Client "JM", Session 3, October 14, 2013: Client discusses ongoing shoulder pain, effectiveness of REBT, irrational beliefs and thought patterns and how to correct them. Client and therapist review her homework from previous sessions. trial
TRANSCRIPT OF AUDIO FILE:
BEGIN TRANSCRIPT:
THERAPIST: Session 3, Monday, Columbus Day, October 14th, 2013.
Hi, Jessa. So you were telling me you're in physical pain. You've had some news from the doctor. What's going on?
CLIENT: That's actually the tricky part. It wasn't the news from the doctor. I had surgery done on my right shoulder in August, on August 20th. That's basically a three-month process just to get over the hump and be able to raise up your arm, which I can't really do. There are a lot of physical restrictions. I can do it, but it hurts. On top of it I started having really bad pain in my left arm and shoulder right after I found out about my right arm and had that done. [00:01:04] I thought maybe it was just compensation, but then I got the MRI results. Then I went and had an MRI done. I think we talked about this last week in our last session. I had an MRI and the guy really hurt me. He was digging needles into my shoulder. I had this huge black and blue bruise and it's been tingling ever since, so he must have hit a nerve when he did it. It was really, really uncomfortable in the days after. Needless to say, I got the actual physical films back and all of that. I think what was the most frustrating part of the whole thing was that when I spoke to the doctor he said that when you read the actual film it looks like there is something there worth really looking into. I don't want to say that he blew me off, but it felt, in a way, like he did because I was in just as much pain, if not more, with my left than I was with my right when I went in at first. I said, "Isn't it the same issue that I have going on with my left that I had with my right?" And he said, "Yes, it is." Not that I'm jumping to do surgery, but I said, "Why wouldn't you do surgery on the right and not the left?" He said, "Well with the left, I don't think you're going to need it." [00:02:14]
Today I went to my physical therapist and I showed him the reports and the first thing he said after he looked at the reports is, "Okay, so when is the doctor operating?" That threw me because I've been feeling like I'm in so much pain and it's sort of the same thing that I had with the right. I guess what's so frustrating about this whole situation is that to me it feels like a mystery, like the doctor is saying one thing, I'm feeling something, and everybody has their opinions. This is part of my issue to start with, that I look to everybody for some type of answer. Not everybody, but from people in the profession I feel like I'm not getting an answer. [00:03:01]
THERAPIST: As you think you should?
CLIENT: Oh. You're saying that? Because I'm not using the word "should." I'm staying away from it.
THERAPIST: I notice you're staying away from it. I'm just suspecting you might believe that you should be able to get, even if you don't use the actual word . . . And I think, certainly, it's a healthy preference: to prefer or want to get reliable and clear answers from doctors and others in the medical profession. It's not an unreasonable want by any stretch of the imagination. Unfortunately, the reality is that one sometimes may, and sometimes may not, get such information from medicos. I also went through situations where I could not get clear answers about the health of my husband and mother and, like you, had experienced different interpretations, different opinions, different stories from different doctors and others. That's the reality. So, yes it would be highly preferable to get one accurate, clear, sure truth and prescription. But there's not really any guarantee that we always will, or that we ever will. [00:04:06] But sometimes it can happen.
CLIENT: My girlfriend even said to me yesterday in the car we went away and we were traveling home and she said, "And, Jessa, that's why they call it 'practicing' medicine." (laughs)
THERAPIST: That's a good point.
CLIENT: I was like, "You're so smart." I thought about it afterward and I said, "That's true." My father is a doctor so I tend to over-credit doctors because I would go to him with all my physical ailments when I was younger and he would say, "Oh, it's this," and I would say, "The doctor knows." That would be where I would look to them. Even my father now said, "I don't really know what's going on. I have no idea." I said, "Fine. We don't have to talk. That's fine. I'll talk to the doctors that specialize in this area." Needless to say, it's been upsetting for me because I want something that's at least going to relieve my pain that's not a pill because that's just band-aiding over the problem. That's not fixing the issue. [00:05:03]
THERAPIST: It's a healthy frustration if it can motivate you to, perhaps, seek a second opinion. The important thing is to work against allowing yourself to feel hopeless, or depressed.
CLIENT: That's what I'm going to do. Exactly.
THERAPIST: And then, when you are in a stable place emotionally, you may better make an adult assessment about what to do and that's the practical strategy I would suggest.
CLIENT: Okay.
THERAPIST: That aside, it gives us an opportunity to look at your tendency to demand the right behavior from professionals. Again, it's healthy indeed to want them to do so. If you notice someone not acting professionally, or not acting appropriately, run the other way; but we are, as you know by now, among other things, looking for your "shoulds." I also want to ask you whether you think it might be worth asking yourself whether you have a strong demand or need for certainty.
CLIENT: I do. I don't have to ask myself. (chuckles) [00:06:03]
THERAPIST: Yes. And do you think, if you're willing to be objective at this second, does a need not a want, but a need for certainty help you in any way?
CLIENT: No.
THERAPIST: Does demanding it actually bring you the certainty or a certain answer from others?
CLIENT: No.
THERAPIST: Is it even possible in this life to have absolute certainty about anything?
CLIENT: No. No, it's not.
THERAPIST: Okay. So I'm really happy to hear you say that you recognize that you haven't had benefit from it after admitting you've had a need for certainty in the past and you've just told me very clearly and convincingly now that you don't find any benefit in demanding that you have it. [00:06:55]
CLIENT: No, there isn't. (chuckles) But yes, that is an issue that I have. I like things wrapped up in a nice, little bow and then tie it on the top and put it to rest. It doesn't work that way, which is what I think actually causes some of my anxiety, sitting with the unknowns; but there is a lot of that in life.
THERAPIST: Is it sitting with the unknowns, or your demanding that the unknowns don't exist and demanding that there be knowns, that creates your anxiety?
CLIENT: Probably a little bit of both. I don't know. I'm not sure. (chuckles) I don't know because I think it might be a little bit of both. From what you just said back to me, maybe what you're sort of leading to is it sounds like it's more of the demand, that piece of it; not just sitting with it, but just the demand. [00:07:57] I guess it also, though, has to do with extremes because there is a difference like you said go in for a second opinion, but then where my head goes is that if I go in for a second opinion, I fear that I am going to get more confused.
THERAPIST: And here you go doing what we've discussed before, which is anticipate . . .
CLIENT: I'm the perfect client for this, aren't I? (laughs)
THERAPIST: Perfect?
CLIENT: I'm the ideal client.
THERAPIST: You're a person who in all probability could greatly benefit from putting into practice what we're exploring in terms of REBT attitudes. It can make a huge difference to your emotional and, really tied into that, your physical well-being.
CLIENT: I said I was the perfect candidate but then you were saying before I said I fear that if I go for a second opinion . . . [00:09:04]
THERAPIST: What I started to point out is that you appeared to be anticipating the worst before you've even gotten there. It wouldn't necessarily be much better for you to anticipate the best, either. Might it not be more helpful, to assess an outcome after you have actually experienced it?
