Journal of Rational-Emotive & Cognitive-Behavior Therapy Volume 12, Number 1, Spring 1994

TRAINING IN RET: DISPUTATIONAL STRATEGIES Ann Marie Kopec Ferrell and Associates and The Institute for RationalEmotive Therapy

Don Beal Eastern Kentucky University

Raymond DiGiuseppe St. Johns University and The Institute for RationalEmotive Therapy

ABSTRACT: The purpose of this paper is to describe a training exercise designed to systematically develop the skill of cognitive disputation. In accomplishing this purpose, DiGiuseppe's conceptual framework for generating disputations is briefly summarized. Then the conceptual framework is applied to a single maladaptive belief of a young woman who had been sexually molested over a number of years during childhood. The application of the conceptual framework resulted in sixteen disputes for a single maladaptive belief. Additionally, several empirical evaluations of the efficacy of conceptual approach are presented. In the case of novice RET therapists, the application of the conceptual strategy resulted in a significant increase in the number of different disputes on the part of the therapists. In the case of experienced RET therapists, the application of the conceptual strategy resulted in increases in the therapists' sense of self efficacy at generating a variety of disAnn Marie Kopec is a staff psychotherapist, Institute for Rational-Emotive Psychotherapy, New York, NY, and she is the Executive Director of the Pennsylvania Institute for Rational-Emotive Therapy. Ann Marie is also a member of Ferrell and Associates, Wilkes-Barre, PA. Don Beal is an Associate Professor, Department of Psychology, Eastern Kentucky University, Richmond, KY 40475. Raymond DiGiuseppe is an Associate Professor of Psychology at St. Johns University, and Director of Research and Director of Training at the Institute for Rational-Emotive Therapy. Requests for reprints should be sent to Don Beal, Ph.D., Department of Psychology, Eastern Kentucky University, Richmond, KY 40475. 47

9 1994 Human Sciences Press, Inc.

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Journal of Rational-Emotive& Cognitive-BehaviorTherapy

putes (albeit not a significant increase). Finally other advantages of the conceptual framework are discussed. DiGiuseppe (1991) has suggested that the process of disputing the client's irrational beliefs lies at the heart of the Rational-Emotive therapeutic process. Further a number of authors have suggested that this activity may take up as much as ninety percent of the therapists' time a n d effort in some therapy sessions (Ellis, 1989a; DiGiuseppe 1991; Lazarus, 1989). Additionally, when observing an experienced RET therapist engaging in a therapy session, one is able to observe the utilization of a wide variety of approaches to dispute a single irrational belief. These disputes may include the use of humor, challenges involving the examination of the logic of a belief, or an examination of the consequences of holding an illogical belief. Further, in the case of skilled RET therapists, these challenges may be delivered in a variety of styles: a didactic or lecturing style, a questioning or socratic style, or the use of a metaphorical style to name a few. Given the importance of disputing the client's irrational beliefs, and the potential complexity of the disputations, any strategy which would systematically increase this ability for the developing RET therapist would be a benefit. The purpose of this paper is to present a training exercise designed to systematically develop a variety of separate disputes for a single irrational belief. In that the training exercise is an extension of a conceptual framework originally proposed by DiGiuseppe (1991), this conceptual framework will be briefly discussed. Following this discussion, the conceptual framework will be applied to a single irrational belief of a victim of sexual abuse, in order to generate sixteen different disputes for the single irrational belief. DIGIUSEPPE'S DISPUTATIONAL FRAMEWORK DiGiuseppe (1991) has suggested that the process of disputing a client's irrational beliefs is~at the heart of RET. Further, DiGiuseppe has suggested that the more disputational strategies a therapist can effectively use, the greater the probability of his or her success in the therapeutic endeavor. Finally, DiGiuseppe has described a number of strategies for examining (or challenging) a belief. These are called Basic Disputational Strategies. The three disputational strategies identified by DiGiuseppe are the Logical, the Empirical and the Pragmatic Disputational strategies.

