why should you question your career choice if your boss does not give you a satisfactory performance appraisal?’, ‘Can you give me a reason that your feeling of panic attack should be directly caused by your riding on the subway?’, ‘What is your evidence that you cannot live a normal life like everyone else?’ Questions such as these help the client become more aware of her irrational thinking.
As the client gains awareness of the irrational thinking, the counselor assists the client to work on cognitive restructuring. Darlene realizes that she does not have to compel herself into these ‘shoulds’ and ‘musts’. Events and experiences can be conceptualized from different angles and with different perspectives. In doing so, how she thinks and feels can be replaced by a series of new attitudes and views. The counseling process educates and facilitates Darlene to reframe her irrational beliefs. Here are some of examples of this cognitive reframing work.
Belief 1: ‘I should be able to carry a full workload without becoming completely anxiety-ridden. I'm a total loser’.
Reframed/Replacement Rationale: It is no wonder that I suffer from anxiety. I rarely have time for myself. It would be nice if I could take two courses at a time and work full-time but this simply isn't realistic-not for me or for anyone. I will be able to accomplish more if I actually give more time to myself. I would only be a loser if I kept trying to keep up with the same old hectic pace.
Belief 2: ‘I must get an ‘A’ in all of my courses or I won't be able to pursue further education’.
Reframed/Replacement Rationale: ‘I have received lots of As in my previous courses. To reduce some time in my present study does not mean that I would never be able to get a good grade. If I use my time wisely and effectively, I will likely keep a good academic record. Even I do not receive an ‘A’ for one course, it is not the end of the world. My other personal assets such as my relevant work experience can also have a positive impact on my application to a graduate school’.
Belief 3: ‘If my boss gives me a bad performance appraisal then I'll know for sure that I'm in the wrong field of work’.
Reframed/Replacement Rationale: ‘I have received very good evaluation from my boss thus far. Chances are that I won't get a bad performance appraisal, but even if I did, I have to remember that this is only one person's judgment of my work. Lots of people have already told me that I have a lot of talent in my field’.
Belief 4: ‘I should be able to ride on the subway without having a panic attack. Why can't I just be normal like everyone else?’
Reframed/Replacement Rationale: ‘It's all right if I can't take the subway to work for a little while. It is the fastest way to get to work but it's not the only way. I will wait and ride the subway again when I am ready’.
The second way that counselors can help their clients dispute their irrational beliefs is through the practice of emotive techniques. Emotive therapy is used in REBT to help clients to make a philosophical change in their outlook (Neenan and Dryden, 2000), to change their self-defeating emotions, and to help them learn to practice unconditional self-acceptance (Ellis, 2000). This is particularly important in the case of the workaholic, who suffers from low self-confidence and low self-esteem.
In relation to the present case, the counselor should be most concerned with helping Darlene practice unconditional self-acceptance because most of Darlene's irrational beliefs are linked with feelings of unworthiness. Unconditional self-acceptance could be taught to Darlene through the following practices.
Accepting self. Darlene needs to accept the consequences of her endeavours, whatever the results. Whenever she is judged in any way, at work or at school, Darlene needs to peacefully accept it. For example, instead of saying to herself ‘I got a ‘B’ on my report. I'll never get anywhere in life,’ she could try saying ‘I got a B on my report. I learned a lot from this project that will help me to work more effectively with my clients.’ In other words, Darlene needs to learn for herself the REBT view that ‘doing is more important than doing well’ (Trimpey, 1993, p. 258).
Shame-attacking exercise. This exercise involves performing, on purpose, an activity that will evoke disapproval from others (Neenan and Dryden, 2000). In Darlene's case, she is encouraged to observe what happens if she reduces her workload. She then realizes that she does not have to feel uneasy, as having more leisure in life does not mean the end of her career. Darlene notices that life goes on, and her re-organization of her workload does not necessarily render disapproval from others, including those significant ones in her personal life and peers in her workplace.
Darlene is also encouraged to try out similar exercises in other aspects of her life. For example, while at school, she may ask a very simple question with an obvious answer. This would help her to learn that acting ‘stupidly’ does not make her stupid. Feelings such as shame, guilt, uneasiness, or stupidity are her own emotions that do not necessarily reflect the true reality she encounters. It would also help her to realize that even if she does not behave perfectly all of the time, the world does not come crashing down.
The third way that clients can dispute their irrational beliefs is through behavioral techniques, whereby the client challenges his or her irrational beliefs by behaving in a way that opposes the belief (Walen et al., 1992). Behavior therapy serves two purposes in REBT. First, it helps clients to become accustomed to more effective ways of performing (Ellis, 2000). Second, it supports the client's cognitive learnings, because he or she is able to test new rational beliefs through real-life applications (Neenan and Dryden, 2000).
