TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Session 2, Thursday the 10th of October, 2013. Hello, Jessa.

CLIENT: Hi.

THERAPIST: Good to see you.

CLIENT: You, too.

THERAPIST: So how has your time been since we last met?

CLIENT: It's not been the greatest, based merely on physical pain. I don't know if I mentioned in the last session that we had that I recently had surgery a month-and-a-half ago on my right shoulder and then literally a week after the right shoulder surgery when I was trying to heal from that, my left shoulder started to really bother me. I had to go for an MRI arthrogram where they injected dye and that didn't take very well, so I was jabbed a lot with needles and then stuck in this machine for 25 minutes. [00:01:03] The whole thing was just intense and uncomfortable. Needless to say, I went to the doctor today to get the results of what's going on and there is stuff. There are two injuries, there is a genetic component, which is the same reason why I got the right shoulder operated on in the first place. The good news is that the doctor said to come back in December and to see. He's not jumping to operate on this one. That's not really what he wants to do. I don't understand anything because I feel like if he operated on the right and it's the same genetic issue, why wouldn't he do the left? But he's just trying to not be preemptive about things. He wants to just see if it gets better. That's kind of where we're at. Needless to say, I'm very down about just physically not feeling well because it's been going on since April.

Going to work and everything is good because it keeps my mind busy instead of focusing "poor me, poor me," but at the same time it's very uncomfortable to try to go to work with a smile on your face when really underneath it all you're just physically in a lot of pain. I'm someone who is very active, super active. I go to the gym. I exercise. I'm constantly moving, so for me I think it's even that much harder because I'm somebody who needs to move constantly. I'm not one of those lumps that just sits there. (laughs)

THERAPIST: You're telling me that you are someone who needs to move constantly?

CLIENT: Yeah.

THERAPIST: Can I offer a different way of thinking about it?

CLIENT: Sure.

THERAPIST: Would you be willing to entertain the idea that you're someone who prefers and/or enjoys and/or is in the habit of moving constantly, rather than thinking "I am a person who does it ..." because if moving constantly defines you or your personhood in your mind you may be setting yourself up for a fall.[00:03:00] Reason being that if you think "I am a person who is active" and then you go through a period like the one you are in now, where you're less active, there can be the temptation (I'm not saying this definitely is the case for you you tell me whether it is or isn't) but I'm hypothesizing that it is possible that you can feel diminished because you're not doing your "you-ness" according to your definition of yourself as someone who is active.

CLIENT: And that is what I feel. Yes.

THERAPIST: How is that working for you?

CLIENT: Not good. Not good. It's upsetting. It's upsetting to me because . . .

THERAPIST: Or you upset yourself because . . .

CLIENT: (laughs) Because I get endorphins from the exercise. I do.

THERAPIST: Most people do.

CLIENT: I'm just saying no, some people can do without exercise. They'll say, "I prefer not to go to the gym;" whereas for me, I look at it as a therapy for me. I get a release or whatever. [00:04:03]

THERAPIST: I am not disputing that it's a good thing for you.

CLIENT: Yeah, exactly.

THERAPIST: We're not talking about whether it's good or bad, or whether it is a good thing that you like it or don't like it, we're talking about how much of your identity it infiltrates this idea that "I am one who is always active." The implication is, therefore, when I'm not active, I'm not me. I'm less me. I'm diminished.

CLIENT: I'm over 30; this is the first time in my life . . . Actually that's not true last year; but the first time this is a period of time where I feel it's impacting me significantly.

THERAPIST: You're allowing it to. You're allowing it to impact you significantly.

CLIENT: Okay. Are you asking me?

THERAPIST: I'm correcting your language reminding you of the power you have to create your emotions and thoughts.

CLIENT: Yeah. (laughs)

THERAPIST: This approach is new for you, and I think I warned you last time we met that at times I may appear really pedantic about the language you use when describing your feelings and states . . . [00:05:05] But it's partly because of what you've indicated: that for years you've thought you were 'this' and for years you've believed 'tha't, identifying too much with a particular activity, and I'm here to share with you a journey through a different way of thinking and, hopefully feeling, in a healthy, realistic and positive sense. One of my goals is to help you recognize when the language you use about yourself is neither based on fact or reality, and when it leads to your creating debilitating emotions.

CLIENT: I understand. I get that. Yeah, that makes sense.

THERAPIST: Frankly, as time goes on, let's say when you're 99, maybe you won't be able to do as much as you're doing now !!! and if you've ingrained within your mind which you have for the last 30-odd years minus the years you were an infant the idea that "I am one who is active, and this dominates your self-identification, then when you can't be as active as you have been in your younger years there is a risk of your creating misery. You know, don't you, it's probable that when you are older you and this applies to practically all of us won't be able to do everything as well as you do now. [00:06:01] There tends to be a kind of peak period in our lives in terms of physical capabilities, and as the decades move on, if you hang onto this false identification that "I AM a person who is active, as active as I've always been" instead of thinking "I am a person who enjoys being active as much as possible", then you increase the chances of creating depression when you are less active because of allowing yourself to then believe: "I'm not being me." So in the line of what we've just talked about, if you can just step back a bit . . . .

CLIENT: Sure. No, I get it.

THERAPIST: Can I ask you a-fresh about your tendency and preference to be active? By the way, unless I have the sense that you're being too active, to your detriment, you won't hear me talking you out of exercising, that because it's very healthy.

CLIENT: I love it. No, it's not a detriment.

THERAPIST: That's not the issue. But the question is are you defining yourself by your capacity for activity?

CLIENT: Right now? Is that what you're asking?

THERAPIST: I'm asking are you, Jessa, defined by, in addition to other things you may identify with, your ability to be active? Is that you? And when you're not active, are you less you? That's my question. [00:07:12]

CLIENT: I see what you're saying.

THERAPIST: I'm glad you see it... And your answer is?

CLIENT: No. Does that define me? Yes. Now you've shed a different light on it and I understand where you're coming from, but I think for me remember last week when I talked about what had occurred sort of in my childhood? And not to go back to that, but there is something important that I think . . .

THERAPIST: I would like you to share that with me in a few moments, but first ...

CLIENT: Because it has to do with the activity.

THERAPIST: I definitely want to hear that, but I don't want to get away from what I've asked you. And I'm not really clear on your answer. [00:07:58]

CLIENT: I don't know if I get the question. You're asking me if it defines me? That if I can't exercise . . .

THERAPIST: ....Are you less ''Jessa'' ?

CLIENT: (pause) No.

THERAPIST: You sound so unconvinced.

CLIENT: (laughs) It feels like that.

THERAPIST: That's why we're talking about it. Put aside what you have habitually thought, and just reflect for a minute. If you cannot temporarily be physically active, have you become any less Jessa? Any less a worthwhile human being?

CLIENT: No. That's true.

