Structuring sessions and asking for problems to work on
I was trained by Dr Al Raitt as an REBT Therapist, and Al had been taught by Dr Albert Ellis, in New York City, so
his system was very close to the original system. This is the approximate structure he taught me to apply to each session
with a client (though he might have recommended 11 stages!):
1a. If this is not the first session, then check up on how the client got on with their between-session assignments
(which are sometimes called Homework).
1b. Ask for a (new) problem,
and formulate it in terms of an 'A' and a 'C' (or an Activating event and an emotional Consequence).
2. Ask for a recent example of this problem arising
in the client's life.
3. Ask for the client's goal for dealing
with this problem.
4. Assess the 'A' to see what is it precisely
about the Activating event that is causing this person/client to think irrationally, and to have consequent disturbed emotions.
(This is called looking for the 'Critical A').
5. Assess the
'C', to make sure it is indeed an overly upset emotion (like anger, anxiety or depression) and not a reasonable upset (like
irritation, concern or sadness).
6. Then teach the client the
connection between the 'B' and the 'C'; because the client probably has an A>C model of human disturbance. That is
to say, the client does not factor any kind of 'B's into their understanding of their disturbance.
7. Debate and dispute the client's obvious irrational beliefs, by teaching them about
the distinction between rational and irrational beliefs, and helping them to see the flaws in the irrational beliefs, such
as "I must be loved and approved by all significant others, otherwise life is not worth living!"
8. Link the client's irrational beliefs to their emotional consequences, and show
them why it is important to change the irrational beliefs in order to change their emotional consequences.
9. With the client's participation, develop a New Effective Philosophy for the client
to apply in between-session assignments and activities.
In
New York City at that time (1998-99) they were using a 12 stage session structure, very similar in most respects to this 9
stage structure. I went on to develop my own structure, which got up to 16 stages at one point, and I then boiled it
down again to 9 stages.
I experimented with this structure for
about nine years. It is very unusual to be able to apply it as it stands, because every client is different, and each
client comes with their own agenda. Inevitably, in the process of working democratically with the client, unique session
structures emerge. Nevertheless, this kind of structure, outlined above, is a very useful target for new REBT therapists
to aim to apply to every session. In practice, different bits of the structure may occur in a different order, and some
bits may get more emphasis at some sessions than at others. But it is helpful to have an "ideal structure"
for which you are aiming.
Eventually, as I began to develop more
into a CENT therapist, I began to use three models at each session, as follows:
| The ABC Model (from REBT) | The WDEP Model (from Reality Therapy) | The
RCFF Model (from Impact Therapy) |
| Check Homework | W = What do you Want? | R = Develop Rapport with the
client. |
| Ask for a new problem in terms of an A and a C, and the client's
Goal. | D = What are you Doing to get what you want? | C = Establish a Contract with the client. |
| Assess the
A and the C | E = Help the client to Evaluate how well they are doing in pursuing
their goal. | F = Focus on a specific problem to work on. |
| Teach, or review, the B>C connection. | P = Help the
client to formulate a new Plan. | F = Funnelling - which means trying to go deeper
into the problem, rather than staying on the surface. |
| Debate, dispute
the client's IB's, and help them to develop a new Effective philosophy. | | |
The model that emerged as the
structure of each session would be a mixture of these three models, depending upon how my encounters with the client developed,
organically.
Later still, I developed a whole new approach to structuring
sessions, which is described on the 'What is CENT?' page.
~~~