Counselling In Mental Health Nursing For Rational Emotive Behavioural Therapy

Critically Analysing the use of the Intervention…

Discuss about the Counselling In Mental Health Nursing for Rational Emotive Behavioural Therapy.

The 21^st century is expected as an era of accelerated mental health retardation and disorder due to growing complexities, development issues, psychological issues creating a lack of peace and harmony in life. This retarded mental health status requires effective psychological interventions and treatments for improvement. Some of the exceptional counselling skills, approaches and interventions hold a promising control over these accelerated mental health issues. One such counselling intervention is Rational Emotive Behavioural Therapy (REBT) developed by Albert Ellis. This REBT intervention is one of the most successful cognitive behaviour therapy (CBT) that holds a promising future (Jarvis, 2012).

This study focuses on analysing REBT intervention effectiveness as a good psychotherapy measure to control the hazardous mental health issues in contemporary situations. The study involves a detailed analysis of therapeutic strengths and limitations of this intervention followed by determination of sensitive factors that manage the counselling practice related to REBT intervention. A detailed note is provided about the implementation of REBT in future mental health practice to understand the importance of this psychotherapy. 

On the basis of behavioural and emotional outcomes of cognitive processes this Rational Emotive Behaviour Therapy (REBT) works to achieve rationality in thinking, feeling and behaving by modifying these cognitive processes. This REBT intervention works by following the basic concept of Cognitive Behavioural Therapy (CBT) where emphasise is made to change or eliminate irrational views, beliefs and thoughts causing distress. However, REBT is different from other CBT by focussing more on the elimination of irrational behaviour and emotions rather than only improving the rational behaviour and emotions (Shilling, 2012).

According to Ellis and Ellis (2013), REBT theoretical concept indicates that not the practical trauma or incidence but the emotional beliefs and thought process that causes distress. As per REBT principles, irrational behaviour includes feeling of anger for predicted situation or trauma, feeling of unrealistic expectations, communicating emotions overdramatically etc. whereas rational behaviour included logical and practical thinking over an unexpected situation. Further, Hyland and Boduszek (2012) indicated that strength of REBT is in its straightforward approaches and simplicity. This therapy is based on ABC model, which works to let people understand their phenomenon of thoughts, feelings and behaviours. In this model ‘A’ stand for an activating event, ‘B’ involves beliefs and attitudes (rational and irrational) and ‘C’ indicates consequences (emotional and behavioural) for an activating event. The therapist uses this model to logically identify the thought process, irrational and rational thinking and the outcomes of any activating incidence to implement the therapy.

Identifying and Discussing Racial, Cultural, Religious and Gender Sensitivity Needed on the Part of the Counsellor / Therapist for your Particular Intervention

Ajzen (2011) mentioned an example of a therapist using ABC model for implementing REBT intervention to cure a student whose failed an examination and developed the feeling of worthiness and lack of intelligence. The therapist interrupted the thought process by stating that poor grades are always the outcome of lacking preparation rather than lacking intelligence and worth. In support, Dodding et al. (2008) indicated that REBT intervention consider the development process as a major part of therapy making it an effective therapy for children as well as youth. The educational style, direct approach and pragmatism basis help to develop a practical treatment rather than believing it as a simple therapy.

Durlak et al. (2011) highlighted another strength of this therapy that involves elimination of judgemental and moral viewpoint from the therapeutic process. The counsellors or therapist won’t judge the vulnerable act or incidence or feelings as good or bad rather they will only work to develop rationality as per REBT principles. According to Ivey, Ivey and Zalaquett (2014) REBT processes unconditional acceptance of self and elimination of criticism about self from the though process, which becomes the unique feature of this therapy. Further, REBT works to enhance self-worth, confidence, optimism and rationality in way of life. These potential features are very much workable for teenage and childhood vulnerable. Ellis and Ellis (2013) also assured in their study that REPT is a very effective intervention for children and teenagers because the strategies of therapy are based on developing the quality that supports optimistic development.

