TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Session One on Tuesday evening, the 8th of October, with J.M. So Welcome, Jessa.

CLIENT: Thank you. (laughs)

THERAPIST: It is good to have this time with you and I'd like to start off this first session that we're doing by asking you to just say a little more, if you would, about what you had expressed to me a little bit earlier about having some trepidation about the sessions you and I are going to do, given that up until now your therapy has been of a different approach. So please would you say more about what your concern has been, and more importantly, what it is right now.

CLIENT: Sure. Absolutely. [00:00:53] The trepidation is that the therapy I've had in the past has been psycho-analytic based and so my trepidation now is that my impression of cognitive behavioral therapy, and the REBT you do, is that you don't really this is just my impression and I could be wrong but that you don't really look into the childhood, so to speak, as much and it's a little bit more just modifying behaviors which, to me, seems wonderful and great. But my trepidation is that that kind of stuff might not be what I'm used to or what may or may not work for me.

THERAPIST: Aah. So that's the concern. I think you're quite right when you say that it may not be what you're used to, because it probably isn't what you're used to. Also, the few words you've just expressed now about your impression of what you call CBT, and what we're doing here being rational emotive behavior therapy... [00:02:00] which is the pioneering CBT, but it has some very distinct qualities and different emphases. Your words just a few moments ago indicate that you have the impression that there's a large focus on changing behaviors, but really changing behaviors is only one possible aspect of it. The goal, after we clarify your specific goal or goals of what you think you'd like to work on and change for the better, if anything, is to do what works best for you and usually in REBT that includes changing harmful thinking patterns. Now, if you don't have any harmful thinking patterns, we won't work on changing them! CLIENT: No, I do. (laughs)

THERAPIST: That's something to explore, and also one of the premises of REBT speaks of the inter-connectedness of behavior and emotions and thinking, so it's really not only about changing behaviors. [00:03:11] Yes, it can include changing behaviors if that's going to be to your benefit. However truly speaking, behaviors are influenced by the thoughts and emotions we have, and often a greater focus, especially an initial focus when we do REBT, can be on exploring your thinking and seeing whether it's helping you or hurting you, also teaching you the healthy ways of thinking, which create healthy behaviors in most cases and healthy emotions. I just wanted to clarify what sounded like a misconception about the REBT approach that we will do.

CLIENT: Yes. Got you.

THERAPIST: You also mentioned that you don't know if it's for you or not, or if it will help you or not. As you notice, I'm not tying you down with chains (both laugh). If you find that it's not helpful, we can stop.

CLIENT: Okay. [00:04:07]

THERAPIST: Now in your interest, it will be good for us to explore why you think it's not helpful if, as sessions progress, you ever think that our work is not helpful to you, but of course you're not bound to keep doing this work. You're a free woman and the only reason that I do what I do is to help you and, more importantly, to help you learn how to help yourself feel healthier emotions, think in healthier ways and, as appropriate, behave in healthier ways if you're not behaving in the ways that serve you the best. Does that make sense?

CLIENT: Yes, that makes perfect sense.

THERAPIST: Does that alleviate any of your concerns?

CLIENT: Yes, it does. It does. Definitely. I think I have to see it; that's how I think. I'm more of an applying and seeing exactly what it is person, but everything you just said yes, that's very helpful moving forward. [00:05:04]

THERAPIST: Do you have any other questions about what I do and the approach before we begin?

CLIENT: No. I'm very familiar with therapy in general.

THERAPIST: You mean you're familiar with the therapy you've had so far, in general?

CLIENT: Yeah, that so far. I'm pretty familiar with just how therapy, in general, works. Like I said, it was just more about the specific type and I think you answered a lot of that. [00:06:03]

THERAPIST: Okay. Away we go then! (Both laugh) Now my next question to you, Jessa, is what issues or areas do you want us to look at? What emotions? You already mentioned anxiety, so tell me anything additional about that, and more. What are your goals for our time together?

CLIENT: I think probably for me the main thing would be just anxiety, but anxiety specific to having to make life decisions and having anxiety over trust and faith in myself that I'm making the right choices, whatever those choices may be. [00:06:57] The reason I'm saying that is because I feel anxiety just in daily life that comes up minute to minute to minute, so I don't really feel like I have specific anxieties like phobias or anything like that. I'm not one of those people that say, "Oh, I'm afraid to go into an elevator. I'm afraid to do this." It's not like that type of thing. It's more of this anxiety of whether I said the right thing or did the right thing or made the right decision and having anxiety over not having the faith in myself to know that I made the right decision. That's basically what I would love to get out of it, to be able to wake up every morning and be like, "I made the right decision." (Laughs) And I'm not always going to feel that way, but if I don't feel that I made the right decision about something, then I'd like not having so much anxiety around it, if that makes sense.

THERAPIST: Yes, it makes sense. It appears that you're a very experienced self-torturer.

CLIENT: Yes. I am. I love to punish myself. No, I'm joking. I don't, but that's what I do. (chuckles) [00:07:59]

THERAPIST: Well it sounds like we're semi-joking, but in all seriousness . . .