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The Logical Disputing Strategy The logical disputing strategy focuses on examining the logic of the client's belief, and ultimately getting the client to vigorously question the logic of hiskher belief. The ultimate purpose of this strategy is to help the client understand why his/her irrational belief does not logically follow from the data. For example, in the case where a client demands that her friends must not look down on him~her, the therapist would help the client see that while this is a desirable goal, there is no logical reason why this absolutely must not happen. Basic steps for using the logical disputing strategy involve: (a) clearly identifying the irrational belief (IB) that you wish to dispute; (b) showing this belief to the client, and getting the client to agree that he/she is in fact holding the belief; (c) asking the question "Where is the logic that . . . . " or "Does it follow logically that because you want your mate's approval, that you must have it?" It should be reiterated that the critical step in the procedure is carefully identifying the irrational belief, and showing the belief to the client before attempting to dispute the belief.

The Empirical Disputing Strategy The empirical disputing strategy focuses on the lack of empirical evidence to support a client's belief. The goal of this strategy is to show the client that his or her belief is empirically inconsistent with reality. Basic steps for using the empirical disputing strategy are as follows: (a) clearly identifying the irrational belief (IB) that you wish to dispute; (b) showing this belief to the client, and getting the client to agree that he/she is in fact holding that belief; (c) asking the question "Where is the evidence that you must have your wife's approval in order to be happy?" Questions that ask the client to provide evidence in support of their irrational beliefs are critical to this strategy.

The Pragmatic or Functional Disputing Strategy The pragmatic or functional disputing strategy focuses on the pragmatic consequences of the client's holding an irrational belief. The goal here is to show the client that as long as the client believes in the irrational belief he\she is going to incur negative emotional and behavioral consequences, and negative outcomes. Again here, after identifying the IB, and showing the client that he/

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Journal of Rational-Emotive& Cognitive-BehaviorTherapy

she is holding onto the belief, the task of the therapist is to get the client to anticipate the consequences of holding the belief. Useful questions here are: "What is believing that you must succeed going to get you?" Another useful question is: "What are the consequences of holding onto this idea t h a t . . . ?

RATIONAL ALTERNATIVE BELIEFS DiGiuseppe (1991), drawing on the work of the philosopher of science Thomas Kuhn (1970) suggests that in order for a faulty belief to be relinquished, two conditions must be met: First, the belief must be shown to be dysfunctional; and second, that a superior, alternative belief (theory), is available, that better accounts for the data. Thus when contemplating the modification of a core belief, it is also important to keep in mind that one is not likely to change a belief despite overwhelming evidence to the contrary unless there is a superior alternative belief. Indeed, the history of science has shown convincingly that a theory is abandoned only when there is a superior alternative. Therefore, after the irrational belief has been disputed it is hypothesized that a client is still unlikely to give up the irrational belief unless there is a superior alternative (e.g., one that is more logical, more consistent with reality and more functional). The basic steps in this strategy are to carefully identify the IB; and then, in collaboration with the client, to develop a new belief which is more logical, more consistent with reality, and one which involves adaptive consequences. Typically, the new belief would be without the demandingness, the self downing, and the catastrophic qualities found in irrational beliefs. In summary, DiGiuseppe (1991) suggested three specific disputational strategies that are available to RET therapists for disputing a client's IBs; these are the Logical, the Empirical, and the Functional disputational strategies. Further, in order to effectively modify an irrational belief, it is suggested that the therapist also develop a logical, empirically based, and functional (rational) alternative belief.

Rhetorical Styles In addition to disputational strategies described above, the therapist can also use several rhetorical styles. Although many individual vari-

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ations are possible, four basic rhetorical styles of disputing a client's irrational beliefs are described by DiGiuseppe. These styles are the Didactic, Socratic, Metaphorical, and Humorous styles.

The Didactic Style The didactic style is characterized by a focus on teaching or lecturing. This is a common approach used in RET. Indeed RET has always been presented by Ellis as a psychoeducational intervention (Ellis, 1962; 1973; 1985; 1989a; 1989b). When therapists observe Ellis performing one of his frequent demonstrations of RET, they notice that he teaches his client the difference between irrational and rational beliefs in a direct, didactic fashion. Thus, the RET therapist frequently does a lot of direct educating about the therapy, its theory, where emotions come from, and the reason why specific beliefs are irrational. A distinct advantage of the didactic style is that it entails an efficient use of time. Therefore, while many rational-emotive therapists prefer the Socratic style, at times it is necessary and efficient to shift to didactic explanations.