CLIENT: Yeah, it would be.
THERAPIST: It is very useful that we get to look at that tendency of yours, because being aware of it that's the first step to changing it. You predict the worst sometimes. I'm not saying all the time. I doubt that you do it all the time, but significantly enough. You have done it at times during the two and a bit times we've had a session. (pause) What do you want to do about that tendency? [00:10:04] (pause)
CLIENT: I don't know. Fix it?
THERAPIST: How would you fix it and why do you want to fix it?
CLIENT: Because I'd like to be more optimistic. I think it's an easier, happier life if you're more optimistic as opposed to thinking the worst. And then at the same time, as we discussed, I think breaking away from how some of my immediate family think, the catastrophizing ways that have always been there, that's something that I've realized over the years; but I don't know how much I've realized that I took it on, and so that's something that I know is going to take a lot of work. Because it's so extreme, I think it's going to take an extra amount of attentiveness to change it as opposed to just "let me just try this activity out," changing the way that I think. [00:11:09] So it's not that I'm thinking the worst, I'm just understanding that this has been a language that I've spoken in my head since I can remember.
THERAPIST: And frankly, there is no predicting how long or how intensely you're going to have to work at it in order for it to change. What I'm very confident about based on my own experience and from my work with others, is that as you begin to make the effort to change it, beneficial outcomes do result; good outcomes result so it's worth the effort. But again, watch that you're not assessing in advance or thinking that because for 30 years you have thought in a certain way, that it's definitely going to be hard, or too hard, for you to change it. To have such an attitude won't help you any. [00:12:00]
CLIENT: Let me just explain that I believe I'm thinking in that unhealthy way because I'm very, very close with my family, so the conversations that I have tend to go in the direction of that sort of thinking. I wasn't even aware of it until we started doing this work.
THERAPIST: And there you are. It is very helpful that now you are aware of it. Good.
CLIENT: I need a little bit of assistance putting the conversations not in that direction from my end. It doesn't matter what they say, but . . .
THERAPIST: Right. Well, indeed, a good goal would be to listen to what they say with the ears of an audience listening to a play on Broadway and enjoy the drama and the entertainment of it. That's possible if you make the effort to not take things too personally, and to not take things too seriously. And attempt to avoid the waste of your energy which could come if you are damning those who are speaking. Notice any damnable behavior that's okay, attempt to be objective about it rather than taking it all on board personally and doing so can help you not take it too seriously. [00:13:05] And in terms of what you would do in such a conversation at dinner, in addition to largely listening and being entertained, is to respond less and to watch and listen more unless you bring up a particular topic. I'm just now talking in generalities, but you might want to make the effort to be less provocative. I'm not saying not to be authentic. It's possible to be both. There is this whole area called diplomacy. And finally, again, allow yourself to be entertained. You could think to yourself, "Wow. Look at the irrational things I believed in the past." You can laugh. You can shed a few tears. But don't take it all too seriously and woundingly. Do you know what I mean? [00:13:58]
CLIENT: Right. Right.
THERAPIST: Have compassion for yourself, in having taken on unhealthy beliefs and attitudes, don't put yourself down for having done so. And then you move on. You get to see the vulnerabilities of the people who spoke such ideas, which is what fuels a lot of their distorted thinking and behavior. They themselves possibly were influenced when they were young by their elders and role models earlier on in their lives. I encourage you to go spend time with them as soon as the opportunity arises. Don't avoid it. Attempt to look forward to seeing them, thinking thoughts such as: "Gosh, what am I going to see tonight?" And drop your former attitude of "I have to protect myself. Will I have to defend myself? What will I say if they say so and so. . ?" Why don't you give up that role? In fact, Jessa, right now I, as the director of the drama department here, dismiss you from that former role "You're fired!" and you may now join me as a member of the audience. How's that attitude?
CLIENT: (laughs) You're so funny. I know you're serious, but you're a character. [00:15:01]
THERAPIST: Humor doesn't it help put things a little bit in perspective?
CLIENT: Oh, I always use humor. That's one aspect . . .
THERAPIST: "You always use humor except when you don't !!! Which means you don't always use it. But it's good that you sometimes use it!
CLIENT: Oh, my goodness. Well I like humor. I like humor and humor helps a lot. With my friends we're always not always, sorry we like to make jokes.
THERAPIST: Well caught.
CLIENT: That can make me a little nuts.
THERAPIST: No, it may require effort to stay alert to your language but I doubt that it will make you "nuts" !!!....
CLIENT: (laughs) Oh, my God. (laughing) I'm just thinking whoever ends up listening to this. Hello to the people who are going to listen to this. You're going to have a wonderful time transcribing this recording . . . I think it's interesting. I think we could make a play. Anyway . . .
THERAPIST: (laughs) That's for a future discussion. Now let's get you to stop "shoulding" on yourself.
CLIENT: Okay. Did I just say should?
THERAPIST: Not just. But you've managed in the last ten minutes, I'm sure. So a need for certainty, let us get back to that let's get really clear, do you agree with my suggestion that you've had that? [00:16:04]
CLIENT: Yes.
THERAPIST: And would you be willing to keep an intention in the forefront of your awareness, as much as possible or appropriate, with the goal of dropping such a need?
CLIENT: Dropping the need for certainty?
THERAPIST: Yes dropping the need for certainty because, in reality, it's not possible to get it is it? 100% certainty? Not possible. With some things you may be able to talk in terms of high probability. Like if it's sunny outside and I open the shades, my room will be lighter in all probability, but that's not 100% certain. Is it?
CLIENT: Right. Right. It could easily start raining within seconds and become grey and skies become dark . . . So yeah, you don't know.
THERAPIST: So why am I asking you to work on changing the need for certainty?
CLIENT: Why are you asking me? [00:16:58]
THERAPIST: Yes. Why do think that am I proposing that as a healthy goal for you? How is it going to serve you to work on changing that need?
CLIENT: To relax a little bit more because then the expectation is not sitting there waiting like waiting panting dogs like they are expressing "feed me this certainty right now" because if it's (certainty) not going to happen I'm just going to be perpetually disappointed with that, which I think I've gotten a little bit better about over the years. I've been through a number of things where I didn't get certainty and I was under the impression that I would. I guess physical pain, though, is challenging when you're feeling really shitty. Am I allowed to say that?
THERAPIST: Yes, you're allowed to say shitty.
CLIENT: I just feel like crap. It's just really, really painful, so that pain I feel affects my mood and how I'm going about daily things that I would do. [00:17:58] Before coming to the session I was just sitting playing music on keyboard in prep for an event that we're doing at school on Thursday. I was limited on how long I could sit there, and it started to hurt. I had to lie down and I just feel taxed physically. I think that changes my mindset. I think I was always the way I was. I'm not going to deny that. I always thought the way I did, but I just feel like it doesn't help right now.