CLIENT: It's true.

THERAPIST: . . . you have this expectation, it sounds like and tell me if I'm wrong but from what you just said, it sounds like you think you should always be able to make the right decisions.

CLIENT: Yes, I do. Unfortunately, yes. That is the way that my thinking operates. I don't know when that started. (Laughs) And maybe we don't even have to talk about that, but I'd love to be able to fix it, if that's possible, because I find it interfering with just daily life, just my general happiness because if I question decisions that I make, it's uncomfortable. I want to call it like that I don't know if it's a perfectionistic thing but I will mull over something until I feel that it's (sighs) the best way. [00:08:59] I'll send e-mails 16 times, 16 different ways was that right? If I make a decision about something I'll have to ask friends, "Do you think I did the right thing?" "Should I go to the doctor? Should I not?" When I have to look things up online I'm very thorough, which I think is a good part of the way that I am. I can see it coming through in my work that it's good that I'm thorough. I take really copious notes and I make sure that I'm involved with students that I work with and things like that. But when it comes to daily life, that can be really, really taxing. (Laughs) I want to be a little more easygoing about stuff like that. That's my goal. I don't know if that's a big enough goal, but to me it feels like it should be.

THERAPIST: Yes. Anxiety is definitely not a healthy emotion and you use the words "you're very thorough" and when you're thorough, certainly professionally it works for you. [00:10:03] But from the example you just gave me, it also sounds like perhaps and correct me if I'm wrong you can get obsessive about your need for reassurance and to do the right thing.

CLIENT: Yes. Exactly. Exactly.

THERAPIST: So we've got some anxiety that would be good to not create, uncreate, and prevent creating; some obsessive tendencies in relation to that; and perhaps additional things to work on. In the course of our times together we'll see what unfolds. We can always, by the way, as other things come up, address them. The goal you state today isn't fixed in concrete. Our therapy is an organic process. And another thing about areas to work on, you yourself, mentioned the word "perfectionistic." It is probable that that tendency is there and it, along with the other areas you mentioned. And you appear to recognize that it and they are not helping your life any. [00:11:05]

CLIENT: Yes.

THERAPIST: How are they hurting you?

CLIENT: (sighs) In my ability to be as happy as I want to be, just on a daily basis. I feel like I have the ability to be this very, very happy person and I think I'm blocking myself from being as happy as I can be because I love what I do, I have goodness in my life, in other words, so there's really no real reason for me to be torturing myself, so to speak. So I think it affects me just in the sense that it prevents me from taking as many risks as I'd like to take just in daily life. [00:11:59] Or even worse, it will sometimes bring on what I call a panic attack. If I become obsessive about something that I think was a bad decision or if I get angry or frustrated with somebody else and then it repeats in my head, it then causes at times, not all the time, but at times it will cause my chest to almost close up to the point where . . . I guess you would call that a panic attack because it's harder to breathe. I know that already. If I changed the way that I thought, it would calm down everything, like my whole body, and I wouldn't be reacting that way. But I think where it's challenging for me is to change the thought, so I guess it's good that we're doing this because, again, this is not the style that I've ever done before. [00:12:55]

THERAPIST: So ...?

CLIENT: No, I'm just saying I've never done it. I've always talked about panic attacks and things like that and then we've looked at it in my other therapy, but you know. I don't want to get off . . .

THERAPIST: You're fine. So you just said a few moments ago that you recognize and you've known the connection between your thinking and the panic attacks.

CLIENT: Yes, I do.

THERAPIST: So what have you done to implement your knowledge that when you're thinking a certain way, panic results and that when you think in a different way, not so... What have you done, or not done?

CLIENT: I think sometimes when I'm in those situations . . .

THERAPIST: Which situations? Be specific.

CLIENT: Do you want me to give you an example?

THERAPIST: Yes.

CLIENT: Okay. All right. I'll give the perfect example.

THERAPIST: A "perfect one"... It had better be perfect, Jessa, or you're out of here! (said jokingly).

CLIENT: (laughs) Okay, so the example that comes to mind is that last year my girlfriend and I were newly dating. Actually, it was last year, December, 2012. [00:14:02] We had just met a month before that. We were walking through the park and it was this beautiful, really nice day. We were in love or falling in love. It was a month into the relationship. What happened was a student of mine, without getting too much into the details and I'm not going to use any names for the purpose of their confidentiality, but a student of mine's mother was suffering from cancer at the time and he meets with me for sessions. The young boy, is adorable. His father is a physician. The mother and the father are divorced and they've been divorced for a while. It was a very, very contentious divorce and a very contentious situation all in all affecting this young boy. The young boy, it was on a Saturday or Sunday and Madeline, my girlfriend and I, were walking through the park and that was when I received this text message from this student and I had no idea how he got my telephone number. [00:15:14] I don't give my telephone number out to students. That's the gist of it. He texted me "I'm not doing well." Eight years old. "I'm not doing well." It was a whole combination of things but it set me into a complete tailspin because . . .

