7

Identifying the A

T H E E X PA N D E D A-B-C MODEL

When clients describe a troublesome event in their lives, the therapist can think
of it as containing up to six elements: (1) what happened; (2) how the client per-
ceived what happened; (3) what the client inferred about what happened; (4) how
the client evaluated what happened; (5) the client’s acceptance or nonacceptance
of the evaluated perception and inferences of what happened; and (6) the client’s
emotional and behavioral reactions. !ere will always be at least one of the first
three, one of items four and five, and always number six. !e first three elements
are aspects of the A—the Activating Event; the latter two relate to the client’s belief
system. Items four and five represent the B—irrational or rational beliefs and the
final element, six, is the C emotional or behavioral consequences. If at A the client
reports, “She said a horribly critical thing to me,” the client is confusing five ele-
ments. !e issue of what actually happened involves an objective description of
what was said and the tone and manner in which it was said. !at the comment
was a criticism is a perceptual issue or an inference, and whether it need be viewed
as horrible that she was criticized is on the one hand an evaluative issue (I do not
like it) and on the other hand an imperative attitude (she should not do that).
We are drawing distinctions, therefore, among confirmable reality, perceived
reality, and inferential reality. Perceived reality is reality as clients describe it and as
they presumably believe it to be. Con!rmable reality refers to a social consensus of
what happened. If it were possible for many observers to have witnessed the same
event, and they all described it the same way, we would have obtained confirmable
reality. In our example above, if a group of people had heard the exact words and
the manner in which they were said to our client, and a high percentage of the
onlookers perceived the event as an insult, we would conclude that in confirm-
able reality the woman had indeed insulted our client. Inferential reality would
be a conclusion the client makes based on what she perceived. !e thought, “She
does not like me.” might be an inference drawn from the fact that “she criticized
me.” !is inference is a thought the client creates about an imagined activating
event. Whether the imaged/inferred event is true or not, the client reacts to it
with emotional disturbances and therefore we treat it like a real event. People
98 T H E A- B - C s O F R E BT: A S SE S SM E N T

o$en confuse inferences and irrational beliefs. However, REBT considers them
two distinct components of cognition.
To avoid confusion, realize that the term “belief ” or “believe” is commonly
used in English to refer to descriptive cognitions, inferential cognitions, evaluative
cognitions, and imperative cognitions. For example, a client named Dan attended
an event where Sue was present and she did not look at him. If many other people
noticed that Sue did not look at Dan, this would be the confirmable event. Dan
reported in therapy, “Sue is avoiding eye contact with me.” !is descriptive cogni-
tion happens to be part of the activating events. Dan went on to say, “Sue isn’t look-
ing at me because she’s upset with me.” !is is an inferential cognition that is also
part of the activating event. !e perceptual and inferential cognitions are thoughts;
they are about events and considered part of the A. Dan then said, “It’s terrible that
Sue is upset with me.” !is is an evaluative cognition that in REBT is a derivative
irrational belief. Dan revealed in the session, “Sue should not be upset with me.”
!is is the imperative/demanding belief that is the core B. To maximize clarity,
REBT uses the term “belief ” to refer only to evaluative/derivative cognitions
and imperative/demanding cognitions. It will become clear in the next several
chapters that it is important to make a distinction between these types of cogni-
tions when the client uses the word “belief.” We want to stress that perceptions and
inferences are cognitions; however, they are not the type of thoughts REBT focuses
on. !ey are thoughts about the existence of reality.
In e%ect, the A-B-C model of REBT can be described as follows:
A-(con!rmable)—the activating event as it could be validated by a group of
observers;
A-(perceived)—what clients perceive happened in the activating event; that is,
their subjective description of it;
A-(inference)—the conclusion about what the client thought happened or could
happen;
B-(evaluative/derivative)—the clients’ appraisal or evaluation about what they
perceived, inferred happened and/or about themselves or other actors in the
event;
B-(imperative/demanding)—what the client thought must happen, or must not
happen;
C-(emotional consequence)—the emotional consequence(s) about what hap-
pened or could have happened;
C-(behavioral consequence)—the behavioral consequence(s) about what hap-
pened or could have happened.
For example, our client Dan also presented a problem of depression because
“nobody in my office likes me.” Further questioning revealed that co-workers
interacted with him primarily about business matters; they infrequently chatted
or invited him to lunch, and when they did so, he refused. !us:
A-(con!rmable)—“Few people ask me to lunch or attempt to socialize with
me.”
A-(perceived)—“People are not including me in social interactions.”
A-(inferential)—“I think that no one likes me.”
Identifying the A 99

B-(evaluative/derivative)—“It’s terrible and awful that no one likes me!”; “I can’t

stand it that no one likes me.”; “I’m a loser because no one likes me.”
B-(demanding/imperative)—“People MUST like me.”
C-(emotional consequence)—Depression.
C-(behavioral consequence)—Social avoidance.
A crucial distinction to understand at this point is that the client’s perception
of the activating event does not in itself cause the upsetting emotional reactions.
In the example above, Dan could conclude that no one in his office liked him, yet
not upset himself about that perception. How would he do so? He could choose
not to evaluate the A as something terrible. !us, if at B, he believed that being
rejected was merely unfortunate or perhaps (less probably) that not being in the
social circle had certain advantages, he could, at C, feel quite di%erently about
the situation. Although the A–(perception) or A–(inference) does not cause C,
the client who misperceives A and holds irrational demands and derivative beliefs
is more likely to be upset than the client who is merely irrational at B. !us, if
Dan thought that almost everyone disliked him and he irrationally demanded
that they do like him, and he evaluated that as terrible or intolerable, he would be
upset more o$en than if he did not hold that particular perception and inference
at A. If Dan held those A–(perceptions) and A–(inferences), he would have more
cues to set o% his irrational thinking.
!e client who thinks rationally at B, but who continues to distort reality at A
can still experience healthy negative a%ect and act adaptively. Let us return to the
example above. If Dan believes that it is only a preference to be liked and he does
not have to be liked and that it is not awful but highly regrettable that people at the
office do not like him, he will still experience a negative emotional response, such
as displeasure or disappointment. !us, the cognitive elements of the A do have
an e%ect on the C, albeit a less significant?dysfunctional? one. !erapeutic work
on these cognitive distortions is, therefore, an appropriate endeavor. We make the
distinction between the philosophical, elegant solution and the inelegant, cognitive
solution to therapy. Targeting these cognitive elements of the A (A–perception
and A–inference) would be the inelegant solution and not the first or primary
choice in REBT. We might target these aspects of A after we intervene at the philo-
sophical elegant solution of changing the B imperative/demanding and B evalu-
ative/derivative. Helping Dan make new friends would be the practical solution
that we refer to in Chapter 4.

Bo( 7.1
Before going on, we encourage you, the reader, to test your understanding of the
crucial distinction between A and B. Examine the following client statements. For
each, discriminate between the activating event and the IB. !e answers are at the
end of the chapter.
“I did poorly on that exam. Oh, I’m such a loser!”
“No one talks to me. I just can’t stand being so alone!”
“My mother’s always picking on me. I know she hates me!”
100 T H E A- B - C s O F R E BT: A S SE S SM E N T

“Doctor, the most terrible thing happened last week. My wife told me she
wanted a divorce.”
“I ate like a pig! You see, I know now that I’m really no good.”
“I only make $100,000. Do you call that success? Only a loser makes that little
money.”
“I’m on top of the world when I’m with George because it makes me feel good
enough when he loves me.”

What are the options available to the therapist if our client Dan above pre-
sented with both categories of cognitions A–(perception) and A–(inference) ver-
sus B–(imperative/demanding) and B–(evaluative/derivative cognitions)? Two
strategies can be recommended. First, cognitive therapists (Beck, 2005) would
begin by challenging the accuracy of the client’s perceptions and inferences of A.
!erefore, if Dan stated that nobody liked him, a cognitive therapist would chal-
lenge the accuracy of this statement, calling into question the word “nobody” and
the criteria that Dan uses to determine how others feel about him. According to
this model, if Dan no longer thought that people disliked him, he would feel bet-
ter regardless of how he evaluated being disliked. If the therapist challenges the
A–(perceived) or A–(inference) the therapist will provide models for the client to
challenge the A rather than to do the more difficult work of challenging the B.
!e cognitive therapy position is to intervene by first tackling the distortions
of the A–(perceptions) and the A–(inferences). As we mention in Chapter 4, Ellis
(1977a, 1979a; David, Lyn, and Ellis, 2010) referred to these attempts to correct
perceptions and inferences of A as the empirical or “inelegant solution.” Ellis con-
sidered it inelegant because this strategy does not provide the client with a coping
technique to deal with his or her distress should reality ever match or approach
the client’s distorted version of it. For example, although unlikely, it is entirely pos-
sible that our client Dan above will indeed find himself in a social environment
in which no one likes him. He would be prepared to endure such a fate if, in fact,
he believed it to be highly regrettable rather than “horrible.” Many Cognitive and
Cognitive Behavioral !erapists choose to use this approach as their first choice.
!e second strategy comes from REBT and suggests that the more philosophical
elegant solution is to enable the client to assume the worst and feel healthy, adaptive,
but still negative emotions even if it were true. If the client insists that no one likes
him, Ellis might have said something like, “Well, we don’t know if that’s true, but
let’s just assume for the moment that it is. What do you tell yourself about that?” !e
assumption in this therapeutic approach is that if the client can deal with this dis-
torted view of the A, the therapist’s focusing on the reality will be more manageable.
Which is the better way to proceed? !ere are no empirical answers because
the crucial experiments have not yet been done. In addition, the question itself
is perhaps misleading because both Ellis and Beck ultimately do lead the client
through an assessment of the accuracy of A.
If the therapist elects to challenge the perception of or inference about A as
an initial maneuver, we recommend that the therapist do so thoughtfully. Some
Identifying the A 101

clients could react to an early challenge to their perception and inferences by feel-
ing threatened, misunderstood, invalidated, and unsupported by the therapist.
Such interactions could weaken the therapeutic alliance.
In summary, the REBT practitioner believes that assuming the worst and aiming
for a philosophical elegant solution is valuable because the A situation for the cli-
ent might be true now or become true in the future, and if this is so, the client will
have coping strategies. Consequently, we recommend that the new practitioner
follow Ellis’s model, reserving the challenge to the client’s perception of or infer-
ence about the A until some work on disputation of the irrational belief has been
done. Some helpful hints on how to intervene “at the level of the A–(perceptions)
and the A–(inferences)” are found in Chapter 17.

CLARIFYING THE A

Unnecessary Detail about the A

As we stated in Chapter 1, clients typically come to therapy because they feel or

behave in a disturbed manner (C) and believe that they are feeling and behaving
disturbed because of some event (A). Usually clients have little difficulty in describ-
ing A and o$en want to spend a great deal of time sharing the details of the event
with the therapist. Elaborate detail about the A might be unhelpful. REBT thinks it
is unhelpful for three reasons. First, there is only so much time in a session and only
so much money for therapy sessions. !e more the therapist and client focus on the
details of the A, the less time they have to focus on identifying, challenging, and
replacing the B. As we uncover Bs that are more central to the client’s problems, we
will spend more time discussing them. Second, allowing the client to spend much
time on the details of the A reinforces the belief that cathartic expression is curative.
Rumination about the details of the A can make the client’s disturbance worse and
reinforce the idea that the A causes the C. !ird, the reality of the A can o$en not be
determined. We just can never have the data to determine whether people at work
really dislike you, or whether your spouse speaks to you in a hostile manner.
Communicating this focus without appearing to be dismissive or unsympathetic
is difficult, particularly with clients who have an expectation that it is appropriate or
curative to present elaborate detail about their past or present troubles. Historical
As can never be changed, of course; only the client’s demands and evaluations of
them are available for discussion, and evaluations can be presented succinctly.

Bo( 7.2
!e types of clients who have a tendency to report excessive detail about the A
include:
!ose with Obsessive Compulsive Personality Disorder (DSM-IV);
Angry clients, particularly those in couples therapy, because they want to con-
vince the therapist that their partner (the transgressor) is at fault;
102 T H E A- B - C s O F R E BT: A S SE S SM E N T

Clients with a history of more traditional psychotherapy;

Avoidant clients;
Children and adolescents have a tendency to provide a lot of detail. In work-
ing with this population we recommend that you allow them to do so in order to
enhance the fragile therapeutic alliance;
Clients with low motivation for change;
Perfectionistic clients who believe you need to have all the details to help them.

Here is an example of a dialogue with a client who gives too much detail about
the A:

T: Well, Jose, what were you upset about this week?

C: Well, Doctor, let me tell you exactly what happened. It all started Saturday
morning. I went over to visit my wife and children. I got out of my car and my
kids came over and greeted me with a big hug. I wasn’t doing all those things
that usually upset my wife. I went into the house. I didn’t say anything about
the newspapers being all over the )oor or the house not being clean. I did not
say any of those things as I usually do. !en I said to my wife . . . (the client goes
on for fi$een minutes describing all the details of what happened and what did
not. He finally concludes) and a$er I begged her to take me back, she did not!

!is therapist has allowed too much detail from Jose. Jose’s final point is really
the most crucial one and is really the A about which he is upsetting himself. One
strategy to get to the crucial aspect of A would have been to stop Jose’s mono-
logue earlier and direct him to focus on the most important crucial aspect of this
sequence of events, as in the following example:

T: Well, Jose, what were you upset about this week?

C: Well, Doctor, let me tell you exactly what happened. It all started Saturday
morning. I went over to visit my wife and children. I got out of the car and my
kids came over and greeted me with a big hug . . .
T: Is that what you were upset about?
C: No! Let me tell you some more.
T: Before you do that, Jose, let me point something out to you. You o$en give me
many details that are interesting but not necessary in helping me understand
just what you are upset about. Try to tell me exactly what you were upset about
in this story about your wife.
C: But if I don’t tell you what happened, how will you understand me?
T: We can go back and get the details later, but for now, just try to help me under-
stand what you were most upset about. It might help to tell me what happened
just before you got upset.

Notice that in this dialogue the therapist tries to help Jose focus on the crucial aspect
of the A that appears to be the detail that occurred closest to the emotional reaction.
Identifying the A 103

A second strategy to deal with verbose clients is to train them to monitor and
condense their own stories by giving them feedback that their present mode of
communication is inefficient. With the client above, the therapist could allow the
story to run its course, and then intervene in the following manner:
“Jose, you’ve just given me a great deal of information and detail. I am confused
about what is the most important part. Could you go back and tell me just what
the reason you got upset was?”
Note the manner in which the therapist allows the client to review his own
report and learn to succinctly extract the relevant information. If the client has
mistaken the forest for the trees and cannot summarize the relevant incident, the
therapist can re)ect the critical portion for the client and thereby model con-
densed speech. For example,
“Jose, it sounds to me that you’re upset because even though you’ve tried to
change, your wife won’t take you back. Is that it?”

Critical Characteristics of the A

Clients o$en give us As that are part of stories that include many elements. !e
therapist needs to clarify what the critical characteristic of the A is. By this, we mean
what about the A was the element that triggered the B that resulted in the dysfunc-
tional C. Failure to make this distinction can result in your searching for irrational
beliefs that are associated with stimuli that are not upsetting for the client.
We have identified two types of situations that are likely to hide the critical compo-
nent of the A. !e first involves As that are part of a sequence of events and the second
involves As that are one of a number of parallel presenting stimuli. A good example of
the sequentially hidden As o$en arises in phobias and anxiety. Marielle said she was
afraid of subways. Although this statement can initially seem specific, careful probing
revealed a critical activating event. We asked Marielle what it was about subways that
triggered her fright. She responded that it was the feeling of being closed-in. We then
asked what might happen if she were closed in? Marielle feared she might faint. What
might happen if she fainted? She answered that people on the train might judge her
poorly. !us, in this example, Marielle’s basic fear was of disapproval, not of trains.
Notice that in this example we kept asking questions in a sequential fashion. Each
stimulus was part of a chain of events that led to the critical aspect of the A.

Vagueness in Reporting the A

Occasionally therapists will encounter clients who have difficulties in presenting

A, being either vague or denying that a specific event triggered some B that, in
turn, triggered their disturbed emotions and behaviors. Possible reasons for this
vagueness can include

Fear of Therapist Disapproval—Clients might be afraid that what they reveal

will elicit disapproval from the therapist.
104 T H E A- B - C s O F R E BT: A S SE S SM E N T

Experiential Avoidance—!e client might fear facing certain events and

talks around them to avoid the fear.
Lack of Introspection—Some clients are not aware of what they upset
themselves about and they can lack insight, have poor introspection,
or they might not have spent much time thinking about the problem. For
these clients, spending more time talking about the A can be helpful.

