A powerful new approach to counseling that could help clients who require active/directive exploration as well as warm, deep introspection is a theoretical integration of Rational Emotive Behavior Therapy (REBT) and Existential Therapy. I find an incredible synthesis between these two theories in that they reciprocally make up what they individually lack.
REBT is effective at quickly helping clients to change their here-and-now thoughts and emotions, but often lacks the deep personal exploration of the roots of those concerns, which is something many clients can gain therapeutic value from.
Existential therapy is more of a philosophic worldview than a structured approach to counseling, and thusly lacks the focused problem-solving direction that many clients require for effective change. I intend to demonstrate that using these two lenses in conjunction can strengthen and increase the effectiveness of both.
Theory of Behavior, Thought, and Emotions
Sound theory is an important component of any system of therapy. Some counselors are comfortable cherry-picking effective techniques when appropriate, but I believe that a primary lens of practice needs to be grounded in a theory that fits one’s own experience of human nature. For that, I turn to both existential philosophy and its therapeutic implications, and the REBT framework for understanding daily reactions to stimuli. I find the ABC framework of REBT a powerful and insightful tool for understanding such emotional disturbances in clients. It is laid out thusly:
A: Activating event
B: Belief about that event
C: Emotional consequence.
This framework argues that activating events (at A) do not directly generate our emotions (at C), but rather they are experienced based on what clients tell themselves about those events (at B).
REBT therapists recognize that a client’s beliefs may be rational or irrational, and thus lead to healthy or unhealthy emotions respectively. Irrational beliefs are ones that are rigid, demanding and conditional, whereas rational beliefs tend to be flexible, preferential, and unconditional. We believe that a client cannot disturb himself unless he is holding strong to an irrational belief about himself, other people, or the world at large.
It is this final point that necessitates an integration of existentialism. Psychotherapist Irvin D. Yalom suggests that all human beings must contend in their own ways with the four ultimate concerns. These concerns are death, freedom, isolation, and meaning, and are said by existential thinkers to exert considerable influence on nearly every aspect of our personality and behavior. I believe that combining this lens with that that of REBT is a crucial step toward understanding their irrational beliefs and emotional struggles on a deeper and more significant level. An REBT therapist listening with an existential focus can pay close attention to evidence of the ultimate concerns in their client’s ABC framework.
Existentialism reminds us that people are meaning-making beings who are both subjects of experience and objects of reflection. I believe that many irrational beliefs are the product of interplay between our propensity to make meaning out of the things we experience, and our ever-present knowledge of the ultimate concerns. Though clients may initially present their issues in surface-level and concrete, situational language, careful analysis can overturn deeper existential reasons for their irrational beliefs and rigidly demanding self-talk.
Format of Therapy and Client/Counselor Roles
Currently, my development of Existential REBT is intended for use in individual counseling practice. We see clients on a one-on-one basis, and follow the REBT prescribed duration and frequency of sessions; each client receiving 5-50 sessions, once per week. The goal of treatment is for my clients to minimize their absolutistic core philosophies, thus converting their unhealthy emotions into healthy ones. This process requires identification and disputation of their irrational beliefs, behavioral exercises, and the assignment of homework.
Central to this process is a strong working alliance. REBT is a directive approach to therapy, and trust must be established in order for the client to feel comfortable with the counselor’s active role in session. Thus, I borrow from existential therapy the use of empathy and the view of counselor and client as equals in the navigation of humanity. I attempt to see their world from our client’s point of view as best I can using this philosophy as a guide. Additionally, the counseling micro skills such as paraphrasing, reflecting feeling, and active listening help to draw out the client’s story, identify the specific activating events that disturb them, and begin to formulate ideas about their underlying irrational beliefs.
Existential REBT will teach clients the ABC framework early on. In the interest of transparency and helping our clients to become their own therapists, we find it critical that a client understands the ABC framework before we can utilize it with effectiveness.
We also integrate the existential concept of being a fellow traveler with the client. REBT is traditionally seen as a fast-paced, short-term and strictly-focused approach to therapy, but integrating an existential lens allows us to take more time with each client, move at slower pace, and explore a much more complete picture of their human experience as we regard the client as struggling against the very same human concerns as we all must. Existential REBT recognizes that the whole of an individual’s experience runs deeper than the daily events that aggravate their irrational beliefs, and extends to what those events represent to them in terms of meaning, isolation, death, and freedom.