THERAPIST: No, it doesn't help, but it doesn't mean it's impossible to make some effort. And when you find that physically you need to stop playing the keyboard, you have a choice of thinking, "Right now I'm in a chapter in my life where I'm limited and I need to rest more than I prefer, but it's not forever." Or you can think, "Damn it. I should be able to do what I did before August." And the "should." Is that going to help you? [00:19:02]
CLIENT: Yeah, I did think like that.
THERAPIST: You don't have to continue to think like that. Your choice.
CLIENT: Well I just have something coming up so soon. That's the reason. I think I would be okay with it if it I didn't have a performance on Thursday.
THERAPIST: Right. If life was perfect then the only time we had an injury was when we didn't have to perform sometime soon after. If only . . . But do you think that you're the only human who, before needing to perform, be it music, a speech, a lesson, a whatever had something unanticipated happen?
CLIENT: No. No. That's true. That's true.
THERAPIST: But the choice you have is your attitude. I remember as a psychology student the first time I heard my husband speak, he was visiting Australia he wasn't my husband then to give a workshop. He started off by saying that he had traveled all the way from New York to Australia and there he was. [00:20:01] He started off by sharing: "This morning I broke a tooth and it's extremely uncomfortable and quite painful, but I've made the decision," he said, and I still remember his words these decades later, "...not to upset myself about it. So it hurts a little. I took some Tylenol, but I'm still able to talk. I'm still able to be here with you. And later on I'm going to go to a dentist." What he said sounds like totally common sense, but I suspect that a good number of people who traveled all the way from New York to Australia who had broken a tooth may not be so honest and forthcoming, and they also may not have had that accepting and non-complaining attitude. Do you think his attitude served him?
CLIENT: Oh, yeah, I'm sure it did. And it also probably benefited the point of his REBT. [00:21:02]
THERAPIST: He was a model. And I remember it to this day.
CLIENT: Exactly. Exactly.
THERAPIST: So it is unfortunate that you have pain, full stop. No doubt about it. It's unfortunate that before you're giving a musical performance you're limited in the hours that you can physically rehearse for it. But didn't you tell me you did get some practice in?
CLIENT: I did.
THERAPIST: Isn't that better than not being able to do any?
CLIENT: Yes.
THERAPIST: And if you think about that, can your disappointment lessen?
CLIENT: Wait I'm sorry. I lost you. If I think about the fact that I practiced a little?
THERAPIST: The fact that you did a little. That is better than NO practice. You're not totally debilitated. (pause)
CLIENT: Yeah.
THERAPIST: Or you can think, "Gosh, I've got a performance in a few days. I shouldn't have to be so limited and go through this. And on top of that, I can't get any certain opinion about my medical condition." If you dwell on thoughts like those where is that going to get you? [00:22:07]
CLIENT: Not a good place.
THERAPIST: You look a little more relaxed in your face now that we're talking about the issues at. Are you feeling a little less tense about it?
CLIENT: Yeah. I think it's interesting stuff and I think I do want, obviously, to make these changes. I notice myself going to the place of concern for me that . . . Can I ask a question?
THERAPIST: Of course.
CLIENT: My question is in your experience with REBT, do you think that it can work for all personality types? (laughs)
THERAPIST: My experience is that with all the 'personality types' I've worked with who put in the effort to make changes, I've seen positive results. And these positive outcomes were maintained according to their ongoing efforts. [00:23:08]
CLIENT: Right. So that's good news. It's not me questioning this, it's just that . . .
THERAPIST: And it would be fine if you did question it.
CLIENT: Actually, I question it in the sense that I think I always felt so different from others, just in life, so I continue to look at this and say that things just don't work . . . It's that negative thinking which I am very much aware of, but it's upsetting myself by saying that it's not going to work for you or you'll try it and . . .
THERAPIST: What are you doing right now?
CLIENT: I don't know.
THERAPIST: You just said it's not going to work for you. A few minutes ago, did we talk about a tendency of anticipating? [00:24:03]
CLIENT: Yeah, I realize all of that. I'm just sharing with you because it would be inauthentic if I sat here and pretended like . . .
THERAPIST: Oh, no. I'm very glad you asked the question and brought it up. I'm just allowing you to notice, yet again, that easy tendency.
CLIENT: I guess it's like a habit.
THERAPIST: It is a habit.
CLIENT: If you're a smoker someone comes to your house and you're sitting there like "oh, man," so it's habitual. But over the years someone says something and then my head immediately goes to that place.
THERAPIST: And then you have a choice of saying, "Oh, look. My head immediately went to that place again. Come here, head. Over here, head. STOP THAT !" And that's the ongoing effort. And with time and practice for many people, including others who are very unusual, which you say you are: 1) it often becomes easier over time to catch the unhelpful thought more quickly and 2) it becomes easier over time to preempt it, or prevent it. [00:25:10] It's possible to preempt it. You're about to think the usual unfounded and unhelpful thoughts and then you tell yourself: "NO I'm not going there." And then 3) You notice that you are doing it less, or that you are no longer ruled by the habit of doing it. Ongoing effort.
So, now, I wonder about your efforts with the homework over the past week!
CLIENT: Well, it was quite interesting. (laughs) There was a lot. I could have kept going last night. My arm started to get tired, as I mentioned with my shoulder. I don't know if I mentioned, it's just difficult to write right now for long periods of time, but I was having a grand old time pages and pages.
THERAPIST: So please tell me about the homework and what you did and how it was . . .
CLIENT: The homework was I did it and then I found that it was very challenging for me to continue with because I don't remember...to be honest with you, I remember that you said to do all this part up to "Does it follow my preferences?" [00:26:04] But then I had a very difficult time with the Effective New Philosophies. That was where I got stuck. I was able to do all of the fun completing stuff no, I'm kidding but then it was hard for me to come up with the new replacement or Effective Helpful Strategies, Rational Beliefs.
THERAPIST: Effective New Philosophies.
CLIENT: Okay. That you can stand what you don't like. Yeah. That was a little bit more challenging for me.
THERAPIST: Okay. So let's hear some examples.
CLIENT: We can actually do this one.
THERAPIST: The newer thing in that homework for you was the disputing, so I'm really interested to hear how that went. So let's hear it.
CLIENT: Okay...the A was feeling as if I don't have the answers. It feels helpless and out of control for the activating event. I don't know. Hopefully I got that right. [00:27:00]
THERAPIST: Clarify -what was the activating event?
CLIENT: What's going on with my shoulder.
THERAPIST: The pain?
CLIENT: Yes, the pain and getting the MRI and then speaking to the doctor and him not giving me a clear answer.
THERAPIST: So identify the "C" now. What were the emotional consequences and any behavioral ones, if there were any.
CLIENT: Okay, there were. I cried yesterday, a little bit of chest pain, uneasy pain in the chest; anxiety, if that's what you want to call it.
THERAPIST: To be very specific is helpful, so I invite you when you're doing the ABC technique to pin down the emotion as precisely as possible. and I can already tell you that your homework for next time is doing some more of these ABC's. Was the C anxiety?