Difficulty in locating A is common in clients who have psycho-physiological dis-

orders, such as migraine or tension headaches. A client might complain of head-
aches, for example, but insist that nothing is wrong in her life. Now, REBT as
a cognitive-change therapy depends on two antecedents: (1) the belief that it is
acceptable to self-disclose; and (2) the ability to recognize that a psychological
problem exists. !e lack of the former antecedent can be approached by remain-
ing empathic, while actively listening over a number of sessions. !e second ante-
cedent can be approached in two ways. !e first strategy is to ask the client not for
problems but for information on how the client could make his or her life even
better or could become more self-actualized with their headaches. Second, the
therapist can help the client learn problem identification skills and help him or
her to recognize areas of con)ict in interests, desires, and so on. !e most con-
structive approach to problem identification entails getting a behavioral analysis.
For example, clients with headaches might be asked to keep a log in which they
record overt and covert antecedents (events, thoughts, and feelings) as well as
consequences of each headache episode. As these data accumulate over a number
of weeks, patterns will usually unfold. Research supports the efficacy of this strat-
egy (Finn, DiGiuseppe, and Culver, 1991).
Some clients sound as if they are experiencing an “identity crisis.” When asked
why he came to therapy, Ted might respond, “To find myself—who am I?” !e
REBT therapist would respond by asking the client to change the question “Who
am I?” to “What do I enjoy and what do I value?” Little progress will occur unless
the therapist can determine what the client would like to do that s/he is not doing.
!erapists would do well to communicate to the client that they do not teach
self-discovery but rather self-construction. REBT views the client not as an entity
to be found, but as an evolving process. Once we discover what the client is not
doing, we would identify what the client is feeling that stops him/her from doing
what he/she would like to be doing. Doing a desired activity then becomes the
activating event. !e thought of doing the desired activity then elicits irrational
beliefs and dysfunctional, unhealthy emotions.
!e use of pinpointing questions is helpful. For example, Joan, a depressed cli-
ent, claimed that she is depressed “all the time.” !e following questions can help
her achieve some focus on her a%ective state: “When did the depression begin?”
“What time of day are you most o$en depressed?” “What seems to make the
depression worse?” If the client reports that she does not know, the therapist can
ask, “Can you give me your best bet about what events, thoughts, or feelings make
it worse?” If this tactic fails, having the client log their mood and corresponding
events might again be useful.
Identifying the A 105

Some clients come to therapy with what therapists call an existential neurosis
(Frankl, 2006). For example, Kenji complained, “Life is meaningless.” A thera-
peutic clarification might entail asking, “What would it take for your life to be
meaningful, or, what would you have to do to give your life meaning?” Clients
like Kenji might be harboring the irrational notion that they need to be pursuing
noble motives or prestigious goals in order to be happy. !eir mundane, everyday
existence or their failure to pursue their motives and goals would be the Activating
Event.
!e most severe problem of identifying A is the client who does not do so at
all. !ey are unaware of what triggers their beliefs and emotions. A client, Robert,
reported that he had been depressed for weeks but he had no idea why. Clients
faced with this problem frequently choose to reduce their discomfort by creating
an attribute for their depression. Understandably, the conclusion that they o$en
arrive at is that they are simply “depressives,” thus giving themselves a new A
about which they further depress themselves. When Robert does not identify an
A at all, the therapist can frequently be helpful by asking pinpointing questions,
such as, “Has anything changed in your life in the past few months?” Or “Do you
anticipate any changes in your life in the next several months?”
In summary, when the client’s description of activating events is confused,
vague, or absent, the therapist might keep in mind the following suggestions:

Talk in the client’s language in drawing the data from his or her experience.
Ask the client detailed questions.
Ask for recent examples.
Avoid abstract language.
Request logs of events and emotional experiences.
Keep the client on track, not only to reduce the problem of scattered focus
but also to serve as a model for the client.
Ask about recent or impending life changes.

Too Many As

Many clients come to therapy with multiple problems and a wide array of activat-
ing events to discuss. !e initial therapeutic focus is on selecting a target problem
on which to work. !erapist and client could list problem areas, and they can have
a collaborative discussion about which problem to start with. Unless you have a
good rationale to begin with one problem, it is best to start with one problem
the client chooses to work on. Occasionally, therapists might wish to make the
choice. !ey could wish to select a small problem with minor a%ective conse-
quences because (1) they think they can best teach the REBT principles in a less
complicated area; or (2) they believe that progress can be made in very few ses-
sions to enhance the client’s positive expectations and participation. !e therapist
might also wish to make the choice regarding what to work on when a problem
exists that, if not resolved successfully or soon, the client will experience a cascade
106 T H E A- B - C s O F R E BT: A S SE S SM E N T

of subsequent serious problems. For example, James was arrested for domestic
violence for hitting his live-in girlfriend and had an order from the court to stay
away from her. He had anger problems with other people in his life and wanted
to discuss in therapy his anger with his mother for taking his girlfriend’s side. He
continued to call his girlfriend to beg for her forgiveness. !e therapist decided
that James’s upset about not having his girlfriend’s forgiveness was clinically more
important than his anger with his mother. If he sought forgiveness from his girl-
friend he would violate the court order and be arrested. !is would cause more
serious problems for James. !e therapist sought to explain this rationale to attain
agreement on the immediate session goal and maintain the therapeutic alliance.
Is it wise to allow the client to bring up new problem areas before some reso-
lution of old ones is achieved? Usually, yes, because the clients typically spend
only one hour a week in therapy and 167 hours in their normal environment.
New problems and crises are bound to arise, and therapists who rigidly insist on
sticking to the previous week’s agenda might not only fail to be helpful but could
jeopardize their relationship with the client. As a caveat, however, the therapist
could be watchful for diversionary tactics by the client. Is the presentation of a
new problem a way to ward o% discussion of difficult or troublesome topics? For
example, a compulsive overeater might bring up a number of other problem areas
to avoid the work of dieting; the diversionary behavior could thus be another
example of frustration intolerance. If the client repeatedly brings up new prob-
lems over a number of sessions, the therapist would do well to confront the client
directly by pointing out and discussing this aspect of his or her behavior.
In some cases, the therapist might note a common theme in the new problems or
a correlation between them and the original or core problem, and can use the new
material as a wedge to get to the core. Consider, for example, the case of a young
woman, Amy, who presented problem a$er problem—with the common theme of
failing. She reported not being able to do well at a job interview because she believed
she did not deserve the job. She described sabotaging love relationships because she
believed she was not good enough for her partners. She told of alienating friends
because “no one could like a person like me.” Amy seemed to believe that it was good
for her to be in pain. A$er several sessions of listening to these activating events, the
therapist asked her if she recognized the common theme in all of these examples—
that she had to su%er because she was not good enough to reap any of life’s rewards.
Amy replied that, in fact, she did recognize that theme and recalled how the other
members of her immediate family had su%ered greatly. Her sister died a$er a very
painful car accident; her mother died a$er a bout with breast cancer; and her father
a$er a sudden heart attack. Only she had remained alive and apparently believed
that it was only right, proper, and moral for her to su%er as well.

T H E C B E C O M E S AN A

One of the most important activating events that the therapist will quickly seek
is secondary disturbance or meta-problems. In other words, the client’s symptom
Identifying the A 107

A1
B1
C1 A2
B2
C2

Figure 7.1 !e Emotional Consequence Becomes an Activating Event.

(e.g., depression) becomes a new A and itself requires an REBT analysis. Ellis
(1979a, 1979d) was in)uenced to add this concept to REBT by the work of Raimy
(1975) who coined the phrase “phrenophobia,” fear of going crazy. He estimated
that at that time 77% of the clients seen in an office practice had such thoughts and
feelings about their primary problems (Raimy, 1975).
!is concept is presented in Figure 7.1. A hallmark of rational emotive behavior
therapy is its focus on these higher-level problems as a !rst order of business. !e
cycle of events can proceed as such:

A—Original symptom (e.g., depression)

B—“Isn’t it awful that I have this symptom!” “I mustn’t feel this way!” “I must
be able to get over my problem quickly and easily.”
C—!is produces more anxiety, guilt, or depression.
!e client can become upset about Bs or Cs in such a cycle. For example,
clients could become angry or depressed about their irrational beliefs:
“!ere I go thinking irrationally again. Damn it, I’ll never stop. What’s the
matter with me? I should’ve learned by now. . . . ”

Similarly, clients could become anxious over the physical signs of anxiety, a prob-
lem that is particularly prominent in agoraphobia (Goldstein and Chambless,
1978). !ese clients appear to focus on the physiological symptoms of anxiety and
believe that they are signs of impending death, doom, or unbearable discomfort:
“I’m terrified of panic. When I get in the car and I feel the anxiety come, I know
I won’t be able to stand it! And I think I must not be anxious.”
Clients commonly upset themselves over their behavioral difficulties as well.
!us, the drug addict might su%er equally from guilt addiction, and the overeater
typically overindulges in self-blame.
Primary focus on such secondary problems might be particularly important
when dealing with seriously disturbed or psychotic clients. Psychotherapy of any
sort might be difficult or even prove ine%ective in ameliorating primary symptoms
such as thought disorders or endogenous depressions that might be a function
of biochemical imbalances (Davison and Neale, 1990). O$en, however, there is
a neurotic overlay or secondary symptom; for example, depression about manic-
depressive episodes. A useful therapeutic goal might be to help clients learn to
accept themselves with their handicaps instead of depressing themselves about
such handicaps. !e same principle is true, of course, with less seriously disturbed
clients. Consider Sam, a compulsive overeater. His overeating is the behavioral C
108 T H E A- B - C s O F R E BT: A S SE S SM E N T

that he and his therapist work on. However, whenever he breaks his diet and over-
eats, he immediately begins to cognitively castigate himself, which inevitably leads
to the meta-problems of uncomfortable feelings of guilt or shame. Once he is feel-
ing badly enough, he tends to “do something nice for himself ” in an attempt to
assuage his guilt and shame, and that “something nice” could very well be another
hot fudge sundae. !e meta-problem causes Sam to engage in the very behavior
that is the target of the primary A-B-C. Breaking the meta-level shame and guilt
cycle is a prerequisite to helping Sam stay on task to achieve his long-range goal of
weight loss.

Bo( 7.3
Secondary problems are particularly troublesome in clients who have begun to
understand their REBT. !e more sophisticated they become, the more upset they
get with themselves for overreacting. !e particular emotional problem these cli-
ents feel is shame.
It might seem like a paradox, but half the goal of therapy is to change dysfunctional
negative feelings and the other half is to accept oneself with these negative feelings. It
is important to know which of the two goals you are working on at any time.

!e REBT therapist will usually try to determine whether the client has a
secondary emotional problem about the primary one by asking directly. For
example, if the primary problem is anxiety, the therapist might ask, “How do
you feel about being so anxious?” It is also important to determine whether
there are secondary emotional problems about appropriate negative emotions,
such as sadness. If the secondary emotional problem interferes significantly
with the client’s ability to deal with the primary problem, or if you can show the
client why it makes more sense to deal with this second layer first, then that will
be the initial contract. Because people usually have beliefs about their primary
problem, it is a good habit to ask the client what problem they want to work on.
We would go with their choice unless we had good reason to convince them
to do otherwise, and at which point we would explain our rationale. When we
are discussing the secondary level problem, it is easy for the client to go back
and forth between the two levels. !e therapist needs to monitor which topic
is being discussed and stay on track. Sometimes the track changes, and even
though the client appears to be speaking on one level, you realize he or she is
actually talking about a problem on the other level. When you notice this pat-
tern, you need to point it out to the client and discuss which topic is the more
clinically relevant to discuss.
Once a second-level disturbance has been identified as A, therapy proceeds in
the usual fashion: C is clarified, irrational beliefs are identified, and the client is
assisted in disputing them.
Identifying the A 109

The Elusive A

We see a common unsuccessful maneuver by therapists in supervision. !e thera-

pist has dikculty identifying the activating event when clients want to stop a com-
pulsive behavior (e.g., smoking, drinking, overeating, procrastinating) or engage
in a bene#cial behavior (e.g., exercise, treat others kindly, eat healthy). !e client
states his behavioral goal (e.g., “I want to stop smoking.”). !e therapist asks the
client when the last time was he smoked and follows up by asking how the client
felt when he failed at the behavioral task. !e client reports a negative emotion
about having failed at changing his behavior. !e therapist looks for the irratio-
nal belief behind this negative emotion. !e therapist has identi#ed a secondary,
meta-A-B-C without #rst identifying the primary A-B-C. !is intervention could
be correct, but it fails to target the client’s stated goal of changing his behavior.

T: What problem would you like to work on today?

C: I want to stop procrastinating and #nish my dissertation.
T: When was the last time you procrastinated?
C: I wanted to work on it last night but I watched TV instead.
T: How did you feel a$er you procrastinated?
C: I felt bad.
T: Ok—let’s look at what you were telling yourself about procrastinating to feel
bad.

In this example, the meta-emotional reaction (i.e., bad) is not speci#c enough.
!e therapist could have persisted for a clearer description of the C. !e entire
focus is on the secondary meta-emotion. !e emotional reaction at failing to con-
trol one’s behavior can be o$en a healthy, functional, albeit negative emotion that
could motivate the client to learn and practice new self-control strategies. It is
important to discriminate between healthy and unhealthy second meta-emotions.

Note
Answers to Box 7.1:
Activating event- I did poorly on that exam.
Irrational belief- Oh, I’m such a loser! (Ratings of worth)
Activating event- No one talks to me.
Irrational belief- I just can’t stand being alone! (Frustration intolerance)
Activating event- My mother’s always picking on me. I know she hates me!
Irrational belief- None present.
Activating event- My wife told me she wants a divorce.
Irrational belief- Doctor, the most terrible thing happened last week. (Awfulizing)
Activating event- I ate like a pig!
Irrational belief- You see, I know now that I’m not really good. (Ratings of worth)
Activating event- I only make $100,000.
Irrational belief- Only a loser makes that little money. (Ratings of worth)
Activating event- I’m on top of the world when I’m with George.
Irrational belief- ...it makes me feel good enough when he loves me. (Ratings of worth)
 8

The C: The Emotional and

Behavioral Consequences

Why do clients come to therapy? Usually because they are feeling badly, they
are in emotional distress, or they are behaving badly. A therapist does not
want to lose sight of this focus. Clients usually do not come in to talk or to
rid themselves of irrationalities. Many are not even aware of their irrational
thinking. The C, the emotional and behavioral Consequences, brings them
to the therapist’s door. We want to stress that in Rational Emotive Behavior
Theory the Consequences are emotional and behavioral. The psychological
construct of emotions includes not only the feelings, but also the action ten-
dencies that are part of the experience. Many emotion theorists see the behav-
ior as part of the emotion (Frijda, 1986). In REBT, we consider the C to be the
emotion(s) that is (are) experienced, the behavior that the client does, or both.
Throughout this book when we talk about assessing the C, we mean both the
emotion experienced and the behavior. Although the majority of the discus-
sions will focus on negative emotions, the same principles can be applied to
positive emotions. Humans can have healthy, functional, positive emotions
as well as unhealthy, dysfunctional, positive emotions. Pride is an example of
a healthy, functional emotion, compared with the unhealthy, dysfunctional
positive emotions such as conceit or pompousness.
Many REBT therapists have found that clients can clearly explain their emo-
tions about certain Activating events. In fact, clients usually begin sessions by
discussing their emotions. !us, the client might reply to the question, “What
problem would you like to discuss?” by saying, “I feel very depressed lately.” If the
client does not volunteer the emotion, the advised strategy, in accordance with
REBT’s emphasis on active-directive intervention, is to ask. A$er the client has
described the activating event, the therapist typically asks, “Well, what emotion
do you experience about that event or situation?”
More experienced therapists might have a clinical hunch about the client’s
emotional state and phrase the question in another way such as, “Are you feeling
anxious about that?” !is technique might also serve as a strong rapport builder,
for clients could conclude that the therapist truly understands their problem. We
!e C: Consequences 111

advise against telling your clients how they feel, however. Phrase your comment
as a question and be prepared to change your mind when you have sukcient data
that your hunch is wrong.
!e more experienced therapist will recognize that certain emotional states
are frequently associated with speci#c clinical problems. For example, avoiding
certain situations usually indicates anxiety; verbally abusive behavior generally
points to anger; lethargy or inactivity probably means depression; self-injurious
or self-deprecatory behaviors indicate guilt or shame; and a recent loss is likely to
lead to grief.

Bw2 8.1
When his clients had trouble in identifying a speci#c emotion, Albert Ellis encour-
aged them to “take a wild guess,” a method that surprisingly yields quite useful
information about C.

In other words, experienced therapists can use four sources of information to

infer the presence of emotional states. !ese include (1) cues from the client’s pos-
ture and behaviors; (2) the client’s vocal reactions such as their tone, metaphors,
and language; (3) the common emotional consequences to life situations in the
client’s culture; and (4) deductions from REBT theory, so that from knowing a
client’s belief system one can infer a speci#c emotion.
A general rule of thumb to remember is not to ask your client questions that
reinforce the “A causes C” confusion. As supervisors, we frequently hear new
REBT therapists phrase questions such as, “How does that make you feel?” An
alternative question that does not imply that the A causes the C would be, “How
do you feel when that happens?” “What is your emotional reaction to that event?”
or “What do you make yourself feel about that event?” We recognize this slight
but ever so important change in the therapist’s wording might feel awkward ini-
tially. Rephrasing your question to emphasize the client’s emotional responsibility
takes practice for new REBT therapists.

