The Case of Margarita



The Case of Margarita

Capella University

Renee Bynum

Abstract

This paper addresses the case of Margarita who is dealing with anger and depression. Her history and present issues will be examined using rational emotive behavior therapy (REBT). Included is the history and key concepts of REBT in addition to it’s limitations. REBT will be applied to Margarita’s case using specific interventions that are unique to her case. This paper aims to provide the reader with the application of REBT using a specific case study.

Introduction

Rational emotive behavioral therapy (REBT) created by Albert Ellis in the 1950’s is a form of psychotherapy and philosophy of living. Albert Ellis was an American psychologist who received his M.A. and PH. D. from Columbia University and founded the Albert Ellis institute located in New York City (Byrne). Ellis’ rational emotive behavior therapy (REBT) was one of the first cognitive therapies created and is still a widely used and effective approach today (Corey, 2009). REBT therapy is based on the assumption that people contribute to their own psychological problems by the way they interpret events in their lives (Corey, 2009). People are born with the ability for both irrational and rational thinking stemming from childhood interactions.

View of human nature

Rational emotive behavior therapy assumptions are that people strive to live happily and seek pleasure with tendencies towards having the ability for both rational and irrational thinking which is affected by their culture and biological factors (Wilde, 2004). As stated by Donnell, “Ellis believes that human beings tend naturally to perpetuate their problems and have a strong innate tendency to cling to self-defeating, habitual patterns, thereby resisting basic change” (2004). REBT aims to help people to become more accepting of both their achievements and faults (Corey, 2009).

Rational Emotive Behavioral Theory

REBT theory identifies blame as being at the core of these emotional disturbances that create, “dogmatic and absolutist demands and commands—shoulds, musts, have tos and got tos—which can lead to illogical conclusions such as: I am worthless; it’s awful; I can’t stand it”. (Jenkins & Palmer, 2003). It is stated by Dryden that REBT argues that these extreme beliefs stem from rigid beliefs, which are the core of irrational thinking patterns (Dryden, 2008). In order for change to occur with a client it is crucial that they begin to recognize how these self-defeating thoughts are negatively affecting them and stop blaming themselves and others. REBT stresses the importance of accepting oneself and others as a beginning step to changing the thoughts and views about themselves and others. Ellis developed an A-B-C framework in which to understand a client’s thinking, emotions, events and behavior. This theoretical framework states that (A) the activating event contributes to the (C) emotional and behavioral consequences, which is either healthy or unhealthy were the individual (D) disputes these beliefs and learns to replace them with more rational ways of thinking (E) through adaptive, and rational beliefs, by providing a positive impact on their emotional, cognitive and behavioral responses and replacing the irrational beliefs of the client to more rational ways of thinking (Szentagotai & Kallay, 2006).

Goals

It is crucial to first identify goals that are realistic for the client in order to achieve these goals and be successful in changing their current situation. The therapist will help the client to identify between realistic and unrealistic goals that will help them to learn to be more accepting and unconditional accepting towards themselves and others (Corey, 200) A basic goal of REBT is to change irrational ways of thinking and behaving to one’s that are more healthy (Corey, 2009).

Interventions

Rational emotive behavior therapy is an educational process in which the therapist assists the client in identifying and defeating their irrational ways of thinking and behaving. The interventions in REBT are solution-based that focuses on learning unconditional acceptance of self and others. In learning self-acceptance, one is able to learn to accept others as well. REBT interventions are tailored methods that consist of cognitive, imagery, emotive, interpersonal and behavioral techniques in order to address the individual needs of the client (Corey, 2009). In utilizing the cognitive methods of REBT, the use of irrational thinking is challenged through disputing and helping the client to learn to challenge their own thoughts. This cognitive method may consist of homework that consists of taking risks and put themselves in uncomfortable situations that challenge their irrational thinking in order to diminish or desensitize the client to these situations. The client will educated themselves through materials that will encourage them to challenge this negative self-talk in which learn new rational ways of thinking (Neenan & Dryden, 2010). Emotive techniques consist of imagery, using humor, shame-attacking exercises, and role-playing. Imagery helps the client envision how they would like to feel and behave in situations in an attempt to diminish the irrational thoughts and learning new ways of behaving through intense imagery exercises. Using humor can help the therapist and client to be more accepting of the situations that cannot be changed and changing the perspective of their life in a more rational way. When clients do not take themselves too seriously they are able to avoid the anxiety that accompanies it. In role-playing the therapist help the client to identify the thoughts that assist in creating irrational ways of thinking, focusing on working through these feelings that are unpleasant and replacing them with healthier ways of thinking (Corey, 2009). Shame-attacking exercises allows for teaching of self-accepting ways of their behavior by minimizing the shame that has occurred over certain behaviors. Behavioral techniques may consist of homework in which they can utilize their new skills in different situations and well as self-management, relaxation and modeling techniques in a concrete way.

Therapeutic relationship

The relationship between the therapist and client is one of student and teacher in which they collaborate in order for the therapist to teach REBT theory to the client in that they will continue after the counseling is ended. In utilizing REBT therapy, the client needs to accept that they are the reason to their emotional disturbances and work towards helping themselves both in and out of therapy as it is essential to their success (Connell, 2004). Ellis (1983) also identified traits such as stubbornness, anger and rebelliousness as being detrimental to the client benefitting from REBT therapy.