Strategies for Change
The flow of Existential REBT moves between sessions of openly exploring a client’s personal experience of their world, and sessions of actively disputing the irrational beliefs that underpin their disturbances. This format may help clients to more clearly understand the need to dispute said beliefs, and begin to fully appreciate the value of doing so as they actively confront and recreate their methods of coping with the existential concerns.
For example, a mid-thirties female client may come for counseling with concerns over not being able to find the right dating partner. She desperately wishes to fall in love, and talks at length of wanting settle down, have children, and grow old with someone. However, attempting to meet the right person overwhelms her with anxiety, and as a result she can’t seem to meet the right person.
Existential REBT can conceptualize this as follows. On the surface, we might find her irrational belief to be something close to “I absolutely must find a perfect partner, or else I’ll be a failure in life.” Thus, whenever she even considers going out to meet someone new, she is overwhelmed with anxiety due to the unnecessary pressure she puts on herself. We can dispute her belief by helping her to understand that she actually has a strong preference for love. Through thought exercises and cognitive worksheets, we help her to see that her irrational demanding is actually hindering her romantic pursuits by causing intense anxiety at the thought of finding a partner. We help her to realize that if she can move from a place of rigid demands to one of unconditional self-acceptance, she will cease to feel anxiety when considering her partner options and may begin to feel motivated to date.
On a deeper level however, in order to help her to accept herself as a complete person and dispel her irrational demanding of a perfect romantic relationship, we integrate existentialism to explore how her ideals of love and partnership are connected with the concerns of meaning and isolation. Perhaps she is experiencing a terrible bout of existential loneliness, feeling isolated within herself, and living an unobserved life. It is altogether likely that her irrational demanding that she absolutely must find a perfect relationship and live happily ever after has slowly developed as a cure for her ultimate isolation.
It is also possible that she struggles to define meaning in her life, and feels a sense of existential purposelessness. As there is no universal cosmic purpose for human life, it is up to every person to quantify meaning in his or her own way. Perhaps our theoretical client has always defined meaning in terms of motherhood, strived unsuccessfully to achieve this role, and has begun to feel the passage of time more vividly in middle age. Death anxiety, another existential concern, may create additional pressure to achieve meaning through motherhood, as she is ever aware that her time on earth is limited and she doesn’t have an infinite window to enter motherhood.
As we move back to the ABC framework, we find that the added effect of all this produces her absolutistic, demanding, and irrational self-talk such as “If I don’t find the right man soon, I’ll be alone forever,” or even, “If I don’t become a mother soon, my legacy will die with me and I’ll be completely forgotten; a total loser in life.” These beliefs are then activated, or brought into tacit awareness, when she encounters situations that in some way relate to her love life.
Helping our theoretical client to confront and explore these issues involves total empathy and therapist transparency. Several sessions of counseling may consist almost solely of active listening and paraphrasing as we show her that her concerns are not unfounded nor solely her own. She may learn through self-disclosure that every person, her therapist included, must confront the same issues she has come up against, and that she is completely normal and even insightful for them.
The effect of giving her space to talk and sort through these feelings will increase her ability to successfully dispute her irrational beliefs and defeating self talk on the ABC model as she explores with confidence new and effective ways to get her romantic goals met. At this stage, the therapist might assign worksheets and homework in the spirit of REBT tradition. Behavioral homework forces our clients to test out their irrational beliefs in the real world and helps them to realize the results are not as awful as they may have anticipated. For the client described above, her therapist might recommend forcing herself to sign up for a dating website and message several potential matches, or to go out to a singles bar with friends and try to talking to attractive men.
Of course, both REBT and Existential Therapy need to take cultural concerns into account for each individual client. In existentialism, an individual’s culture is not simply a minor consideration, but a critical aspect of their personhood and worldview, and likely influences the ways in which they approach the ultimate concerns. Using empathy to meet the client where they are, and accepting them fully for their culture, beliefs and traditions is key to a successful working alliance.
REBT also recognizes the importance and value of an individual’s cultural beliefs in so far as they are not absolutistic or demanding. In this sense, REBT can be successful for persons of every culture so long as the therapist is careful not to conflate irrationality with cultural difference. REBT is also active and directive, and the degree to which a therapist drives the engagement may need to change for persons of traditionally introverted and emotionally guarded cultures.