D I S T U R B E D V E R SUS UNDISTURBED EMO T I O N S

A crucial focus of REBT theory is the distinction between healthy functional,

negative emotions and unhealthy, dysfunctional, negative emotions. Not all
emotions are disturbed or are targets for change. REBT theory does not say
that negative emotions are undesirable; in fact, they are an essential part of
our ability to adapt and cope with negative activating events. Emotions tell us
that we have a problem that needs attention and a reaction (Darwin, 1872). An
unhealthy, dysfunctional negative emotion impedes clients’ ability to achieve
their goals, to react to problems, and to cope with adversity, and often results
in self-defeating behavior. In addition, some emotions are physiologically
112 T H E Aj B j C s O F R E BT: A S SE S SM E N T

harmful—such as anxiety, which can lead to psychosomatic disorders (e.g.,

colitis, duodenal ulcers, and hypertension), or intense and damning anger,
which at least knots up the stomach. Thus, while it is quite appropriate for
a client to feel sad—even very sad—about a loss (e.g., when a parent dies, a
spouse leaves, or a child becomes ill), when the sadness is prolonged or debili-
tating and becomes depression, it becomes a potential target for therapeutic
intervention. At some point, we would say that it is more than a negative func-
tional emotion, that it is a disturbed negative emotion.
It is sometimes very dikcult to discriminate between a negative but adaptive
emotion and a disturbed emotion, but here are some suggestions to di(erentiate
them, qualitatively and quantitatively:
Phenomenologically, an adaptive emotion might not be experienced internally
by the person as “su(ering,” although it might be intense and negative.
Physiologically, a disturbed a(ective response might be much stronger, accom-
panied by intense or prolonged autonomic nervous system hyper-reactivity.
Behaviorally, the disturbed emotion leads to self-destructive behaviors or
blocks problem-solving behaviors so that the person remains “stuck.” As a
social stimulus, the disturbed emotion has a higher probability of eliciting
punishing or avoidance behaviors in others, rather than empathy or support-
ive nurturance.
Cognitively, disturbed emotions are distinguished by the irrational thoughts
that go along with them.

Bw2 8.2
!e English language is notoriously impoverished in emotional language. In addition,
many of us are raised in homes in which emotions are not discussed. At the dinner
table, mom or dad might ask what we did during the day. However, only the rare fam-
ily follows up by asking how you felt about what you did. Some cultures impose a vir-
tual prohibition on expressing emotions, particularly for men; this lack of emotions is
described as alexythymia (Lane, Ahern, Schwartz, and Kaszniak, 1997). Alexythymia
is a psychiatric term that derives from the pre#x “a,” meaning “without”; “lex,” a stem
from which we get the word “lexicon,” indicating “language”; and the sukx, “thymia,”
meaning “mood.” !us, the term implies being without a language to describe mood.
Without a lexicon in a topic, it is dikcult if not impossible to express ourselves,
and certainly, we have trouble indicating subtle shadings of meaning. Semanticists
have taught us that the absence of a rich vocabulary also tells us about how the
culture values the topic. !e science of General Semantics has taught us that it is
dikcult if not impossible to make discriminations when we do not have words to
describe what we are di(erentiating.
Even our clinical language is confusing. Consider the word “depression.”
William Styron, the Pulitzer prize-winning author, states: “I want to register a
complaint about the word depression. [It is] . . . a term with such a bland tonality
that it lacks any magisterial presence, used indi(erently to describe an economic
!e C: Consequences 113

decline or a rut in the ground, a true wimp of a word for such a major illness”
(Styron, 1990). Similarly, can we distinguish between a depressed mood, grieving,
a depressive syndrome, and depressive illness?
Sadness is a mood state, a normal reaction to negative life events, which usu-
ally remits without undue laboring. Grieving [is] a more prolonged and intense
mood typically precipitated by a major loss . . . [in which] the focus of the client is
on the loss rather than on the self and self-blame. . . . More than a blue mood, the
syndrome of depression is a cluster of symptoms that might include an overreac-
tion to a negative Activating Event, and other cognitive, emotive, behavioral, and
physical symptoms. . . . [!en there is] depression, an illness. Actually, this title
would more accurately be, “depressions: a spectrum of illnesses [which seem to be
largely heritable and usually recurrent] (Walen and Rader, 1991, pp. 232–3.)
Clearly, we had better teach our clients a vocabulary and a set of discriminating
words so that we can be sure that we understand each other!

Although the discrimination between disturbed and nondisturbed emotions is, in

our view, one of the most helpful aspects of REBT theory, it is also one of REBT’s most
problematic aspects because of the dikculty in establishing an operational de#nition
of these terms. Even so, the distinction between disturbed and nondisturbed Cs can
serve to give a clear focus to one of the main goals in therapy: transforming su(er-
ing into appropriate, adaptive, albeit negative emotions. In addition, the therapist can
acknowledge the severity of a negative activating event, communicate empathy for the
problem the client faces, and address the reality of dealing with dikcult, prolonged As
without colluding with the client’s “awfulizing.”
We suggest that you adopt the typology and vocabulary of common emo-
tional expressions presented in Table 8.1 so that you and your clients might
better discriminate among appropriate, helpful, adaptive, undisturbed, healthy
emotions, and inappropriate, harmful, maladaptive, unhealthy, and disturbed
ones. The terms in Table 8.1 provide a start toward facilitating clearer com-
munication. Because many languages are not designed to discriminate well
between functional and dysfunctional emotions, some of the pairs of healthy
and unhealthy counterparts could look more different in strength than in
quality (e.g., annoyance—anger; or concern—anxiety). Therefore, it could be
useful to speak of healthy fear as opposed to unhealthy fear or healthy anger as

Table 8.1. A Vw)v!,-v./ O0 A11.w1.2v34 v56 D273,.!46 E8w32w57

Healthy and Functional Unhealthy and Dysfunctional
Concern Anxiety
Sadness Depression
Annoyance Clinical anger
Remorse Guilt
Regret Shame
Disappointment Hurt
114 T H E Aj B j C s O F R E BT: A S SE S SM E N T

opposed to unhealthy anger. One pair, sadness as opposed to depression does

not have this problem and everybody can see that one can be very sad without
being depressed.

T R O U B L E - S H O O TING PROBLEMS IDENTIF Y I N G T H E C

A common problem for therapists is the failure to accurately identify the client’s C.
Sometimes this problem arises because therapists simply do not take the time to
label emotions clearly or because therapists assume that they and/or the client
intuitively understand what C is. Such an assumption is o$en wrong, of course.
More o$en, problems in identifying C come not from the therapist’s negligence
but because emotions are a dikcult and confusing problem for the client to iden-
tify. !e following sections might help the therapist to trouble-shoot some of the
reasons for the client’s dikculty with identifying the C and o(er some ideas to
help explore and identify the client’s emotions.

M I X E D F U N C T I O NAL AND DYSFUNCTIONA L E M O T I O N S

Some emotional experiences are a mixture of healthy and unhealthy ones.

!erefore, identifying such emotional experiences can be dikcult because one
has to identify the two components of the functional and dysfunctional emotion
parts. Clients who are not familiar with this distinction will talk about one emo-
tion. A good practice within REBT is to discriminate between the two types of
emotions, because we leave the functional emotion unchanged and only focus on
the unhealthy one (Backx, 2012).

G U I LT A B O U T C

Trouble in identifying the C might stem from guilt; clients might be unwilling to
label their emotion if they are experiencing negative emotions/meta-emotions
for which they denigrate themselves, thus causing a second C (i.e., “C becom-
ing an A”). We saw an example of this in the case of Talya, the wife of a devoted
rabbinical scholar. She o$en felt compelled to interrupt his studies to remind
him of his responsibilities to his congregation, such as visiting the sick or the
bereaved. He would do as she suggested and received the thanks and approval of
his 9ock. She, however, being quiet and shy, was perceived as aloof, and received
no credit for her contributions to the congregation. Talya stated her problem
vaguely as wanting more support, understanding, and appreciation; yet she
could not de#ne a speci#c C other than reporting she felt she was overlooked
and taken for granted. !ese statements are A–(perceptions) and A–(inferences).
Further exploration revealed that Talya’s underlying C was anger. However, as
the wife of a clergy, she believed she could not feel such an emotion. Her guilt
!e C: Consequences 115

about her anger prevented her from sharing this emotion with the therapist, let
alone her husband.
What might the therapist do in such cases to encourage the client to face the
emotion? Iris Fodor (1987) suggested that Gestalt exercises might be helpful to
REBT and CBT therapists in general to help clients reveal their emotions. Ellis
(2002) used the Gestalt exercises in marathon groups for the same purpose. Using
Gestalt or psychodrama exercises, such as the empty chair technique, could have
helped Talya, the rabbi’s wife. We could ask her to imagine her husband or one of
the ungrateful parishioners sitting in an empty chair. She might then be engaged
in a dialogue in which she plays one or both parts, perhaps moving between the
two chairs as she exchanges roles. Loosening the usual stimulus constraints in this
way might increase the likelihood that she will acknowledge her anger.

Bw2 8.3
A very powerful way to help clients become aware of their emotions is visual
imagery. Ask the client if she would be willing to close her eyes. Tell her you will
be giving her some very open-ended instructions and that you do not want her to
report her thoughts or give you many words. Instead, ask her to be very still and
wait until a picture or image comes to her mind. Very mild direction in the case of
Talya for such an image might be, “Let an image of you and your husband come to
mind.” or “Imagine you are among the members of the congregation.”
O$en, therapists can use this extraordinarily evocative and emotive procedure,
particularly when they probe the image by follow-up questions such as what is
going on, what feelings are being expressed in the image, and what bodily sensa-
tions the client is experiencing. !ese images will help identify the emotion.

Try modeling. !e therapist might say, for example, “Talya, do you know any-
one else in a similar situation? What do you think they would be feeling?”
Try using humor. Be deliberate in your exaggeration, gently poking fun at the
situation, or make a humorous analogy. !e therapist might set the climate for a
less threatening acknowledgment of Talya’s anger. Examples: “I guess you really
are a saint; some people would be boiling mad!” or “It’s great how you let them
ignore you; everybody loves that!”

SHAME ABOUT C

Clients might not be in touch with their emotions because of a tendency to intel-
lectualize their predicaments. Such individuals will avoid labeling their emotions
and instead describe the situation or o(er rationalizations for their behavior. !ey
might even deny that they experience emotions at all. Underlying this emotional
anesthesia might be the belief that the expression of emotion re9ects a sign of
116 T H E Aj B j C s O F R E BT: A S SE S SM E N T

weakness to others. Avoidance of emotions prevents the client from being judged
negatively by others and feeling shame.
!e key concept here is that the therapist wants to communicate that all
emotions are justi#ed in the sense that they exist. Emotions are neither accept-
able nor unacceptable for any external event, because emotions are internal
and come from what a person is saying to himself or herself about the outside
events.
Machiavelli (1532/1998), in his famous book, The Prince, taught that it might
be in one’s best interest to withhold information from others on how one is feel-
ing. We would want to help clients understand when it might be in their best
interest or not to reveal their emotions. However, they need not feel ashamed
or be condemning of themselves if others think less of them for having an
emotion.

L I T T L E O R N O E MOTION IN THE SESSION

!e therapist might encounter clients who express no emotions in the sessions.

Assuming that the absence of emotion is not a psychotic symptom, the therapist
might want to check out two possible hypotheses about such clients.

1. Clients might believe that they are “supposed to be serious” in therapy.

!at is, therapy is a solemn occasion requiring hard work and a
no-nonsense attitude. In such situations, the therapist will want to
disabuse clients of such notions by direct suggestion, modeling, and use
of creative strategies to elicit more emotion and put the client at ease
(e.g., encouraging disagreement with the therapist, or asking clients to
pantomime their problems or express them in song or poetry).
2. !e therapist’s behavior might elicit little emotion and might even inhibit
its expression. For example, the therapist might be making long-winded
speeches, asking closed-ended questions, stacking questions, moving too
fast, or confusing the client. Listen to recordings of your therapy sessions
with such clients and observe your own remarks that precede instances
of minimal emotion. Try to encourage verbal expression by asking
simple, open-ended questions (e.g., “And then what?”).

F E A R A B O U T E M OTIONS

Clients might not be aware of their feelings because they fear the emotion; the prob-
lem might be one of avoidance of emotional states. For example, feeling depressed is
an uncomfortable or even painful experience. !e client might avoid discussing life
situations that are evocative of this emotion. We have seen clients who are fearful of
their anger outbursts, fear depression, and fear their anxiety and phobias. !e prob-
lem in this case seems to be one of discomfort anxiety and frustration intolerance, in
!e C: Consequences 117

which clients convince themselves that the emotional turmoil is more than they can
stand. Avoidance of emotions because they are too painful can cause many psycho-
logical problems such as agoraphobia or substance abuse (Hayes, Wilson, Gi(ord,
Follette, and Strosahl, 1996), and procrastination (Steel, 2007).
!e important clinical strategy is helping clients realize that their own fear of
their emotions blocks and prevents them from facing and resolving their problems.
Consider the case of Felix, a prominent professor who came to therapy with vague
complaints about a stilted life and the desire to become more self-actualized and
happy. Felix described his wife with 9at, unemotional language. He described her as
being over-involved with her career, her parents, and the children. However, Felix
did not sound close to her. In addition, Felix described an extramarital a(air as his
soul mate. His happiest times were with his mistress. Felix felt angry with his wife
for allowing distance in their relationship. However, he was afraid to admit these
problems.

T: Felix, you seem to describe your happiest times as when you see your girl-
friend. Moreover, when you speak about your wife, you sound cold and dis-
tant. I am wondering how you feel toward your wife.
C: I really did not come here to discuss this.
T: I know. I think you would be happier if I did not notice your feeling toward
your wife.
C: Yeah, that would be a lot easier. I guess I love her, but sometimes I think she
stopped loving me.
T: So is this something you might want us to discuss?
C: (Exhales deeply) !at might open a whole can of worms that I don’t want to
face.
T: So you are aware that you are avoiding your feelings about your marriage and
your a(air?
C: It is just so scary to think about it. We have kids and a history together. I am just
afraid to examine how I feel about her because of all the things that might unravel.
T: It sounds like you are just too frightened to look at your feelings. But, if you let
that fear win, you might never solve any of the problems that brought you here.

Identifying Felix’s fear about examining his emotions placed this meta-emotion
on the top of the agenda.

C O N F U S I N G T H E A, B, AND THE C

People in our culture frequently confuse thoughts and feelings. Sometimes you might
ask a client to describe a feeling and he or she will respond with a belief. For example,
the client might say, “When she said that, I felt dumb.” At other times, you might
ask a client to identify a belief and get a feeling for a response. You might ask, “What
were you thinking then?” and the client might respond, “Oh, I was thinking I was
anxious.”
118 T H E Aj B j C s O F R E BT: A S SE S SM E N T

A dikculty that new therapists and clients o$en share is discriminating Bs

from Cs, and this problem might relate in part to the imprecision in our language.
!e word “feeling,” for example, could have many di(erent meanings in everyday
speech:

Physical sensation—“I feel cold.”

Opinion—“I feel that taxes should be lowered.”
Emotional experience—“I feel happy.”
Evaluation—“I feel that it’s terrible.”

!e therapist can carefully listen for clients’ meaning of “feel” and encourage them
to use the term to describe emotional consequences rather than opinions and
evaluations. !is distinction will help clients detect the di(erence between their
beliefs and emotional Cs, which will be of great value to them when they attempt
to dispute their irrational beliefs. !us, when clients mislabel B as a feeling, it
is o$en useful to stop and correct them. !e important point is to listen to the
client’s answer to your question. Make sure s/he is answering the question you
asked.

C O N F U S I N G T H E A AND THE C

Although REBT has taught you to distinguish between A and C, many of your
clients will not make such distinctions. Frequently when you ask clients what they
were feeling, they will give you an A–(perception) or A–(inference) as the answer.
Remember our discussion from Chapter 3 that these components are actually
cognitions, but they are not the beliefs that we think are crucial to disturbance
in REBT. !ey are part of the A because they are potential events about which
the clients get themselves upset. Here are some examples of responses we have
heard clients give to questions about their feelings, responses that were actually
not emotions but A–(perceptions) and A–(inferences).

I feel ignored.
I feel disrespected.
I feel unloved.
I feel le$ out.
I feel betrayed.
I feel powerless.
I feel I am not smart (pretty, sexy, sophisticated, thin) enough.

In each of these examples, the client has used the verb “feel” to identify a per-
ception or inference about a potentially true situation. !e clients have used the
verb “feel” but have not described the emotional Consequence. !e strategy we
recommend in such situations is as follows. !e therapist would re9ect back and
acknowledge that the perception or inference the client has reported might be
!e C: Consequences 119

true or could happen. !e question to follow would be, “What emotion would you
feel or experience if that were so?”

T: How were you feeling then?

C: I felt betrayed.
T: Well, let’s suppose you were betrayed. What emotion would you have felt about
being betrayed?
C: Well, I suppose angry.

Sometimes clients persist in answering questions about the C with synonyms for
events about which they are upsetting themselves. For example,

T: How were you feeling then?