The Socratic Style The Socratic style of disputing involves asking questions concerning the illogical, empirically inconsistent, and dysfunctional aspects of the client's beliefs. The Socratic method comes from the Socratic Dialogues written by Plato of the teachings of the Greek philosopher Socrates. Socrates believed that people are more intelligent than they get credit for. He thought that the best way to teach people is to try to draw information out of them through a series of leading questions, as opposed to more didactic processes. Socratic disputing is probably the mainstay of interventions among most experienced RET therapists (Whalen, DiGiuseppe & Wessler, 1980). The purpose of this style is to encourage the client to think for him/herself rather than to accept the therapist's viewpoint just because the therapist is in the role of an authority as a therapist. In this style, the therapist asks clients questions to get them to see for themselves that there is no evidence for their irrational beliefs. Some examples of Socratic disputes are: "How does it follow logically that your spouse must love you, because you really strongly desire her to?"; "Can you tell me how it has helped you to believe that your spouse

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must love you?"; or "Is there any evidence that your spouse behaves lovingly to you when you demand that she must?" These are examples of the logical, the functional and the empirical disputational strategies using the Socratic style.

The Metaphorical Style The explicit use of metaphor has been mentioned as a specific approach to cognitive restructuring by a number of cognitive and RET writers (e.g., Beck & Emery, 1985; Dryden, 1986; Guidano & Liotti, 1983; Walen, DiGiuseppe, & Wessler, 1980; Wessler & Wessler, 1980). The Rational-Emotive use of metaphor typically involves abstracting a concept from a topical domain that the client knows well. A metaphor for that concept is then applied by analogue to a new area to help explain or construct an experience in a different manner. For example, a client with athletic experience was having difficulty in understanding appropriate roles in therapy (the client wanted the therapist to make decisions for him). The therapist looked for a way to explain a therapist's role in the psychotherapeutic setting (that is, a therapist teaches clients skills to help solve life's problems without making the actual decisions for clients). The metaphor of"coach" came to the therapist's mind, and he explained to the client that the therapist was like a coach, teaching skills and making sure that the athlete practices. A coach, however, cannot compete for the athlete. Here, the abstract concept embodied in a familiar arena (i.e., a coach in athletics) was applied to a new arena (i.e., a therapist in therapy) to help the client understand a new concept (i.e., the therapist's role) (Muran & DiGiuseppe, 1990). Muran and DiGiuseppe (1990) have suggested several rules for constructing a psychotherapeutic metaphor for use in therapy: (a) clearly define the concept that you wish to communicate or teach; (b) attend to the client's language and search for an arena which he/she understands and has comfortably mastered; (c) search for an analogue construct in the client's arena of knowledge that includes the core elements of the concept that you wish to teach; (d) if none comes to mind, start over with a new arena about which the client has knowledge (p. 70). To illustrate the concept of metaphorical disputes, several examples are offered. A metaphorical approach w a s utilized to challenge perfec-

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tionistic goals that led the client (who inevitably failed to reach his superhuman goals), to rate and berate himself as subhuman. This was done by likening the client to Superman. With such a metaphor, the client was humorously persuaded to "hang up his cape" and accept himself as simply but realistically human. Another disputation utilizing a metaphorical style involves showing clients who procrastinate and evidence low frustration tolerance that while they think what they are avoiding is hard, it is even harder if they do not do it. Metaphorically, this was dealt with by representing difficult tasks as "weeds" in that "they grow taller, the roots grow deeper, and they spread out to ever and ever wider areas if they are not attacked when detected" (Hauck, 1980, p. 138).

The Humorous Disputational Style The final rhetorical style of disputing IBs involves the use of humor. Ellis has long advocated the use of humor (Ellis, 1977, 1985). In particular, the use of humor in RET seems particularly useful in enabling clients to put their thinking in a more realistic perspective. For example Trower, Casey and Dryden (1988) provide a helpful example where humor was used to help a client see the difference between opinions and facts. In this case the client thought he was useless because this is what someone thought of him. The therapist challenged this conclusion. To aid in the disputation, the therapist asked the client: "If I thought you were a porcupine, would that make you one?" In order to use humor effectively, there is a critical guideline that the therapist should observe. That is, never make fun of a client; joke only about the client's behavior or thoughts. Indeed, Ellis frequently isolates the thought that he is disputing before the humorous comment. He does this by careful use of pronouns to ensure that the target of the joke will always be clear and that no one could infer that the target is the client. In summary, disputations of a client's maladaptive belief can be classified by the Disputational Strategy: (Logical, Empirical, Pragmatic or Functional, and Alternative Rational Belief, and by the Rhetorical Style of Disputation: the Didactic, Socratic, Metaphorical or Humorous. This organization can be conceptualized as a 4 x 4 matrix, with four levels of Disputational Strategy, and four levels of Rhetorical Style as shown in Figure 1.

