Behaviour Therapy Case Study
Thomas is a 33 year old married man, who has recently become a father. He explains that he feels his self-esteem has been gradually deteriorating ever since he was married. He says that he can’t find reasons to enjoy life with his wife due to feelings of inadequacy as a husband.
In his new role as a father, Thomas had hoped to find the happiness that he was looking for; however this has not been the case. He mentions that his relationship with his wife’s family is strained and thinks that this is the root of his problem. In this scenario, the Professional Counsellor will be using a Rational Emotive Behavioural approach with Thomas.
For ease of writing the Professional Counsellor is abbreviated to “C”.
Thomas was married 4 years ago to Helen. They met after leaving school and have been in a continuous relationship since that time. Thomas describes his relationship with Helen as a strong friendship, but also explains that they have experienced recurring problems in their relationship.
Thomas feels that the main problem is the interference of Helen’s family in their partnership. Helen has had a close relationship with her mother and father and had been living with them up until 5 years ago. Neither Helen’s mother or father approved of her relationship with Thomas, since their first meeting. Thomas is at a loss to explain their disapproval of him, and it appears that he has tried in many ways, to gain their respect.
Initially Helen was hesitant to continue a relationship with Thomas, due to her parent’s strong reaction to him. At times they even carried on their relationship in secret to avoid her parent’s reaction. It became more apparent to them that they would eventually have to overlook Helen’s parents’ opinions of their relationship and follow their own wishes.
Finally, Helen and Thomas moved into their own apartment and became engaged to be married. Since becoming married and having their first child, Thomas has continued to extend himself to great personal lengths to maintain any of his parents-in-law’s support. It is his belief that if he extends himself enough, that they will come to love him as much as they love their daughter.
He finds this position very demanding. Of particular difficulty is that Helen’s parents expect to be visited on a weekly basis, by their daughter and new grandchild. These weekly meetings are very draining for Thomas as his parents-in-law are still openly critical of him. At best, he says, they ignore him. In these situations, he finds that Helen is quite passive, though she tells him that she wishes her parents were less critical. Helen has said to him that it is usually best to just let them have their way, and this appears to reflect her pattern of coping with the situation.
“C” firstly aims to assist Thomas to understand his feelings and beliefs about the current difficulties. They discuss Thomas’s beliefs and feelings about his relationship with his wife and parents-in-law. It appears that for a long time Thomas has held the belief that if he just tries hard enough, Helen’s parents will stop their criticism and come to respect him. He also thinks that without their approval, he will never completely gain the full respect of his wife.
“C” used humour to begin to challenge Thomas about his views. The use of humour in REBT is a strategy to reduce the importance and value that clients place on certain irrational beliefs. This strategy does need to be balanced with sensitivity and timing, to ensure clients do not become offended by the counsellor’s use of humour. Humour is most effective when the client is also able to enter into the joke and it shouldn’t be used to belittle the client or their feelings.
“Thomas it seems to me that you have been seeking the approval of these people, since the first day that you met them. In that time you have been ignored, belittled, backstabbed and denied respect. Even after your public declaration of love to their daughter, their behaviour towards you has not changed. Under these trying circumstances, I must congratulate you on your undying loyalty to your wife and her family!”
Thomas reacted well to the humour and responded with a joke about his wedding vows, “On my wedding day, I never realised that I also had to love, honour and cherish my wife’s mother and father!”
“I am absolutely certain that you never would have vowed that on your wedding day. After all, a marriage is the unity of only two people”, replied “C”. “This leads me to wonder about your reasons for continuing to appease Helen’s parents, in what appears to be beyond the call of duty and in the face of such adversity.”
Thomas responded to “C’s” confrontation. “I’ve always felt this need for their approval. To me, it is all wrapped up in my role as a husband. It is my duty to be a good son-in-law and I’ve just hoped that they’ll come to accept me in time.”
“C” asked Thomas about how he would prefer to be treated by his parents-in-law. Thomas replied that he wanted a friendship with his new family and to be respected by them. He wanted them to be less pushy and more cooperative with himself and Helen.