CLIENT: Anxiety, yes.
THERAPIST: In addition to anything else?
CLIENT: Anxiety. You're only talking about the main emotion? Is that kind of what it is?
THERAPIST: Well, the predominant one. Put everything down, but yes, first the predominant unhelpful emotion. [00:28:02]
CLIENT: Anxiety.
THERAPIST: That would be good to have in there under the C section, if it's not already.
CLIENT: Okay. The need for reassurance; that's what I put in, but that's not a . . .
THERAPIST: That's your irrational tendency. That would be more the "B" section of Irrational Beliefs. Is that clear to you? That's how you're learning. You're learning. It's all right, when you don't do it correctly now that is part of learning the correct ways.
CLIENT: And then what I also do is call friends and family for reassurance. Then I gave an example. And I said guilt. I said, "What do you think I should do? Did I do the right thing?" I was underlining, "Would you have done the same?" I'm very aware of all the irrational stuff.
THERAPIST: You wrote that in the B section Irrational Beliefs?
CLIENT: No. In the Irrational Beliefs I said, "I should know because my parents always know the answer. I must be wrong. I'm never right. People will think I'm terrible." I don't know where I got that one from.
THERAPIST: From your head.
CLIENT: And "I can't stand it." Then for "D" I said, "Having these beliefs hurt me. They're not getting me anywhere." [00:29:02] Oh, wait. I wrote here, "Well, this is where I have an issue (laughing) since I feel like the evidence is being told that I was wrong so many times. I need help here. This is not logical. That I know. It's not realistic, but I need help with fixing it." I guess I got stuck there.
THERAPIST: Yes. And then you didn't go on to do any of the Effective New Philosophy?
CLIENT: No, I didn't.
THERAPIST: All right. Please don't turn the page. Let's work on this.
CLIENT: I need a pen.
THERAPIST: If you want to jot anything down.
CLIENT: I like writing stuff down because then I can reflect.
THERAPIST: By all means. Yes, here is a pen.
CLIENT: Thank you.
THERAPIST: Let's go through your Irrational Beliefs one at a time. But before we do, I think you put a few in the "C" section instead of in the "B".
CLIENT: Yeah, like how I call people? That's not really irrational, just that I need to be reassured. I said, what do you think? "I need to be reassured." [00:30:06]
THERAPIST: Yes, that would be a belief. "I need to be reassured."
CLIENT: Oh. Okay. (pause)
THERAPIST: And you said you felt guilt. What was or were the irrational belief or beliefs that created your feeling of guilt?
CLIENT: I think I felt very angry at the people that were giving me the answers that I didn't want.
THERAPIST: Hang on. That's a whole other emotion that we'll look at in a second.
CLIENT: Okay. So the guilt part? That was what it was.
THERAPIST: What were the irrational beliefs?
CLIENT: When I said "the guilt?"
THERAPIST: What creates your guilt? What thoughts create guilt?
CLIENT: Feeling angry at not getting the answers, at the people.
THERAPIST: Why are you making yourself feel guilty about that?
CLIENT: Because then I feel guilty that I feel angry at them.
THERAPIST: You are thinking "I shouldn't feel angry"?
CLIENT: Yeah.
THERAPIST: That would be the irrational belief. [00:31:01] connected to the "when I'm angry I'm a no-good person". Put it in your own words.
CLIENT: No, I shouldn't feel angry. They are helping me. This man operated on me. I should feel that he's God. (chuckles) I'm just being extreme.
THERAPIST: Yes, you are, but it's good you're laughing. Are you getting a sense of what this process is asking you to identify?
CLIENT: Yeah. I was just about to do a 'should'. I was going to say "should have written it down last week" because once you left, it was hard for me to remember it exactly. But there it goes with the "shoulds." Can I say I wish I would have written it down last week? Is that different?
THERAPIST: Tell me if it's different? Come on really, think about it.
CLIENT: (chuckles) It feels different to say that because it's not so carved in stone. I really do wish I had written it down last week.
THERAPIST: And that's a healthy thought, because you're wanting something that would have helped you and it suggests it.
CLIENT: It does feel better to say that.
THERAPIST: And it feels better because of the fact that even though you didn't do what you wanted to do, you're not quite as much of a wretch in your self-evaluating as you might have thought your were if you didn't do what you should have done, according to the rules in your head. [00:32:07]
CLIENT: Exactly.
THERAPIST: You'll get, I believe, more and more familiar with the benefit of 'wanting' rather than 'demanding'.
CLIENT: I'm starting. I'm starting to.
THERAPIST: You are starting. I'm seeing and hearing you notice when you're should-ing, and fortunately at times laughing at it, which is good.
CLIENT: It's fun. It's kind of fun sitting here with you and then I'm like, "Oh, my God. Look at that. I was just about to 'I should have' tried to be the good girl." I should have written it down.
THERAPIST: There's another one. And that is a core belief that will create a smashing guilt.
CLIENT: (laughs) That particular one?
THERAPIST: Yes. When you think: "I should be a good girl", then the inference is "and when I'm not, how shameful, how inferior, how unworthy I am of all the good things in my life when I'm such a shit. How unworthy." [00:33:06] And one of the things that came up last time, Jessa, that certainly I want to revisit if not today, but in the course of our times together the importance and benefit of you working on developing greater unconditional self-acceptance where you know you're worthy, whether you act like a good girl or not. I think we agreed last week that you don't appear to have that a lot of the time.
CLIENT: I don't. Yeah.
THERAPIST: It will feel very healthy to be consistently working on that. (pause) I'm pausing now, waiting for you to finish writing notes about what you want to recall.
CLIENT: I'm good. I can multi-task.
THERAPIST: Unconditional self-acceptance.
CLIENT: I was thinking conditional. Unconditional self-acceptance. USA? [00:34:05]
THERAPIST: U.S.A.
CLIENT: Oh. Look at that. Okay.
THERAPIST: So do you think you've written down most of the shoulds which created anxiety, guilt? Have you written down the shoulds that created the anger that you told me you felt?
CLIENT: Yeah, I definitely felt angry because should I go with that?
THERAPIST: Should !!! Yes, go with that. What we're doing now is identifying the irrational beliefs. That's what we're doing now.
CLIENT: So this one I think you'll find interesting, as will I.
THERAPIST: Well I had better find it interesting !!!(said jokingly)...
CLIENT: (laughs)
THERAPIST: You "should" be interesting to me. You "shouldn't" bore me!!!
CLIENT: (laughs) Oh, my God. It's crazy.
THERAPIST: And you're laughing, which is good.
CLIENT: No, no, no. Can I ask a question about this? Where does that come from?
THERAPIST: You've already told me. So tell me again Where do you think the shoulds come from? [00:35:05]
CLIENT: I've already told you?
THERAPIST: In the past, yes.
CLIENT: Some family things and how I was talked to, and things I was taught.