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J o u r n a l of Rational-Emotive & Cognitive-Behavior T h e r a p y

DISPUTING S T R A T E G Y Logical

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H-E

H-F

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*D-L is a logical dispute, presented in a didactic manner. **S-L is a logical dispute, presented in a socratic manner.

Figure 1 D e p i c t i o n of All P o s s i b l e C o m b i n a t i o n s of D i s p u t i n g Strategies b y R h e t o r i c a l Styles

APPLICATION OF THE FRAMEWORK TO ONE MALADAPTIVE BELIEF To demonstrate the utility of the conceptual framework, it will now be applied to a single IB of a client in therapy. The client, June is a thirty-year-old female who had been sexually molested by her father over a period of thirteen years. He began to have oral sex with her at the age of five, and intercourse at the age of eleven. She married at age eighteen, and is currently the mother of two daughters, ages five and eight. She is a recovering alcoholic, being alcohol free for the last four years.

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June entered treatment to address her depression and her anxiety. She was also experiencing flashbacks and nightmares as a result of her sexual abuse. On the basis of the clinical assessment, it was evident that June held a number of irrational beliefs. For the purpose of illustrating the application of the conceptual framework, her belief "If I were perfect, my father wouldn't have molested me" is utilized. In order to demonstrate the use of the conceptual strategy, a clinician is first instructed in DiGiuseppe's conceptual model of disputation, and then provided with a four by four grid pattern similar to the one shown in Figure 1. The individual is instructed to put the IB at the top of the Figure, and then encouraged to fill in each of the sixteen cells using the information provided in the discussion of DiGiuseppe's conceptual framework. An example of sixteen possible disputations is shown in Figure 2. As can be seen from Figure 2, there are sixteen possible disputes to the single irrational belief. Because of the seriousness of the problem, and the harshness of the behavior inflicted on the client, one has to be very cautious with the humorous disputes. The examples were included for teaching purposes, and may not have been attempted with the client, as so many other disputes were available.

EMPIRICAL EVALUATION OF THE CONCEPTUAL MODEL There have been two separate empirical evaluations of the utility of the conceptual model. The first examined the effect of the conceptual model on the production of disputes by novice RET therapists. In this study, a group of second year graduate students, who had undergone a general introduction to the RET model were requested to list all of the disputes that they could think of to counter the IB "In order to be worthwhile, I must have my husband's love." The students were allowed fifteen minutes to list as many disputes as they could. Following this, they were introduced to DiGiuseppe's conceptual model of disputation. This presentation was similar to the material presented above. After the presentation, they were presented with the 4 x 4 grid, and again requested to produce as many disputes to the belief as they could think of in a fifteen minute period. Before the conceptual model was presented, the students produced an average of 2.5 disputes. Following the presentation of the conceptual model, and the four by four conceptualization grid, the students

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Journal of Rational-Emotive & Cognitive-BehaviorTherapy

produced an average of 8.875 disputes, for an average increase of 6.375 disputes. This increase was significant as measured by a t test for repeated measures, t(7) = 8.449, p<.001, suggesting a statistically significant increase in the production of disputes, following the presentation of the conceptual framework. A second empirical evaluation of the conceptual framework looked at the change in the sense of self efficacy as a result of the presentation of the DiGiuseppe conceptual model of disputation among beginning fellows at the Institute for Rational Emotive Therapy. In this investigation, the fellows were presented a questionnaire regarding their self assessment over various aspects of the RET process. One question concerned their perception of their efficacy at generating disputes to IBs. The response to the question involved a nine point likert scale. The postdoctoral fellows were requested to fill out the questionnaire at the beginning of their fellowship. Shortly thereafter, they were given a presentation of the DiGiuseppe conceptual framework. Following the presentation, and practice on the 4 x 4 grid with their clients, they filled out the questionnaire a second time. Similar to the earlier investigation, there was a noticeable trend in the increase of the self-efficacy scores, although the trend was not statistically significant. A post hoc explanation of this outcome was that because these were beginning fellows, they had previous experience with the RET approach, and likely had some skills at developing disputes. Thus what occurred was a ceiling effect on their self-efficacy scores.