THERAPIST: Can I interrupt you here to point out that you set you into a tailspin, not "it". We'll go back to that in a minute. Go ahead.

CLIENT: Okay. Okay, sure. It threw me off.

THERAPIST: You felt thrown off.

CLIENT: I felt thrown off, yeah. Okay. (laughs) When I felt thrown off, I immediately what I tend to do when I get into those situations is it brings me back, unfortunately, to some things in my past. . . ach....(teary) [00:16:05] I don't want to cry because this just doesn't seem like that type of therapy (laughs).

THERAPIST: It is fine to cry if you do.

CLIENT: It brings me back (laughing), unfortunately, when those types of things happened to me in my childhood and some things that just when . . . (voice breaking) not the best. So with that in mind, it sort of I don't know why I brought this example up. I really don't, but I guess it was because it bothered me so much that day. I really did have a panic attack after that and I could not get out of it. (Crying) My girlfriend at the time, who is still my girlfriend now, was (crying) talking me through and helping me to sort of change my thinking and explaining and helping me to understand why I might have been feeling the way I was feeling. [00:16:59] She was rational at the time, but I couldn't get out of it so it lasted for many, many hours.

That's the best example. I'm probably crying now because it happened in December of last year but I can remember it like it was yesterday. To answer the question, in those moments I feel like I don't have control sometimes over how I'm going to respond, if that makes sense. Changing the thinking, for me, doesn't really feel like an option because maybe I've never done it before so maybe I'm not used to it. I'm just more used to obsessing or, once I'm having that panicky type feeling, it's very hard to then change the thinking, if that makes sense. My thinking won't change sometimes because . . .

THERAPIST: Because you don't change it.

CLIENT: Yeah. Or maybe because I don't know how. I don't know how to get out of it. [00:17:59] Anyway, that was probably the best example because it didn't end.

THERAPIST: It's a strong one and even now the thought of whatever had happened to you in your past brings tears, so it's worthwhile for us to, perhaps, look at what you're telling yourself now about that. Also, in reference to your indication about crying and your thought of "I shouldn't cry", and your impression that the cognitive approach shouldn't include that that's not so. REBT is NOT about your not having feelings, it's about realizing and this is really an important thing to remember it's about realizing that we do have a choice about how we feel. [00:19:04] That it's not what happens that creates the emotion, but our thoughts about what happens that creates the emotions.

CLIENT: (crying) That's true. I'm okay. I'm fine. I'm sorry. THERAPIST: No need to apologize. When we think in healthy ways and part of what I want to do in our sessions is inform you of the healthy ways when we think in healthy ways, we're less likely to create those debilitating emotions. When we understand clearly the difference between healthy rational thinking and irrational thinking, it's easier for us to catch ourselves when we're thinking in irrational ways, then to dispute those thoughts and replace them with the rational ones. Which create healthy and appropriate emotions. You said a few minutes ago that maybe you didn't change your thinking because you didn't know how to, so part of what I can offer you as we explore what's going on, is helping you with your learning and using REBT. [00:20:03] REBT is the way to clearly distinguish when you're thinking in a way that's helping you or in a way that's hurting you and shows you how to change the harmful thinking when you identify that. REBT is not anti-emotion. It's very much encouraging of our feeling appropriate emotions as we embracing facts and truth about any given situation. Right now you're feeling what you're feeling and if it's not helping you, we can become detectives to look for the thoughts, the beliefs you have, that are creating the unhelpful emotion. And we can change any of them which are not based on solid fact, the irrational ones. Remember earlier I hopefully not rudely interrupted you when you were talking about walking in the park and you got the text message from the boy, and I forget your exact words, but it was something like that caused you to go into a tailspin or panic (00:20:49). I interrupted you to put the seed into your mind at that moment that it wasn't the text message, but something you were telling yourself about that unexpected intrusion into your privacy. [00:21:01] I invite you to see more and more, and to just be aware more and more imperfectly! you don't have to do this perfectly of the connection between the emotion that you feel and the thought that precedes it, and the fact that it's not what happens to us that creates the emotion, past or present, but what we tell ourselves about what happened whether it was in the past, in your childhood or right now with the text message, that creates the emotion. With awareness we have choice to change thoughts and therefor feelings created by them.

We have choice. We have freedom. You have the choice and I offer you the following mantra-like question. When you're feeling a debilitating emotion ask yourself: "What am I telling myself to create this emotion?" And already you'll have more control over your emotion. [00:21:56] You mentioned a few minutes ago that one of the contributors to your panic is feeling you're out of control, so I offer you a change, to know that when you are willing to make the effort and change your irrational thinking, you can change the debilitating feeling. Yes, it takes effort. But the longer you do it, make the effort to watch what you are thinking and telling yourself about undesirable situations, the less difficult it will be, to a point where it can become not even difficult, just an action or an effort that you make. Does that make sense?