THERAPIST: Yes, you take on . . .
CLIENT: Yeah, which is what I was just about to bring up to you. I do. I felt that with my family they used to, if I had an injury or anything, both of my parents are in medical fields so they would both sort of come to the rescue, so to speak, so I think I feel angry now that they don't have answers. I think it's been a rude awakening over the last ten years of my life since I've been out of college to see that what I thought they were and what they did was a disservice in a lot of ways, but also what they did was create, if there was an answer, very clear cut "Jessa, this is what you have; this is what we're going to do," and now I'm lost without that. [00:36:05] But I'm not.
THERAPIST: You realize that? You are NOT lost without that.
CLIENT: I realize that. Yes, I do; but I think that's sort of been the theme of little Jessa. I could see it. It was very clear to me that that was what occurred. So I do I want to get out of that pattern because it's not healthy and I realize it now. I don't know that I always realized it. There was fear and then (sigh) they have an answer. They know. They didn't. It was an illusion, I think.
THERAPIST: So how good that you are allowing yourself to have these insights and to take your parents off unrealistic pedestals and see them as humans.
CLIENT: Yes. It's a harsh reality when you get to that place, but I think it's healthier to realize that. [00:37:06]
THERAPIST: It's adult.
CLIENT: Right. It's more adult.
THERAPIST: It's not as comfortable, perhaps, as having niche categories, but it's truthful and, in the bigger picture, certainly most of the time because I'm not letting myself say all of the time, but it gives us a realistic picture more of the time of life, which allows us to live a healthier life with more realistic thoughts and healthier emotions. [00:37:43] One of the misconceptions you may have had about the REBT approach that we're talking about and that you're learning about and applying, was a misconception I believe you may have had about limiting emotions or ignoring them when, in fact, what an efficient REBT practitioner has I don't just mean therapist, I mean a human in the world practicing it is a real willingness to experience the emotion. And then to assess whether it is helping or hurting; and then to do the detective work of "I created this emotion by what I thought;" to question the thinking and replace any irrational thoughts, using the disputing. Hence, we don't create null emotion or neutral emotion or 'la-la land, peace and love' happy all the time, but a healthy approach with human emotions. So coming back to the ABC homework that you did and are correcting and adding to now looking at the anger. We're now looking for irrational beliefs that created the anger in response to the activating event. What might they have been? [00:39:11]
CLIENT: What created the anger was this doctor that has . . .
THERAPIST: No, the doctor didn't create the anger.
CLIENT: Oh, okay. I created the anger. But didn't you ask for what triggered the anger? I'm just confused.
THERAPIST: Yes, what belief.
CLIENT: Oh, belief.
THERAPIST: Yes. We already know the activating event. We're looking for the belief.
CLIENT: That all doctors should have the answers. If this is their profession, then they should be able to tell me surgery or no surgery without this muddled "come back in December and maybe we'll decide then."
THERAPIST: So you think they shouldn't be non-specific, non-direct?
CLIENT: Yeah, not specific. Right.
THERAPIST: Should be clear, definite?
CLIENT: NOT Unclear. Right.
THERAPIST: Whatever the English is.
CLIENT: Exactly. [00:40:05]
THERAPIST: As they should be. So that resulted in anger. Any other beliefs?
CLIENT: What I mentioned before, that when I was younger I always got answers. Always.
THERAPIST: So you think -"As I should now"?
CLIENT: As I should now. Yes.
THERAPIST: And when I don't? Finish the sentence.
CLIENT: And when I don't it creates a tremendous amount of anxiety.
THERAPIST: What's the belief? And when I don't get the answer that I should then it is . . ?
CLIENT: When I don't get the answer that I should then it's a catastrophe.
THERAPIST: Is that what you think?
CLIENT: That's what I think, yeah. (chuckling)
THERAPIST: Well really get clear on that. "And when I don't get the answer that I should, I can't stand it" is that it maybe?
CLIENT: I can't stand it. I have a low frustration tolerance.
THERAPIST: Okay. So we have a good number of irrational beliefs. Are there any others you want to add before we do the "D?"
CLIENT: (chuckling) Before we do the "D."
THERAPIST: Of Disputing. [00:41:02]
CLIENT: Well I'd like to add a lot, but I think I get it right now. They are all kind of together, in a sense the anger and then you have the belief and the guilt and then you have the belief.
THERAPIST: No, you have the belief first and then you experience the anger.
CLIENT: Oh, I see. The belief comes in, then the resulting emotion. I see.
THERAPIST: Do you see that?
CLIENT: Yes. I do.
THERAPIST: All right. So for the purpose of our discussing it here because we don't want to run out of time, and as I said before, this is going to be your homework again, to do some fresh self-help forms, what I'd like you to do now, please, if you would, Jessa, is one by one read out the irrational beliefs. We're just going to stick with this example now, because it looks like you did quite a few.
CLIENT: I did a lot, yeah.
THERAPIST: Good. How many? Your homework was at least three and, clearly, you did more than three. [00:42:01]
CLIENT: I did four.
THERAPIST: Good.
CLIENT: But then I also went off on some tangent and went with a bunch of beliefs. These are all beliefs.
THERAPIST: It's good you made the effort, but as you shared with me, you only got as far as the disputing. As we've discovered exploring this, you can be more thorough in your irrational belief hunting, which is what we did. But first, what's required is getting really clear about the emotion. Remember I asked you to pin down the emotion and you said "anxiety."
CLIENT: Can I just tell you that at this moment, by the way, because this is very important, the whole time you're speaking I'm saying "I should have listened to you better." "I should have taken notes." This is what my head is saying right now. "I should have been more thorough." "I should have gotten it." "I should be smarter. Maybe if I had read the book." I said I had memorized it. (laughs) [00:42:57]
THERAPIST: And while you're telling yourself those shoulds, what are you feeling?
CLIENT: Terrible. I don't know.
THERAPIST: What does terrible mean? What's the emotion?
CLIENT: Guilty.
THERAPIST: And isn't that your easy tendency?
CLIENT: Yes.
THERAPIST: And do you want to feel this way for the rest of your life?
CLIENT: No. I just wasn't aware, so no, no. I don't. I don't. This is not what I want. I thought that was important to share that with you. It was a very "in the moment" . . .
THERAPIST: Yes, good ! And it shows you have the ability to be aware in the moment. And then you can either go with telling yourself "I'm such a shit for not listening to my therapist, Yes you are, Jessa. How could you?" You have the choice of going with that now that you're aware of it, or saying, "Hah! Here I go again. No, I'm a fallible human, not any of those damning self criticisms... That's been my habitual attitude," and then do the disputing, which we're about to do. So very good that you caught yourself. Very good that a) you're not taking it all that seriously in a sense you can smile; but b) seriously enough, you realize it's hurting you and I believe that you're going to make some effort to change it. [00:44:10]
CLIENT: I am.
