REBT
Not every Rational Emotive Behavior Therapy (REBT) practitioner adheres to theory, tradition, or principles of this psychotherapeutic modality, and understandably so. The function of science is an evolution of awareness in an attempt to understand truth.
Moreover, as fallible human beings, we are incapable of attaining perfect knowledge—flawless facts, information, and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject without blemish.
Consequently, when the late Albert Ellis developed REBT – a modality based on “reason and scientific method” – his efforts presumably weren’t meant to serve as a purist or absolutist be-all, end-all to further REBT development. As such, evidenced-based practical application and rigorous study of the model is needed to evolve REBT.
To give an example of what I mean, the first iPhone was released on June 29, 2007, and Ellis died on July 24, 2007. It would’ve been virtually impossible for Ellis to have known how smartphones and social media would correlate with many issues reported by minors (people under 18-years of age).
Therefore, REBT theorists, researchers, trainers, practitioners, and others continue to evolve the modality so that it will remain applicable to problems associated with modernity. Nevertheless, REBT maintains its core components which are tested and applied to modern populations.
REBT theory uses the ABC model to illustrate how when Activating events (“Actions”) occur and people maintain irrational Beliefs about the events, these unhelpful assumptions – and not the actual occurrences – are what create unpleasant cognitive, emotive, bodily sensation, and behavioral Consequences.
To illustrate each of these unhelpful assumptions, consider the following:
Demandingness – “I must alter my body in irreparable ways in order to feel like the gender with which I identify.”
Awfulizing – “It would be awful for others to perceive me as the gender I believe I am.”
Frustration tolerance – “I can’t stand when people misgender me!”
Global evaluations – “Anyone who doesn’t acknowledge me for what I believe I am is a complete douche bag!”
From a psychological standpoint, people disturb themselves using a Belief-Consequence (B-C) connection. Of course, this isn’t to suggest that in the context of the naturalistic or physical world there is no Action-Consequence (A-C) connection.
To clearly demonstrate the distinction between A-C and B-C connections, consider the following:
A-C connection – Although you believe you’re actually a female, you were born a biological male who appears conventionally masculine (Action). When walking into a restaurant, the host says, “Welcome, sir” (Consequence).
B-C connection – When walking into a restaurant, the host says, “Welcome, sir” (Action). You then Believe, “I can’t stand when people misgender me, and anyone who doesn’t acknowledge me for what I believe I am is a complete douche bag!” Because of your self-disturbing assumption, you become angry and demand to speak with the manager (Consequence).
Noteworthy, I assist clients with Disputation of unfavorable assumptions so that they may develop Effective new beliefs. However, we don’t challenge Activating events or the Consequences produced by unproductive Beliefs. This is because disputing truth and reality is akin to the practice of denial, and the ‘D’ in the ABC model doesn’t represent Denial.
Aside from the ABC model, REBT uses unconditional acceptance to reduce the effects of self-disturbance. Recognizing that I’m capable of making mistakes, I use unconditional self-acceptance (USA) to admit my own fallibility.
Understanding that I’m prone to err, I can then conclude that others are also faulty. Therefore, I use unconditional other-acceptance (UOA) to keep from disturbing myself about this undeniable fact.
Likewise, I practice unconditional life-acceptance (ULA) to remind myself that even life itself is imperfect. In addition to these techniques, I use Stoic and existentialist principles when working with clients, as REBT incorporates both of these philosophical practices into the method.
According to one source:
[M]any of the overarching values and goals of REBT can be related to facets of positive psychology. Values of unconditional acceptance (e.g., of self, others, and life) and high frustration tolerance, for example, as well as some of the other values and goals (e.g., flexibility, social interest, commitment) suggest potential research questions related to factors involved in resiliency, human optimization and happiness, health promotion, and rational living.
Given this information, I suggest that there are three main objectives in my approach to REBT. First, I aim to help people get better, not necessarily feel better. Although it may be cathartic to have a psychotherapist validate the nonsense you tell yourself, joining with your unproductive beliefs isn’t going to help you function at an optimal level.
Second, I support people with achieving a higher level of functioning and improving their quality of life. As an example, because you reduce the use of self-disturbing beliefs (function), you may experience fewer unpleasant consequences (improved quality of life).
Last, I try to help people live rationally. This occurs as you don’t needlessly suffer when unhelpfully practicing irrationality, and instead begin using rationality—the practice or quality of being based on or in accordance with logic and reason.