“C” spent some time then explaining the nature of irrational beliefs with Thomas. “Due to certain learning experiences in our lives, we come to accept certain beliefs about ourselves and others. These beliefs may be inappropriate for us if they don’t allow us to realise happiness or acceptance of the disappointments in life. Our beliefs are reinforced by particular thoughts that we should behave in certain ways.
If our thoughts and behaviours are more concerned with the welfare of others, rather than ourselves, this can lead to lowered self-esteem and further self-condemnation. The task that all of us face at sometime, is to realise that some of our thoughts and behaviours are not healthy and to replace these with more self-appreciating thoughts and behaviours.”
From this discussion, Thomas came to understand that he had control over his own beliefs and therefore, control over his behaviour and a chance to improve his self-esteem. The first step, “C” explained, was to identify the irrational beliefs that were controlling his life. The irrational beliefs that “C” and Thomas identified are listed below:
- “I must have the respect of my parents-in-law”.
- “It is my duty as a good son-in-law and husband to meet the approval of my wife’s parents”.
- “My wife will never completely respect me if her parents do not respect me”.
- “If I keep trying, they’ll eventually accept me”.
- “My need for happiness is secondary to the needs of my in-laws”.
“C” said, “Thomas, you said before that you want Helen’s parents to be less pushy and more respectful of you. I would challenge you that these are preferences that you have, which you have little personal control over. You cannot expect to change another’s behaviour. Instead I would like you to think about your own behaviours and how you might have more control of them, by changing your irrational beliefs. We can do this through a process of debate, where we weigh up the pros and cons of your beliefs”
“C” began the debate by challenging Thomas about his beliefs through a series of questions. “Why do you need your parent’s-in-law approval to be a good son in law? What constitutes good parents-in-laws? If you had a son-in-law, how would you treat him? At what point do parents need to reduce their control of their children? Do you expect to be meeting your parents-in-laws demands for the rest of your married life? Where did you learn that you have a duty to obey Helen’s parent’s wishes?”
Through open debate and discussion of these questions, Thomas was able to view his irrational beliefs from different angles. He was able to see how his belief impacted on his own well being, and that his future happiness was dependent on his ability to change his belief and subsequent behaviours.
The next step involved identifying and constructing new, more appropriate beliefs with Thomas. “C” encouraged Thomas to rethink alternatives to the irrational thoughts that he identified earlier. Instead of the belief, “I must have the respect of my in-laws,” Thomas was encouraged to rephrase this as a preference. “I would like to have the respect of my in-laws.” To this belief he also added some other preferences such as “I would like to be able to respect my in-laws in return.” Other modified beliefs for Thomas included:
- “It is not my duty as a son-in-law to accept personal criticism or being ignored”.
- “It is my duty to be respectful of my wife’s family, though not to the point of sacrificing my happiness”.
- “My wife respects me as her husband and partner”.
- “My wife’s love is not determined by the influence of her parents”.
- “My wife and I have the right to determine how we will be involved in the life of our families”.
- “My priorities for happiness begin with myself, my wife and my son”.
- “I accept that my in-laws may never accept me for who I am”.
“C” and Thomas also listed behaviours that could increase his personal happiness and reflect his new beliefs about himself:
- Personally invite his parents-in-law around for visits, instead of visiting them.
- Address any demands from parents as requests and notify them that the matter will be discussed by Helen and himself in private. With Helen, redefine boundaries between couple issues and family issues. For example, discuss the amount of time that should be spent with various family members.
- Expect parents to be more respectful of him and do not tolerate criticism. Determine the consequences if this behaviour is not forthcoming, ie: politely leaving, hanging up the phone or ending conversations if no respect is shown to him. Encourage ways in which Helen could also expect more respect from her parents.
- Discuss his personal changes with Helen and talk about the implication of these for both of them.
In summary of the session, “C” expressed enthusiasm at Thomas’s willingness to explore his irrational thoughts and self-condemning behaviours. “C” recommended a further discussion of Thomas’s self-statements and establishment of a program of behaviour change, structured on his new beliefs.