C: I felt betrayed.
T: Well, let us suppose you were betrayed. What emotion would you have felt
about being betrayed?
C: Well, I felt deceived.
T: Well, let’s suppose you were deceived, what emotion would you have felt about
being deceived?
C: I felt they were disloyal to me.
T: You know Roxanne, betrayal, deception, and disloyalty are all events that you
thought happened to you, but they are not emotional reactions. Emotions are
experiences like anger, joy, sadness, anxiety, and shame. So, what emotion did
you feel about being betrayed and deceived?

Another example is a client, Tom, who felt fear that people would reject him because
he thought he was inadequate in many ways. Tom was depressed because he con-
demned himself for not being more successful and popular. When we asked Tom,
“How were you feeling on the day you did not apply for the job?” and he responded,
“I felt dumb,” we recognized that Tom (1) has most likely strong feelings of anxiety
and depression; and (2) he possibly could be making a self-deprecatory statement
about himself. However, before trying to test these two hypotheses, we pointed out to
Tom that “dumb” is not an emotion but re9ects a thought or inference he concluded
about himself, one which he was frightened would cause people to reject him. Dumb
was not the emotion. It is important to make this distinction because Tom might
have attempted to dispute his feeling of “dumb” or to justify his belief that he is dumb
because of this so-called feeling. !us, in the example above, the therapist would
point out to Tom that he does not feel dumb; he feels anxious and depressed about
believing that he is dumb. !e stage is now set for working on this irrational belief.

D E S C R I P T I V E D E FICITS

When asked how they are feeling, clients can be confused about their emotion.
The confusion might be because they lack an adequate emotional vocabulary
120 T H E Aj B j C s O F R E BT: A S SE S SM E N T

to express themselves. In general, the more the therapist can help clients
label their emotional problems, the more easily they will be able to grapple
with them. Again, if a client can only describe him or herself as feeling “down,”
the therapist can inquire if he understands the word “depression.” In other
words, the therapist might want to take the opportunity to expand the client’s
vocabulary. A side benefit of this procedure is increasing the client’s ability
to profit from bibliotherapy, because most self-help books use terms such as
“depression,” “anxiety,” and so on.
!e therapist might help clients label their emotions by instruction and model-
ing. Initially, the di(erence between positive and negative emotions might be sug-
gested (e.g., “Did you feel good or bad?”), a$er which more descriptive terms might
be suggested and discussed. Some of the following exercises might be useful either
in session or as homework assignments: Here are the names of some emotions or
feelings:

happy sad
angry disappointed
proud hurt
embarrassed curious
scared frustrated
nervous guilty
relaxed anxious
Pronounce each word to yourself; say it aloud.
Do you know what each word means?
Pantomime (act without words) each of the words that you know. (People
express the feeling in different ways, so there is no right way to do it!). Are there
any other feelings you can think of? If so, write them down.
Orally or in writing, complete the sentence, “I feel ___” in as many ways as you
can.
Start a diary of “I feel” or “I felt” statements. At !rst, just write the statements.
Later, begin to add, “When such and such happened, I felt ___.” For example,
“I felt anxious when I started writing this diary.” Finally, keep a log of your
emotional experiences through the day.

Another reason clients confuse their emotions is that they are experiencing sev-
eral emotions about the same event. Although we have an A-B-C theory, this does
not mean that clients will have only one of each element in their experience. In
clinical practice, it is more likely that multiple elements exist at each level. A client
might have A to B to C1, C2, C3. It is important to check with the client that they
have identi#ed the various emotions they experienced in response to the activat-
ing event. Do not assume that the #rst emotion reported is the most clinically
relevant one.
Let us return to the client, Felix, mentioned above who had a fear of examining
his emotions toward his marriage. His Primary A was that his wife worked a lot and
displayed very little a(ection toward him. Once the therapist successfully identi#es
!e C: Consequences 121

this meta-fear, the session can focus on this primary problem. He reported feeling
confused about what he felt. !e therapist o(ered Felix the possibility that he had
more than one emotion. Could Felix identify all the feelings he might have toward
his wife? Once he was free not to have one correct answer, Felix identi#ed several
emotions. He felt angry with her for not being a(ectionate. He felt guilty that perhaps
her lack of a(ection resulted from his own inadequacy. He felt hurt that perhaps she
did not love him anymore. He felt fearful that she would leave him and he would be
alone. He also felt shame that he would be disgraced if she le$ him. Once this list was
identi#ed, the therapist asked Felix which emotion they should work on #rst.
Notice that each emotion has a slightly di(erent crucial component of A. Felix’s
anger emerged from the A–(inference) that she did not love him. His guilt was
triggered by the A–(inference) that he was responsible for her lack of love. His
fear was elicited by his A–(inference) that she would leave him and he would be
alone. Finally, his shame was related to the A–(inference) that others would view
him negatively for being divorced.

D I C H O T O M O U S THINKING

Many clients categorize emotional states dichotomously; for example, they

might believe that the only emotion they can feel is an unhealthy, dysfunc-
tional negative emotion or a neutral feeling as if nothing happened. In fact,
clients have choices about which qualitatively different emotion they might
experience. Let us suppose that a client has experienced a loss. Within the
larger category of sadness, which is one of the basic human emotions, she
could feel sad, depressed, despondent, or disappointed. Some of these choices
are healthy/functional emotions that will help the client resolve the loss.
Others are unhealthy/dysfunctional emotions that will lead to disturbance and
failure to resolve the loss. Therapy focuses the client on realizing that people
have options regarding what they can work to feel (Dryden, DiGiuseppe, and
Neenan, 2010; DiGiuseppe and Tafrate, 2007).

Bw2 8.4
Your client can report feeling “frustrated” at C. Technically frustration refers to
the blocking of goals and is an activating event rather than a feeling (DiGiuseppe
and Tafrate, 2007; Miller et al., 1958; Trexler, 1976). However, the word frustra-
tion can refer to an emotion or feeling of disappointment that is a weak version of
anger. We think that the original meaning of blocking of goals is the correct one.
However, therapists need to be clear, and ask their client which usage the client
intends. You might say to your client, “‘Frustration’ o$en means a blockade of a
desire. !at is something that blocks or frustrates us from getting what we want.
When you were frustrated by your receptionist yesterday, what emotion did you
feel—anger, annoyance, disappointment, or indi(erence?”
122 T H E Aj B j C s O F R E BT: A S SE S SM E N T

If the client can envision and label various types of emotions, he or she might
also be able to envision ways (cognitions) to arrive at a more desirable or adaptive
feeling state. !e therapist might, for example, present a group of emotional labels
to the client and help him or her to classify the words as unhealthy/dysfunctional or
healthy/functional emotions. It can then be pointed out that rational thinking usu-
ally leads to healthy/functional emotions (such as intense regret or sorrow), which
are adaptive, and irrational thinking leads to strong and debilitating emotions.

M I S L A B E L I N G E MOTIONS

Clients o$en mislabel their emotional states, so that it is a good rule of thumb to clarify
the emotional referent. !e therapist would be wise to ask routinely for some explana-
tion or expansion of the client’s emotional label (e.g., “What do you mean by guilty/
anxious/bothered?”) and, if the client seems to be in error, point it out (e.g., “Sam, it
sounds more like you’re angry than anxious.”). Emotions that clients frequently seem
to mislabel are guilt or anger, which are confused with anxiety.
Some clients, more o$en men, and people from some other cultures, are likely
to somatize their feelings rather than clearly label the emotion. When asked how
they are feeling, such clients might describe having “tension in my neck,” thus
describing the physiological sensation rather than the emotion.

U N C L E A R L A B E L ING OF EMOTIONS

Clients might use a label that, although clear to them, might be unclear to the
therapist. For example, Junko said, “I was so indignant!” Do you understand pre-
cisely what she means? Is this level of a(ect mild, moderate, or intense? Is it an
adaptive or maladaptive emotion? Does it stem from a rational or irrational belief?
!e answers to these questions can become clear by asking Junko clarifying ques-
tions such as, “What do you mean when you say ‘indignant’?” or “!at sounds like
you’re angry; what do you feel, think, or do when you are indignant? How angry
are you?” Common examples of unclear labels include:

I feel bad.
I feel upset.
I feel distressed.
I feel stressed out.
I feel uptight.
I feel overwhelmed.

!erapists can help with clari#cation by asking directly, “When you say you feel
upset, do you mean you feel angry?” or “When you say you feel overwhelmed,
are you overwhelmed with depression? Or sadness?” !erapists might also ask a
multiple-choice question, such as, “By ‘stressed out,’ do you mean you feel anxious?
!e C: Consequences 123

Or depressed? Or angry? Or guilty?” Writing this simple emotional menu on a

chalkboard or even an index card can help the client clarify his or her current
mood and provide a teaching model for future communication.
Sometimes clients will assert that they cannot #nd the exact right word to
describe their emotion. You might help by suggesting that they show you how
they feel by using their facial movements or body postures, and modeling yourself
just a bit to break the ice. !is strategy of using exaggerated kinesthetic facial and
body cues might give the therapist a clue as to what the emotion might be and
help the client by evoking a keener awareness of the emotional state.
A preliminary goal for such clients might be to appreciate the extent to which all
people react emotionally. As a homework assignment, the therapist might request
clients to write down all the di(erent “I feel ___” or “I’m in a ___ mood” state-
ments that they hear others make in the course of a week. !ey can also monitor
their own statements of this sort. In addition, the therapist could make use of the
three techniques described above.

L A C K O F A P PA R ENT DISTRESS

Occasionally, one will interview clients who rattle off a list of problems, but
they are not in distress about anything. Research has documented that there
are clients who come to therapy with very low levels of disturbance; and they
tend to get worse as the session progresses. The therapist might want to con-
sider the following possible explanations for those seeking therapy but dis-
playing low levels of disturbance. Perhaps the client (1) is truly not in distress,
but is seeking some type of growth or actualization experience; (2) has come
to therapy for companionship rather than help; (3) is worried about not being
“normal” and has come to therapy to seek reassurance; or (4) is defensive and
engages in avoidance of negative emotion. If no emotional distress is appar-
ent, confrontation might be recommended. The therapist could discuss one
or more of the above explanations with the client so that appropriate goals for
action might be set.
Avoidance maneuvers pose perhaps the trickiest problem, for if clients’ behaviors
e(ectively prevent them from experiencing unhealthy, negative emotion, both they
and the therapist will be in the dark about C. If an emotional consequence is not evi-
dent but clients describe troublesome behaviors, it is o$en helpful to apply a learning
theory model to the behavior problems. Behavior is maintained either by its pleasur-
able results or by the avoidance of negative stimuli. O$en the negative stimuli are
the clients’ own hidden emotions. Sometimes direct confrontation might break the
blockade, as in the following instance. A possible solution is to ask clients to imagine
they are doing or confronting the things that they avoid. A client, Jerry, was avoiding
taking a major licensing exam, yet claimed he felt no anxiety about it.

T: Jerry, if that were so, if you had no anxiety at all, why would you avoid taking
the test?
124 T H E Aj B j C s O F R E BT: A S SE S SM E N T

C: But I don’t experience any anxiety now.

T: Right, because as long as you stay away from that test, you avoid experiencing
your anxiety. Do you see that something is blocking you from getting too close
to the exam, and that something could be anxiety? Now what do you think
would happen if you took the test and failed?
C: Well, I am not sure.
T: OK, can you imagine that you wake in the morning and are in the exam room
faced with taking the exam. How do you feel in that image?”
C: Well, I won’t like that.

O$en, a more extensive use of projective fantasy is called for to discover what the
client fears. We recall a client, Grace, who reported that she was concerned that
she was dating only married men. She denied any particular negative emotion and
stated that she was simply more attracted to married men. !e therapist guided
her through a fantasy in which she imagined herself out on a date with an attrac-
tive man who suddenly announced that he was single and who found her to be
the most desirable woman he had ever met. Here we asked Grace to confront in
imagery what the therapist hypothesized Grace was avoiding.
In another case, an obese client, Kees, reported that he had no dysfunctional emo-
tions. !e therapist hypothesized that Kees avoided dating, and that his excessive eat-
ing and weight was a mechanism to avoid interaction with potential lovers. Kees had
no reaction to the therapist’s hypothesis. !e fact that he was so neutral to the idea
was unusual. !e therapist asked Kees to fantasize about being very slim and out on
a date with an attractive man. Kees began to squirm when the therapist mentioned
this idea. When he began the image, he became red and said he felt “uncomfortable.”
In both instances, the imagery exercise allowed the clients to access interpersonal
anxiety, which their avoidance behaviors (dating married men or being overweight)
had successfully blocked. !e anxiety then became the focus of therapy.
A client, Charles, came to therapy but reported that he experienced no speci#c
emotional problems except exhaustion. He complained of feeling tired almost all of
the time, and no matter how he slept, he never felt truly rested. Medical evaluation
revealed no physiological basis for his fatigue. His physician referred him to ther-
apy. Extensive questioning revealed that Charles had a demanding yet ful#lling job,
enjoyed a full social life, and was active in athletic events. In all respects, he appeared
to be “living the good life.” On closer questioning, however, Charles reported that
he did not always enjoy all of his activities and occasionally did not want to do
them. Because the intrinsic pleasure of the activity was not always maintaining his
behavior, the therapist hypothesized that some of his busy schedule was actually
avoidance behavior. !e therapist asked Charles to fantasize a typical day in his life,
and to omit one of his activities. A$er each imagery scene, Charles reported, much
to his own surprise, feelings of guilt. Further analysis revealed an irrational notion
of self-worth based on accomplishing all that he thought he should do. !us, he
avoided the underlying emotion of guilt by maintaining an extremely active life.
A similar problem is o$en encountered with clients who report an inability to
control addictive behaviors such as drug abuse, smoking, drinking, and overeating.
!e C: Consequences 125

!ey might not acknowledge any emotional problems that increase the frequency
of their addictive behaviors, although they do sense guilt over having done them.
With such clients, the therapist might ask them to imagine that they are sitting in
front of the food or cigarettes and deny themselves these pleasures. Clients usually
report a very uncomfortable feeling akin to intense agitation, heightened arousal,
muscle tension, or jitteriness. !is emotional consequence, a result of their irra-
tional belief that they need to have what they desire, might have remained out of
their awareness because they were so successful at avoiding the unpleasant feeling
by quickly devouring what they desired. Such an imagery exercise might help
clients get in touch with their Cs.

E M O T I O N I N T H E SESSION

Whether or not clients are able to identify emotional reactions in relation to

their life events, the therapist will want to attend to emotional cues within
the therapy session. Body position, tensed muscles, clenched teeth, breathing
changes, perspiration, facial expression, moisture in the eyes, giggling, and so
forth can reveal the relevant emotions. A good therapist can read clients’ body
and facial expressions and will make associations between what is said or not
said and clients’ expression of emotion. This is a crucial skill for identifying
emotions and becoming a good therapist. Do everything possible to enhance
and practice this skill.
When you see these signs of emotion, you might want to begin to do an
in-the-moment A-B-C analysis. Do not make the mistake of avoiding working
with emotions expressed in the session. !erapy does not always have to deal with
problems of past or recent history. Re9ect what the client is expressing and use
that as a start of your analysis. Below is an example of such an interchange:

T: Sally, I notice that your eyes loom red and your posture seems dejected.
C: Oh, you are right! (sobs)
T: Sally, you seem to be feeling upset right now. I wonder if you could tell me what
emotion you are feeling.
C: Well, it is so hard. My whole life is ruined. I have nothing to live for.
T: I understand. It seems that you are feeling depressed about that.
C: Yes.
T: Well, why don’t we talk about that now rather than the other problems you
brought up? Because as long as you believe that, you are going to feel depressed
and cry.

A G R E E I N G T O C HANGE THE C

Once clients have acknowledged and correctly identified the distressing emo-
tion, they have a decision to make. Do they want to keep experiencing or
126 T H E Aj B j C s O F R E BT: A S SE S SM E N T

change this emotion? For example, they have the right to keep or give up their
anger, anxiety, or depression, and the pros and cons of their choice might be
an interesting topic for discussion. Emotions after all, have their advantages;
they communicate what is going on within us to others, and others could
respond in ways we like. Sometimes people have what therapists call “second-
ary gain” for their emotions. These gains or advantages are often immediately
reinforcing, but the negative consequences of the disturbed emotion make
them self-defeating.
Identifying and challenging one’s irrational beliefs only makes sense if one
holds some prerequisite beliefs. !ese include:

1. My present emotion is dysfunctional.

2. !ere is an alternative, culturally acceptable, and more functional
emotional script to experience in response to this type of activating
event. It is better for me to give up the dysfunctional emotion and work
toward feeling the alternative one.
3. My beliefs cause my emotions.
4. !erefore, I will work at changing my beliefs to change my emotions.