Nevertheless, I agree with Ellis’ statement, “I think that human beings have a right to be emotionally sick.” Therefore, I don’t inflexibly demand that others should, must, or ought to value REBT as I do, or that this psychotherapeutic modality mustn’t evolve with the times.
Radioactive
The pragmatic definition of radioactive refers to emitting or relating to the emission of ionizing radiation or particles. However, in common parlance, the term suggests that something is so divisive or controversial, as to require avoidance. Herein, I’m referring to the latter definition.
Within the field of mental, emotional, and behavioral health (collectively, “mental health”), there remains a topic that is so radioactive that many of my professional colleagues seemingly avoid discussion of it – even behind closed doors within rooms wherein people of like mind gather.
As I’m exceptionally low in agreeableness, I’m unlike many of my colleagues. Therefore, I don’t hesitate to discuss my views regarding transgender (“trans”) children.
Herein, “trans” describes a person whose gender identity does not correspond with the sex registered at birth. I allude to sex being “registered,” as opposed to “assigned,” because registering suggests an indication of what is while assigning infers the act of appointing what ought to be.
“Gender” thus relates to the male sex or the female sex, especially when considered with reference to social and cultural differences rather than biological ones, or one of a range of other identities that do not correspond to established ideas of male and female.
As well, “sex” refers to either of the two main categories (male and female) into which humans and most other living things are divided on the basis of their reproductive functions. For instance, “female” (sex) is typically associated with “girls” and “women” (gender).
Given my framing of REBT, and with respect to the fact that evolving science informs and shapes this modality, I posit that it’s neither logical nor reasonable for a psychotherapist to participate in the delusional practice of gender-affirming care for minors. You may disagree.
To those who’ve followed posts within my blog, you’re likely unsurprised by my admission. For context, consider the following past entries within my blog.
In a blogpost entitled Swimming in Controversial Belief (August 12, 2022), I relayed something a judge said to Alex Jones, during his legal case that took place in Texas, to one’s irrational beliefs regarding transgenderism:
Judge Guerra Gamble stated to Jones, “You believe everything you say is true but it isn’t. Your beliefs do not make something true. That is…that is what we’re doing here. Just because you claim to think something is true does not make it true. It does not protect you. It is not allowed.”
I understand how a judge may determine what is or isn’t allowed. However, from an REBT perspective, I don’t bother telling people what ought to be.
Nonetheless, I invite people to consider philosopher David Hume’s is-ought problem—attempting to derive and ought from an is (e.g., The gender I choose ought to be accepted by others, because the limitation of only two sex-based genders is unfair).
Simply because an individual claims to believe something is true does not make it so. Unlike a judge who instructs people about what ought and ought not to be, I concur with Ellis by maintaining that people have a right to be emotionally sick if they choose to violate Hume’s axiom.
In a blog entry entitled Transitioning Beliefs (April 1, 2023), I addressed criticisms some people may level against me, perceivably because psychotherapists shouldn’t challenge irrational beliefs related to the delusional perspective of those who demand that we join with their assumptions:
Noteworthy, the absurd non-sequitur appeal of [individuals] who [deny] biological facts of existence by accusing people who disagree with them of denying their ability to exist is not an argument I wish to validate. In fact, disputing irrational beliefs is what I do for a living—and I require compensation for my efforts.
Doubtlessly, there are many psychotherapists who will willingly accept payment for merely affirming a client’s irrational beliefs. However, I’m not one of those individuals and I challenge unproductive motivated reasoning that concludes people can be whatever they believe they are.
In a blogpost entitled For What it’s Worth, I’m Grateful (April 5, 2023), I used critical thinking by comparing the process of transitioning children (surgical, hormonal, or otherwise) to the hypothetical example of my parents allowing me to get a facial tattoo as a minor:
I was a child without a fully developed brain and absent of matured cognitive capacity. Basing life-altering decisions on underdeveloped hardware (brain) and software (mind) wouldn’t have been prudent.
In most circumstances, minors aren’t permitted to obtain tattoos, purchase firearms, consume alcohol, vote, or partake in other activities reserved for those in the age of majority. However, transitioning minors is promoted as an appropriate level of care. It’s an absurd practice.
In a blog entry entitled Disconfirming Care (March 14, 2024), I took a firm stance on rejecting the practice of gender-affirming care:
Perhaps you irrationally believe that you are something which you simply are not. Maybe polite members of society have gone along with your delusion, as not to offend your sensibilities.