For homework, Thomas was required to identify other problems and self-defeating beliefs that were affecting his life. For each of these, he needed to challenge their rationality and record these thoughts in a personal log book. The log book would act as an inventory of all of Thomas’s irrational thoughts and beliefs. He could refer to this book as a reminder to himself of the beliefs that he was challenging.
“C” also suggested that he could begin to identify more appropriate thoughts to supplement his irrational thoughts and record these in his log book. “C” highlighted to Thomas that disputing irrational beliefs was something that required practice and to not expect this to happen automatically.
Thomas also suggested inviting Helen to take part in counselling with him, so that she would be more aware of his new beliefs and for them to discuss mutual strategies for managing their family problems.
At the end of the session, “C” reminded Thomas of the presence of irrational and self-defeating beliefs that he holds and how these impact on his opportunity for personal happiness and self-confidence. The challenge for Thomas was to continue to become more aware of the presence of self-defeating beliefs in his life and to energetically replace these with more personally satisfying thoughts.
End of Session
Some points to consider with Rational Emotive Behaviour Therapy are as follows:
People have the capacity for rational and irrational thoughts and beliefs. Irrational beliefs can also be described as absolutistic cognition’s. Absolutistic cognitions by nature demand that certain situations or behaviours should, or must occur in order to meet certain standards that the client believes to be necessary.
REBT proposes that humans are fallible and imperfect and endeavours to help clients realise and accept their fallibility and construct more satisfying thoughts and beliefs. We often seek counselling due to the consequences that we are experiencing because of our irrational thoughts and beliefs.
The focus of REBT is to help the client to understand the connection between their irrational beliefs and their present problem. The counsellor aims to expose the irrational and self-destructive beliefs and to challenge their value to the client. For example, if a client thinks that they need the approval of everyone around them, then the REBT therapist will identify this belief and dispute the client’s reasons for holding this belief.
Once exposed, the therapist and client can then work towards identifying more appropriate and rational beliefs. From these beliefs it is hoped that new feelings and thoughts will arise for the client. This process is known as the ABC theory of personality where:
(a) The activating event or stimulus, paired with the
(b) belief about the activating event, causes a
(c) consequence (the emotional and behavioural response)
(d) is the disputing intervention that is introduced to change the (b) belief. After which a new
(e) effect (more appropriate belief) becomes associated with the original (a) activating event. Lastly new
(f) feelings arise which are associated with the new beliefs about ourselves.
The methods involved in REBT include:
- Disputing irrational beliefs in a systematic and logical way.
- Changing one’s language from shoulds, oughts and musts to preferences.
- Using humour to reduce the exaggerated effects of irrational thoughts and beliefs.
- Doing cognitive homework to identify absolutistic beliefs behind their problem. This can include assignments to observe their self-fulfilling prophesies, reading self-help books and listening to tapes of earlier counselling sessions to critique their original self-defeating beliefs.
- Using modelling and role play in the session to encourage the client’s use of more rational thoughts and beliefs.
Author: Jane Barry
Changing Amy's Behaviors
In order to change Amy's behaviors, her team must know what Amy is doing that distracts her own learning process which is defined below:
- What the IEP team knows is that Amy is repeating the acting out and being off task because those behaviors are serving a purpose leading to some reward that Amy sees as gratifying and a positive outcome in response to the behavior.
- Amy's grades are mediocre because she can't complete assignments, yet she continues to get massive amounts of attention from Ms. Ames and Mr. George who interact with her daily to deal with the discipline referrals that say the same thing, "Disruptive Behavior-Amy acts out in class."
- Amy appears gleeful when she is asked about the high number of referrals and the attention she gets from everyone including a new Psychologist trying to figure out how to provide behavioral therapy specifics to her team.
Knowing that Amy's behavior serves the function of getting attention and interaction from adults in her life, the new Psychologist provides the team and his new client with strategies to change her behavior and still get the attention and adult interaction, she so craves in her life.
- Amy is now journaling her daily student and adult interactions in a reflective journal that she shares with her psychologist and Ms. Ames.
- The additional time that she spends with them both has provided a new outlet for attention and a redirection of old behaviors into new positive behaviors in the classroom.
Changing Amy's behaviors required the specifics of the behavior and the application of behavioral therapies to address the required behaviors.