THERAPIST: Which is what we're doing now. You're in training. Well done. So let's work with what was present. Dispute the "I should have listened to Debbie. I should have read the book."
CLIENT: I was trying to do that when you were speaking.
THERAPIST: Do it right now.
CLIENT: It's okay. We're doing it now. I'm learning now.
THERAPIST: Finish the sentence "Just because I didn't . . .
CLIENT: Just because I didn't take notes or didn't read extra or didn't have more thorough sentences in part of the activity doesn't make me a terrible person. It doesn't make me less smart.
THERAPIST: Finish: "It just means that . . .
CLIENT: I didn't really have enough practice with the exercise. [00:45:02]
THERAPIST: "I didn't do as much as I could have done that time and I can make more effort this time". Something like that. How does that sound?
CLIENT: Sounds good.
THERAPIST: If you think that more accepting way, do you feel as guilty?
CLIENT: Yes.
THERAPIST: You do feel as guilty?
CLIENT: Yes.
THERAPIST: Oh. Because what are you telling yourself? If you think "so next time I can make more effort."
CLIENT: It actually empowers me to think that it's okay that I didn't because . . .
THERAPIST: So you don't feel guilty.
CLIENT: No. Right.
THERAPIST: That was my question to you. When you dispute, do you feel as guilty?
CLIENT: No. I don't.
THERAPIST: Honestly?
CLIENT: No, I'm being honest. I don't feel as guilty. It's just going to take a lot, be hard. It's so interesting because it's . . .
THERAPIST: Stop here.What did you just do?
CLIENT: I went back to the thing.
THERAPIST: "It's going to take a lot."
CLIENT: Because it feels weird.
THERAPIST: No. You think it's weird. It feels unfamiliar, but yeah we've spent 2.75 minutes . . .
CLIENT: Right. This has been 30 odd years of . . .
THERAPIST: We just spent a few minutes disputing the now beliefs that created now guilt and you said you felt better.
CLIENT: I do.
THERAPIST: It took minutes.
CLIENT: Yeah, that's true.
THERAPIST: And in the next breath get ready to giggle you're telling me "but it's going to take . . ." And then you easily reverted to the "It's going to take a lot" attitude.
CLIENT: (laughing)
THERAPIST: Do you see that?
CLIENT: I do.
THERAPIST: Do you see your tendency? It would be like you've made a decision to go on a diet . . .
CLIENT: This is a good one for me.
THERAPIST: And to not have what naughty food do you like?
CLIENT: Pizza.
THERAPIST: Okay. And to not have any pizza for a month because you're a bit overweight and no pizza for a month. You're still eating. You're not anorexic. [00:47:01] And then someone comes over and brings pizza, and says "have a pizza, Jessa." You say, "No, I'm not going to have any." They eat it and you eat your salad and you don't have any pizza. They finished the pizza, you didn't have any, and you have had your salad. You've succeeded. And then, despite that fact, you tell yourself, "If anyone ever brings a pizza I don't know how I'll ever handle it." !!!
CLIENT: Oh, my God. I just had this conversation. That's freaky. Now you're freaking me out because I literally just had that conversation on Saturday about pizza specifically. (both laugh) Those social situations that it's hard.
THERAPIST: Do you know what I'm . . ?
CLIENT: Yes.
THERAPIST: I'm describing that you've just in real time here and now with me done something beneficial, and in the next breath you are predicting or indicating it's going to be hard but you've just done it! It may be hard, but not too hard unless you tell yourself it will be.
CLIENT: Exactly. I just did it. Exactly. No, I got it.
THERAPIST: Could you please give yourself some credit right now?
CLIENT: Yes.
THERAPIST: I want to hear it in words. [00:48:00]
CLIENT: (laughs) I think I'm going to be able to do this.
THERAPIST: Based on what?
CLIENT: Based on the fact that I just did it.
THERAPIST: You just did. And you felt less guilty within moments.
CLIENT: I did. I did.
THERAPIST: Could you please remember that evidence? You see, one of the things I love about this approach is that when people make the effort, that they don't have to rely on me telling them that it makes a difference. You created the experience of having a different emotion. You know it from your own experience.
CLIENT: Right. Right.
THERAPIST: You did it. Granted, I told you some things. I guided you. I used some humor -you laughed. But you did it. There's the evidence. Hooray, Jessa!
CLIENT: You're so funny. (laughs) No, no. It's exciting. Every time, each session, I have felt more and more empowered with each . . .
THERAPIST: You're empowering yourself because you're taking in the information and allowing yourself in a non-resistant way . . . [00:49:05]
CLIENT: To not feel like a victim, I guess.
THERAPIST: And to take responsibility, and to be working on removing guilt for not having done it until now. Well, how could you have done it by now if you didn't have the tools which you found helpful?
CLIENT: Right. I didn't know. Right.
THERAPIST: So hooray. Now let's get back to disputing the irrational beliefs that you had written down and wrote down about what we've discussed. Look back at your notes. Read an irrational belief and dispute it and I'll help you if you don't do it quite as thoroughly as is helpful for you.
CLIENT: Here's one. "I should know the answers. My parents always do or did."
THERAPIST: I think there are two areas of disputing here. Go for it. You do it first.
CLIENT: (sighs)
THERAPIST: What are the two areas you can dispute? [00:49:58]
CLIENT: The two areas I can dispute? Just be a little more specific if you can.
THERAPIST: Okay. Read that belief again.
CLIENT: I should know. My parents always do. Should.
THERAPIST: Say it again slowly.
CLIENT: I should know.
THERAPIST: Stop. And then?
CLIENT: My parents always do.
THERAPIST: Do you think there's any room for disputing those two halves?
CLIENT: Oh, totally.
THERAPIST: Go for it.
CLIENT: The second half or both?
THERAPIST: Both.
CLIENT: Both. Okay. (pause) It would be nice to have some answers, right? I feel like an actress. (laughs) It would be nice to have the right answers.
THERAPIST: Of course it would.
CLIENT: And it may or may not allow me to feel more comfortable in moving forward. I don't know. No, no, no. That's not rational. (laughs) [00:51:09]
THERAPIST: Can I help you with that?
CLIENT: Yes, please. (laughs)
THERAPIST: It would be really helpful.
CLIENT: Can I write it down, by the way, as you're saying this? I think the more I look at it, it would be easier to digest. Okay. It would be helpful . . .
THERAPIST: It would be helpful to have answers to my questions, and I'll keep seeking for them, but the reality is there aren't always clear answers and I'll do the best I can to get as much information as I can without demanding that I have the perfect, all-inclusive information, which may not even exist. Does that make sense? [00:52:12]
CLIENT: Yes.
THERAPIST: The reason I'm saying this to you now is because it is new-ish to you, but as our sessions go on, you're going to do more work. (giggles) This is going to be homework.
CLIENT: Yeah. I have no problem with the work. It's very new.
THERAPIST: I know you know that. That's why I'm doing this. You're doing fine. Make sense?
CLIENT: Then that part about my parents.