Convincing the client of these four ideas will motivate clients who are reluctant to
change their emotions to engage in the REBT process. !is model facilitates agree-
ment on the goals of therapy and moves clients to the action stage of change.
We have presented a model to establish these insights as a way to motivate
change (DiGiuseppe and Jilton, 1996; DiGiuseppe and Tafrate, 2007). !e steps
involve asking clients to assess the consequences of their emotional and behavioral
C in a Socratic fashion. !is helps clients identify the hidden costs and negative
outcomes of their emotions and behavior. Next, the therapist presents alternative
emotional reactions that are culturally acceptable to the client. Because people
learn emotional scripts from their families, and learn that some emotional scripts
are acceptable to their cultural group, it is possible that a disturbed client has not
changed because he or she cannot conceptualize a healthy/functional emotional
script to experience in place of the disturbed emotion. !erapists can explore
with the client alternative emotional reactions that are culturally acceptable.
Next, therapists help the client make the connection that the alternative script is
more advantageous to the client. Once the client reaches this insight the therapist
teaches the B to C connection to the client and can move on to identify the IBs.
Consider the example of Tamara, an angry young mother. In many ways, Tamara’s
anger worked for her; when she yelled at her son about his messy room, he quickly
tidied up. !e display of anger also was intrinsically reinforcing; a$er Tamara had
a temper tantrum, she felt a pleasant state of fatigue and relaxation akin to the
a$ere(ects of exercise. Quite simply, it felt good when she stopped. In addition,
Tamara provided her own cognitive self-reinforcement for her abreactive display
(e.g., “I did the right thing by getting angry!”). !us, interpersonal, kinesthetic,
and cognitive factors operated to help maintain her angry feelings and behavior.
To help overcome these factors, the therapist could suggest that (1) Tamara could
!e C: Consequences 127

consider the long-range consequences of her behavior. Certainly, her displays of

anger did not endear her to her son. (2) She was providing a poor model for her
son. (3) !ere were more helpful ways of achieving a release of tension, such as
relaxation exercises. (4) !ere were more e(ective ways of controlling her son’s
behavior. (5) And, her cognitive statements were misplaced and stemmed from
an exaggerated and un9attering sense of righteousness.

Bw2 8.5
One strategy used by REBT and CBT therapists to increase the client’s motivation
to change is the two-column format (e.g., Burns, 1980). !e therapist can assist
the client in developing a list of advantages and disadvantages in changing a par-
ticular emotion. Here, for example, is one client’s (partial) list of pros and cons in
giving up her chronic anger at her husband:

Advantages of eliminating anger Disadvantages of losing anger

I would have more energy. I will become a doormat.
Long-term health consequences would be It works. I would be giving up a useful
improved. tool.
It would be better for the kids. I might be manipulated.
I would be less jealous of other couples. I do not have any other way of getting
I would feel proud of myself. my needs met.
I would be more comfortable in my own I will not be standing up for my
home. principles.

We recommend that you have your clients list the pros and cons for both the
short-term and long-term. Can you imagine the work that this client has to do
before she will agree to reducing her anger?

A more subtle source of gain can sometimes be operating; a debilitating emotion

is maintained to avoid an even more distressing one. Consider, for example, the case
of a mother who lost custody of her children to the father, an event that precipitated
intense and prolonged depression, which the client seemed unwilling to surrender.
What would it mean to this woman to give up grieving? Apparently, she believed that
it would prove her an uncaring and uncommitted mother, a concept that induced an
even more intense feeling of guilt. Once this irrational belief was successfully disputed,
however, the client could agree to work at relieving her depression.
Clients might decide to remain upset rather than do the hard REBT work of
disputing. In essence, they might be saying either, “!at’s the way I am.” or “I can’t
change.” or “I’ve always been this way.” or “It’s more rewarding [or easier] for me
to be upset.” Once identi#ed, these hypotheses can be tested, perhaps by simply
requesting that the clients do an experiment that will allow them to test their
hunch: “Is it, in fact, true that you cannot change or that it’s easier to be upset?”
128 T H E Aj B j C s O F R E BT: A S SE S SM E N T

!e point to keep in mind is that there might be many reasons why the client is
reluctant to change C, some of which the therapist might be able to challenge. If
the client does not want to change C, however, rational emotive behavior therapy
usually cannot proceed.

B E H AV I O R A L A S PECTS OF C

So far, we have discussed clients presenting primarily emotional problems. As we

stated in the beginning, emotions produce action tendencies that are meant to
resolve threats or problems. Behavioral reactions are part of the C and in all cases
we want to be careful to assess what clients actually do and not just what they
feel. Sometimes their behavior might be in the foreground and is more important
than the emotion. Such behavioral Cs are procrastination, addictions, compulsive
behaviors, and defensive avoidance. O$en new REBT therapists focus so much on
what clients feel that they ignore or miss a behavior problem because they have
not considered a behavior as part of C.
REBT falls under the category of the behavior therapies. As such, it is impor-
tant to identify behavioral goals that clients will work toward. Change in feelings
without change in behavior would be an unsuccessful treatment. In addition, cli-
ents can claim to change their feelings, but if there is no corresponding change in
behavior, one must question the accuracy of the emotional change. !e discussion
a priori and post hoc A to B to C in Chapter 7 emphasized this point.

T E A C H I N G T R A N SCRIPT

In the following therapy transcript, the therapist is confronted with a client who
describes experiencing a number of unpleasant emotions, and the therapeutic
task is to label them, rate their severity, and rank-order them for investigation.

T R A N S C R I P T S E GMENT

T: Hello, Ashwin. What problem do you want to work on today?

C: My wife says I am depressed, and she is very concerned about me. I have very
confused moments. !e reason I originally felt suicidal—I don’t even know
how to express the feeling that I had, because I know if I really wanted to com-
mit suicide I would have accomplished it.

Note that the client really has not answered the therapist’s question.

C: Well, I felt this way, if it happened, if the eight pills had done the job that would
have been OK, and if they didn’t, #ne.
T: But you were not going to ensure that they did by taking twenty-#ve or thirty?
!e C: Consequences 129

C: Exactly. !at is how I felt.

C: Well, a$er my #rst divorce, I was uptight and I thought about it. Twice, in fact.
T: How are you feeling today?

Here the therapist returns to the client’s feelings a$er making reasonably sure that
suicide was not imminent.

C: Extremely anxious.
T: Anxious?
C: Yes.
T: Usually, most people who attempt suicide are depressed, but you are anxious?

Notice that the therapist is working from a conceptual schema and checking the
client’s response against it.

C: Yeah, I am pretty anxious.

T: How anxious do you feel?
C: Well, when I become nervous my back goes out.
T: You get muscle pains?
C: !at is why I am wearing my girdle now. I went out Sunday night, and I didn’t
do anything physical. I just bent over and it went. So, I know that is an indica-
tion that something is not right.
T: Have you been to a physician about your back problems?
C: Yes. I slipped a disc about #$een years ago. It has been a chronic thing. Many
times, I think it is due to muscular strain because I do work physically. And
sometimes this has nothing to do with any . . .
T: Well, it could be just muscular tension. So, you do get muscular tension and get
tight?
C: Well, I was not aware of it, but it has really become more of a chronic situa-
tion. My children live in Canada and that is when it really started to become
chronic, when they moved to Canada. Mary brought it to my attention.
T: How long ago was that?
C: Four years ago.
T: So, for the last four years your anxiety has been getting worse.
C: Only when I know they are coming in.
T: When they are coming, you get more anxious. How frequently does that happen?

!e therapist is acknowledging and accepting the client’s feelings while gathering

additional information about the client’s life situation.

C: Well, they are supposed to come in twice a year. !is year it has been only once
and they will be coming again in three weeks. It is starting to build—the anxi-
ety is started.
T: So, as your children come closer you get anxious, or frightened, as if there is
something you will not be able to cope with, and you feel immobilized? Or
130 T H E Aj B j C s O F R E BT: A S SE S SM E N T

do you mean that as the kids get closer, you get concerned about it, become
committed to action, and still feel in control? Or do you mean that you are just
excited about it?
C: No, I am really anxious, panicky.

!e therapist has just modeled the key di(erential issue for this client: the dis-
crimination between disturbed emotion (anxiety) and a functional healthy ver-
sion of it (concern or excitement).

T: Now, can I ask you something else? What is it about your children coming that
frightens you?
C: Well, let me say, anytime anybody mentions my children to me I sort of swell
up. (Client gets tears in his eyes.)

Note that the therapist will deal with this in-session emotion.

T: So, that sounds like you are feeling sad. So, there is some sadness along with
your anxiety.
C: Maybe it is because what I do is I become afraid and I think about what I am
going to feel when I see them—also when they leave.
T: So, in other words, what you’re doing right now is experiencing or imag-
ining your feelings when they come off the plane or when they go on the
plane and you feel sadness then—and you’re feeling anxious about the
sadness?

!e therapist hypothesizes that a C has become an A, and he asks for feedback

about this hypothesis.

C: Right.
T: Which one of the problems do you think is more important, then, the anxiety,
or the sadness?
C: !at is a very interesting question.
T: Both emotions are there.
C: What I am trying to #nd out myself is if it has a totally self-pity type of feeling
I have. I don’t know. I have been trying to analyze that for four years.
T: Let me ask you this: Do you have any anxiety about other issues besides your
children?
C: Yes. What brought about the suicide attempt, let us call it that for the
moment . . .
T: !e attempt.
C: Might have been due to many other things. !at is, like anything I have to do I
have to work very hard at; nothing comes easily for me.
T: Even killing yourself! You cannot even do that easily, right?

Note the therapist’s attempt at humor and how the client received it.
!e C: Consequences 131

C: I could have if I really wanted to. !at might be part of many of my prob-
lems. However, I was married eighteen years the #rst time. And for literally
seventeen of the eighteen years, I felt I had a very happy marriage. I was very
content. And we, my ex-wife and I, became friendly with another couple and
before I knew it, my best friend and my wife took o( together. I found out the
hard way—detective, the whole thing. And I thought that a$er I had overcome
the initial shock that I would never trust another woman again. I was very
secure and all of a sudden not only did I lose my wife, I lost a friend, I lost my
children—it was a three-way disaster.
T: Can we stop?
C: Yes.
T: When you think about your children and you feel the sadness when they visit,
does it also remind you of the sadness you felt at that particular time?
C: No.
T: Does it remind you of how vulnerable you are?

!e therapist is working from a hypothesis that the client, in the face of serious
problems, has an irrational belief that he cannot cope.

C: Oh yeah, because in a way, I blame myself for losing my children. I am not happy
about losing my ex-wife because I loved Carol very much. !ere is no priority. It
is just that I lost my children and there are no feelings going back to that point.
T: You agree with me that when you think about your children coming, you
remember the vulnerability you had. Now is it vulnerability toward losing your
children or the vulnerability of losing your wife?
!e therapist has just heard the word “blame” in the client’s remark but is holding
that concept for a later intervention.
C: No. Just the sadness that it’s just a temporary thing I have with my kids and I
feel myself becoming distant on both sides—their distance and my distance.
It’s such a brief period that we see each other.
T: So what you are sad about is that you don’t see your children a lot.
C: Right.
T: Let me stop and rede#ne your words. You said that you feel sad. I agree that
you do, but are you feeling just sad? Or are you feeling sad and depressed? It
is normal to feel sad about negative events, but you might be feeling a more
disturbed emotion that we call depression. Which are you feeling? Do you feel
just sadness, or sadness and depression?
C: Well, let’s bring a little guilt in there . . .

!e therapist is not letting the client de9ect the conversation. He is #nishing the
work on sadness about the children and, while he has heard the comment about
guilt, he is saving it for a later point in the session.

T: I guess it might be important for us to discriminate—and maybe what you are

feeling isn’t just sadness but is really, largely, depression. Because I think, any
132 T H E Aj B j C s O F R E BT: A S SE S SM E N T

man would feel sad about losing his children the way you did—and sadness
now. But they would not be as debilitated as you are. So, the sad feelings you
are probably always going to feel. You are going to feel sad about not having
your children . . . at least I hope so. You are not going to be cold-hearted, and I
do not think I could help you to be that way; even if I could, I do not think I
would want to. However, the point is, your problem is not sadness. !at is nor-
mal. It is depression. You are depressed about this. And, I think it is important
that we use di(erent words, rather than just sad. Now, what is the guilt factor?

!e therapist has discriminated and helped the client correctly label his emotions.
Not only the high intensity, but also the guilt and self-denigration and the suicide
attempt, are clues that his problem is depression, not merely sadness.

C: In whatever my ex-wife needed—it was mostly the #nancial area—I overin-

dulged her. Our lifestyle went far beyond my #nancial means because I felt it
was what she needed. And, I work hard, many hours, and I go home and go to
sleep. Get up and go to work, go home, and go to sleep. !at was the vicious
cycle, except for the weekend. I used to look forward to the weekend like it was
a vacation of two months coming up instead of only a few days—just so I could
spend time with our friends and enjoy my life. !e guilt comes in where I was
not smart enough to realize that there is more to life than just working.
T: And because you did not realize that, what happened?
C: She found the fun part of her world with my friend.
T: Because you were not there, she went somewhere else, and if you were smart
enough to know better, you would not have lost your children?
C: Exactly.
T: You think you are really stupid, don’t you?

!is is an attempt at humor and was said with a grin.

C: No.
T: You are really beating yourself up about it.
C: Well, I am beating myself up about it because I was almost falling into the same
problem in my new marriage again. And, I was not quite aware of it and I am
very confused about it. Because what I started to say before and I want to get that
part out of me, what brought on this attempted suicide was my lack of con#dence
in living—and friends. I don’t have a true friend, even a$er this past weekend.
T: You don’t trust them, as you do not trust women?
C: Exactly. Except might be, a$er this weekend, I have found a new friend. It’s
about time. But Mary has always made me feel #delity, honesty, on a conscious
level, and that I’m number one, and no other man will ever come between us.
And I was very comfortable. It took a lot of work for me to believe again. And
unfortunately, a very ridiculous situation came up. Mary was depressed about
not being able to #nd a job. !is has been going on for two years now. And, last
!e C: Consequences 133

week, I don’t know how the conversation came up, Mary said to me, she could
even go to bed with a guy if he would get her a job—the right job.
T: She was a$er his connections?
C: Yeah. In the meantime, my mind has really had it. So, I told Mary how I felt and
that weekend was a disaster. I couldn’t cope with the fact that my wife would go
to bed with another man at any price.
T: It appears to me, at least in REBT terms, there are several activating events,
several emotions, going on at the same time. Some of them being depression,
some of them anxiety, and some of them guilt. !e activating events appear to
be seeing your children, missing your children, and having le$ your children
or causing that to happen; and another is a futuristic one that your wife would
leave. From what you tell me, it appears that the thing that upsets you the most
is something that is right now. !at you are afraid your wife will leave. And,
any slight indication that that might come true really leads to an awful amount
of anxiety. And, it appears that when you think about your children, possibly
you think about how your wife le$ you suddenly, and if it could happen then,
well . . .

Even though this was a #rst session, the therapist introduced REBT to the client
through the books he had read. Note that the therapist summarizes the complex-
ity of the client’s problems and is hypothesizing that the client believes that he
caused his former problems and might do so again with his present wife.
 9

Assessing the B

F I N D I N G T H E I R RATIONAL BELIEFS

Clients’ irrational belief systems are not easy to identify. !ese thoughts are greatly
overlearned cognitive habits that have become automatic. !ey are tacit, implied,
and unspoken assumptions that o$en fail to reach consciousness. Irrational
thoughts and other schematic thoughts are well-rehearsed and for reasons of
cognitive economy, they operate quickly and out of our awareness. !e Soviet
developmental psychologists Vygotsky (1962) and Luria (1969) traced in chil-
dren the development of self-talk. At the earliest stages of verbal development,
children’s behavior is controlled by the overt vocalizations of others. Somewhat
later, children can be heard giving themselves similar behavioral directives aloud.
Ultimately, their self-talk is completely internalized. With repeated practice, not
only is the need to focus on the internal commands reduced, but also a kind of
short-circuiting apparently takes place so that individual elements of the thoughts
are subsumed under larger headings. !is last point will perhaps be clearer if you
recall learning to drive a car or watching your child learn to tie his or her shoes. In
both cases, a complex task is initially broken down into smaller units of instruction
and communicated by someone other than the learner, then usually verbalized
aloud by the learner, repeated subvocally, and #nally integrated into a continu-
ous whole that can proceed without conscious attention. !e thought processes
that precede emotive reactions presumably follow similar, although perhaps more
subtle, developmental patterns. !us, a clinical task may be to help clients identify
and verbalize their thoughts, beliefs, attitudes, and philosophies. REBT postulated
that IBs are unconscious not because our psyche banishes them out of awareness
because they are unacceptable, but because they are over-rehearsed and reach a
stage of automaticity (DiGiuseppe, 1986).
Because of this aspect of irrational beliefs, they do not come easily into clients’
awareness. When you ask clients what they were thinking when they experienced an
emotion, they will report stream of consciousness thoughts such as A–(perceived)
and A–(inferential) or what cognitive therapists call automatic thoughts. Some
additional assessment and exploration is necessary to discover clients’ IBs.
Sometimes when therapists query clients about their thinking, they respond with
emotions (“I think I’m sad/anxious/apprehensive,” etc.). !e therapist’s task is to
Assessing the B 135

go beyond clients’ feelings and A–(perceived) and A–(inferential) to the irrational

thoughts.
!erefore, once the therapist has identi#ed the relevant Activating events and
Consequences, we then move to explore the Bs. To start this process, ask the cli-
ent what they are thinking a$er the A or before or during the C. Some questions
you could ask are:

• “What was going through your mind when that event happened?”
• On the other hand, if a client is emoting in a session, you could ask, “What
is going through your mind right now as you experience that emotion?”
• “What were you telling yourself about the event when you had that
feeling?”
• “Were you aware of any thoughts in your head when you felt that way?”
• “!ere goes that old tape in your head again. What is it playing this time?”
• “What was on your mind then?”
• “Are you aware of what you were thinking at that moment?”