CLIENT: It does. It makes sense, but I think that sitting here right now with you, it seems easier said than done. I get what you're saying, that it's an effort, a lifetime effort. I don't know. Maybe you'll teach me some techniques because I've already tried. This is something that I've been working on for a really long time. [00:22:57]

THERAPIST: What is? What have you been working on?

CLIENT: Changing on how I think about things.

THERAPIST: Have you?

CLIENT: Yeah. Yeah. I absolutely have. I think for a period of time I think I was sort of in a state of crisis.

THERAPIST: What period of time? What do you mean by crisis?

CLIENT: Last year I got pretty sick. I couldn't walk; I couldn't get up out of my bed; I couldn't feed my animals. I had my closest friend and somebody, a past relationship, who were involved in trying to help me, but I think I was feeling a lot of things at the time all at once that I couldn't go to work and so I started having a lot of concern about financially.

THERAPIST: You were thinking those thoughts, not feeling them and in so doing, you created feelings. [00:23:55]

CLIENT: Yeah, let me just explain. The part that was frustrating that then led to, as much as I wanted to change my thoughts, was that my body I couldn't move and I think that was a really debilitating feeling. And so it was hard for me to overcome, so to speak, and for me to change my mindset. Believe me, I worked on it every day and people were saying, "Oh, you're so positive," and this and that, but it was a constant effort. And I do, I feel like I work on it every day, but I feel like it's just constant for me. I don't feel like it's in me. Maybe for some people it comes more naturally to not be as reactive to things. I feel like I get very reactive as opposed to just going with and that's always kind of been my nature.

THERAPIST: Your tendency. [00:24:58]

CLIENT: My tendency, yes.

THERAPIST: So if you decide that tendency isn't working for you, then you can choose to change that tendency by making the effort. And the effort that is going to work is the most helpful effort. Maybe you were making effort, but it wasn't most appropriate. I'm just out of the blue picking this example of if you thought "I can change my panic by being more positive" and you were telling yourself "not being able to move my body is fine; it's for the best," that wouldn't convince me either.

CLIENT: That was what I was saying.

THERAPIST: You're kidding?

CLIENT: No, I'm serious.

THERAPIST: Well I'm not surprised.

CLIENT: I'm spiritual and this and that, so I'm like, "God wants me to slow down. This is happening for a reason." Yeah, that was how I was thinking and it wasn't working (chuckles) because I said it and it sounded good, but it didn't feel right, if that makes sense. [00:25:59]

THERAPIST: It makes a lot of sense. What you just said and what we're exploring now can be helpful in, perhaps, giving you less trepidation about this approach and clarifying it, because it's not about thinking in a Pollyanna positive way it is about thinking in a realistic, healthy way. Because you're an intelligent woman, telling yourself that semi-paralysis is for the best how can you buy that? No wonder your body said, "Huh?" It doesn't connect. You're intelligent.

CLIENT: It wasn't connecting. That's the thing. I was feeling super frustrated with that.

THERAPIST: In life, not everything may be for a reason, not everything may be for the best.

CLIENT: Right.

THERAPIST: But in life, until we die, we can choose to claim our resilience and go forward. So that's just a small example of using the mind in a healthy way with conviction, where we're not telling ourselves nonsense based on having heard a general slogan such as "if I think positively, I'll definitely be better". [00:27:10]

CLIENT: Right. Right.

THERAPIST: Such a slogan is very vague, and you have first-hand experience it didn't work for you.

CLIENT: I did think that was REBT, to tell you the truth.

THERAPIST: No, it isn't. REBT is not about B.S.-ing yourself!

CLIENT: Oh, okay. (laughs)

THERAPIST: REBT which, by the way, is infused with compassion, encourages loving kindness towards yourself and others and life itself. In that regard it truly discourages perfectionism because, at the root of perfectionism, we're telling ourselves that if I can't do the perfect thing, then I'm rotten, I'm not good enough, I'm worthless. [00:28:00] That thought may or may not lead to panic, but it certainly can dull our sense of life. It can lead to depression and anxiety and/or a whole cartel of the above. REBT encourages unconditional self-acceptance and it reminds us that we have a choice about minimizing misery and maximizing joy. It reminds us that panic and anxiety and any other debilitating emotion doesn't come from the circumstance, and may not be fixed with positive Pollyanna-ish thinking, but with realistic, healthy, encouraging thinking. So when you asked me earlier "maybe you can teach me?" that is part of my agenda: to teach you the tools and the healthy ways of thinking, the healthy ways of identifying the irrational ideas and disputing them and replacing them with rational ones. [00:29:03] Does that make sense?

CLIENT: Yeah. That makes great sense.

THERAPIST: So at this point, any comments or questions?

CLIENT: Nope. Nothing.

THERAPIST: Good. All right. In the light of what we've shared so far, can I give you some further information about REBT?...

CLIENT: Sure.

THERAPIST: ...because really a large part of this approach is psycho-educational. It's teaching you tools so that you can prevent yourself from creating debilitating emotions; and attend to changing unhealthy negative emotions when they have been created: as fallible humans, it can happen. And then when you make effort to change, and experience your gains, it reminds us of ways to maintain them. So there you have a few more points about REBT. I believe you have a book about it?