THERAPIST: You adore your cats. If, heaven forbid, some temporary illness afflicted them and they couldn't jump around as they do these days, are they any less your beloved cats?

CLIENT: No. [00:09:00]

THERAPIST: What are they?

CLIENT: Still the cats.

THERAPIST: They're cats who are not moving as much. And in a similar way and please tell me if you disagree with me if what I'm saying is not what you agree with but let me ask you.... In the same way, even though you love to exercise and it's a good thing and there are lots of perks, if you don't exercise as much for any reason, when you don't, as right now you're going to have to limit yourself if you don't want to create possible unpleasant consequences such as a life-long injury then do you have any less worth as a person, and are you any less acceptable as the whole package of the human Jessa that you are?

CLIENT: No. (laughs)

THERAPIST: I think you're giving me what you think is the right answer, but again, you don't sound convincing. And it's really good that we can look at that, actually that you can see that this appears to be awkward to for you to digest. [00:10:08]

CLIENT: Yes.

THERAPIST: Is it possible that you've been over-identifying with that part of your being?

CLIENT: Yes.

THERAPIST: Heaven forbid what I'm about to tell you is not going to apply to you, but I would like to bring up an example of Christopher Reeve, who in movies played the role of Superman Superman! Chris Reeves who broke his neck when he fell off a horse. Do you remember that? Even though you were a toddler probably when that happened.

CLIENT: Of course. No, I remember. I was older. I remember.

THERAPIST: I was being complementary about your age (jokingly).

CLIENT: (laughs) Thank you.

THERAPIST: Even though you're so ancient...

CLIENT: (Laughs) No, but I actually remember it very well because it was when I was old enough to remember when that happened and I just empathized with him, of all people. Anybody, yeah, but Superman, that this would be . . . And I think it was on a horse. I think he was on a horse. [00:11:07]

THERAPIST: That's right. He broke his neck when he fell off a horse. And initially he suffered from deep depression. He didn't want to live anymore. And then he experienced insight and awareness that he was loved by his family, who he loved, and that he could still experience that. And then he found this mission, this goal, of promoting his cause of stem-cell research, and he created motivation and more meaning in his life. He couldn't move below his neck, but there was still quality in his life. Meaning. He found meaning. So in a moment we're going to get off this subject because I want to ask you about your homework and you wanted to share with me that situation in childhood that you said still impacts you....

CLIENT: Exactly.

THERAPIST: Yes, I'm very interested in us looking at those things, [00:12:00] so let's finish talking about this topic . I bring up Christopher Reeve as a model in a sense for you to think about, another human being, who I am guessing probably actually I don't know if it is accurate to say "probably" but very possibly identified with his physicalness, his handsomeness, his athleticism, on and off the big screen before the accident. When he couldn't move from the neck down, Jessa, and answer me honestly please about what you think and feel, not what you think is the "right'' answer Tell me what you honestly believe Was he any less himself as a human being because he couldn't move from the neck down, because he had less physical ability?

CLIENT: No. But I do remember that he had those tubes. It scared me to see it because he had those tubes at his throat.

THERAPIST: You're jumping away from answering. Yes, it was frightening for many to look at however ....[00:12:58]

CLIENT: Was he any less of him? No, but I can imagine that for people that I didn't know him personally, so that's why you're asking this question. I only knew him on the big screen. When I saw him I think it wasn't that it was any less him, it was what I would imagine it was for people that were close to him to see him talking with the tubes and all that, that maybe it would feel at first that it wasn't as much him. At first, and then probably afterwards, once it sunk in that it's still him . . .

THERAPIST: Okay, but I'm not asking you to answer on behalf of the people.

CLIENT: (laughs) It's hard for me.

THERAPIST: I realize that. This is why I'm persisting, not to torture you, but to highlight this tendency that you have that you haven't challenged until now. That's what I'm exploring with you. I don't say exploring in a superficial sense, but we're doing this so that you may possibly entertain a new way of thinking about you for you. [00:14:05] And yes, he's an example. He's a model. We did start with you and we'll get back to you. It's interesting that in answering the last question, you spoke for 'the people' who would see him.

CLIENT: Because it's uncomfortable for me. I think it still bothers me to this day what happened to him. I don't like about myself that I feel like I take on, I feel a lot of emotions of others. I would like to correct that, but that's something that I think maybe I just put myself in the shoes of the family that, God forbid, something like that were to happen.

THERAPIST: A correction here you don't take on the feelings of others. You can't. It's a biological impossibility.

CLIENT: Because I don't know what they're feeling? [00:15:00]

THERAPIST: It's highly possible you can know what they are feeling. That's what empathy is. You experience a feeling, but I want to keep reminding you that you create the feeling because of the way you think, very beautiful sensitivity and caringness about other human beings. You empathize, you identify, but you create the feeling within you for them -you don't "take on their feelings" You create your own. Do you understand?

CLIENT: Yes, of course.

THERAPIST: So, again, it's me being pedantic because part of what I am doing is offering you a retraining in the way you use words, the way you think, with the ultimate goal of your thinking in ways that are healthy. In terms of a misconception that you shared with me in the past about REBT that REBT is not about allowing emotions or that it discourages feeling nothing could be further from the truth, thankfully. [00:16:02] When it comes to your deep sensitivity, you won't hear me discouraging you ever from caring about the suffering of others. What I'm about to say, watch the way you interpret it, watch that you don't interpret it wrongly...Whilst it is a beautiful human trait that you have in caring about others, it's very important that you don't care too much, meaning: in a way that debilitates you, because if you allow that you can be of less help to them and you can hurt yourself. So it's not about not feeling, it's about feeling healthy, appropriate emotions. Sometimes grief is the healthy emotion. REBT does not suggest that humans live in a steady kind of mono-emotion. REBT is not about not feeling, but encourages you to work against debilitating yourself when you are creating unhealthy emotions. Developing that tendency to choose healthy thinking and emotions doesn't lessen the capacity for empathy, which is a very fine human quality. [00:17:05]

CLIENT: Sure. I get that.

THERAPIST: So we've been spending a bit of time here on Christopher Reeve, but actually it's not so much about him, it's about you. However now let's move on.

CLIENT: (laughing) Okay, because I'm getting sad thinking about him.

THERAPIST: Well, you're making yourself sad and let's look at that in a moment. By the way, sadness is appropriate, feeling sad, but are you feeling "too" sad?

CLIENT: No. It's probably just an emotional . . . I'm just waiting right now to know what the next thing is. (laughing)

THERAPIST: Drum roll. Let me repeat the question, which is . . .

CLIENT: (laughs) I think I know what it was.

THERAPIST: What was it?

CLIENT: About myself, identifying.

THERAPIST: Yes. .. before you went into horrifying yourself by the image of the tubes in his throat.

CLIENT: (laughs) [00:18:03]

THERAPIST: Was he any less Christopher Reeve when his body was less capable?