THERAPIST: What was that comment again?
CLIENT: That they always know or that they always have the answer.
THERAPIST: So might it ring true for you in disputing that to say "since I don't know everything my parents know, I have no evidence that they know everything."
CLIENT: Wait, you lost me. Hold on. Since I don't know everything my parents know, I don't have evidence that they do know? (laughs) [00:53:02]
THERAPIST: That they know "everything". Do you?
CLIENT: (laughs) No.
THERAPIST: Do they know Mandarin Chinese?
CLIENT: No.
THERAPIST: Then they don't know everything. Already you've caught yourself (laughing). You stated that your parents always knew or know the answers.
CLIENT: In the medical I should have probably been more specific.
THERAPIST: You should have been more specific?
CLIENT: (laughing)
THERAPIST: It would be more helpful to be specific and you're getting better at it.
CLIENT: (laughs) But no, let me be more specific. Let me just be more specific. My parents always know when it comes to medical questions.
THERAPIST: Prove to me they always know everything. Do they know what's in the Journal of Psychiatry, August, 2012, edition? Or in the October, 2013 Journal of Medicine?
CLIENT: No.
THERAPIST: Then they don't know everything when it comes to medical questions, do they?
CLIENT: (laughs) No. [00:53:59]
THERAPIST: Is there any evidence that they know everything?
CLIENT: Nope. (laughs)
THERAPIST: Is there any evidence that they're always right in their conclusions. We're talking about medical.
CLIENT: There has been some. Not that they know everything, but that they . . .
THERAPIST: I just said always.
CLIENT: No. Always no, not at all.
THERAPIST: But that was your irrational belief.
CLIENT: Yeah. Exactly.
THERAPIST: So do you see how I'm disputing the absolutism of that part of your irrational belief?
CLIENT: Yes. I have a question, though. I think I know all of these things rationally, if that makes sense. I believe that I'm rational. In other words, this is where I get caught is that I can see what the rational belief is, and yet something . . . I end up going to the irrational. Do you understand what I'm saying? In other words, I can look at the situation and be like "wow, that is not rational at all," but I go to that. Does that make sense? [00:55:03]
THERAPIST: It does. Perhaps until now you've done that because you haven't exercised the state of disputing, which is what we're doing now.
CLIENT: It's a lot of fun to dispute.
THERAPIST: Keep that attitude.
CLIENT: Yeah, it's a lot of fun.
THERAPIST: And it's a nice exercise for the brain. See? If you can't exercise your shoulder right now, at least you can do a little more brain exercise!
CLIENT: Exactly. I know. This is my next exercise. It is. I'm having fun with that. So disputing the one about my parents that in the medical field they always know answers. Let me try that one. You sort of did that a little bit, but my parents might know some answers.
THERAPIST: It is not unhelpful to say that they know some answers based on evidence and your past experience, if that's factual.
CLIENT: They do. They know a lot.
THERAPIST: Then say what's true, but say what's true.
CLIENT: Okay. My parents do know a lot. They're very knowledgeable people, but they don't know everything. [00:55:58]
THERAPIST: So this is your changing the tendency of little girl Jessa looking up at the pedestal of her holy parents who can do no harm and know no wrong and know it all, and now in an adult way, seeing them as the fallible, though indeed intelligent, humans that they are.
CLIENT: Exactly.
THERAPIST: Good. Because of our session time running out now , we're not going to be able to dispute all of the irrational beliefs that you wrote down.
CLIENT: No problem. Yeah.
THERAPIST: But do you have a more comfortable sense and understanding now about the disputing stage?
CLIENT: Yes.
THERAPIST: And you could go on further, even on the belief we looked at. You could attack some of the presumptions a bit more using what's on the sheet.
CLIENT: Oh, I could go on further with these, you're saying? [00:57:01]
THERAPIST: Yes, with these and with all the other irrational beliefs So that will be your homework. But before we finish up on this and before we complete this session, you didn't do, in most cases, the next step of Effective New Philosophies, which is understandable because you didn't complete the preceding stage of disputing. So let's use this limited disputation that you have done so far. Can you repeat it?
CLIENT: Sure. It would be helpful to have answers to my questions and I'll keep seeking for them, but the reality is there aren't always clear answers. I will continue to seek for maybe a second opinion I just threw that in there without demanding the perfect answers. That was kind of the gist.
THERAPIST: Remembering perfect answers may not exist.
CLIENT: That's important.
THERAPIST: (Singing) "To dream the impossible dream . . ." And then the belief about your parents....
CLIENT: My parents do know a lot, but they don't know everything in the medical field.
THERAPIST: (chuckling) But everything else they know everything about? I'm just teasing you. Okay. Very good. So then, Effective New Philosophies. I'm reading from this self-help sheet that's your tool here. That's your basis. It says, E: "State new rational beliefs, philosophies which emphasize preferences; that you can stand what you don't like; the evaluation of bad actions, but not of the worth or worthiness of you or others or life." Just with this limited example, come up with some effective new philosophies, Jessa, please.
CLIENT: (pause) [00:59:01] I can live with the fact that I'm not always going to be . . .
THERAPIST: I can stand.
CLIENT: I can stand not having all the answers right now or in general.
THERAPIST: A nice REBT mantra that's often applicable is: "I can stand what I don't like, I just don't like it."
CLIENT: Okay. So I can stand what I don't like.
THERAPIST: Can you?
CLIENT: Let's see. (laughs)
THERAPIST: Can you?
CLIENT: Yeah.
THERAPIST: You're alive.
CLIENT: I'm a human being.
THERAPIST: You've survived a whole lot of things that you haven't liked until now.
CLIENT: Yes, I have.
THERAPIST: So can you stand what you don't like?
CLIENT: Yes.
THERAPIST: To the degree that you allow yourself to do so.
CLIENT: Right. It's to the degree that I allow myself. Exactly. Empower.
THERAPIST: Carry on.
CLIENT: Just give me an example, and then I can give it back. Not of this one, but just what is really a preference? [01:00:04]
THERAPIST: I would like to see doctors that I have more faith and confidence in and I'll keep exploring and doing my best to find them, but I can stand the fact that I may not ever find the perfect doctor and I can live with a doctor that's good enough to help me with my issues. Something like that. Does that make sense?
CLIENT: Yes. It does.
THERAPIST: This evaluation of actions but not worth, behind that is unconditional acceptance.
CLIENT: Oh, I see what you're saying. So in other words, I'm not going to evaluate the effectiveness of the doctor that is treating me based on the fact that he can't give me an answer right now that is clear.
THERAPIST: No you do evaluate the effectiveness. You had better evaluate the effectiveness, but not the worth.
CLIENT: The worth. That's different. Effectiveness and worth are two different things. [01:01:05]
THERAPIST: He's not a damnable person. He's probably not setting out to frustrate you. He's not what you would prefer when he seems unclear. But you prevent anger when you don't damn him just evaluate his performance as rationally as possible.
