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Section 16
Rational-Emotive Therapy with Children and Adolescents: Treatment Strategies

Question 16 | Test | Table of Contents

Rational-emotive therapy (RET) has a long history of use in the treatment of a variety of childhood problems commonly dealt with by school psychologists. This article presents the RET conceptualization of childhood disorders, discussing the interaction of child temperament and parenting styles. RET child treatment goals, which involve the modification of negative and inappropriate childhood emotions, are discussed. The particular RET cognitive change methods (philosophical disputation; disputation of irrational beliefs in specific situations; disputing of inferences; rational self-statements are illustrated. Specific suggestions for using RET with parents, for using RET effectively, and for using RET with different combinations of child, parents, and teachers conclude the article.

When a school psychologist finishes an assessment of a referred student and concludes that the student is experiencing an emotional problem (e.g., high anxiety, depression, extreme anger) as distinct from a behavioral, practical, or vocational problem, then rational-emotive therapy (RET) is an extremely viable treatment approach. AS described in the opening article in this series, RET has a long history of application with school-age children and to the treatment of a variety of childhood problems typically encountered by school psychologists including conduct disorders (e.g., DiGiuseppe, 1988), low frustration tolerance (e.g., Knaus, 1983), impulsivity (e.g., Kendler & Fischler, 1983), academic underachievement (e.g., Bard & Fisher, 1983), anxieties, fears, and phobias (e.g., Grieger & Boyd, 1983), social isolation (e.g., Halford, 1983); obesity (e.g., Foreyt & Kondo, 1983), and childhood sexuality (e.g., Walen & Vanderhorst, 1983). Waters (1982) briefly illustrated the use of RET for school psychologists in The Handbook of School Psychology (Reynolds & Gutkin, 1982).

RET Treatment Perspectives
A brief overview of the RET model of childhood maladjustment will help to make clearer the rationale for the methods RET prescribes in treating the social, emotional, behavioral, and learning problems of school-age children (see Bernard & Joyce, 1984). RET takes extreme cognizance of the wide individual differences observed in the way students in school (and elsewhere) react to the same event. Whether the event be teasing, performance failure, criticism, parental rejection, unfair treatment, or frustrating and difficult tasks, children and adolescents of the same age experience different degrees of adaptive and maladaptive emotions and behavior. This is especially the case after children have entered the concrete operational period of thinking as defined by Piaget and begin to actively mediate their environment. As children enter this stage of development, they are less influenced by events in their immediate perceptual environment. They begin to be more independent in their thinking and, in particular, think much more about things which have happened in the past or might happen in the future. From a RET perspective, the belief system and the logical reasoning processes of children determine in a fundamental way the extent to which they react adaptively to particular bad events they encounter. RET accepts the findings of the cognitive-developmental literature which point to a progressive differentiation and sophistication of perceptual, symbolic-representational and information-processing abilities. However, RET has a particular theory as to why certain children bring with them to their immediate environments irrational belief systems and faulty reasoning processes which are atypical for their cognitive-developmental level.

RET incorporates the findings of Chess and Thomas (1985) and other researchers who have found that children are born with reliable and consistent patterns of behavior which they label temperament (activity level, regularity, adaptability, approach/withdrawal, physical sensitivity, intensity of reaction, distractibility, positive/negative mood, persistence). RET theorists (e.g., DiGiuseppe,1988) have argued that all children are born with NFT or no frustration tolerance.

Additionally, RET theorists have for many years (e.g., Ellis, Moseley, & Wolfe, 1966) described differences in parenting styles and how parenting style along with parent emotions influence the development of children. For example, Hauck (1967) identified the "unkind and firm" pattern ("unquestioning obedience to authority combined with a kick in the ego") as contributing in certain children to low self-esteem, insecurity, and guilt as well as avoidant, overly dependent, and submissive behavior. "Not firm" patterns of parenting which involve parents setting few rules and limits has been linked in the RET literature with children who manifest low frustration tolerance and an inability to delay gratification. Bernard and Joyce (1984) argued that child psychopathology results from an interaction of child temperament with parenting style and, in particular, that adaptive development occurs because of a good match between parent child-raising approach and child temperament. Clinically, the RET practitioner is "on the look out" for children with age-inappropriate low frustration tolerance and who have "egorelated" problems and, in particular, "self-downing" thinking tendencies (e.g., Knaus, 1985).
In understanding why these children think, feel, and behave the way they do, RET gives attention to their temperament and the way their parents think, feel, and behave towards them.