CLIENT: No. His soul was still the same. (laughs)

THERAPIST: And how can you translate that to apply to you during this temporary, though much longer than you prefer, time of physical restriction?

CLIENT: No, it's been hard, but as long as I can still laugh, I think that's an important thing. And I've been doing that.

THERAPIST: That's good.

CLIENT: It's hard for me, though.

THERAPIST: Because?

CLIENT: Because it's something, I guess, that's new for me, what we're discussing right now. I've never done anything like this before.

THERAPIST: I know. And as you're reflecting on it . . .

CLIENT: Yeah, it's good. It's good to reflect and I think it's a good thing to take a risk and to try something different because I think I was so anti I'm being honest anti-REBT. (laughs) [00:19:03]

THERAPIST: I got that and I'm not here to convince you to like it, I'm here to help you help understand it more accurately, and in so doing to have a tool you can choose to use to help you help yourself.

CLIENT: And that's all I want to do, honestly.

THERAPIST: Sometimes I may sound a little theoretical because this is our second session and I'm wanting to educate you about this approach and philosophy and way of thinking, but there will be sessions in all probability where we don't mention theory or REBT per se. This is an early stage and educating you about the approach is part of it.

CLIENT: Sure. I appreciate that.

THERAPIST: That's why part of your homework was to read a section of the REBT book.

CLIENT: Exactly.

THERAPIST: Final reminder of the question, which you still haven't answered! and then we'll probably leave it. Again With your limited movement, Jessa who loves to be active, who is now less active are you less yourself? Or is the accurate way of looking at it that you are less able to do things? But no less your essential self?

CLIENT: (laughs) I know what the answer is supposed to be. No, I'm not less me. I'm not. [00:19:59]

THERAPIST: Then put it in your own words the words that describe more precisely what you think when, the fact is, right now you are deprived of something.

CLIENT: I feel deprived.

THERAPIST: Okay, but let's get clear. You're deprived of activity you like to do. You're not deprived of a "you-ness" isn't that so?

CLIENT: Okay. I don't know what that is "you-ness".

THERAPIST: I just made that word up. You're not deprived of being Jessa are you?

CLIENT: Oh, I see what you're saying.

THERAPIST: You're not deprived of being Jessa, unless you tell yourself that you are, which I think you were telling yourself 15 minutes ago.

CLIENT: Yes.

THERAPIST: So is that more clear now?

CLIENT: Yes. It is. It's a new way of thinking.

THERAPIST: It's a new way of thinking. Correct. Don't expect it to feel comfy and familiar yet.

CLIENT: Right. Right.

THERAPIST: I warned you, didn't I?

CLIENT: (both laugh) You did. It's definitely a new way of thinking. Sorry, you go ahead because I'm not sure if there's something that you want to say and then I'm sure it will come out later on. It's just new, that's all. [00:21:06]

THERAPIST: Correct. It is new for you at present. But is it making sense to you?

CLIENT: Yeah. It absolutely makes perfect sense that's just an expression "absolutely perfect".

THERAPIST: Oh, you caught yourself. That's very good, Jessa.

CLIENT: I'm very self-aware. (laughs) Sometimes too much. THERAPIST: And sometimes you have not been aware enough of the thoughts that hurt you, which is where these sessions come in. Your tendency to be self-aware will serve you well if you're willing to contemplate what we're doing, and the thoughts you tell yourself.

CLIENT: And that's the thing. I get that it takes work, but it's interesting. I'm always up for a challenge, whatever it is because this is challenging. I'm not going to lie.

THERAPIST: Let's keep on exploring the challenges. All right. Moving along, unless there's anything else you'd like to tell me first, I'd like to know how you went with your homework, whether you did it or not, what happened? [00:22:03]

CLIENT: I did do my homework.

THERAPIST: Did you read the section of the book?

CLIENT: The reading I did not get a chance to do, but I had read it already the last time and I read up to page 70 in the book. I'm the type of person that when I read something, I don't forget it, so I remember exactly what I had read. I mean if you want to test me, you can, but I did. I read it on the beach.

THERAPIST: I very well may test you (smiling).

CLIENT: (laughs) I was on the beach when I read it in the summer when I first looked at the book, so I was trying to really take it in. Actually, I read the book right after I had my surgery, so I absorbed it. I know that you had asked me to read it again, but unfortunately I've just been a little busy with work stuff. I will definitely read it after this session again, if that's what you need me to do. But I did my homework and the other thing that you asked me to write down, all those "shoulds". [00:23:05]

THERAPIST: Tell me about them.

CLIENT: You want me to tell you what they were?

THERAPIST: Yes, I do. Before you do tell me the specific "shoulds", tell me what was your experience of doing that homework for you? Was it revealing?

CLIENT: It was fun because it was very revealing. To be honest, I think that I did know, that I already had done this. I called it being hard on myself.

THERAPIST: That would be one way of describing it.

CLIENT: Okay. So that's what I called it, but it's good to write it down. Anyway, it was very interesting to write it down. One irrational belief of mine: "I should be able to wake up in the morning, without being in pain".

THERAPIST: Because if you don't wake up, you're dead. (both laugh)

CLIENT: No, without being in pain, I said. I should have better willpower and not eat whatever it put in front of me that's bad for you, not the healthiest. I should be thinner. [00:23:57] I'm playing this game that I have on the iPhone. My girlfriend got me into it. We were out of town this past weekend and she got me into it. It's a fun game but it's really challenging. I look at everybody else's scores. What I'm saying here I just want it to make sense is that I should have a better score considering that I'm smarter than the people that are playing it. (laughs) And then I said I should like people. I meant to say, I should like people at work more, not be so frustrated with them and be in a good mood at work, in a better mood or in a good mood at work. I feel like I need to be in a good mood all the time, especially in my role as . . .

THERAPIST: As a saint?

CLIENT: (pause) Oh that I act like I should be a saint? Right. I can't go to work and be like . . .

THERAPIST: Human. (laughs)

CLIENT: 'F.U.' to everybody because that's really what I want to say.

THERAPIST: Well, you may lose your job if you say that. [00:24:59]

CLIENT: And that's the anxiety, all the things that are running around in my head of what I want to say not to the kids because they're innocent and cute, but to the adults. (laughs) This isn't going anywhere. Okay. (laughs)

THERAPIST: Continue -

CLIENT: So that was a few of the things the shoulds. I could probably go on and on, but I just ended there.

THERAPIST: Oh, that's where you stopped.

CLIENT: Yeah, I stopped there for the reason of not wanting to take up too much time because, really, the thoughts that I have are all constantly shoulds, musts that's how I think. That is how I think.

THERAPIST: And how is that helping you?