Role of therapist

As a REBT therapist, it is important to be well supervised and trained in REBT theory if therapy is to be effective. The therapist is identified by Ellis as a teacher in which the therapeutic relationship is crucial. It is important that the professional avoid a warm personal relationship, as this will not work with those who utilize REBT theory (Mcleod, 2008). The therapist needs to be aware of their effect on the client and make sure that their values are not imposed on the client. In regards to cultural limitations this therapy is a confrontational style which may be to forceful in some cultural so it is essential that the therapist modify their style to a more gentle approach in order to modify to the client’s needs (Corey, 2009).

Case Study: Margarita

The therapeutic process will consist of cognitive methods, in combination with emotional and behavioral techniques. In Margarita’s case she struggles with anger, anxiety and depression, which is negatively affecting her relationship with her family and developing of friendships. Margarita has expressed that she is often depressed although when she is working is able to suppress those feelings and behaviors in order to be professional at work. She states she sometimes feels so angry that she thinks about hurting her husband, but has never done anything physical as of yet. She stated that although she feels confident in her working environment she feels anxious when in social situations.

Cognitive methods

The first step in the therapeutic process is for the therapist and Margarita to explore her distorted feelings that are connected to her thoughts and behaviors that are contributing to her depression and anxiety (Corey, 2009). Margarita will initially need to identify her problems and take responsibility for her behaviors associated with the continuation of these problems. Once Margarita is able to identify what the problems are she will begin to dispute her rational thoughts with the help of the therapist by evaluating other reasons to why events in her life have happened. This questioning will allow Margarita to identify her problems in behavioral terms, which will allow her to separate herself from her behavior giving her more control over the situation. The therapist will give Margarita homework that will consist of putting her in real life situations to allow for continued work on disputing irrational ways of thinking. Margarita has stated that public interactions are bothersome due to her thoughts of being judged. The therapist will ask Margarita to go to a public place and begin to become aware of her self-defeating thoughts in which she will begin to challenge by questioning them. Margarita may hear herself saying, “I look awful, everyone is staring at me”. This will allow her to begin to reframe her ways of thinking by asking, “It’s ok if I don’t look perfect, no one seems to care or notice”. By allowing herself to identify more realistic ideas in her self-talk will allow her to begin to think differently thus prophecy of not seeing others staring at her will allow her to have less focus on people glancing at her as they walk by. Margarita’s use of rational thinking will enable her some control during situations that she is in and will allow her to begin to use more self-accepting self-talk which will decrease her anxiety during future situations.

Emotive techniques

The second intervention will be the use of imagery where Margarita will imagine herself the way she would like to be in real life in her thoughts, feelings and behaviors (Corey, 2009). The therapist will explore how Margarita would image herself in public situations and allow her to envision how it would be to have more rational thoughts and feelings, which will contribute to her future behaviors during these situations. Imagery will allow her to experience feelings associated with how she ideally sees herself. She will also explore one of the worst incidents happening to her so that she may experience the intense feelings with some direction from the therapist to begin to use techniques in disputing those irrational thoughts and feelings allowing her to separate herself from her behaviors. This separation of feelings and behaviors will allow Margarita to find a new sense of control over the negative thinking that occurs during these situations. During this role play humor will enable Margarita to identify a new perspective through exaggeration of her thoughts and feelings In addition, the therapist may challenge Margarita to engage in reverse role-play by adhering to her self-defeating thoughts in order to encourage her to forcefully debate them (Corey, 2009). Exercises in shame-provoking situations will allow Margarita to find out that her behaviors are not that interesting to other people. One specific exercise for Margarita will be for her to go out in public without doing her hair, which will provoke undesirable feelings allowing her to work on self-acceptance.

Behavioral Techniques

Behavioral techniques consist of operant conditioning, self-management, systemic desensitization, relaxation techniques, and modeling (Corey, 2009).

In is important that Margarita learn some relaxation techniques in order to help her to learn ways to stay calm in certain situations as to avoid her angry outbursts with her husband. Margarita will begin to use systemic desensitization in combination of her imagery by taking a situation and putting her anxiety into levels of low to high and taking each step one at a time and confronting those feelings, which will eventually lead to decreasing her anxiety associated with the situation. During the learning process of desensitization, Margarita will learn ways to decrease her anxiety levels, which can be used in other situations as well.

Relaxation techniques can be beneficial in the area of anxiety as it can help to lessen the effects it has on a person and can help them to stay calm during situation that may have otherwise caused high levels of anxiety. Margarita would benefit from yoga as it can help to relieve stress and help her to learn to focus using breathing methods during times of stress.

Reading to re-educate is an important aspect in which Margarita will be able to review literature that will aid in helping her to learn ways to accept herself and change her irrational ways of thinking.

Limitations

In utilizing REBT therapy with Margarita her cultural background will need to be considered as this is a direct in which client may feel is to forceful, which is why it will be crucial to the therapeutic relationship to explain how REBT works with the client. Margarita is a Puerto Rican immigrant who is in a biracial relationship so it will be crucial that the therapist understand about her cultural and familial background in order to modify REBT techniques to work with her unique set of circumstances. It is important that the therapist understand their amount of power in this relationship in order to prevent misuse of it with the client. Ellis’ REBT therapy limits exploration of the client’s past as being “ineffective” (Corey) to the client’s change. Spiritual dimension is lacking in that Ellis did not consider as he considered it to consist of rigid types of beliefs (Corey, 2009).

Conclusion

In Margarita’s case, rational emotive behavior therapy can be utilized in helping her to deal with her irrational thought patterns that contribute to her anxiety and depression that ultimately leads to bouts of anger. In utilizing the interventions Margarita will learn to challenge her irrational thoughts through working on cognitive, emotive and behavioral techniques directed towards identifying distorted self-views in order to educate her on ways to change it to one that is more rational and healthy.

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