For the reasons stated above, the answer to these questions will usually be A–
(inferences) or automatic thoughts. !erefore, we suggest you ask more speci#c
questions such as:

• “What were you telling yourself about the A (plug in the client’s speci#c A)
that made you feel C (plug in the client’s speci#c C)?”
• “What were you demanding should happen when you were upset?”

Clients who answer these questions with IB–(imperatives/demands) such as

shoulds, musts, or IB–(derivatives) have better insight into what they are thinking
and you will be able to move through the steps of therapy quicker.
Several strategies can lead clients from their A–(inference) to the tacit irrational
beliefs.
Clients’ Awareness through Induction. In many forms of CBT, therapists have
clients report their inferences and attempt to challenge the truth of these thoughts.
If therapists do this for enough sessions, the client will have had the experience
of associating their problems with these inferences. Just by this repeated revela-
tion, the client can come to see that there is a pattern or common theme in their
inferences. Seeing these themes among many speci#c inferences helps clients
inductively become aware of their core imperative demands that cut across the
accumulated inferences.
Below is an interchange between a socially anxious client named Miguel, who
became aware of his irrational beliefs on his own a$er seven sessions of challeng-
ing his inference that corresponded to his anxiety.

C: You know, I am thinking that people will reject me. Each week I come here
with a di(erent event where I was scared. And I always think people will not
like me.
136 T H E Aj B j C s O F R E BT: A S SE S SM E N T

T: I agree; that is an accurate observation. For seven weeks, you have presented
predictions of people rejecting you that have not been true.
C: Maybe I predict that people will reject me because I think it would be so devas-
tating if they did. Somehow, I think I need them to like me!

From the many individual episodes of anxiety and thoughts of social rejection,
Miguel used inductive reasoning to draw a general conclusion. !is technique
allows clients to self-discover their core irrationalities on their own, if it will hap-
pen at all. It works. However, it takes many sessions just to identify the IBs before
you even get to challenging them. !is is an e(ective, but less ekcient strategy.
!e advantage to this strategy is that it relies on self-discovery. If you believe that
self-discovery is a crucial component in psychotherapy, this strategy makes the
most sense. Some psychotherapists value self-discovery over guided discovery.
!e issue of whether self-discovery is a more e(ective means of change remains
open to debate. Research on learning through self-discovery has not shown this
to be a uniformly superior strategy. It works well for some things, but fails to
be a good strategy in learning things such as mathematics. Imagine that they let
students discover the solution of di(erential equations by themselves. Whether
it is a better strategy than guided-discovery in psychotherapy is still an empirical
question. Self-discovery might work well with bright, articulate clients. When we
are working with a less intelligent, or nonintrospective client, as is frequently the
case, the fumbling of the client for self-discovery can result in a more protracted
period. As we wait for the client to self-discover, they continue to su(er.
Inductive interpretation. A somewhat more active procedure utilizes inter-
pretation by the therapist. A$er collecting and challenging a large number of
A–(inference), the therapist can point out common themes that the inferences
contained, and, by interpretation, suggest possible core irrational beliefs or
underlying schema. !is strategy, however, is relatively time-consuming. It pres-
ents the problem of how many examples of the client’s emotional episodes and
A–(inferences) is necessary before the therapist has a sukcient sample of episodes
to draw a correct conclusion. How many are necessary for an adequate sample:
three, #ve, or seven sessions worth of material? Another problem with this strat-
egy is the manner in which the interpretation is o(ered. We usually avoid the
use of the term interpretation. Interpretation in psychotherapy involves the con-
ceptualization of the client’s problems by the therapist, and the therapist sharing
it with the client. However, the therapist is o$en right. Used in this context, the
practitioner might be tempted to think that the amount of material they collect
upon which to base their interpretation ensures their accuracy. Interpretations are
still educated guesses or well-formed hypotheses; and as such are subject to error.
Let us continue with the case of Miguel and show how a therapist could use this
strategy.

C: !is week I went to a family engagement. I did not know many people there
from my wife’s family. I was so anxious again. And I just thought they were
judging me.
Assessing the B 137

T: Miguel, for weeks you have come in reporting being anxious in social situations.
Each time you have had thoughts that people would be judging you negatively
and would dislike you. Tell me if this makes sense. Perhaps you think you need
other people’s approval and you think you are unlikeable.

!is procedure usually works. !erapists are good at inferring client’s core irrational
beliefs from a large sample of A–(inferences). Again, our question is whether the time
it takes to collect the sample is an ekcient use of therapy time. We think not.
Inference chaining. A psychologist from Florida named Bob Moore developed
this technique. Here, the therapist identi#es the A–(inference) and o(ers the
hypothesis that the A–(inference) could be true. !e therapist asks the client one
of two questions. “What do you think would happen if that were true?” or “What
would that mean to you if it were true?” Shorter versions of these questions would
be, “What if that were true?” or “What would that mean?” Each question can yield
new A–(inferences) and these types of questions are repeated until an irrational
belief appears. !e therapist keeps phrasing questions until the irrational belief
is conscious. Below is an example of a dialogue with our socially anxious client,
Miguel, that demonstrates inference chaining.

C: I have that business event to go to next week, and I know that those people are
not going to like me.
T: Well, we do not have any evidence for that. However, let’s suppose that would
be the case. What would happen if they did not like you?
C: I would fail to make contacts and would lose business.
T: Well, I am not sure it would mean that, but let us assume you are correct and you
do not make contact and you do lose some business. What would that mean?
C: Well, if I fail at business, I would have less money and not be able to keep up
with my friends and then they would dislike me.
T: Well again, you are jumping the gun. We do not know if all that would happen.
But if it did, and you lost these friends, what would that mean?
C: Well I would be a total loser. I mean you have to be liked to be somebody.

In inference chaining, the client draws out the core irrational beliefs from
their own experience, although the therapist directs the client’s search for the
core beliefs. !is strategy has the advantages of ekciency and the advantage of
self-discovery. Inference chaining rests on the Socratic dialogue technique, which
is a time-honored method of teaching through self-discovery. Clients are o$en
surprised when they hear themselves speak at how much information can be elic-
ited by these inference-chaining questions. We o$en #nd that clients reveal core
irrational beliefs that surprise them. !is demonstrates that they were unaware of
the core irrational beliefs before the questioning.
Similarly, a chain of time-projection questions may be useful. Below is another
example of inference chaining where we tried to ask time-sequenced questions.
!is client, Vladimir, was jealous of his wife. He constantly thought that she would
leave him, and he was spying on her actions to catch her cheating.
138 T H E Aj B j C s O F R E BT: A S SE S SM E N T

C: !is week I had such a #ght with my wife when I took her cell phone and
checked whom she was calling.
T: What were you feeling when you decided to check her phone?
C: I was feeling anxious and jealous that she was talking to other men.
T: Vladimir, we have no evidence that she is talking to other men. But, what
would happen if she was frequently talking to other men?
C: !at would mean that she does not love me anymore.
T: Well, we don’t have evidence for that yet, but suppose that happened. Suppose
she did stop loving you? What are you afraid might happen next?
C: She might leave me.
T: Yes, that would be very bad, but let’s suppose it happened, what is the worst
thing that could happen if your wife did leave you?
C: I might not #nd another woman. My God!
T: But let’s suppose you never did #nd another woman. What is the worst that
could happen then?
C: I would be alone. And, that can’t happen and I couldn’t stand it if I was.

Many therapists are o$en tempted to stop at each A–(inference) and challenge it.
We do not want to get distracted by challenging the sometimes outrageous and
improbable A–(inferences) that are discovered along the chain. !ey sidetrack us
from getting at the core IB. !e therapist can continue pursuing the chain to target
the IB that is identi#ed at the bottom line. Our clinical experience suggests that
it is best to go right to the end of the inference chain and challenge the IB uncov-
ered by the last A–(inference) there. Stopping to change all the A (inferences)
and their respective IBs along the chain can be distracting. And the therapist is
less likely to get to the most important core IB. Sometimes the most important
A–(inference) might not be at the end of the chain, and the therapist can discover
which A–(inference) is the most important by re9ecting back to the client on the
A–(inferences) uncovered in the chain and asking him/her which one is most
related to their disturbance.
In the example above, the therapist continues to probe for the client’s core irrational
beliefs by asking questions and, along the way, uncovering their IBs. Clients may begin
by complaining that they want their mother, their spouse, their children, their boss,
and so on to do what they want (“I want things to be the way I want them to be.”) !e
therapist’s next question in the case of Vladimir might be, “Why can’t you stand not
having a woman in your life?” “Why must you have a lover in your life?” If the thera-
pist continues to ask why Vladimir must be loved, still more irrational beliefs could be
revealed. In this example, the client may state that he believes that it would be awful if
his wife did not care for him, because it would prove that he was worthless. His belief
in his worthlessness would be the core IB.
Client Awareness through Use of Conjunctive Phrasing. Related to inference
chaining is the use of conjunctive phrases to complete the inference chain. In
this technique, instead of re9ecting and posing a question, the therapist responds
to the client’s identi#cation of an A–(inference) with a phrase that encourages
the client to continue speaking. For example, a$er the client’s A–(inference) the
Assessing the B 139

therapist would say, “ . . . and that would mean . . . ” or “ . . . and then . . . ” or “ . . . and
therefore . . . ” Imagine that the therapist erases the period at the end of the client’s
sentence and inserts a conjunction to continue the line of thought. Ellis o$en
employed this strategy. One reason it might be ekcient is that it can be less dis-
tracting than a full re9ection, which the client would then have to process for its
accuracy before continuing the phrase. !e client maintains momentum and stays
focused on the line of thinking on which he or she had been engaged. Again, we
will use an example of how this technique would work with our socially phobic
client, Miguel.

C: I know they are not going to like me.

T: . . . and then . . .
C: I’m not going to make any business contacts.
T: . . . and that would mean . . .

Another simple alternative for the therapist is to use a sentence-completion

phrasing:

C: I’m going to make less money and fall behind my friends.

T: . . . .which means . . . .
C: I’m a loser. I have to be liked to be somebody.

We have found that the more verbal, insightful, and intelligent clients respond bet-
ter to the use of conjunctive phrasing; and the more concrete and literal-minded
clients do not do so well. People with less introspection and verbal skills seem to
do better with the more structured technique of inference chaining.
Sentence Completion Chain. Another variation of inference chaining is the
inclusion of a sentence completion technique to form a sentence completion
chain. In this technique, when the therapist uncovers an A–(inference), she or
he places the inference into a sentence stem such as, “!e worst thing about
______________ is . . . ” If a new inference is uncovered, the process is continued
with the same sentence stem. We will show how this technique would be imple-
mented with our socially anxious client, Miguel.

C: I know they are not going to like me.

T: !e worst thing about them not liking you is?
C: I might not make any business contacts.
T: And the worst thing about not making business contacts is?
C: I’m going to make less money and fall behind my friends.
T: OK, the worst thing about making less money and falling behind your friends is?
C: I am a loser. I have to be liked to be somebody.

!e sentence completion technique keeps all of the advantages of all the

inference-chaining strategies. However, the higher degree of structure makes
these advantages available to a wider range of clients who require structure.
140 T H E Aj B j C s O F R E BT: A S SE S SM E N T

Deductive Hypotheses Driven Assessment. If the self-discovery methods of

inference chaining fail to uncover the client’s IB, several more directive tech-
niques are available. !e #rst of these is o(ering hypotheses to the client. Karl
Popper’s (1968) philosophy of science, which we discussed in Chapter 1 has had
a large in9uence on REBT. Popper said that people cannot help but formulate
hypotheses about questions they are investigating. !ink about it; how long does
it take you to formulate a hypothesis about a new client’s diagnosis, or a new cli-
ent’s IB? We bet a matter of minutes. Popper believed that science progresses fast-
est when the scientists acknowledge their hypotheses and attempt to discon#rm
them. Popper’s philosophy would posit that clinical knowledge about a speci#c
case would develop fastest if the clinician acknowledges his/her hypotheses and
attempts to discon#rm them. Clinicians do not objectively hold hypotheses. A
clinician’s hypotheses in9uence what questions they ask and what they remember.
!erefore, it is best to acknowledge the hypothesis and develop a line of question-
ing that will provide data to discon#rm the hypothesis.
Clinicians can formulate hypotheses based on their clinical experience, their
knowledge of the person, their knowledge of psychology and psychopathology,
and their knowledge of REBT and other forms of CBT. Rather than allow the
generation of hypotheses to only be automatic, think through the information
mentioned above and try to come up with the best hypotheses concerning your
clients’ IBs.
Once you have formulated the hypothesis, o(er it to the client. We have sev-
eral suggestions on how to o(er hypotheses to clients. First, use suppositional
language. Most people do not like to be told what they are thinking. So, avoid
declarative sentences. Second, give up narcissistic epistemology (epistemology is
the philosophical study of how we know things). !at is, give up the philosophical
position that you are such a brilliant clinician that your ideas must be correct. We
all make mistakes and we all need to acknowledge that. !ird, ask the client for
feedback. Clients are the ultimate arbiter of the correctness of their experience.
Fourth, observe the client’s a(ect when they respond to such queries. Listen to
their tone of voice and watch body language. !is will provide you with important
information concerning whether the IB you proposed to the client aroused some
emotion.
Here is an example of how a therapist would use the hypotheses driven assess-
ment strategy, again with our socially anxious client Miguel.

C: I went to a social engagement the other day and I was so anxious.

T: Were you aware of what you were thinking?
C: No. I was not aware of any thoughts. I guess I am just not aware of what I have
been thinking. I have been scared of people rejecting me for so long; it is just
part of me.
T: OK Miguel, thanks for clarifying that. Let’s consider another idea. Could you
be thinking something like, “I have to be thought of as a successful person.”
C: No, that does not sound like me. I do not have to be great, just be accepted in
the group.
Assessing the B 141

T: OK, how about the idea, “I’m a loser, and can’t stand to be rejected. I have to be
liked to be somebody.” How does that sound?
C: (His shoulder and neck muscles tighten and he answers in a noticeably fearful
voice). Yeah, at least someone has to accept me. I need to be accepted in some
group.

Asking for the Must. Based on REBT, we would postulate that an imperative/
demand drives the emotional disturbance. So, we can ask the client what they are
demanding in the situation in which they are upset. For example, if the client is
reporting anxiety about potential criticism from others, rather than asking, “What
are you telling yourself about this criticism?” you might ask, “What demand could
you be making about criticism from others?” or “What kind of person would you
think you are if others criticize you?” Again, we will apply this technique with our
client, Miguel.

C: I know they are not going to like me.

T: OK, what demand are you telling yourself about people not liking you that is
making you anxious?
C: I am not going to make any business contacts and I will make less money.
T: Yes, that might be true, but again what are you demanding should happen that
is making you anxious?
C: I must make money to keep up with my friends.
T: And if you don’t make more money, what are you telling yourself must happen
with your friends?
C: I must have them like me and if they don’t, I am loser. I must be liked to be
somebody.

Choice-Based Assessment of IBs. One of us (WD) invented an assessment

technique to identify a client’s IB that is particularly e(ective. We call this the
choice-based assessment technique. We present an example of how to use this
method in identifying the client’s premise and provide a commentary on the
thinking that underpins the therapist’s interventions. We then outline the points
to follow with your clients when using this technique. !ere are several steps to
use in the choice-based assessment. !ese include (1) assert the client’s preference
about A and elicit the client’s agreement; (2) state that the client could hold one of
two beliefs that account for his or her emotion or behavioral problems at C and
ask for permission to present them; (3) state the client’s C and then present the
two beliefs. One will be a rigid, absolutistic belief and the other will be a nondog-
matic preference; (4) ask the client which belief accounted for his or her unhealthy
dysfunctional C. Note that this technique also could be used in assessing your
client’s IB–(derivatives).
Below is an example of how to apply this technique with our client Miguel:

T: Now we know that it is important to you that your boss is not cross with you.
Is that right?
142 T H E Aj B j C s O F R E BT: A S SE S SM E N T

Here the therapist asserts the client’s preference. !is underpins both his rigid
belief and his undogmatic preference.

C: Yes, that is correct.

T: OK. Can I suggest two beliefs that you could have been holding at the time you
were anxious? Can I outline them and then you can tell me which belief related
to your anxiety?

Here the therapist is drawing on REBT theory and thus is using a theory-driven
method of inquiry.

C: OK.
T: At the time when you were anxious, was your anxiety based on belief number
1: “It’s important that my boss is not cross with me, and therefore he must not
be cross with me,” or belief number 2: “It’s important that my boss is not cross
with me, but that does not mean that he must not be cross with me”?
C: De#nitely, belief number 1.