CLIENT: It doesn't. It doesn't. I think it was okay probably when I was younger because I didn't have the same challenges as you get when older, so I didn't realize that it was eventually going to catch up with you and be debilitating, this sort of perfectionistic way of thinking. [00:26:04] I think as I'm in this situation and when I was in a situation last year when I was sick and I couldn't do the things that I think I should be doing, I think that that's when it started to come out a little bit more, that this is not a good way of thinking. You get to a point in your life when you do realize that it's not the best.

THERAPIST: When you were reading those irrational beliefs to me, you were laughing.

CLIENT: Well, because it's funny.

THERAPIST: It's highly probable when you think those shoulds, you don't think they're funny, that you're quite in earnest about them.

CLIENT: No, it's not funny. Right.

THERAPIST: So I think it's quite healthy that now you're able to have this more objective perspective and look at them and evaluate "this is funny and it's also not true." Not that I will ever discourage you from seeing something that's not desirable as not desirable. It's not about thinking that you have to accept everything is fine, because everything in life is not fine. But unless it kills you you can stand it.

So, tell me with all those statements that you just read to me, if instead of saying "I should," I should," "I should," you had said "I prefer" or "I want" or "I desire." How would that make a difference to you?

CLIENT: My God, that would be so strange because I'm not used to it.

THERAPIST: So we're coming back to that again. That is true. You are not used to it. The good news is it sounds like you have a real asset when you tell me you have a good memory because it might or might not but it might take you less time to catch yourself when you're thinking and doing what's unhelpful and to change it. And in time, what doesn't feel familiar right now, will feel less unfamiliar, and hopefully, in time, it will feel not only familiar, but feel good. And with ongoing work and practice, the healthy way of thinking rationally can become almost an automatic tendency: [00:28:10] to want what you want, but not to "should" on yourself. My question was, which you haven't answered yet other than saying that it's unfamiliar if you had said those demanding sentences, or thought them, where instead of thinking "should," you thought : "I wish" or "I want" or "I would prefer," how would the outcome be different? Because the outcome of believing the shoulds you've shared with me has not been good: from what you tell me the outcome has been your experience of anxiety, and tendencies of perfectionism. So how would your experience be different if you wanted those things instead of demanded that you should have them?

CLIENT: I think that I wouldn't be as disappointed because if it didn't happen, it was just that I wanted it but I didn't get it, so it's okay.

THERAPIST: Yes. Wouldn't that be helpful in life? Just to feel disappointed instead of doing post-mortems and over-analyses and then feeling despondency or anxiety or both ? [00:29:12]

CLIENT: Sure. Sure.

THERAPIST: So do you see that it is worthwhile to keep your alertness active, and catch the shoulds?

CLIENT: Yeah.

THERAPIST: How willing to work on that are you at this point? How motivated, in all sincerity, are you to do that?

CLIENT: (sighs) I feel motivated, but I feel like I still have to just share with you the one aspect of my childhood, because you know that's important to me.

THERAPIST: I want to hear it. I wasn't digressing from that but first we were looking at your homework.

CLIENT: I know, but I feel like if I don't say that part about my childhood, then it's not going to make as much sense. I look at people's life from that thematic, if that's a word. Sometimes the language that you speak to yourself is ingrained in a certain way. You can get out of it, and I think you can. [00:30:02]

THERAPIST: Yes. This REBT we do is to help you with that, I remind you.

CLIENT: Absolutely. Absolutely, but what happens, and I can see this as we talked about tendencies, is that I almost feel that when somebody has let's say we'll use weight as an example. Let's say that everyone has a set point in their weight and that much I know just from what I've read in life and experiences.

THERAPIST: Could you explain what that means.

CLIENT: A set point so that, in other words, if you just eat regularly and exercise or do whatever you do, normally, everyone's body type has a sort of set point that it stays at, that it likes to stay at. But if you reduce calories, it can go lower. If you eat like a pig, it can go higher. But the body has a set point that it likes to go back to, where it's comfortable at, basically. I look at this type of work as that a lot of things that went on and I make it seem like I had this completely traumatic childhood and it's not that. [00:31:03] I don't want it to come out that way because it wasn't that, but I'll explain in one minute. My fear, I guess, is that it's going to be continuous work, which life is and I can understand that, but I feel like the tendency is to always go back to the set point of whatever it was that I had learned that was very much ingrained, basically until I left to go to college. It still goes on because my family is still the same way. I have changed, but they're still the same way; and so I always tend to go back to the thinking. And the therapy that I did in the past, it was very, very helpful for me to sort of try to change a lot of things that I did, but it's just constant. I think that's the source of anxiety, which that's not really me. Like the whole changing of the thinking is so extreme that it almost feels like I can't do it. That's kind of what it is. [00:32:05]

THERAPIST: So you're pre-supposing you can't do it before you've even tried.

CLIENT: It's just a fear. I'm not saying it's going to happen.

THERAPIST: It is so good that you bring that up. That's really important. A question I have for you is is it a tendency for you to presume what will be and base your fears on what you assume will be before it even happens?

CLIENT: Yeah. I've tried really, really hard to acknowledge when I do that, but the anxiety piece is where I just jump to what I know.

THERAPIST: You jump to what you assume. You can't know for certain what will be, because it hasn't happened yet.

CLIENT: No, what I know it's just pedantics. It's what I know, meaning what I've learned. That's what I meant. In my life.

THERAPIST: What you believe. [00:33:01]

CLIENT: I don't know what I believe.

THERAPIST: Translate "what I know" for "what I believe."

CLIENT: Okay. I just feel like it becomes almost, though and this is just my opinion about it...Let's forget about the labels of REBT, just what we're discussing right now, maybe this has to do more with confidence than anything else because I feel like a lot of times when you're not confident about certain things, it's a lot easier to say, "I should have done this," when you're not secure in how you're thinking or feeling about something. Does that make sense? I'm feeling that this has a lot to do with self-esteem more than anything else.

THERAPIST: Self-acceptance. I think that what you just said is an accurate description of what you think, and it is important and beneficial that you realize that. I agree that many times people who think in perfectionistic ways do so because they don't accept themselves unconditionally and they believe, wrongly, unethically, that they should be of a certain standard to be acceptable. [00:34:10] So I think your observation about yourself is very right and I think that it will be very helpful for us, as the time rolls on, to work on that. So it's good that you have that awareness and that you brought it up. Now, going back to your fear okay?

CLIENT: Oh, yeah.

THERAPIST: Going back to your fear about the work required in REBT, and what it's going to take to change, and that you think you have this set point that you talk about ... There is biology and then there is the ability to use cognition, our thinking; and certainly one affects the other. [00:34:57] May I say, from experience, that hundreds of people I've worked with who were motivated to change their unhelpful thoughts that they had thought some for 20 years, some for 30 years, some for 50 years made progress.

CLIENT: I'm embarrassed to say that the thought that I just had when you said that, but maybe we can work on it if I share it with you, but I thought in my head when you said that, "That's good for them, but that's not me."