CLIENT: Yes, I do. (laughs)

THERAPIST: At the end of our time together today, I'm going to suggest you do some homework, and reading parts of that book will be part of it. [00:30:08]

CLIENT: All right.

THERAPIST: What I'm doing now is educating you and if your sincere goal is to stop creating anxiety and panic, then that is an all-important first step. Does that sound good?

CLIENT: Yes.

THERAPIST: So generally speaking, as I've already mentioned, when we think in healthy, rational ways we create, in the face of adversity, appropriate emotional responses. And when in the face of adversity or an unpleasant situation or a shocking situation or a shocking memory from childhood that comes up we think in irrational ways we create those debilitating emotions that can lead to physiological outcomes, like the panic attacks that you described and behaviors that don't serve your life. [00:31:19]

What are the healthy negative emotions (negative because they're not pleasant, but healthy because they're appropriate) If someone is intrusive, rude, obnoxious, if a huge disappointment happens, if you're rejected, if you make -"heaven forbid"(said by therapist in joking exaggerated dramatic manner) a wrong decision, and you think in rational ways about any of the above, it wouldn't be healthy to feel ecstatically happy, but would be healthy and appropriate to feel disappointment and/or concern. If there has been some injustice, rational thoughts may lead to an appropriate anger, which is very different from rage, because appropriate anger can fuel you to take good, helpful action. [00:32:11] Creating concern not anxiety, sadness not depression, appropriate annoyance not rage. You see? These are called negative, but they're healthy negative because they're in response to a disappointment or to an unjust or in some way offensive situation.

CLIENT: Sure.

THERAPIST: The unhealthy debilitating emotions I've already mentioned. They're the opposite of the healthy negative emotions which include sadness, concern, disappointment, and annoyance: the unhealthy negative emotions include depression, anxiety, panic, guilt, shame, rage.

CLIENT: Right. Exactly.

THERAPIST: So what's the difference between rational thinking and irrational thinking? When we think in rational ways, we keep things in perspective. [00:33:02] We don't have unrealistic demands and expectations of ourselves. We have healthy preferences. We want what we want, but we don't demand that it must be the case that we have them. We have high frustration tolerance. In other words, we can stand not having what we want when we want it. We may not like it, but we can stand it high frustration tolerance. A kind of adult attitude.

CLIENT: Yeah. (chuckles)

THERAPIST: When we think rationally we strive to have unconditional acceptance. The bottom line is that every human is fallible and every human can fail at things and make mistakes, but we realize when we fail at something we're not failures. We just failed at the thing we were doing. So unconditional self-acceptance means that we accept ourselves as worthwhile humans just because we're alive, full stop, unconditionally. [00:34:04] Unconditional other acceptance means that even if you detest actions another person did, and even if you healthily choose to fight against any injustice, you make the effort to remind yourself that the person is a fallible human with some disturbance thinking, if they've done immoral things, and whilst you detest what they've done that's wrong and will fight against it, you don't detest the selfhood of that person, their core, their essence. They, like us, are fallible humans capable of making mistakes. Similarly, unconditional life acceptance means that when atrocious things happen in life such as wars, torture, natural disasters such as hurricanes as they do, we don't label all of life or the world as atrocious and terrible , nor do we think that we don't want to live in such a world any more. We say to ourselves something like: "this bad thing happened, but it doesn't make all of life or all of the world terrible." [00:35:05] Unconditional acceptance that's part of healthy thinking that keeps a healthy human perspective on things. It helps keeps us sane when crazy things happen as they do, when cruel things happen as they can.

Irrational thinking is the opposite to that. There is a "should" and a "must": demands. We think: "He shouldn't", or "I should." "I should always make the right decision." "I should never make a mistake." "I should make sure I made the right decision and call all my friends until I feel sure, or I just can't stand it." There's this need, not desire, but this need for certainty. There is this demand should, ought, must that you and others and life have to be a certain way or it's terrible and awful. [00:36:00] In irrational thinking, there is catastrophizing, which is blowing things out of proportion. As Albert Ellis, the founder of REBT, would remind people again and again and again, if you're still alive nothing is awful meaning the worst that it can be because if you're alive there is still some hope. It may be atrociously bad, but when people awfulize and catastrophize . . .

CLIENT: (sniffling) It makes it worse.

THERAPIST: Right! Much worse and it's a very easy road to depression and anxiety.

CLIENT: Definitely.

THERAPIST: In irrational thinking there's damnation of self if we don't do the perfect thing, as seems to be what happens within you, sometimes there is damning of others and of life itself, so it's the opposite of those aspects of rational thinking. [00:36:57] When we are aware and thinking clearly, when we can clearly distinguish between rational and irrational thinking, it's easier to identify any irrational thinking and recognize that's what creates the debilitating emotion. You're smiling now.