In working specifically with workaholics, the counselor helps the client to see that work is only a part of, and not the only, component of life. Life is still worthy and meaningful even if a person devotes less time to his/her work. Following this awareness, the counselor helps the client to learn more effective coping strategies that will lead to more specific behavior changes in life. Attention may need to be drawn to three principles in facilitating behavior change.
As workaholism is a complex and habitual psychological phenomenon that integrates cognitive, emotive, and behavioral variables, three principles are worth noticing when helping the client change behavior. First, behavior modification goes hand-in-hand with cognitive and emotive reframing to promote a more holistic learning and change. Second, behavior modification needs to be gradual and persistent, reinforcing a sustainable effort to influence daily life. Third, objectives for behavior change need to be clear, specific, and obtainable so that the client can experience some concrete differences in adopting a rational behavior.
The client in this case is to learn that she needs to take some action in dealing with her workaholic problem. Once such actions and practices are implemented, she can expect to reap positive mental and physical well being from working fewer hours and participating in more recreational activities, returning to a more balanced and healthy lifestyle. Many behavioral tasks are carried out as homework. With regards to the present case, Darlene could be encouraged by her counselor to practice the following behaviors between therapy sessions.
Delegating tasks to others. At work, Darlene could ask the administrative assistant to help her clients with their CVs, rather than taking the time to do it herself. At school, Darlene could practice not taking the lead role in all of her group projects, and she could also plan on taking only one course per term instead of the two-course workload she is taking in the present term.
Setting boundaries. Using boundaries to confine the workday appears to be another strategy to affect behavior (Burke, 1999). Darlene could try leaving her job after an 8-hour workday, even if all her tasks are not completed. Not only does she follow this 8-hour rule in a strict manner, but she also reminds herself that any planning related to her work schedule must follow this 8-hour rule. In other words, only a reasonable and achievable workload is arranged in this work time boundary so she will be able to finish her work within this length of time. This will hopefully give her a more balanced work life without feeling falling behind in her work, aiming at reducing anxiety and distress.
Desensitizing anxiety. To increase or decrease an activity on a gradual basis can help the client get used to a more desired circumstance or behavior. To encounter her anxiousness in riding the subway, Darlene may ride the subway once per day, starting with 5 minutes per day and gradually increase her riding time until she can ride the whole way to work. Similarly, to promptly reduce her work time from 12 hours per day to an 8-hour workday could be difficult. Darlene could give herself a couple of months to gradually scale down her daily and weekly work schedule. The key point for behavior change here would be to adjust to the new workload for a while, getting used to it before the next step. This process continues until the balanced workload is reached and preserved.
Practicing substitution. Darlene should not take on any new work or school-related tasks until she eliminates another task with a corresponding time value. Following this rule will provide a more structured context for Darlene to maintain a balanced work life.
Exercising leisure. Very often workaholics not only hold the irrational belief that leisure is a waste of one's valuable time, but they often also have no knowledge of how to make leisure a part of their life. After correcting such misperceived thinking and feelings, the counselor facilitates Darlene to gain more hands-on experience in learning how to ‘play.’
This should take two points into consideration. First, leisure can be more long lasting and promote personal growth if it is deemed to be personally meaningful to the person. Second, making a commitment to scheduling leisure time is important as it provides the client with a structure for action execution and reinforces behavior change. In the case of Darlene, she should attempt to ‘play’ at least twice per week, by doing activities that she enjoys, such as eating out with friends, watching movies, or hiking.
Workaholism negatively affects not only a person's work life, but personal and social life as well. Individuals with a workaholic tendency maintain an unbalanced lifestyle that can consequently cause threats to their physiological and psychological well-being. As a viable helping alternative, REBT seems to provide the counselor with both the conceptual framework and the applicable intervention tools in working with workaholic clients.
In presenting a case analysis, the foregoing discussion has illustrated the use of REBT in counseling a workaholic client. The relevance and applicability of REBT in this therapeutic context lies with an integrated cognitive-behavioral approach that addresses the three essential components in forming human psychology, namely, cognition, emotion, and behavior.
The theoretical foundation of REBT, particularly the ‘ABCD’ conceptualization of human psychological process, appears to be heuristic in understanding the psychological processing of workaholics. Following this understanding, a range of cognitive, emotive, and behavioral techniques can be applied to help the client cope with the workaholic problem, moving towards a more balanced and healthy lifestyle that integrates work and personal activities, including leisure time. Hopefully, more effort may be given to the further exploration of the application of REBT in dealing with similar psychological difficulties people encounter in their everyday work life and social life contexts.
- Burwell, Rebecca & Charles Chen; Applying REBT to workaholic clients; Counseling Psychology Quarterly; Sept 2002; Vol. 15; Issue 3.
Reflection Exercise #4
The preceding section contained information
about applying REBT to workaholic clients. Write
three case study examples regarding how you might use the content of this section
in your practice.
What are the three principles behind behavior modification in a workaholic client? Record the letter of the correct answer