THERAPIST: And we haven't even started to look at your particular issue related to your childhood that you wanted to start with telling me or at the specifics of what you learned early on. But you also just exposed the tendency that you shared with me not minutes ago about that lack of acceptance. You said "I'm embarrassed." Embarrassed cab be another way of saying "I did something shameful." [00:35:59] If one of your beloved cats did an accident on a new carpet, it wouldn't be particularly healthy for you to be ecstatically joyful or even pleased, but would you damn the cat for doing something that was so unhelpful? What would your attitude be?

CLIENT: I'd probably feel bad that he or she didn't feel good, but . . .

THERAPIST: Maybe she felt great and just took a shit.

CLIENT: Oh. (laughs) I'd just be frustrated that I had to clean it up.

THERAPIST: But would you think any less of the cat? Would you love it less, even though you didn't like what it had done?

CLIENT: No. No. No. (laughs)

THERAPIST: My hunch is you're less kind to yourself.

CLIENT: Yes. Should I just say the thing already?

THERAPIST: Should you? No, you shouldn't, but I think it could be helpful if you did.

CLIENT: I think it's going to be really good because I think I'm sitting here like a kid in a class with my hand raised and I just want to say the one thing. (laughs)

THERAPIST: And I'm here to torture you (said jokingly).

CLIENT: Exactly. I feel like I'm being tortured. [00:37:02] No, I'm joking. I'm not being tortured. I don't feel that way. Really what it was is that growing up, and I never was aware of it until I went to therapy, so it was actually good that I started to go to become aware of it. I was basically brought up in my life by the two people that you put on pedestals because that's what you do . . .

THERAPIST: That you put on pedestals. Talk about you.

CLIENT: All right. But I do. I put them on pedastals a child. I was criticized day in and day out continuously. I hate talking about it because (sighs) it does upset me because I know that I personally would never do that (crying) if I had kids of my own. It was pretty much every day, every minute, so it's just . . .

THERAPIST: Give me an example.

CLIENT: Are you sure? (laughs) [00:38:00] I left a wet towel on the bed earlier in the day. Then later I would be at a friend's house and I would get a phone call, at six years old, interrupting a play date, screaming at me that I left a wet towel on the bed. It was pretty extreme. (crying) And it was pretty much for every little movement, like, "You have to fix your hair." "You're not thin enough". It was mixed in with, "You're amazing." "You're great." "You're wonderful." "We love you." So for me, I feel like that was the challenge I was given because it was so mixed up. It was so confusing.

THERAPIST: Contradictory.

CLIENT: It was so contradictory that one minute you would think that you were amazing, you're great, you're so smart, you're wonderful; and then five minutes later it's like you're a piece of shit, basically. It was pretty bad. I don't think that my family really realized how damaging it actually was because I don't really try to share that with them because that's me. (crying) [00:39:01]

THERAPIST: What's you?

CLIENT: What's me is that I protect and I try not to . . .

THERAPIST: Your tendency, your inclination.

CLIENT: Okay. My inclination is that I don't want to hurt them to say, "Look at how screwy my thoughts can be now," but basically the language or the chorus of voices that I sometimes tend to hear is just everything that was said to me continuously every day (crying) from the time I was really, really little; probably starting at five because I don't know how much you can really criticize a three year old. But maybe it happened at three. I don't know. But really at five on is when I would remember it. I would come home from a day at school... "Why are you so dirty?" So there was a lot. Then it was comparisons to "we would never do that." I have very professional and highly intelligent parents.

THERAPIST: What are their professions? [00:39:59]

CLIENT: My parents are in medicine. They're both sort of "we know best and you don't really know what you're talking about." It's been challenging because I had that sort of banged into . . . Like "I'm going to beat you down until you can't take anymore criticism," (laughs) basically, is what it was. It was mostly by my mom, but also my dad threw in his little things here and there. It was more from my mother more than anything. It's hard to break away, so to speak. So when you're doing this with me, I'm kind of like it's been comfortable even though it's uncomfortable to live like that, that language and that vocabulary of "fix yourself, you're not good enough" basically has been so ingrained that it's hard. [00:41:09] Taking this chance to do something like this is really out of the ordinary for me because as much as I've had therapy and acknowledged all that's gone on, I don't know if I've necessarily changed the language that I've used in my life. That's why I thought it was important for this type of thing, because I think how we speak to ourselves generates from how it all started, I guess. (pause) You didn't know what you were getting into (laughs) when we started therapy. I'm sorry that it came out this way but . . .

THERAPIST: Jessa, Jessa, stop. Stop. Look how you're apologizing.

CLIENT: Because I just feel bad. I didn't know that it was going to you know... [00:42:00]

THERAPIST: So you had some expectation or thought that in the work I would do with you, we'd keep it light and simple and just analyze shoulds?

CLIENT: (laughs) I did, actually.

THERAPIST: Okay. Wrong assumption. Wrong assumption, but really useful to see now, because it's giving us another example of a tendency you have to assume things before you have evidence for them.

CLIENT: (laughs) I should probably just get my own (tissues) . . . (laughs)

THERAPIST: (Gives Jessa tissue) That's a clean tissue.

You assume before you have evidence.

CLIENT: Exactly.

THERAPIST: I applaud you for being willing to step out of the comfort zone.

CLIENT: That's why I didn't want to do this. (crying)

THERAPIST: Because you wanted to stay comfortable and keep torturing yourself until the day you die?

CLIENT: (laughs)

THERAPIST: Because that's really comfortable! Self torture! (jokingly said). [00:43:00] Can I offer you this hypothesis: that if you're willing, step by step, somewhat uncomfortably at first perhaps, not necessarily extremely uncomfortably, but sufficiently bearable and steadily, to simply be watchful and change the unhelpful thoughts so that you stop the self-torture I hypothesize that, in a sense, you'll be reborn in a way and that will feel very empowering.

CLIENT: I'm looking forward to that because I don't ever do that with my students. That's what's interesting.

THERAPIST: What don't you do?

CLIENT: I don't look at them from the same eye that I look at myself. I'm always very fast to jump to that "I did something." That's sort of what I want to get at. That's why they love me so much at school because I give them unconditional acceptance. [00:44:00]

THERAPIST: Are you willing to start working on having that relationship with yourself? Giving that unconditional acceptance to yourself?

CLIENT: Yes. I'm willing. I'm not going to say that it's going to be easy, but I'm willing to do it.

THERAPIST: Well thank you for predicting the future again. Thank you for anticipating before the fact !!!....

CLIENT: (laughs) Well you said it's going to be a lot of work.

THERAPIST: I don't think that I emphasized it's going to be a lot of work.

CLIENT: You didn't? I heard it wrong.

THERAPIST: I think I said work, effort, practice. More like steady effort, steady ongoing effort. You can translate that into a lot of words.