CLIENT: I am only because I do know all of that. I do. I mean it's like, I know it logically, but then putting it into action is a completely different thing. Not to say that you just said all that and that it didn't register, it did. And that's just it, it's that I know when I'm thinking or acting irrationally. I'm very aware of that, so I guess that's a good start; but then how to change it? (laughs)

THERAPIST: So up until now, what have you done to change it? And how has it worked for you?

CLIENT: There has been some benefit to what I've done. [00:37:59] I started doing meditation, just putting on relaxation music, lighting candles. I have stuff on my iPhone with connections to YouTube so that it has soothing music in the background or it has positive thinking. That type of thing, which I don't know if that's necessarily something. I listened to something the other day on the way to work that was like, "You are confident. You are secure." (laughs) I felt a little better by the time I got to work, but then the day happens. I don't really remember if that fully stuck. I've done things like where I've tried to listen to other people who I know are rational, because I also have some people in my life that are very irrational that are close to me. We won't say who, but you can guess. [00:38:56] There are some people that I speak to that I know every time I talk to them it's going to probably lead to a very irrational response; and so I try to change it up by calling other people. And these irrational people are very close to me.

THERAPIST: Who are they?

CLIENT: It's my parents.

THERAPIST: Thank you. (both laugh) You are allowed to say that!

CLIENT: They're wonderful human beings, intelligent, highly intelligent people.

THERAPIST: However . . .

CLIENT: Very over-reactive, very irrational.

THERAPIST: In their thinking.

CLIENT: In their thinking, yeah. Exactly. I think the circumstance has been more challenging for me, I feel, because I'm very close with my family and I want to . . .

THERAPIST: And you've taken their tendencies to think and respond in irrational ways seriously?

CLIENT: Yeah, without a doubt.

THERAPIST: Without effort.

CLIENT: Exactly. But I've worked very, very hard to know that that's not the appropriate responses. Growing up I thought that it was because that's all I knew; but now as I'm older I've realized that it's not and I want a better life for myself. They're fine with the way they are. They're happy with their irrational thinking and all that. [00:40:05] They don't want to change and that's fine, but I do. What else have I done? I go to the gym, which I've always done. I'm somebody who's very physically active, so I really make a concerted effort.

THERAPIST: To . . ?

CLIENT: To think in a better way. My issue is that I find when I'm out in the real world, so to speak, I act as though things happen to me. I notice that and I think you had said it earlier, that sometimes I feel out of control when it's situations . . .

THERAPIST: You think you're out of control.

CLIENT: Oh, okay. So it's not what I feel. Okay, so I 'think' that I'm out of control. Right.

THERAPIST: And then you feel what?

CLIENT: So I think that I'm out of control and then I feel panicky afterwards.

THERAPIST: Good to clarify it in that way. When I interrupt you, the reason is because I'm already getting you into training for distinguishing between thinking and feeling, and how one creates the other. [00:41:10] Okay? So thank you. That was a good and thorough answer to my question, which was "so what do you do to change that thinking?" And your strategy so far is not too bad: the yoga, the relaxation, and the positive statements which are definitely healthier than the . . .

CLIENT: thinking "I'm a piece of crap". (laughs)

THERAPIST: Yes, I would say positive statements are better than thinking "I am a piece of crap". Now, in REBT that would be called an inelegant solution.

CLIENT: Inelegant?

THERAPIST: It is a temporary solution 'inelegant' means here that it changes your frame of thinking, is a healthy distraction, and you feel a calmer state of mind and so your emotion adjusts or changes accordingly. [00:42:05] What it doesn't do is root out the thought that you were thinking that was in the first place creating the disabling emotion and laser it to pieces, demolish it. That would be an 'elegant' solution. So the distraction is okay. It has had a positive effect...

CLIENT: Yeah, it has.

THERAPIST: But the reason it hasn't gone all the way is because it's that inelegant solution. It's more a healthy distraction than a ''let's weed out the toxin here and replace it with healthy stuff'' attitude. And so that is also a part of what our sessions can offer you, and we have already begun: realizing that yes, doing yoga is much better than thinking "I am crap." But at some point, exploring more substantially, will lead to a healthier long term solutions. . . . It's interesting that [00:43:03] some people who criticize REBT say it's superficial. I think it is really an in-depth approach.

CLIENT: Right, because you're actually attacking whatever the negative thought is.

THERAPIST: Identifying. Identifying it, and when you're clear that it's irrational because, by the way, it may be rational, and we don't need to dispute our rational thoughts ...

CLIENT: (Interrupts) Can I ask one question, though?

THERAPIST: You can even ask two. But no more than two! I'm joking, of course.

CLIENT: (laughs) I guess my question and the part that I'm I don't want to say uncomfortable with but I want to say this... I want to claim it because I feel like it's only fair because everyone's mind is different. My mind and the way that it sort of operates I enjoy. I enjoy this aspect of me, this is sort of how I attack my work every day.