CLIENT: This is the most important, in my opinion.
THERAPIST: This leads to that leads to that. It's all . . .
CLIENT: I see. Right, you have to go through it, but this is great. Yeah, it's true because that's where the anger . . . The reason I'm saying that is because I feel like with this there is a lot of anger and frustration and then when you see the effective new philosophy, you realize that everyone is human and the limitations that everyone is human.
THERAPIST: It reminds us that everyone is human. Yes, and that we can stand it and it doesn't mean not doing our best to find more adequate or compatible people who help us, or work with us, or live with us, or whatever it is. Do you understand?
CLIENT: Yeah, I do.
THERAPIST: It's important to evaluate the actions and the behavior, but that's different from evaluating their worth.
CLIENT: Exactly. Exactly.
THERAPIST: Dislike inefficiency, but watch that you don't hate the person who behaves inefficiently. Remember that they're fallible with their own abilities and flaws, if that makes sense.
CLIENT: No, it's true. It helps me not to idealize people.
THERAPIST: That is really important.
CLIENT: Because I do that.
THERAPIST: You tend to idolize people.
CLIENT: Oh, yeah.
THERAPIST: Yes. Would that have something to do with, for example, the attitude you held towards your parents?
CLIENT: (laughs) Oh, yeah. Of course it does. I know that. No, I know the relation. I did that to them, so I'll do it to others.
THERAPIST: Maybe. If you allow it. Another effective philosophy along the lines of that might be and with these new philosophies again, I'm talking a lot today because we're in training, but you'll do it in your own language and you'll do it better for you in your own language when you're more solidly cognizant of the principles, which is what we're going over and over. It's not complicated, is it? [01:02:59]
CLIENT: No.
THERAPIST: It's a new way of thinking for you.
CLIENT: It is a new way.
THERAPIST: With time, it won't be new.
CLIENT: Exactly.
THERAPIST: So I started to say regarding this tendency to idealization, an effective new philosophy for you to remind yourself might be along the lines of, in your language, : "I can appreciate the good qualities in others without glorifying them and putting them on unrealistic pedestals whilst accepting their human fallibility." Does that ring true?
CLIENT: Oh, yeah.
THERAPIST: So if you like that, keep it no extra charge (jokingly said) or write it in your own language, I mean by that in your own familiar way of expression. At the bottom of this self-help form it says, "After completing this self-help sheet, write down an action plan for next week about exercises or homework you do every day to enable you to begin to effectively eliminate unhealthy irrational beliefs, debilitating emotions and unhelpful behaviors which were identified, and to enforce and reinforce new healthy thoughts, emotions and actions which replace the harmful ones." We have come to nearly the end of our session, so your homework do you want to write down your homework?
CLIENT: Oh, yeah.
THERAPIST: If you want to write down your homework... I suggest that you do a minimum of three self-help forms every step of the way, meaning A, B, C, D, E. You didn't get to the D's and E's this past week.
CLIENT: Oh, so just do what I was doing, but just complete it; make it more thorough?
THERAPIST: Yes, including the E's, which you didn't do this week and you didn't complete the D's, which is one of the reasons we have these sessions (laughs) to get you more familiar with the approach. [01:04:58] I'm giving you the homework of doing these, but in addition, the homework would be to make a list, a separate list, of all the effective new philosophies. It can be almost look like a list of affirmations or mantras. Write them down, carry them with you, and read them at least ten times a day. It can be on the train. It can be on the john. It can be wherever, that you read over them, and remember them.
CLIENT: Okay.
THERAPIST: We want to get more solidly into your brain these new healthy ways of thinking.
CLIENT: Read them at least ten times a day, you said?
THERAPIST: At least. (pause) Have the list by your bed. End of the evening before lights out, you read it. When you wake up in the morning, at some point before you really start getting up or getting showered or whatever, read them. It will take you moments.
CLIENT: Okay.
THERAPIST: Make sense?
CLIENT: Yes.
THERAPIST: Comments or questions?
CLIENT: (laughs) No. I was just going to say "it makes perfect sense" and then I thought "I shouldn't say that to her. (laughs)
THERAPIST: Humor is good. Humor is good. [01:06:04]
CLIENT: No, it makes excellent sense.
THERAPIST: How are you feeling now in comparison to when we first started talking this afternoon?
CLIENT: It feels great. I feel more empowered, in a sense, that there are ways to help oneself. I feel just more relaxed and not as helpless, I guess, as I was feeling earlier. Physically, it's hard. Just physically I'm in a lot of pain right now.
THERAPIST: I want to acknowledge your ability to persist despite discomfort. Well done.
CLIENT: That I do.
THERAPIST: So if you can do that with a sore shoulder, you can do it with uncomfortable emotions if you choose to.
CLIENT: That's true.
THERAPIST: And I also want to remind you that it took you only a few minutes for you to move yourself from feeling guilt to not feeling guilt. It took you minutes.
CLIENT: Not years. And then I went back and was I was like, "It's going to take so long."
THERAPIST: Yes, so have that light-hearted humor and acceptance about this old schnooky tendency to anticipate the worst before it happens. But also persistently work to change it.
CLIENT: It's anticipating. Right.
THERAPIST: And, by the way, the other thing you did here in vivo was that you caught yourself shoulding, so we have evidence that you have that ability to be aware. That's step one: awareness it proceeds change.
CLIENT: No, I said last night when I was doing this, I'm very self-aware. That's not an issue for me.
THERAPIST: So I want to say well done.
CLIENT: Thank you.
THERAPIST: Well done.
CLIENT: Thank you. (laughs)
THERAPIST: And do you know what you also just did that's different from one week ago? Actually, it's not even a full week since our last session. You, with a smile, just said "thank you" when I complimented you. Last time your face turned a bit red, your eyes looked down, you even got teary and, as you noticed, your inability to accept a compliment. And just now and now you feel the emotion of that, too do you see? You accepted my compliment.
CLIENT: Yes, I do.
THERAPIST: So what's different in you now that allowed you to do that? To say thank you instead of finding excuses to not accept?
CLIENT: Because I think I actually can do this, so I feel more confident in that. So it's easier to accept it because I actually felt more confident.
THERAPIST: You believed in your capacity.
CLIENT: Yeah I believed. You use believe instead of . . . I just want to write that down for myself. I know we have to end the session. Use the word "believe." I'm just going to try that out instead of "feel." I notice you do. [01:00:09]
THERAPIST: Right. Get really clear language-wise, because it's our beliefs that create the emotions. We feel our emotions. It just makes things a little clearer.
CLIENT: Yeah, it does. It does and I'm also going to read more before our next . . . I think I had a little resistance, maybe, before; but I want to read it. I'm going to read it differently now.
THERAPIST: And please include the section on unconditional self-acceptance in your reading.
CLIENT: Okay.
THERAPIST: All right. Any final comments or questions?
CLIENT: Nope.
THERAPIST: Again, very well done.
CLIENT: Thank you.
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