Treatment Goals: Modify Negative and Inappropriate Emotions
The goals in the RET treatment of school-age populations are similar to those in adult treatment although the means vary depending on the cognitive-developmental status and intelligence level of the student. That is, RET is directed at bringing about a reduction in the intensity of inappropriate, negative emotions of students which are seen to be causing misery as well as making it harder for students to solve current problems and achieve future goals. RET is not designed to help the young client solve current presenting practical problems, but rather to reduce extreme levels of anger (rage), anxiety, and feeling down (depression) which prevent the young person -- or make it harder -- from figuring out how to overcome a specific problem. Extreme emotional upset disrupts the thinking process. The RET practitioner does not ignore practical, manipulative, or behavioral problems. While using RET with a student to solve emotional problems, the RET practitioner will frequently employ different cognitive-behavioral techniques such as interpersonal cognitive problem solving (Spivack & Shure, 1974); self-instructional training (Meichenbaum, 1977; Kendall & Finch, 1979); cognitive social skills training (Halford, 1983) to help the student acquire skills to modify aversive events in the environment and to solve practical problems.

Take the example of Andrew in Grade 7 who has been referred to his school's psychologist because of being very scared and depressed about the amount of teasing he receives. From a RET assessment perspective, Andrew might be assessed as experiencing a high level of depression and anxiety surrounding being teased. (He may as well have a deficit in social skills or an inhibition of his social skills due to his anxiety as well as experience other emotions like extreme anger.) The RET treatment goal for Andrew would be to reduce the intensity of his depression and anxiety so that not only would he be happier with his friends at school, but also through greater emotional self-control, be more effective behaviorally to decrease the frequency of teasing. Once Andrew's depression and anxiety is reduced, his high level of anger may also be targeted for change.

In RET, the modification of emotional problems is primarily accomplished via the modification of the young person's assumptions, inferences, evaluations, expectations, and beliefs which are either anti-empirical or irrational. "Errors" of inference refers to faulty conclusions (e.g., "Everyone is teasing me.") and predictions (e.g., "Everyone will always tease me.") a student makes about past, present, or future external events as well as misattributions of cause-effect relationships (e.g., "The reason my classmates tease me is because they hate me."). Irrational evaluations refer to the manner in which the student appraises the significance of the initial interpretation or inference of reality and typically are manifested in "absolutistic statements" (e.g., "I need my classmates' approval."), "awfulizing" statements (e.g., "It's terrible to be teased."), "I can't stand-it-itis" statements (e.g., "I can't put up with teasing any longer.") and "global rating" statements (e.g., "I'm hopeless.").

Said another way, when a student is assessed as having an emotional problem, according to RET theory, one can anticipate a number of different cognitions which are causing and/or concurrent with emotional problems. Erroneous and irrational cognitions are seen as exacerbating bad external circumstances. In the case of Andrew, Andrew's ideas that "No one likes me," "Ill never have any friends," "Everyone is teasing me," "I can't stand being teased," and "I'm hopeless" are seen as leading to inappropriately strong negative emotions. A student with a more rational attitude towards teasing would feel appropriately negative (disappointed, irritated, concerned), but would not be as upset as Andrew. To reduce Andrew's depression and anxiety, RET would employ a number of different techniques to modify Andrew's way of thinking about being teased.

The Impact of Rational Emotive Behavior Therapy on Teacher Efficacy and Student Achievement

- Warren, Jeffrey. Dissertation. The Impact of Rational Emotive Behavior Therapy on Teacher Efficacy and Student Acheivement

Personal Reflection Exercise #2
The preceding section contained information about treatment strategies for rational-emotive therapy with children and adolescents. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Rational emotive health therapy for the management of depressive
symptoms among parents of children with intellectual and reading
disabilities in English language

- Ugwuanyi, L. T., Egbe, C. I., Nnamani, A. P., Ubah, J. C., Adaka, T. A., Adama, G. N., Ejide, A. B., Uloh-Bethels, A. C., Emelogu, N. U., Ossai, R. C., Okoyeukwu, N. G., Agbo, P. A., & Otu, M. S. (2022). Rational emotive health therapy for the management of depressive symptoms among parents of children with intellectual and reading disabilities in English language. Medicine, 101(32), e30039. https://doi.org/10.1097/MD.0000000000030039

Peer-Reviewed Journal Article References:
Davis, H., & Turner, M. J. (2020). The use of rational emotive behavior therapy (REBT) to increase the self-determined motivation and psychological well-being of triathletes. Sport, Exercise, and Performance Psychology, 9(4), 489–505.

Henderson, C. E., Hogue, A., & Dauber, S. (2019). Family therapy techniques and one-year clinical outcomes among adolescents in usual care for behavior problems. Journal of Consulting and Clinical Psychology, 87(3), 308–312.

Lennard, A. C., Scott, B. A., & Johnson, R. E. (2019). Turning frowns (and smiles) upside down: A multilevel examination of surface acting positive and negative emotions on well-being. Journal of Applied Psychology, 104(9), 1164–1180. 

Turner, M. J. (2016). Rational emotive behavior therapy (REBT), irrational and rational beliefs, and the mental health of athletes. Frontiers in Psychology, 7, Article 1423.

QUESTION
According to Bernard, what childhood problems typically encountered by school psychologist does RET treat? To select and enter your answer go to Test.