THERAPIST: Just your work? [00:43:56]

CLIENT: No, no. But at work, at school, I like my job, I love it. I like to look at different angles of things and I also like to understand sometimes how a problem began, and then I feel like I can work on it a little bit better. I just wanted to explain that, and sometimes you might not know right away or it might not be clear. It might be a little bit murky, but I feel like maybe when people sort of say, "Oh, this is what I feel about REBT," maybe they think the way I do, that you don't really look at yeah, you have those thoughts. You have those feelings afterwards, but where did that start? I think some people need a little more clarity. That's just me. I know that. I'm more comfortable understanding something instead of just looking at it and going, "Two plus two equals four." I was never a fan of that because I needed to understand. (laughs)

THERAPIST: I think it can be very useful for us to look at what you learned and how you learned beliefs that are hurting you to this day, so we will do that, and we'll explore further. [00:45:08]

CLIENT: (laughs) Can't wait. (both laugh)

THERAPIST: We'll explore is this helping you or hurting you?

CLIENT: That's true.

THERAPIST: So it is a misconception that REBT doesn't want to explore the source of current beliefs. Not at all. It can be helpful, but I think it will be a waste of time to spend too long, say eight weeks, on let's say one belief that you think you had when you were three and a half when a fly excreted on your nose.

CLIENT: (laughs)

THERAPIST: It might be informative to look at that once or maybe twice, and maybe if you're obsessing, three times. But more than that would that really be productive? Do you understand?

CLIENT: (laughing)

THERAPIST: So I'm glad you're revealing your misconceptions about REBT, but most importantly, that you are willing to understand the principles and apply them. If you're really sincere when you tell me you want to stop your tendencies to panic and anxiety, it's going to take you making some effort.

CLIENT: Okay. No, that's fair. That makes sense to me. Thank you. (laughs) [00:46:00]

THERAPIST: You're very welcome.

CLIENT: I think I cut you off, though, because I think you were saying something else and then I asked if I could ask a question.

THERAPIST: That's okay. That happens. I'm trying to think of what I was saying, but it's really relevant that you said or asked what you did, so no problem. So are you willing to reconsider past false impressions about REBT, following what I've shared with you so far, and is it clear to you that our thoughts create our emotions?

CLIENT: Oh, yeah. 100%. Yeah.

THERAPIST: The difference between rational and irrational thinking is that clear to you?

CLIENT: Very clear.

THERAPIST: The difference between healthy negative emotions and unhealthy ones?

CLIENT: Very clear, yeah. [00:46:59]

THERAPIST: So what would be the healthy emotion if one were thinking in a rational way, to an eight-year-old student having your private phone number? What would be the healthy response? Would it be joy and delight?

CLIENT: No. (laughs)

THERAPIST: What would be the healthy emotion?

CLIENT: The healthy emotion. (pause) I guess one would be confusion as to how that happened.

THERAPIST: Confusion is a state of mind. One thing about REBT, and you'll notice this and please don't perfectionistically expect yourself to get it in two seconds. Be very watchful of language and be quite precise. Confusion is a state of mind, is it not? So my question is: if this boy texts you and your number is confidential . . .

CLIENT: I was shocked. That was my first reaction. [00:48:03] I don't know if it wasn't healthy, but you're asking what a healthy reaction was. What's the healthy reaction?

THERAPIST: You felt anxiety you told me earlier, I believe.

CLIENT: Yes, I did.

THERAPIST: That's not healthy, is it?

CLIENT: No, but that was the second reaction. The first reaction was just looking at the phone and being shocked. Second came anxiety.

THERAPIST: Okay. So what would be the healthy response?

CLIENT: Maybe this is where I need your help because I don't know. I don't know.

THERAPIST: Concern.

CLIENT: Oh. Oh.

THERAPIST: Concern.

CLIENT: That's true.

THERAPIST: Concern doesn't create the high blood pressure and heart palpitations and it's appropriate because concern, instead of anxiety and panic can lead to your thinking something like: "okay, I don't like this situation, but it isn't the end of the world I'll try to find out how he got my number and what I can do now about this undesirable situation."

CLIENT: Okay.

THERAPIST: You see? So there's a healthy response and an unhealthy one. I just picked that example as one of many possible ones. [00:49:02]

CLIENT: Okay.

THERAPIST: Makes sense?

CLIENT: Yeah. Yeah.

THERAPIST: So our time is coming to an end for tonight. (both laugh) I don't mean we're about to drop dead. (both laugh) And before we end our session I'd like to give you homework to do.

CLIENT: Sure. You're giving a perfectionist homework? I'm joking.

THERAPIST: Joking, by the way, is good. Yes, I am about to give you homework!

CLIENT: When is it due?

THERAPIST: We talk about it next session. Homework provides us with evidence that you're making an effort, or not, and, as the result of making an effort, you have evidence of how it's working for you, or not. Homework is really important and beneficial. And if you don't do it, we explore the reasons you didn't do it. Before that, any comments or questions?

CLIENT: No.

THERAPIST: What are you feeling right now? [00:49:58]

CLIENT: What am I feeling or what am I thinking? (laughs)

THERAPIST: I'm glad you listened. Feeling.

CLIENT: (pause) Anticipation. Maybe hopeful that the homework will be helpful.