Dilworth et al. (2013) indicated that REBT is a self-development therapy where vulnerable develop the potential to help themselves. Hyland and Boduszek (2012) proved in their study that REBT carries low relapse rate when compared with other therapies and medication. Further, the time duration and therapeutic goals of REBT are very short and concise achieved within 10 to 20 sessions.

However, in contrast, Ajzen (2011) stated that along with potential strengths this REBT intervention also persists certain limitation like therapy possess the capability of reproducing individual conscious in a wrong manner by other vulnerable in a group. In the study of Ellis and Ellis (2013) on the basis of observation, it is stated that group REBT intervention creates a jumble of irrational and rational thinking process where generally the vulnerable selects wrong pathway to work upon their mental issues. Therefore, group intervention REBT is a huge failure. Another noticeable limitation of this therapy is its confrontation process where the vulnerable has to confront with their feelings, emotions, thoughts and cognition in front of the therapist. Generally, people suffering mental health issue don’t persist that much calibre and strength to face their own psychology and they may develop a feeling of fear, anger or ignorance in response (Kazdin, 2012). These are the strength and limitations of REBT intervention that structures it as a potential nursing intervention. 

For providing any therapeutic intervention with the counsellor, nurse or therapist needs to follow certain ethics, laws, regulations and rights to balance the act of treatment. There are certain sensitive factors that require special attention while providing REBT intervention because unlike other psychotherapies, REBT involves a clear confrontation of vulnerable and their trauma (Dryden & Neenan, 2014).

According to Hyland and Boduszek (2012), any therapist practising REBT needs to develop a multicultural counselling competency because many of the vulnerable of trauma or mental disorder belong to the ethnic minority group. With the intention to work effectively, it is essential for the counsellor to know the importance of culture in lives of people and determine the culturally based differences to address them in the treatment process. The culture of people defines their attitude, behaviour, spirituality, symbolism and beliefs. Therefore, to implement rationality in the emotions and behaviours as a part of REBT intervention the counsellor must perform with multicultural competency to provide effective treatment. The cultural differences in a therapist-client relationship may develop hurdles in communication styles, languages and perceptions. However, multicultural competency can help to overrule these issues in intervention practices.

Further, Ajzen (2011) indicated that REBT counselling approaches should set gender aware counselling goals to address the gender sensitivity issue. Some of the counselling processes involve both the female and male partners while implementing REBT intervention while dealing with marital conflict, divorce or separation. Francis (2014) indicated that feminist counselling approach should be adopted to deal with women patient in REBT counselling. This feminist counselling process aims to provide self-confidence, empathy and control over the life that is required to overcome the low self-esteem, losing hope and worthlessness in women patient. Ellis and Ellis (2013) studied about the men counselling approaches required in REPT intervention to address the men issues and problems related to irrational thinking of life. The male suffering psychological issues only require the development of positivity in their life. However, not much study is performed to address the psychological issues of men. But, as per Hyland and Boduszek (2012) five principles addressing men counselling involves pluralism, external importance, and control over domination, democratic relationship and value of individuality. On the basis of these principles, the REBT counselling becomes more user-friendly towards male vulnerable as well.

Further, Durlak et al. (2011) studied that REBT counsellors need to deal with the diversity of racial and religious population to provide treatment. Therefore, this diversified REBT counselling involves the use of skilled client model to meet the sensitive needs of different client groups. There are three stages of this model that involves relating stage, understanding stage and changing stage. In the relating stage, counsellor tries to understand client’s religion, practices and culture as a form of pre-counselling data. In the understanding stage, the therapist tries to focus on understanding the cultural, social and community factors that are creating suffering and irrationality. Lastly, in changing stage, counsellor tries to improve the identified defects in mind, communication, attitude and behaviour of vulnerable. 