CLIENT: (laughs) It's a lot of work. No, I'm kidding.

THERAPIST: In my opinion, it's a lot harder work to continue to live with this experience of self-damnation. So a really, really helpful thing is you've already begun this journey and you seem to still be alive and kicking. Even if it feels hard apparently not TOO hard. You're still here!

CLIENT: Yes. (laughs)

THERAPIST: And another helpful thing is the awareness that some of the beliefs that you hold, or have held, that hurt you, you learned them from your parents. Knowing the source can help you be somewhat more objective. Now as an adult woman in the here and now, you can make the decision to assess thought by thought I don't mean obsessively assessing every thought you have in your life, but thoughts of the nature of the self-damnation. You can ask yourself Now where is the evidence for this idea of inadequacy I judge myself to have or be? And really it's highly probable, if you think about it, you can conclude well there is no evidence, but that's what mom always used to say and I wrongly believed it in the past. That's what mom used to say.

CLIENT: Oh, just switch it to that.

THERAPIST: That's one of the things you can do in recognizing that when you damn yourself, it's not the voice of universal truth if you tell yourself that you're excrement, a dirty little no-good-person who leaves wet towels on the bed with an 'off with your head' kind of attitude. [00:46:03] If that was the message you perceived from the words and actions of your mother it is helpful to recognize that they are words of a mother, perhaps with her own flaws and unhealthy beliefs, to say the least, and when I say that, I'm not damning your mom, just suggesting such words are not necessarily accurate... they are not the words of Universal Truth.

CLIENT: No, of course not. I understand that.

THERAPIST: Such words and attitude to you were not healthy, from what you're telling me.

CLIENT: It wasn't.

THERAPIST: And if that was the case that came from her own distorted ways of thinking. So you won't ever hear me damning anyone for doing things that you took on, but in my attempt to be realistic and objective, from what you tell me the attitude and words may have been very unhealthy and, understandably, as a young child who doesn't have the ability to discern, you believed them. But now you DO have the ability to discern truth and constructive criticism from unhealthy put-downs.

CLIENT: Now I have the ability.

THERAPIST: Now you recognize that you are allowing it to hurt you and doing so is not helping you. Now you've chosen to be courageous, for a start, to have these sessions. [00:47:04] You've recognized 15 minutes ago your lack of unconditional acceptance. I want to ask, are you willing to make some effort, just as you are patient with some of the children you work with. Make the gentle effort, just like you're patient with your cats when they need special attention when they're sick and you give them that. Would you be willing to start doing that to yourself?

CLIENT: Yeah. I am. The way that I operate is that I like to have maybe this is why it's good is when I'm in the moment of having that thought, to maybe have a replacement thought. I don't know. [00:48:12]

THERAPIST: Which brings us to homework time.

CLIENT: Okay. (laughs)

THERAPIST: That's a great segue.

CLIENT: What did I do with my phone. . ?

THERAPIST: Is that all right I had placed it on the side?

CLIENT: No, that was okay. I was going to put it in there.

THERAPIST: Oh, sorry. I just didn't want you to be distracted.

CLIENT: Of course. No.

THERAPIST: Now, as we conclude today's session first of all, well done.

CLIENT: (laughs) Really? Ach.

CLIENT: See? (laughs)

THERAPIST: What did you just do?

CLIENT: I don't know.

THERAPIST: No. Tell me. What did you just do? I told you "well done and ..."

CLIENT: I didn't believe that it was. (laughs)

THERAPIST: Let's look at this now you didn't believe it because: what were you probably telling yourself? [00:48:58]

CLIENT: I was telling myself "I cried. Why did I do that? I shouldn't have gotten into so much. Maybe I could have done this more superficially".

THERAPIST: Okay. Pretend that I'm your student. I'm a ten-year-old girl and I've come to you because my big brother was bullying me. I cry as I am telling you my big brother was bullying me. And you say to me after we have talked about it and I have calmed down, "Well done, sweetheart," and I say, little girl that I am, "I shouldn't have cried. I shouldn't have bothered you, Miss Jessa." What would you say to me?

CLIENT: "You're being ridiculous". I wouldn't say that, but I would say, "Come here any time. Absolutely not."

THERAPIST: (Role playing the 10 year old girl) "But I shouldn't have cried. I shouldn't have bothered you really". What would you say?

CLIENT: (laughs)

THERAPIST: What would you say to me, Jessa? [00:50:02]

CLIENT: (crying) I'm crying right now. It's very hard.

THERAPIST: Come on. Come on. So you're crying. Come on...you can do this What would you say to me if I were that little girl?

CLIENT: I would say that you come to me so I can help you, that it's okay. The reason that you came here was to cry and to get it out and to talk about what it is that you're feeling and not keep it in.

THERAPIST: (Role playing) "But aren't I stupid for crying?"

CLIENT: (laughs) You're just making me laugh. No, not at all. Not at all.

THERAPIST: Truly, Jessa now I'm (therapist) talking here, not roleplaying that was a role play for a few seconds. Would you really not think I was stupid for crying?

CLIENT: No, I wouldn't. I wouldn't think that, no. I guess I think it's different with kids. (laughs)

THERAPIST: You were a kid when your mother told you you're a whatever for leaving a wet towel on the bed, isn't that so? And you haven't challenged those criticisms until now, right? I'm going to help you with that if you're willing to do that challenging. [00:51:00] If you're genuinely willing to tell the little ten-year-old girl who comes to you or let's say a friend who came crying to you and they were saying, "Oh, Jessa. I feel like such an idiot for crying."

CLIENT: (crying) Right.

THERAPIST: Would you damn them for crying?

CLIENT: No.

THERAPIST: And so let's make it clear again what did you tell yourself just a few minutes ago when you damned yourself, in a sense, feeling embarrassed for crying here? Tell me.

CLIENT: (crying) You really want to know?

THERAPIST: Yes I really want to know.

CLIENT: (crying) Because whenever I cried when I was little I would get yelled at.

THERAPIST: And the belief is .."if I cry, then . ." ?

CLIENT: Then I'm doing the wrong thing. I should be stronger.

THERAPIST: (repeating in exaggerated manner) "You should be stronger, yeah".

CLIENT: (crying) And I should be tougher and whenever I felt that way, what I heard and what I repeated in my head was, "I never cried and I had to get through everything myself. I didn't have anybody to talk to." [00:52:02]

THERAPIST: So can you now see that thinking was not, and is not, helpful?

CLIENT: Yeah, I do. (crying)

THERAPIST: And since ideas were inflicted on you at an age when you did not have the ability to figure out whether your parents criticisms were constructive or not. By the way, my hunch is that your parents were not intending to hurt you...

CLIENT: No, of course not.

THERAPIST: ....but their unhelpful thoughts were in a sense inflicted on an innocent, though it was not their intention to hurt you.