ADDITIONAL APPLICATIONS OF THE CONCEPTUAL MODEL While the most direct benefit of the conceptual model comes from its use with novice RET therapists, the conceptual model has additional benefits as well. One particularly potent benefit derives from the observation that ones ability as an RET therapist seems to be directly related to ones ability to have readily at hand, a wide variety of disputes for most irrational beliefs. One way to develop this breadth of skill is simply by trial and error in the actual therapy session. Another way to rapidly develop this skill is to simply take an IB that is particularly difficult and to systematically develop the sixteen disputes from the model when one has available time (e.g., between therapy sessions). This exercise will quite quickly result in a broad range of disputes for any particular belief.

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An additional use of the strategy lies in its use with experienced therapists. In this domain, a therapist can review several tapes from previous therapy sessions, and classify his/her disputes into the 4 x 4 conceptual format. What is often observed is that experienced therapists "drift" to preferred styles, overlooking or simply failing to use alternative disputes. Unfortunately, this approach fails to take advantage of a rich variety of disputes available. Further this strategy may result in less than optimal therapeutic results. Thus, when such a pattern is observed, the therapist may benefit by putting some effort in the development of these strategies and styles as well. SUMMARY In summary, the purpose of this paper was to demonstrate a training exercise designed to systematically develop a wide variety of separate disputes for a single IB. DiGiuseppe's conceptual framework for developing disputes was briefly summarized, and then the framework was applied to the case of a young woman who had been sexually molested in childhood. The framework produced sixteen disputes for the single belief. Additionally, data was presented demonstrating the empirical efficacy of the conceptual framework. REFERENCES Beck, A.T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books. Bernard, M. (1986). Staying rational in an irrational world. Victoria, Australia: McCulloch Publishing in association with The Macmillan Company. DiGiuseppe, R. (1991). Comprehensive cognitive disputing in RET. In M. Bernard (Ed.), Using rational-emotive therapy effectively: A practitioner's guide. New York: Plenum. Dryden, W. (1986). Vivid methods in rational-emotive therapy. In A. Ellis & R. Griger (Eds.), Handbook of Rational-Emotive Therapy (vol. II, pp. 221-245). New York: Springer Publications. Ellis, A.E. (1962). Reason and Emotion in Psychotherapy. Secaucus, NJ: Lyle Stuart. Ellis, A.E. (1973). Humanistic psychotherapy: The rational-emotive approach. New York: McGraw-Hill Ellis, A.E. (1977). Fun as psychotherapy. Rational Living. 12(1), 2-6. Ellis, A.E. (1985). Overcoming resistance: Rational-emotive therapy with difficult clients. New York: Springer. Ellis, A.E. (1989a). Comments on my critics. In M. Bernard & R. DiGiuseppe

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(Eds.), Inside rational-emotive therapy: A critical appraisal of the theory and therapy of Albert Ellis. San Diego, CA: Academic Press. Ellis, A.E. (1989b, June): Is rational-emotive therapy "rationalist" or "constructivist"? Paper presented at the World Congress of Cognitive Therapy, Oxford, England: Hauck, P.A. (1980). Brief counseling with RET. Philadelphia, PA: The Westminster Press. Guidano, V.F., & Liotti, G. (1983). The cognitive processes and emotional disorders. New York: Guilford. Kuhn, T. (1970). The structure of scientific revolutions. (2nd ed.) Chicago: University of Chicago Press. Lazarus, A.A. (1989). The practice of rational emotive therapy. In M.E. Bernard and R. DiGiuseppe (Eds.), Inside rational-emotive therapy: A critical appraisal of the theory and therapy of Albert Ellis. San Diego, CA: Academic Press. Muran, J.C., & DiGiuseppe, R.A. (1990). Towards a cognitive formulation of metaphor in psychotherapy. Clinical Psychological Review. 10, 69-85. Trower, P., Casey, A., & Dryden, W. (1989). Cognitive-behavioral Counsellinq in Action. Beverly Hills, CA: Sage Publications. Walen, S., DiGiuseppe, R., & Wessler, R. (1980). The practitioner's guide to rational-emotive therapy. New York: Oxford University Press. Wessler, R.A., & Wessler, R.L. (1980). The practice and principles of rationalemotive therapy. San Francisco: Jossey-Bass.