According to Dal Santo et al. (2014) the Rational Emotive Behavioural Therapy is a single therapy workable for different mental health issues like posttraumatic stress disorder, depression, anxiety etc. further, it is also workable for non-clinical problems like social skills, stress management, career changes, relationships etc. as a counselling technique. Hence, future of medical science persists a promising approach from REBT intervention as this therapy aims to provide mental health and wellness to develop healthy mind and body.

Durlak et al. (2011) indicated that REBT is a “Smart Recovery” therapy where the emphasis is to forget the past rather than holding back the distress and trauma. The REBT is also used as rational effective training in educational, business and work settings to practice SMART recovery (Self Management and Recovery Training) along with various other specialised strategies to let people develop mental health. Ellis and Ellis (2013) studied that REBT also involves implementation through various resources like phone, workshops, internet counselling, educational programs and seminars, which makes it future of psychotherapy and counselling process.

Conclusion

The Rational Emotive Behavioural therapy (REBT) is an effective and workable intervention to provide mental health and wellness. This therapy-based intervention is meant to overcome irrationality from though process implementing rational thinking, emotion, behaviour and attitude. The intervention follows ABC model for treatment of mental disorder. Along with remarkable strengths, this intervention posseses certain minor limitations but these limitations cannot overrule its effectiveness. Further, REBT is workable therapy for different mental illnesses like depression, anxiety, PTSD etc. that are becoming major concern of contemporary society.

The therapist and counsellor practising REBT interventions need to practice multicultural counselling, gender awareness, feminist counselling for women and rationalised counselling for males. The therapists use skilled client model to address the needs of the diverse population in this intervention. Lastly, REBT intervention promises a brighter future of psychotherapy promoting mental health and wellness.

References 

Books

Dryden, W., & Neenan, M. 2014. Rational emotive behaviour therapy: 100 key points and techniques. United Kingdom: Routledge. 

Jarvis, P. 2012. Towards a comprehensive theory of human learning (Vol. 1). United Kingdom: Routledge. 

Kazdin, A. E. 2012. Behavior modification in applied settings. United States: Waveland Press. 

Shilling, C. 2012. The body and social theory. California: Sage. 

Ivey, AE, Ivey, MB & Zalaquett, CP 2014, chapter 5 ‘Questions: opening communication’, in Intentional interviewing and counseling: facilitating client development in a multicultural society, 8th edn, Thomson Brooks/Cole Publishing Company, California, pp. 117-137. 

Journals

Ajzen, I. 2011. The theory of planned behaviour: reactions and reflections. Psychology & health, vol. 26, no. 9, pp. 1113-1127. 

Dal Santo, L., Pohl, S., Saiani, L., & Battistelli, A., 2014. Empathy in the emotional interactions with patients. Is it positive for nurses too? Journal of Nursing Education and Practice. vol. 4, no. 2, pp. 74-81. 

Dilworth, S., Higgins, I., Parker, V., Kelly, B., & Turner, J. 2013. Finding a way forward: A literature review on the current debates around clinical supervision. Contemporary nurse, vol. 45, no. 1, pp. 22-32.

Dodding, C., Nasel, D., Murphy, M., & Howell, C. 2008. All in for mental health: a pilot study of group therapy for people experiencing anxiety and/or depression and a significant other of their choice. Mental Health in Family Medicine, vol. 5, no. 1, pp. 41–49.  

Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. 2011. The impact of enhancing students’ social and emotional learning: A meta?analysis of school?based universal interventions. Child development, vol. 82, no. 1, pp. 405-432. 

Ellis, A., & Ellis, D. 2013. Rational Emotive Behavior Therapy. Current psychotherapies, pp. 151. 

Francis, A 2014, ‘Strengths-based assessments and recovery in mental health: reflections from practice’, International Journal of Social Work and Human Services Practice, vol. 2, no. 6, pp. 264-271 

Hyland, P., & Boduszek, D. 2012. Resolving a difference between cognitive therapy and rational emotive behaviour therapy: Towards the development of an integrated CBT model of psychopathology. Mental Health Review Journal, vol. 17, no. 2, pp. 104-116.