CLIENT: Yes.

THERAPIST: Okay. But now, as a young woman, you are no longer the child, you can keep stabbing yourself with ideas that your took on or with recollections about any of your parents mistakes, or you can start nurturing yourself and treating yourself with the same sweetness and kindness with which you treat your friends, students and colleagues, and your cats [ ] (inaudible at 00:52:42). And the journey has begun.

CLIENT: I did not realize so much of this. (crying and laughing)

THERAPIST: And I want to point out to you again the words you said, " I didn't realize." [00:53:03]

CLIENT: I didn't. (laughs)

THERAPIST: Granted. Now, watch out for any tendency to tell yourself "I didn't realize this as I should have!" And keep on watching for your tendency to assume things, to jump to conclusions, and believe them without evidence. That's what it appears you tended to do with yourself up until our sessions, without questioning it.

CLIENT: Thank you.

THERAPIST: You're very, very welcome. So we were going to talk about homework, but before we do that do you want to say anything now? What are you feeling and thinking right now, given that you've expressed a lot of emotion and also revealed a lot of really valuable information for us to work with? What do you want to say? What do you feel? [00:53:57]

CLIENT: (pause) I'm wondering, I guess truthfully, I'm thinking in graduate school, why didn't I focus more on this type of therapy because it's interesting. They did a very quick educational background on it in classes?

THERAPIST: Well aren't you lucky you got me to work with now. (laughs)

CLIENT: Yeah, I feel blessed. I do.

THERAPIST: What are you thinking now about the issues we talked about?

CLIENT: I think it's shocking. I feel shocked.

THERAPIST: At?

CLIENT: At the way I've been thinking for such a long time.

THERAPIST: Oh, good. You recognize it wasn't helping you.

CLIENT: That's what I was really going to say, but I just . . .

THERAPIST: "But I just . . ." Were you going to modify?

CLIENT: (laughs) Yeah.

THERAPIST: Did you notice?

CLIENT: I didn't modify, though, right now. I'm shocked. I'm really surprised. I'm stunned, actually, that I didn't realize things till tonight. Yeah.

THERAPIST: And as a result of what you now realize, what is your intention?

CLIENT: To fix it. (laughs) To make it better so that I'm not living a life of constant criticism of myself. It's not fun. It's shitty, a shitty life. [00:55:08]

THERAPIST: It's like living in the same small room with your parents when they are in their critical mode over and over every single day.

CLIENT: It is. They come with me to work. They come with me home.

THERAPIST: Only because you offer to give them a ride to work and home. You invite them to be with you.

CLIENT: Yeah. (laughs)

THERAPIST: Tell them to take their own transport. And last week you were telling me that sometimes you wake up and you're thinking, "How can I fix this?" Can you see the relation to wanting to avoid the criticism and the damnation.

CLIENT: I want to avoid it. That's what it is.

THERAPIST: So it's not working for you, is it?

CLIENT: No. No.

THERAPIST: Are you feeling hopeful now?

CLIENT: Yes. I guess I am proud of myself in the sense that I did take the risk because there were a lot of times I was going to call you and say, "Mmm, no. I don't think I want a session tonight."

THERAPIST: Ahh. Well done. Well done. [00:56:07]

CLIENT: In that respect, I do feel like I should give myself credit.

THERAPIST: It's not that you should, but it's a good idea to do so. (laughs) And not only that, I want to point out to you that just now I said to you: "Well done" and you accepted. Only minutes prior to that when I said "well done" to you, you shed tears again and you were embarrassed. So only in minutes already we see there is a change. Do you see what's possible? Do you see that changing your habitual reactions and thoughts is do-able ?!!!

CLIENT: Yes. (laughs)

THERAPIST: Okay.

CLIENT: You're so funny.

THERAPIST: So now homework. Last time your homework was "cherchez le should" I love saying that. It's French for "look for the should." That was your homework and you indicated that there were at least three billion more shoulds slight exaggeration that you could have found.

CLIENT: Oh, yeah. You get that now. I think you see it. [00:57:08]

THERAPIST: Yes. What I am giving to you here, I'm giving you what's called a Self-Help sheet and if you want to you can make photocopies of it so that you have many sheets on hand to fill in, but also it's in the REBT book that you've got. In any case, and it's called the ABC approach, it's a magnificent tool to help us get into the habit of specifically identifying the shoulds, realizing what the emotional and behavioral consequences are which aren't helpful, and then and this wasn't part of your homework last time disputing, disputing, disputing, and then replacing those irrational beliefs. [00:58:01] You wanted thoughts to replace the unhealthy ones, but that's missing a really important point. That's like having a wound and you only want a bandage to put on it. What I want is for you to notice the wound, to do what you can to extract or pull out the poison from it, and then following that: you put a bandage on. So in this approach you notice the wound (the debilitating emotion), you identify the irrational beliefs, and you realize the emotion that goes with it that's not healthy. Then the pulling out of the toxin or the poison is the disputing part of the process, because you're breaking apart, you're getting rid of, you're dispelling the toxic beliefs. And then you enjoy the outcome of doing that which is the effective new healthy thought. You just wanted to jump from harmful thought to happy thought. No, let's get rid of the unhealthiness from the roots. Make sense?

CLIENT: Yes. That does.

THERAPIST: I'm going to leave this Self Help form with you.

CLIENT: Can I just say a quick example then, just to make sure I'm understanding it? The thought is looking for the shoulds ...

THERAPIST: Yes ....

CLIENT: ''I should practice piano tonight for the concert that I have on Thursday''. That's one thing, right? Is that what we're talking about?

THERAPIST: 'Should' in this example seems to be a loosely chosen word. If you're saying it lightly, meaning "it would be better if I practice piano" no it would not the best example. But if you are telling yourself "I should practice piano or I'm not good enough"...that is a helpful one for the Self Help form.

CLIENT: Right, it's that. It's that latter thought. It's actually that or "I'm not going to do well" or blah, blah, blah. I've had a lot of those thoughts. Even looking at the piano I can feel it. So there is that, so then dispute it. If I don't practice tonight . . .

THERAPIST: Wait. Let's look at this form.

CLIENT: Oh, okay. I'm sorry. You're going to show me on the form what it is?

THERAPIST: Yes. So A is the Activating Event. Jessa, it is you thinking that "I should be practicing. If not I'm going to be terrible and I'm just a lazy so and so". And then you identify the C and I suggest that you do this in writing and please bring it and show it to me for our discussion next time. When I say "it" actually I would like you to fill a few of these forms in. At least three. At least three, and as many as 300!

CLIENT: (laughs)

THERAPIST: So then you identify the C Consequence. Make it really clear to yourself. How am I feeling when I think this? What is the emotion? Anxious. Would it be anxiety?

CLIENT: It is anxiety, yeah.