It very well may be the case that your beliefs have been pacified by others, so you illogically and unreasonably believe you are that which you aren’t, never was, nor ever will be. I suspect that you may even inflexibly demand that other people must agree with your farcical behavior.
Given my approach to REBT outlined herein, I wouldn’t provide affirmative care to you. Rather, I’d use a disconfirming care approach so that you could stop disturbing yourself with nonsensical beliefs.
Admittedly, psychological literature related to REBT and gender dysphoria or gender identity isn’t complete. As scientific knowledge evolves and the psychotherapeutic modality advances, so, too, may my views expressed herein – as unforeseeably unlikely as that may be.
In the meantime, a 2021 source states:
The cognitive behavioral and specifically rational emotive behavior therapy literature are lacking in conceptual work and empirical research to assist gender diverse children and adolescents in managing the unique difficulties and challenges they may face psychologically, socially, environmentally, and medically.
I wonder if research of this kind aims to focus on helping minors challenge irrationality that causes their condition, practice UOA for those who opt not to validate their delusions, or perhaps something else. As of yet, literature related to this topic and REBT is scant.
One 2022 source states:
Of the limited research on REBT and body image, results indicate that irrational beliefs are linked to negative body image. However, a key limitation of studies examining the theory of REBT in body image is a failure to accurately assess irrational and rational beliefs, thus, greatly impeding researcher’s ability to provide the necessary support for its efficacy and effectiveness in body image. At present, no such psychometric exists that assesses irrational and rational beliefs in body image.
What’s difficult to understand about “irrational and rational beliefs” when determining whether or not the empirical nature of one who’s born a male and identifies as a female comports with the principles of logic and reason? The matter isn’t as complex as the source suggests.
Although the mere discussion of gender-transitioning children appears to be a radioactive affair, I practice rationality and remain unconcerned with what’s considered polite or not. Contrarily, I argue that it’s highly inappropriate to so subject minors to so-called “care” that may be clinically contraindicated and potentially irreversible.
The word “clinical” relates to the observation, management, and treatment of actual clients or patients rather than theoretical or laboratory studies. Regarding contraindication, one source states:
A contraindication is a specific situation in which a medicine, procedure, or surgery should not be used because it may be harmful to the person.
There are two types of contraindications:
· Relative contraindication means that caution should be used when two medicines or procedures are used together. (It is acceptable to do so if the benefits outweigh the risk.)
· Absolute contraindication means that event or substance could cause a life-threatening situation. A procedure or medicine that falls under this category must be avoided.
For context, the Mayo Clinic suggests of gender dysphoria, “Treatment options might include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy.” The manner in which I practice REBT is clinically contraindicated with advocacy for giving a child hormone therapy or utilizing surgical procedures.
Although I don’t treat minors, imagine a hypothetical scenario in which I did. Little Johnny’s parents seek mental health services for their seven-year-old son who identifies as a girl.
Even with use of a non-disputation technique such as the elegant solution (credibly presuming what one believes is true), I would assess whether or not Johnny believes he is able to tolerate and accept the notion that he’s apparently a little girl trapped in a boy’s body.
I could suspend intellectual integrity long enough to determine if little Johnny is so self-disturbed that he needs to be placed on unnatural levels of hormones or undergo mutilation of his body through surgical procedures. Still, willful self-deception goes only so far.
Suppose Johnny, with an underdeveloped brain, refuses to unconditionally accept himself, would his unhelpful response serve as just cause for an alternative form of conversion therapy (the practice of attempting to cause a non-heterosexual person to become heterosexual by using psychotherapy, behavior modification, spiritual counseling, etc.)?
I posit that would be immoral and unethical for me to simply collude with little Johnny’s delusion. His refusal to practice psychological techniques isn’t justification for Johnny to remain subject to potentially irreversible effects of clinically contraindicated alteration of his anatomy.
Still, for approximately a decade, I’ve been aware of so-called “scientific” support for gender-transitioning children. As well, critics of ideology masquerading as science – such as Debra Soh, Heather Heying, and Abigail Shrier – are often lambasted by clinical and non-clinical personnel alike.
To me, criticism of those who value rationality seems toxic. Through use of a syllogism, think of the basic illogical argument one would use to arrive at the conclusion that removing little Johnny’s penis is an appropriate intervention for his medical care:
Form –
If p, then q; if q, then r; therefore, if p, then r.
Example – If a minor believes s/he was born as the wrong sex, then sex-reassignment surgery is required to alleviate suffering.