THERAPIST: Anticipation is more of a state of mind. Hope is borderline thinking/emotion, so that's acceptable. So it sounds like you are feeling quite a different emotion than you did when we first started talking.

CLIENT: Yes.

THERAPIST: And the emotion then was more . . .

CLIENT: Before, when we started talking?

THERAPIST: At the beginning of our session tonight.

CLIENT: Is anxious one of the things?

THERAPIST: Yes, that is what you said then. Are you feeling that now?

CLIENT: Not really, no.

THERAPIST: Because?

CLIENT: Because I like to do things and so if I know that there's something that I can do to fix or correct a situation, then it gets me excited. (laughs) [00:51:02]

THERAPIST: You get yourself excited.

CLIENT: Oh. Okay. (laughs)

THERAPIST: Okay. So what were you thinking earlier to make yourself anxious that you're not thinking now?

CLIENT: (pause) That this wasn't going to work for me. (laughs)

THERAPIST: That's what you were thinking before?

CLIENT: Before, yeah.

THERAPIST: And were you adding to that thought of "This won't work for me""As it should. And if it doesn't, that's awful"?

CLIENT: Wait as it should? No, that's not right, what you said.

THERAPIST: I am not saying that is the right way to think I'm suggesting that that's possibly what you were thinking and asking were you?

CLIENT: Oh I'm like no, that's not . . . Oh, yeah. I was thinking something like that. Now it doesn't sound right.

THERAPIST: Good. Well caught.

CLIENT: Yeah, that was it. And I was feeling sick. I have a bad cold and I had just had a procedure done before we started, so I was in physical pain.

THERAPIST: And now you're not in physical pain?

CLIENT: No, I still am. (laughs) Yeah, maybe I can change the thought to not sit and dwell on it, but unfortunately the physical pain is going to be there for tonight so I just have to deal with it. [00:52:04]

THERAPIST: Are you a mind reader or psychic? Are you a prophet?

CLIENT: Why is that?

THERAPIST: How do you know the pain is going to be there all night?

CLIENT: Because I've had this procedure before.

THERAPIST: So it might be, but it might NOT be, as it has been before.

CLIENT: Oh. (laughs) You know I expect it, but I try to do that so I don't get disappointed if it is there. We can talk about that next week. We'll work on that.

THERAPIST: Very good. Okay.

CLIENT: One thing I've noticed, this is funny therapy. (laughs)

THERAPIST: Humor is a . . .

CLIENT: I love humor. I'll use it. It's fine, but you are hilarious.

THERAPIST: I hope that any helpful aspects of humor, and non-humor, from our time together is something that you adopt in your day-to-day life.

CLIENT: I already do that. That I use constantly. I'm always trying to make light. That I do already. [00:53:00]

THERAPIST: Good. Well, keep on doing that. All right. Homework.

CLIENT: Yeah. Homework.

THERAPIST: You've got the book titled Rational Emotive Behavior Therapy authored by my husband, Albert Ellis, and me?

CLIENT: Yes, I do.

THERAPIST: So there's a section in it, and it's not a long section at all, that describes the main aspects of REBT. I mean you're welcome to read the whole book, but your homework is to read at least that section.

CLIENT: I have already read a part of it actually.

THERAPIST: Yes, but now, even if you've read that part, specifically on the main aspects of REBT, I suggest that you read it again giving attention especially to the difference between rational and irrational thinking, the healthy negative emotions and the unhealthy negative emotions. So that will be your homework number one. Is that doable?

CLIENT: To read the healthy negative emotions and the unhealthy negative emotions and all the stuff that you just said?

THERAPIST: Yes. Will you do that?

CLIENT: Yeah. Yeah. Of course. [00:54:00]

THERAPIST: Okay. Good. Second homework. We talked about the unhealthy emotions being created often by the "shoulds" and the "musts" and the "oughts" and demands. Jessa, between now and when I next see you, would you please write down for me all the shoulds and musts that you can think of that are in your head and heart and repertoire and all of the above?

CLIENT: All the shoulds and the musts?

THERAPIST: I mean beliefs containing the shoulds and the musts and the oughts that you believe, as many as you can think of.

CLIENT: Okay.

THERAPIST: Will you do that?

CLIENT: Yes. How long can the list of those be? (laughs) I'm joking. I'm kidding.

THERAPIST: I'm trying to think of a funny response.

CLIENT: Are you ready to read a novel next week? No, I'm kidding.

THERAPIST: I am ready to read a novel next week from you...as long as it contains the many irrational elements, your irrational beliefs, you are able to identify. And if you are willing to work on changing them .... then healthier emotions can be the result. [00:55:05]

CLIENT: (laughs) Sure. I'll do that.

THERAPIST: So is your homework clear?

CLIENT: Yes, very clear.

THERAPIST: Comments or questions?

CLIENT: No, I don't think so. (laughs)

THERAPIST: Okay. Well done. And I will see you soon.

CLIENT: Okay. (laughs) Sounds good.

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