!e last three techniques we have suggested to assess the IBs are very active and
directive. Some therapists are reluctant to be so directive because they think that
these techniques put words into their clients’ mouths. Some therapists object
because they believe that the only insights that clients can use are those that the
clients have reached through self-discovery. One could suggest that the therapist
could be reinforcing the client for irrational beliefs that he or she might not really
hold but that they agree with to please the therapist. However, the alternative dis-
advantage is remaining stuck, with no IBs to challenge; the therapy, in that case,
might not help the client. Be respectful of your client and remain aware of your
fallibility. Whenever you are wrong, use that information to help reformulate a
new hypothesis.
!e advantage of such questions is that they e(ectively orient clients toward
looking speci#cally for irrational beliefs. If it is clear that clients’ emotional
responses are unhealthy and self-defeating, what you will likely #nd is that the
clients experience a clear recognition when the therapist directs them to search
for shoulds, musts, or related demands.

M U LT I P L E I R R AT I ONAL BELIEFS

A key point to remember is that the emotional and behavioral consequences usu-
ally have multiple determinants. Too o$en, the new REBT therapist forgets this
principle of psychology and thinks that the client’s C will be linked to one IB. !e
therapist obtains the C (emotion or behavior), #nds one IB to target, and consid-
ers the case closed. By allowing the client to talk freely or by persistent question-
ing, the therapist can #nd that the client’s C results from several IBs, o$en with
spiraling, lateral, or hierarchical connections.
Assessing the B 143

Do not be surprised if you encounter clients with a group of Bs, or a “regular

B-hive.” A client could have two musts and each could be associated with more
than one derivative. !e therapist can jot down the IBs as they emerge and then
present the list to the client for discussion and evaluation. Perhaps the therapist
can point out any common themes; if there are none, client and therapist can
work together to hierarchically arrange the IBs for change. It is important that the
therapist obtain the client’s agreement on which IB to target #rst. Failing to do so
could disrupt the therapeutic alliance. So, if you have failed to discuss which IB to
target, and the client appears irritated or confused, go back and ask the client what
s/he is feeling and how you can help reformulate the goals and tasks of the session.
Doing so can restore a ruptured alliance.
Let us return to the jealous client, Vladimir, discussed above. When Vladimir thought
that his wife was cheating and might leave him, he had three demands. First, he thought
that she should remain faithful to him even if she did not love him IB–(imperative/
demand #1). !is demand elicited the derivative IB that she was a worthless person
if she did not remain faithful IB–(derivative #1/global rating). !ese thoughts lead to
his anger. Vladimir’s jealousy was linked to two demands. First, he thought that he
needed (must have) her to be happy and to live with him IB–(imperative/demand #2).
!is demand was associated with the derivative IB that he could not stand living with-
out her IB–(derivative #2/frustration intolerance). He also had the demand that he
must be the type of person that she would love IB–(imperative/demand #3). He had to
be as good looking, sophisticated, and intelligent a man as she wanted. !is demand
was coupled with the derivative IB that he was worthless if he could not be what she
wanted in a man IB–(derivative #3/global rating). Complex cases such as Vladimir are
what therapists usually encounter.
!e #rst step in identifying the core IB is to make a decision on whether
Vladimir wants to work on his anger or anxiety. So start by selecting one C.

C: I am so angry, and so jealous. I feel one or the other emotion all the time.
T: OK Vladimir, think for a moment which of these two emotions you want to
work on #rst, the anger or the jealousy.
C: How do I make that decision?
T: Well, you could chose to work on whichever one is the most disruptive to your
life. Or, you could pick the one that might be easiest to change #rst.
C: Well, I would pick the one that is the most disruptive. I get no work done
because of the jealousy. So let’s work on that #rst.

Once the therapist and client have agreed on what emotion to address, they have
reduced the number of IBs to target by a third. Next, the therapist will guide
Vladimir to decide which jealousy-related IB to target.

T: OK then, we will focus on the jealousy.

C: Yeah, that’s good.
T: Well, you said that you had several beliefs that preceded your jealousy. Can I
review them?
144 T H E Aj B j C s O F R E BT: A S SE S SM E N T

C: Yeah, go ahead.
T: First, was the demand that you needed her to be happy and to love you. Second,
you think you cannot stand to live without her. You also think that you must
be the type of man that she would love. Last, you think that you are a worthless
loser if you cannot be what she wants in a man.
C: Wow, those are all really upsetting just listening to you recite them.
T: Yes, but which one do you think we should try to change #rst. Again, we can
try to change the one that might be easiest to change #rst, or we could pick the
one that is most upsetting, even if it is hardest to change.
C: Let’s go with the most upsetting one.
T: And which one would that be?
C: I just cannot stand the thought of living without her. I need her so much.
T: OK, so help a bit more here. So, is it the thought that you cannot live without
her, or the thought that you need her which is most upsetting to you? Notice
that the thought that you cannot live without her is related to the demand that
you must have her or that you need her.
C: I just cannot stand not having her in my life.
T: OK, let’s look at the idea that you cannot live without her, and then we can
work on the demand that you must have her.

In this dialogue, the therapist has gone from six IBs to one. Several remarks might
be helpful to understand the REBT process. !erapist and client have several choices
to pick from; the most frequent IB, the one most strongly endorsed, the most closely
connected to the dysfunctional emotion, the easiest to change, or the one that seems
centrally linked to all the others. We do not have sukcient research to guide us in
choosing which irrational belief to target to attain the best therapeutic outcome. We
think it is best to go with the client’s choice to maintain cooperation unless the thera-
pist has a compelling reason to make a di(erent argument to the client.
It is possible that choosing any IB to target for change will have a ripple e(ect
in reducing the endorsement of all or some of the others. It is possible that there
is one central or core IB from which all the others are derived and that targeting
this belief resolves all the client’s problems. !is search for the “Holy Grail” of IBs
sometimes becomes the obsession of therapists. We just do not know yet whether
such core IBs exist, or how to identify them, and whether targeting them for
change leads to pervasive improvement in the others. If targeting the core belief
does not lead to pervasive change and the client changes only that #rst targeted IB,
the therapist will know because the client will remain disturbed. It is equally plau-
sible that each IB becomes rehearsed and stands on its own. Remember Allport’s
concept of Functional Autonomy. Allport believed that some psychological con-
structs can develop because of their link to a central or core idea, emotion, or
behavior. However, as they play a role in a person’s life, they become independent
of the construct to which they were #rst linked. Functional autonomy implies that
the therapist might have to work on all the client’s IBs. In the case of Vladimir, the
therapist would target each of the six beliefs. So knowing the number and extent
of the client’s IBs is important to plan the course of treatment.
Assessing the B 145

Now that Vladimir and the therapist have agreed on an IB to target, they can
move on to work at changing the belief, which is the topic of another chapter.

A S S E S S I N G I R R ATIONAL BELIEFS ASSOC I AT E D

WITH DILEMMAS

New therapists o$en have problems identifying all of the IBs when clients have
dikcult life choices to make and they are blocked from deciding a path of action
by strong dysfunctional emotions. Suppose a client comes to therapy for help
in making a decision. !e client has two or more alternative paths. It is not the
therapist’s job to pick a choice for the client, but to help the client identify IBs
that prevent him/her from selecting one or the other path. One IB could elicit an
emotion that blocks one path and another IB elicits a di(erent unhealthy emo-
tion that blocks the other path, and so on for each path. !ese IBs could be
about giving up one possible solution or about the possibility of losing some-
thing that would have eventually turned out to be good. A third possible IB that
can block decision-making is the belief that “I must make the right decision.”
!e therapeutic goal is to uncover all these IBs so that the client can engage in
problem-solving, to weigh the pros and cons of the alternatives, and to make a
decision for her or himself, and to live with it. !is is a problem for therapists
because clients may present vague complaints of feeling ambivalent, or report the
disturbed emotion associated with one of the alternatives. How does the thera-
pist proceed so that he or she can target the irrationalities associated with all
alternatives? Targeting the irrationality of only one option could unblock one
choice only and leave the other alternative(s) emotionally blocked; thus prevent-
ing a real analysis of the pros and cons of each option. !e therapist can easily
fall into the trap of uncovering the IB that is associated with the dysfunctional
emotion that blocks the path that the therapist values and would chose for her
or himself.
We recommend that when clients present problems of choice, the therapist fol-
low a sequence of tasks.

• First, ask the client how they would feel if they made the wrong decision.
If this a disturbed emotion, assess the possibility that the client believes
that s/he must make a perfect decision and replace that thought with the
rational belief that there are no guarantees of perfect decisions.
• Second, clearly identify all of the choices the client could make, even ones
that appear unlikely to be chosen.
• !ird, ask the client to identify what emotions s/he would feel upon
choosing each alternative.
• Fourth, assess the irrational beliefs associated with each of the emotions.
• Fi$h, ask the client not to make a decision until the therapist and client
have examined each of the irrational beliefs that elicit each disturbed,
blocking emotion.
146 T H E Aj B j C s O F R E BT: A S SE S SM E N T

• Sixth, proceed to target each of the IBs for intervention until the IBs
associated with each blocking emotion are successfully changed.
• Seventh, a$er the IBs and emotions are changed, the client can analyze the
pros and cons of each alternative.

Consider the case of Mark, who came to therapy for help in deciding to stay mar-
ried to his wife, Paula. Mark presented the problem clearly in terms of his strong
desire to leave because of a long list of her faults. Staying with her meant that he
had to accept her fallibilities. Mark was paralyzed by his demand that he had to
make the right decision. Once we dealt with the fact that no guarantees were avail-
able, we proceeded to identify the emotions associated with leaving Paula and
staying with her. Mark said he felt scared of staying with Paula. !is emotion was
elicited by the irrational belief that he would be missing the best relationship that
he could possibly have. Because Paula had some 9aws, he would be denied a great
wife. He thought that he deserved (must have) the best, most loving relationship
possible. When he thought of leaving Paula, he felt guilt and shame. Although
Paula had a short temper and a sloppy nature, she loved him and wanted to be with
him. In addition, separation and divorce would upset their children. He thought
he must stay with Paula to make her happy and prevent the children from being
hurt. A$er we challenged Mark’s IBs, he was able to experience functional, healthy
concern about not attaining great happiness, and not guilt or shame but regret and
disappointment about possibly leaving. He then reviewed how he could make the
best of staying and what his real chances for happiness were if he le$. So far, he
has remained with Paula.
Another way of dealing with a dilemma comes from decision-making theory.
O$en we use the method of weighing the pro’s and con’s. We can also look at what one
decides eventually compared with what will turn out to be the right and wrong deci-
sion later, say #ve years from now. We can make a matrix like the one in Figure 9.1.
!e two cells with an OK in them are not problematic. !e ones with an X in
them are. Now you can ask the client, “You see two di(erent wrong decisions.
Which of the two do you want to avoid most? Or, which of the two do you think
you can live with more easily?” !is allows the client to look at the dilemma in a
di(erent way than with pros and cons, and it helps the client to open his or her

Five years from now it turns out that the right

decision was
Staying in the
Decision I take

marriage Divorcing
Staying in the marriage Okay X

Divorcing X Okay
Figure 9.1 Comparing the actual decision with what turns out to be the right decision
#ve years from now.
Assessing the B 147

mind to which possibly wrong decisions they could tolerate. We advise using this
a$er the REBT work has been completed as described above.

G U I D E S T O F I N D ING THE IRRATIONAL BE L I E F S

F O R S P E C I F I C E MOTIONS

In order to use the hypothesis driven assessment and choice-driven assessment

strategies to identify a client’s IBs, it would be helpful to know what irrational beliefs
are usually associated with which emotions. In each of the IB assessment strate-
gies mentioned, the therapist knows the emotion but hypothesizes the IB. So, we
will identify the IBs associated with the major emotional disturbances. !e reader
might be overwhelmed with what seems like an in#nite number of connections
between Bs and Cs. You may be reassured to #nd, however, that speci#c common
thoughts generally lead to speci#c common emotions. By way of illustration, we
will present the irrational beliefs that underlie eight major emotional dysfunctions:
anxiety, depression, guilt, shame, dysfunctional anger, jealousy, envy, and hurt.

Bw2 9.1
When clients have trouble identifying cognitions, the therapist can suggest a vari-
ety of thoughts, urging clients to signal or stop when one “feels right.” You can
explain to clients that because they have helped you to identify their feeling, there
are a limited number of thoughts that they could be thinking with that emotion.
Your job is to help clients to listen to their own cognitions, or to let you suggest a
few and then tell you if any of the suggestions seem to #t.

Anxiety. Anxiety results from future-oriented cognitions; people are rarely afraid
of events in the past. !e therapist would do well, therefore, to ask future-oriented
questions: “What do you think might happen?” or “What kind of trouble are you
anticipating?” What is usually heard in response is some form of catastrophizing
or awfulizing. Fears may range from speci#c and isolated to pervasive and vague
(so-called free-9oating anxiety). !e two most common fears, according to Hauck
(1974), are the fear of rejection and the fear of failure, followed closely by the
super-fear—the fear of fear itself.
!ere are three cognitive steps to anxiety:

1. (Inference)—Something bad might happen.

2. IB–(demandingness)—It must not happen.
3. IB–(derivative)—It would be awful if it did; Or—I would be worthless if
it did happen; Or—I could not stand it if it did.

!e #rst statement might be a good prediction based on valid evidence, although

the therapist would do well to check this out. !e bad “something” that clients are
148 T H E Aj B j C s O F R E BT: A S SE S SM E N T

anticipating might be an external event, their own thoughts about some potential
failure, or their own anticipated emotional experience. If we assume that the cli-
ent is correct about a bad event occurring, the client’s #rst irrationality appears
at statement 2, the clearly irrational “should” or “must,” as if the individual had
command of the universe and could prevent bad events from happening. At state-
ment 3, we see the irrational evaluation of the event or the person in the Activating
event, which tends to keep the individual thinking in a demanding way about the
future, as if doing so will magically ward o( disaster.
Depression. Beck et al. (1979) outlined a cognitive triad that descriptively iden-
ti#es depression. !e elements include a negative view of the self, a negative view
of the world, and a negative view of the future. !ese views are similar to and
overlap the dynamic irrational beliefs that REBT theory (e.g., Ellis, 1987a) sug-
gests are the main causative agents in depression:

A devout belief in one’s personal inadequacy

!e “horror” of not having what one “needs”
!e “awfulness” of the way things are

Hauck (1974), in his excellent book on depression, divides the problem of depres-
sion into three types of thoughts, each with its underlying irrational structures.
Depression can be caused, #rst, by self-blame. !e thinking pattern that leads to
self-blame is generally as follows:

1. A–(inference)—I failed, or possess some 9aw or fault.

2. IB–(demandingness)—I should be perfect and not do bad things or have
such a 9aw.
3. IB–(derivative)—I am, therefore, a bad person and I am not deserving.

!e second cause of depression is self-pity, whose irrational core is:

1. A–(inference)—I have been thwarted in getting my way.

2. IB–(demandingness)—I must have what I want.
3. IB–(derivative)—I cannot stand the loss I have experienced. Or “Poor
me!” I am inadequate.

Finally, one can become depressed by other-pity if one focuses on bad things that
have occurred to a loved one or a disaster that happened to a large group of peo-
ple, and believes the following thoughts:

1. A–(Inference) Bad things are happening to other people when they don’t
deserve it.
2. IB–(demandingness) !ese bad things must not happen to others when
they do not deserve it.
3. IB–(derivative) !e world is a terrible place for allowing such su(ering
and bad things to happen.
Assessing the B 149

Guilt. Guilt cognitions have two components. First, clients believe that they are
behaving badly, or have done something wrong, or are in violation of their moral
code. !ey might or might not have behaved badly, and their moral code could
be too severe and logically inconsistent. However, this would not be the primary
focus of REBT. A person’s bad acts could be sins of commission or sins of omis-
sion. Second, they believe that they must behave by the moral code. !ird, they
condemn themselves for doing the wrong thing. !ese last beliefs are the core that
REBT would attempt to change:

1. A–(inference) I violated my moral code.

2. IB–(demandingness) I must always live by my moral code.
3. IB–(derivative) I am condemnable because I violated the code.

!e #rst statement may be an accurate assessment of reality according to the cli-

ent’s value system or it may be an exaggerated error. Considered alone, it is a
statement of self-responsibility and can be useful in changing the client’s behav-
ior. !is type of statement, therefore, might not be the target of change in REBT.
Statements 2 and 3 add an extra, unnecessary idea, however. Consider the di(er-
ence if, instead of statement 2, the client said, “Yes, I did the wrong thing. I really
regret that, but people make mistakes from time to time, and I’ll try my best not to
do it again.” !us, true guilt always includes the component of self-condemnation
and self-denigration, which sabotages emotional or behavioral improvement.
Shame. Shame is another dysfunctional emotion and it is o$en confused with guilt.
Guilt and shame di(er in one crucial way. In guilt, the IB involves self-condemnation
for violation of a moral code; in shame, the person is upset about public rejection that
follows the public moral transgression (Ard, 1990). To experience shame requires
several di(erent thoughts. !e #rst is that the person has violated a public moral
code. Second, is the belief that signi#cant others or the social group know about the
infraction and will negatively judge and reject the person because of the moral trans-
gression. !ird, the client has the belief that s/he should not have violated the moral
code and that others should not reject her/him. Fourth, the client believes that it is
awful that others reject him/her, or that s/he cannot stand to be rejected. Fi$h, the
client believes that being rejected by others means that s/he is no good? An example
of the thoughts in shame would be as follows:

1. (Inference)—I have violated a moral code and others know it or will know it.
2. (Inference)—Others will negatively judge me and condemn or banish
me because of my moral transgression.
3. IB–(demandingness)—I should not have violated the moral code; or,
Others should accept me despite my moral transgression.
4. IB–(derivative)—!e group is correct. I am condemnable; I cannot stand
being condemned by, rejected by, or banished from the group and it is
awful that they reject me.
5. IB–(derivative)—!e group is right. I am condemnable and therefore
I am no good.
150 T H E Aj B j C s O F R E BT: A S SE S SM E N T

Dysfunctional anger. !e word “anger” is used to describe a broad range of emo-

tional reactions, some of which are appropriate and helpful. Clinical dysfunctional
anger, on the other hand (i.e., hostility, rage, or contempt), is an emotion that
interferes with goal-directed behavior. DiGiuseppe and Tafrate (2007) and Ellis
and Tafrate (1997) describe anger cognitions as a series of Jehovian commands
and demands. !e #rst step consists of de#ning rights and wrongs, re9ecting an
absolutist kind of moral indignation. !e second step is the absolutist should,
“You should act correctly.” or “You shouldn’t act that way.” !e third step is oth-
er-condemnation: “!ey are worthless for acting that way.” or “You’re a bastard!”
and “You deserve to be punished and damned!”