If sex-reassignment surgery is required to alleviate suffering, then little Johnny should undergo a vaginoplasty procedure.
Therefore, if a minor believes s/he was born as the wrong sex, then little Johnny should undergo a vaginoplasty procedure.
Keep in mind that little Johnny is seven-years-old. Even if the most extreme surgical example is deemed too farfetched for consideration, settling for the potentially irreversible effects of hormone treatment isn’t much of an improved solution.
Though I remain highly skeptical of the peer review system of knowledge that is largely responsible for pseudo-scientific disinformation regarding sex and gender, a recent study (2024) may suggest a swing in a rational direction. Researchers report:
We studied the development of gender non-contentedness, i.e., unhappiness with being the gender aligned with one’s sex, from early adolescence to young adulthood, and its association with self-concept, behavioral and emotional problems, and adult sexual orientation. Participants were 2772 adolescents […]
Gender non-contentedness, while being relatively common during early adolescence, in general decreases with age and appears to be associated with a poorer self-concept and mental health throughout development.
In essence, minors who perceive themselves to be gender-nonconforming tend to grow out of a phase which is indicative of “poorer self-concept and mental health,” as gender-affirming care may not be necessary at all. How many of those minors could have benefitted from REBT?
In 2002, when it was perceivably less controversial to objectively assess potential risks of hormone treatment, one study concluded, “The overall increased risk of serious adverse effects—including breast cancer, stroke, and pulmonary embolism—with long term hormone replacement therapy (HRT) outweighs the potential benefits in disease prevention.”
Still, science has evolved since 2002. Two decades later, a 2022 study reported:
Gender dysphoria is a persistent distress about one’s assigned gender. Referrals regarding gender dysphoria have recently greatly increased, often of a form that is rapid in onset. The sex ratio has changed, most now being natal females. Mental health issues pre-date the dysphoria in most. Puberty blockers are offered in clinics to help the child avoid puberty. Puberty blockers have known serious side effects, with uncertainty about their long-term use. They do not improve mental health. Without medication, most will desist from the dysphoria in time. Yet over 90% of those treated with puberty blockers progress to cross-sex hormones and often surgery, with irreversible consequences. The brain is biologically and socially immature in childhood and unlikely to understand the long-term consequences of treatment. The prevailing culture to affirm the dysphoria is critically reviewed. It is concluded that children are unable to consent to the use of puberty blockers.
Despite this topic serving as a radioactive wasteland for many of my professional colleagues, I don the protective gear of rationality and traverse train of a controversial nature. Clinically contraindicated and potentially irreversible interventions for gender dysphoric children aren’t something I advocate.
Conclusion
As is the case with other psychotherapeutic modalities with a scientific base, REBT continues to evolve with modernity. Through my approach to REBT, I aim to help people get better, increase levels of functioning and quality of life, and help people to live rationally.
Within the mental health field, there are stark differences to the treatment and management of symptoms and traits for which people seek clinical intervention strategies. Moreover, there appears to be a radioactive topic that serves as a deep divide in the wellness landscape.
Aversion to open, honest, and curios discussion regarding gender dysphoria, gender-affirming care, and transitioning people under the age of 18-years-old is an approach favored by many of my professional colleagues. Fortunately, I’m not inflicted with the irradiated contaminate of willful ignorance or self-deception in this regard.
I posit that it’s highly inappropriate to subject minors to interventions which may be clinically contraindicated and potentially irreversible. Rather than violating the is-ought problem or working backwards from a foregone conclusion, I challenge the use of hormone therapy and surgical procedures for gender-nonconforming children.
Additionally, I admit that there is little literature available to adequately guide REBT practitioners that work with minors who wish to transition. Nevertheless, the distinction between rational and irrational beliefs isn’t as complex as some resources suggest.
Unless REBT practitioners suffer a Cartesian dilemma by subscribing to an ‘I believe I’m a different gender; therefore, I am,’ then the core tenets of REBT remain intact. Then again, as Ellis stated, people have a right to be emotionally sick – and even cognitively ill.
As for my practice of this psychotherapeutic modality, I will continue disputing irrational beliefs and teaching unconditional acceptance in a wasteland of radioactive irrationality. Interestingly, my background as a nuclear weapons security provider is suddenly relevant.
According to one source, “With half-lives of 700 million and 4,500 million years respectively, uranium 235 and uranium 238 are relatively stable isotopes.” I suppose that the half-life for toxicity related to mutilating children is substantially lower than with nukes. How’s that for Stoicism?
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
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