THERAPIST: Then you clearly write down B's your irrational Beliefs. So one "should" you have already mentioned because that was the activating event in this case, but there are probably more "so you look for the shoulds en mass. [01:01:05] You look for catastrophizing and awfulizing, which you can tend to do. We understand one of the things, with compassion, which contributed to those tendencies it's helpful and informative that you shared what you shared today about the childhood experience, because just as you had compassion for the ten-year-old I was role-playing with you, that's what we want for you. Compassion and unconditional self acceptance from you to you. Also you look to identify any low frustration tolerance LFT. It may or may not apply. "I can't stand it when I have to practice and I don't do so" might be an example of LFT or "I can't-stand-it is", and any rating or damning of oneself or others or life itself. And then, and this is the new thing that I'm asking you to actively do, you perform the pulling out of the poison, the destroying the poison. By doing the D part of the process Disputing. Dispute the irrational beliefs realistically, logically, pragmatically, asking questions like, "Will this help me or hurt me?" "Where is it getting me? Where is the evidence to support this belief? Is this belief logical? Is it realistic? Does it follow from my preferences?" Now, Jessa, because we have to finish up in a couple of minutes, dispute your irrational beliefs regarding your "I should be practicing piano."

CLIENT: It's really hard. Really hard.

THERAPIST: Try it. You'll have more time to spend on it when you do the homework, but just to get a sense of it, try doing some of it with me here now . . .

CLIENT: I know. I'm just trying to think. I have to switch it off. Irrational belief. Let's just do the piano one because we were just on it. Now I'm going to dispute. I should play it -that is the irrational belief. Now I'm going to dispute it and the thought that I should, otherwise I'll be a mess. I'll be worthless. No one will think I'm the great musician that they think that I am.

THERAPIST: As they should think I am!

CLIENT: (laughs) Exactly. Will this belief hurt me or help me? It will hurt me. Believing this will hurt me. Where is it getting me to maintain this belief? Not making it any better.

THERAPIST: Isn't it getting you Anxiety...and Procrastination.

CLIENT: Anxiety. Procrastination. Okay. Where is the evidence to support this belief?

THERAPIST: Let me help you because of our session time having to end shortly. Where is the evidence that "it will prove worthlessness?" "There is evidence that if I, Jessa, don't practice I won't do as well as I want to do, but it doesn't mean I'm a rotten person or totally inadequate and it doesn't mean it's terrible or that I am terrible. It doesn't mean it's terrible if I don't practice today but do it in the morning. Do you see? If you're acting in a perfectionistic way, there can be this "either I do it tonight or it's awful."

CLIENT: Right. Exactly.

THERAPIST: REBT invites flexibility. Not laziness. Do you see what I mean?

CLIENT: I do. It's balance, actually.

THERAPIST: A nice balance, which doesn't mean neutralizing feelings. It means healthy feelings that don't paralyze us. Makes sense?

CLIENT: Yeah. It's not logical, it's not realistic to believe those irrational beliefs, and does it follow from my preferences? No.

Right. No. I can do this. If I sit down to actually focus, I can definitely do it. [01:00]

THERAPIST: And earlier you said that you wanted a new idea to replace the old. That comes after the disputing. In this self-help form it's the E Effective New Philosophy, where you state the new rational beliefs and philosophies which emphasize preferences. You remind yourself that you can stand what you don't like, you evaluate any bad actions but don't allow yourself to doubt your worth or worthiness, which exists whether or not we perform bad or good actions. You might say, "Well, I would prefer to practice tonight, but if my shoulder makes it too uncomfortable, I can wake up ten minutes earlier in the morning and still do it then; and it's not the end of the world. Even though I would prefer to do it tonight, I'm not a no-good person if I don't. I'm not awful. Worst case scenario, if I don't practice it means I'll do a less good performance maybe, but that doesn't make me a less worthwhile human. It just means that my performance won't be as good as it might be if I do practice. Not a great outcome, but far from the end of the world."

CLIENT: Right.

THERAPIST: If it helps you to think of the compassion you would have for a child, then think of that.

CLIENT: Okay. Okay. (laughs) It does.

THERAPIST: But we're talking about you.

CLIENT: No, that does help.

THERAPIST: So do you have any questions about the how-tos of doing this?

CLIENT: No. I think it's good. I'm excited to do it.

THERAPIST: Lovely. Good. It's a start. Now as I said, I'd like you to write it all down. The more often you write responses to each of the steps, and over the course of our weeks together I'll encourage you to do this Self Help form often, here is what happens over time... I'm telling you this from my own personal experience and the many people I've worked with who learned to use the REBT approach, that when you fill in the Self Help forms many times I don't mean all on the one day but over time, it becomes easier to just think the A B C process through in your head. The whole procedure can become quite automatic.

CLIENT: It's just more natural.

THERAPIST: Yes. Right now, to use a word you love, it's unfamiliar but the more often you will do it, the more familiar it will feel...

CLIENT: Right.

THERAPIST: So will you do your Self Help forms in writing?

CLIENT: Yeah, sure.

THERAPIST: A minimum of three of these. So get another piece of paper and do the A, B, C, D and E's yes?

CLIENT: Okay.

THERAPIST: This is your guideline (showing sheet describing the ABC approach). You can also see information written here that can help you clarify the unhealthy from the healthy negative emotions.

CLIENT: Okay.

THERAPIST: Any final comments or questions before we finish for today?

CLIENT: No. I'll just end on this note, what you said about my upset about the boy who had my private phone number who called last week and I used that today, actually, with one of my students. Instead of freaking out, I just felt concern. It wasn't the same extent of that other situation, but I have very high emotional situations every day at work with the kids and so I used that today and felt just concern instead of . . . I find that sometimes if I don't take on too much, then the concern is easier to have and also it is easier if I don't worry about all the things about me. It's just easier to just have concern and be there for them. So I think I'm already a good counselor, but I think this is going to make me a better counselor as well, which I'm excited to do.

THERAPIST: I'm sure of that. It can make you a better counselor. However I'd like you to be equally, if not more, excited about the fact that there is huge potential that you are going to be so much more comfortable in your own skin and feel greater contentment if you don't demand that you be some perfect Jessa.

CLIENT: That would be nice. (laughs)

THERAPIST: That's one of the areas for us to focus on.

CLIENT: So thank you.

THERAPIST: Oh, you're welcome. Any other comments or questions?

CLIENT: No.

THERAPIST: So keep watchful, do your homework, and I'll see you next week.

CLIENT: (laughs) Sounds good.

THERAPIST: Good work. Really good work.

CLIENT: Is this off? (referring to recorder) No, is it?

THERAPIST: Does it matter?

CLIENT: No. (laughs)

THERAPIST: Good work.

CLIENT: Okay, thank you.

THERAPIST: And you accepted the compliment that I gave you !

CLIENT: Yeah. (laughs)

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