1. A–(inference)—Someone behaved badly or violated my rules.

2. IB–(demandingness)—!ey must behave as I think they should.
3. IB–(derivative)—!ey are no good and deserve to pay for acting badly.

In addition, we recognize “ego-defensive anger.” Some clients become enraged

over other people’s criticism of them. It is commonly believed that anger is
triggered by low self-esteem, self-condemnation fear that another’s criticism
re9ects one’s own inadequacy, for which one condemns oneself (Beck, 1999).
Substantial research has shown that angry and aggressive people do not suf-
fer from low self-esteem but that they actually have high unstable self-esteem
or narcissism (Baumeister, Smart, and Boden, 1996; Baumeister, Campbell,
Krueger, and Vohs, 2005); DiGiuseppe and Froh, 2002). Anger appears to
be caused by the belief that others do not see the person as great as they see
themselves.

1. A–(inference)—Others have not treated me with the respect, deference,

or admiration that I deserve.
2. IB–(demandingness)—Others must treat me with the respect, deference,
and admiration that I deserve.
3. IB–(derivative)—I cannot stand being treated with less respect. !ey are
condemnable for treating me with less respect, deference, or admiration
than I deserve.

Sometimes the anger is related to beliefs that the criticism is unwarranted because
the client believes that they should not make any mistakes.

1. A–(inference)—!ey criticized me and think I made a mistake.

2. IB–(demandingness)—!ey must not see that I made a mistake. People
must see me as perfect.
3. IB–(derivative)—I cannot stand for people to see me as imperfect. !ey
are no good for thinking I am fallible.

Unhealthy jealousy. Jealousy involves the perception of a threat of losing some-

thing that you already have. Usually people experience jealousy about the threat of
Assessing the B 151

losing a relationship with a romantic partner to a third person. !e actual emotional

experience could be fear of losing the relationship or anger at the competitor or
interloper who threatens to win the love of the person’s partner. An example of the
thoughts involved with unhealthy jealousy that is close to fear would be as follows:

1. A–(inference)—My partner is showing interest in another potential

lover. I could lose him/her to that person.
2. IB–(demandingness)—My partner must not leave me. I must have him/her.
3. IB–(derivative)—I could not stand to be without my lover. I would be a
failure or loser if my lover le$ me for that other person.

An example of the thoughts involved in unhealthy jealousy that is close to anger

would be as follows:

1. A–(inference)—!at person is interested in taking my lover away from

me and s/he might succeed in seducing my partner.
2. IB–(demandingness)—S/he must not try to seduce my partner. And my
partner must not succumb to the interloper’s advances.
3. IB–(derivative)—!e interloper is a condemnable person and deserves
to be punished. My partner is condemnable for being interested in the
interloper and deserves to be punished.

Unhealthy envy. Unhealthy envy is similar to and o$en confused with unhealthy
jealousy. !e theme of unhealthy envy is that another person possesses and enjoys
something desirable that the person does not have. !e emotional experience in
unhealthy envy is close to that of unhealthy disturbed anger (DiGiuseppe and Tafrate,
2007). An example of the thoughts involved in unhealthy envy would be as follows:

1. A–(inference)—!at person has highly desirable resources that I could

use.
2. IB–(demandingness)—I must have what that person has; I deserve it.
3. IB–(derivative)—!at person is worthless and not at all deserving. I can’t
stand being without valuable resources that others have.

Hurt. Hurt is an emotional pain and anguish characterized by the theme that
others have treated the person badly. !ere is also a tendency to become stuck
in thinking about past hurts. !e hurt person expects others to make the #rst
move toward repairing the relationship, and sulks and makes little or no attempt
to communicate with others. !ere are several possible thought patterns associ-
ated with hurt. Sometime the inference is that the person was treated unfairly.

1. (Inference)—!e other person treated me badly and very unfairly.

2. IB–(demand)—I should not have been treated that badly and very unfairly.
3. IB–(derivative)—I cannot stand being treated so badly; and the other
person is condemnable for treating me so unfairly.
152 T H E Aj B j C s O F R E BT: A S SE S SM E N T

Sometimes the person is upset about being alone, uncared for, or misunderstood.

1. (Inference)—Others do not care for me, understand me, or pay enough

attention to me.
2. IB–(demandingness)—Other people must care for me, understand me,
and attend to me.
3. IB–(derivative)—I cannot stand being uncared for and unattended to
or misunderstood; and others are condemnable for not caring for me.
Because they do not care for me, there is something wrong with me.

A variation in style. Some CBT therapists, as distinguished from REBTers, stress

the idiosyncratic nature of the client’s cognitions. In addition, they try to describe
the client’s cognitive world without any categorization of the thoughts, by using
the client’s language exactly as stated. !e client is urged to speak from the direct
experience of his or her thoughts, rather than talking about those thoughts. For
example:

Not: I was thinking about how stupidly I acted.

But, “What a jerk I am!”

Similarly, the more broadly stated silent assumptions are gathered in the cli-
ent’s own language, rather than formed into categorical musts or shoulds. For
example:

“I need other people’s approval to feel good about myself.”

“I may not be an adequate human being.”
“Others will be critical of me and won’t accept me or respect me unless my
work is of a very high standard.”

!ere are advantages to both the use of REBT terminology and use of the client’s
own words. In our clinical teaching experience, the structure of irrational beliefs
laid out in REBT theory helps therapists-in-training to look for and recognize
their clients’ irrational processes. As REBT therapists become more experienced,
they can move from the language of REBT theory toward the idiosyncratic lan-
guage of the client without losing sight of REBT constructs. For example, the
experienced therapist can detect a client’s demandingness even if a “should” or
“must” has never been spoken.
!erefore, language that re9ects demandingness without using the words
should, ought, must, or have to could be:

He is supposed to do that.
I expect him to do that.
I insist that he do that.
Of course, I anticipated that he would do that.
I thought I could count on him to do that.
Assessing the B 153

I cannot believe he did not do that.

Why doesn’t he do that?
Why are people so stupid?

Demandingness is an idea. It is usually conveyed in English with the words

“should,” “ought,” or “must.” However, other words could be used. !e same is
true for frustration intolerance. !is idea of not being able to bear more frustra-
tion is usually conveyed in English with the phrase, I can’t stand it.” Alternatively,
clients might say:

I have had enough.

!at was too hard.
I have had it with him doing that.
It is unbearable that he did that.

!e use of the client’s own language frequently seems to make the disputing pro-
cess more meaningful to the client. Our recommendation is to learn the REBT
constructs and as much as possible to use the clients’ language with them.

O T H E R G U I D E L I NES

In the previous sections, we described how the REBT therapist uses the cli-
ent’s speci#c C as a clue in identifying the relevant irrational beliefs, and uses
A–(inferences) as guideposts to underlying belief structures. In addition, as you
gain experience as a therapist, you will #nd that particular clinical problems are
commonly associated with speci#c belief systems. Clues to irrational beliefs could
be found in the A that the client describes or in characteristics of the client that
you note. In other words, in searching for the irrational cognitions with which
clients upset themselves, you may begin with cognitive schemas of types of clients
derived from cumulative experience with similar cases. !ese schemas can serve
as initial hypotheses. Although it is beyond the scope of this book to suggest all of
the common schemas, an example can help illustrate their form.
If the client is a mother who is experiencing a great deal of anxiety or dysfunc-
tional anger at her children for their misbehavior, the key irrational belief underlying
the problem could be one of self-worth. !e mother could have not only identi#ed
the children’s behavior as bad but could also have overgeneralized, concluding that
she is a bad mother and, therefore, a worthless person because her children behave
badly. !us, she could have rated and devalued herself based on the behavior of her
children. In working with mothers, whether their children are infants or indepen-
dent adults, the therapist can keep such a schema in mind as a hypothesis.
!e development and use of such schemas will evolve as you accumulate pro-
fessional experience. Also, it is important to consider the ideas you apply to spe-
ci#c cases based on such schema as hypotheses that you need to test. You can #nd
that you have many such decision-making schemas already. !e point we wish to
154 T H E Aj B j C s O F R E BT: A S SE S SM E N T

stress, however, is that schemas suggest hypotheses, not facts. In other words, we
advise you to present your schemas in suppositional language to your clients, and
to empirically validate your hypotheses by data from the client before you proceed
further with therapy.

W H E N A L L E L S E FAILS

Not all clients can identify IBs that they have before or during their emotional
episodes or dysfunctional behaviors. !is can occur for two reasons. First, some
people might just be poor at identifying their cognitive process. Just as we have
referred to alexythymia in Chapter 8, so too people with poor introspection might
have dikculty becoming aware of the thoughts associated with their disturbance.
!e identi#cation of these thoughts would entail recalling what happened when
the disturbed emotion or behavior occurred. Humans most likely store such expe-
riences in episodic memory, and these experiences are probably not stored ver-
bally. People have to experience the memory and translate their thoughts into
language. Our clinical experience has suggested that people with low introspec-
tion or poor verbal skills have the most dikculty reporting the IBs or any other
CBT construct as associated with their disturbance.
Also despite REBT theory, it is possible that some emotional disturbances are
not mediated by thoughts. In Chapter 2 we mentioned Power and Dalgleish’s
(2008) SPAAR model, which proposed that there are at least two pathways
for external stimuli to the eliciting of emotions. One pathway is through clas-
sical conditioning and involves immediate, mostly subcortical connection.
Some people might not experience thoughts with their disturbance because
this classical conditioning pathway mediates the emotional disturbance. Our
experience suggests that people with Acute Stress Disorder or PTSD some-
times fail to report any thoughts associated with stimuli that were associated
with their trauma and their fear.
So what do we do? At some point, the therapist takes the client’s failure to iden-
tify thoughts at face value and moves on. At this point, the therapist can use REBT
theory to suggest rational alternative beliefs that could counteract the client’s dis-
turbed emotions. !e therapy would not involve disputing the IBs, since none
have been identi#ed. Nevertheless, therapy can progress and provide rationales
for the new RBs and many exercises to practice them.

T E A C H I N G T R A N SCRIPT

!e following transcript illustrates a therapist assisting a client in identifying

his IBs and teaching the client to discriminate between rational and irrational
beliefs.
!e client, Sam, is a thirty-eight-year-old married man whose #ve-year-old
daughter has a habit of waking in the middle of the night and calling for her
Assessing the B 155

mother. On a recent night, Sam became angry. He 9ew into the child’s room,
picked her up by the shoulders, shook her, and yelled at her, “Shut up, you little
brat! !is is ridiculous! And I won’t stand for it!”

T: It sounds like you were angry to go in and shake her.

C: Yeah. And I yelled at her.
T: Yes; and how did you feel about your yelling a$erward? (!erapist assesses for
meta-emotional problem.)
C: Pretty rotten.
T: What do you mean, rotten?
C: I felt guilty. (Client reveals meta-emotional problem.)
T: OK Sam; what problem do you want to work on—the guilt or the anger?
C: I want to work on the anger so I do not do that to my daughter again.
T: OK, Sam. Let’s go back, if we can. !ere you are, resting in bed, and you hear
that whiney voice, “Mommy, mommy. . . . ” What thoughts go through your
head? What are you saying to yourself? (!e therapist assesses thoughts.)
C: I have had it with that kid. I’m just going to walk right out on her if she gives
me any 9ak.

!e therapist’s initial query about thoughts resulted in behavioral not cognitive

information. !e therapist persisted and again asked for thoughts.

T: Well, that is a prediction you made about how you would act. But, before you came
to that, you must have had some other thoughts. If we could read your mind, like
some printed script, what were some of the words? . . . What were you saying?
C: Damn it. I don’t want to have to go through it again.
T: (repeats) OK, good. What else were you saying?
C: I don’t need this aggravation. I get up early in the morning. I am going to go in
there and she is going to tell me to get out. !en my wife is going to go in and
she is going to get upset and be a grouch the next morning.

Note that the client continues to provide predictions but has not yet identi#ed
any IBs.

T: You are anticipating all kinds of things. Is that what rolled through your head?
Now, suppose for a minute that the situation had been a little di(erent: your
kid was throwing up, and she almost never throws up. Would you have had the
same kind of thoughts?
C: No, I don’t think so.
T: OK, so was there something else going on here? In terms of anticipating that
this could go on forever.
C: Yeah.
T: Well, what did you say about that?
C: Here we go again. It is never going to end. I do not know what we can do to
make this kid sleep through the night. She keeps us up all the time.
156 T H E Aj B j C s O F R E BT: A S SE S SM E N T

T: So you were pretty helpless. You really didn’t know what to do. You know, Sam,
in addition to that, I think some other things might have gone through your
head . . . because if that were all that went through your head, you would have
only felt annoyance. !at would have been very understandable. You would
have said, “Oh, no. I have to get out of this warm bed and calm her down now,
damn.” You would not have been very happy, but you would have done it, or at
least have tried to, and if it did not work, called your wife. But that isn’t exactly
what you did, is it? What happened then?
C: I went in there and started shaking her, and yelled, “Stop it, stop it, stop it . . . I
can’t stand it!”
T: Ah. So, you had some more powerful thoughts passing through your head. I
can’t stand it. You shouldn’t have done this to me. What is the matter with you?
C: Uh hum (nodding assent).
T: !ose are the kind of things that were going through your head?

Note that the therapist asks for feedback to corroborate her hypothesis.

C: Uh hum.
T: OK, Sam. Now I am going to say something to you that may surprise you. !at
is, it is not so much that your daughter was crying in the night and interrupting
your sleep that enraged you. It is what you said to yourself about that irritating
event. Now, if you lined up a thousand judges, everybody would agree that this
is an irritating event. Nobody wants to get up in the middle of the night, night
a$er night. So, for you to feel irritated, that is functional. But in order for you
to get so upset that you actually wanted to go in there and throttle the kid or
choke her or hit her with something . . . . See, you didn’t just say, “Oh, gosh, here
we go again.” Which one of those things I said before . . . which one do you
think really triggered you?
C: I think, “I can’t stand it anymore.”
T: (repeats, twice, with emphasis) OK, now I am going to say something pretty
strange to you. (pause) Did you stand it?
C: I got through it. I didn’t like it.
T: !at is right; you did not like it. But, you did not die, though, right?
C: (inaudible murmur)
T: All right. See, you made an irrational statement to yourself. “I can’t stand it.”
Could you also have been thinking, “She must not do this to me.” !at is what
gave you your dysfunctional anger. By “irrational,” I mean destructive and
hurtful. Causing you to go in and commit an act that you were sorry about
later. You told me that the next day you felt guilty and wished you had not done
it . . . it was overkill. Here was a kid howling in the middle of the night, and
your overreaction certainly did not help that problem any, and can even have
made the situation worse. So now, we have two problems instead of the one
problem. But, do you understand what I am saying to you?
C: Yeah. I am telling myself that I cannot stand something. I guess what you are
saying is that when I say that, I make myself more angry?
Assessing the B 157

T: Absolutely. You got it! You are the one . . . you’re the author of your own feel-
ings. Now that is a kind of a profound statement. I am going to say it to you
again . . . because it permeates a lot of your life and how you deal with yourself
and other people. You are the author of your own anger. Do you believe that?
C: You’re saying that she gets me irritated, and I get myself angry.
T: You actually—technically—irritate yourself about it, but I think most people
would think it natural, because you are, a$er all, human. It is perfectly reason-
able for a person who is trying to get some sleep and has to go to work the next
day, if he is awakened by a daughter who is not a baby and who has a bad habit
of doing this. To feel irritated is OK. But the fact that you lost control over
yourself and actually went in and tried to throttle her in the night . . . that you
did because of your thinking. She really did not have anything to do with that.
And it is what you said in your head about the crying in the night that really
got you so upset that you lost control of yourself. See, that is what we are label-
ing dysfunctional. You lost control of yourself. !at is not a good feeling to go
through life with—letting other people pull your strings. And I would like to
help you understand that, so that you don’t feel helpless about controlling your
anger.