1. You must treat me as I want you to treat me.
2. I must perform as well I wish to perform.
3. Life must be only as difficult as I think it should be.
After a short discussion patients will achieve intellectual insight. This may happen in the very first session or two. In REBT intellectual insight means that patients appreciate how their beliefs largely impact their feelings when they are blocked in the course of pursuing their goals. Intellectual insight also includes the appreciation that rigid and extreme beliefs lie at the core of emotional upset. This is the easy part of REBT.
Emotional Insight follows from diligent effort
Once the patient has achieved intellectual sight this is when the hard work or the grind of REBT begins. In order for the patient to experience improved emotional well-being and improved behavioral functioning when they are blocked by adversity the patient will have to achieve emotional insight. Emotional insight is when the patient is able to act in a way consistent with the flexible and non-extreme beliefs discussed in therapy. Proof that the patient has achieved emotional insight is when the patient reports that they encountered an adversity but instead of experiencing an unhealthy negative emotion, as they typically would have, they responded differently. The patient reports, often with great satisfaction, that they thought in a flexible and non-extreme way about the adversity and then behaved in a more creative, persistent, or adaptive way to the adversity. Emotional insight is actively earned by the patient. It is not given by the psychologist and passively received by the patient. The patient has to think about REBT, understand it, try to identify their rigid beliefs when they are disturbing themselves or shortly thereafter, question these beliefs, adopt a more flexible belief, and then act in a way that is consistent with this new flexible belief. They have to reflect on this process and see how it helps them function in the real world.
Emotional Insight is then repeated
Once the patient has had their initial positive experience using REBT they have to do it again and again to hold onto their newly acquired way of responding to adversity. Using REBT leads to emotional insight but using REBT when it is needed most is not easy. I keep showing patients that there is no magic and that emotional insight is earned through repeated effort and practice. Some patients give up on achieving emotional insight and dropout of therapy looking for an easier way to change. Other patients embrace the reality that humans have the capacity to make significant emotional and behavioral changes but it takes hard work. These patients usually are greatly rewarded for their efforts. They make real and enduring changes in their lives. Sadly, other patients think that psychological change should be quick and easy. This is the philosophy of low discomfort tolerance, also known as low frustration tolerance, which is a fundamental form of human disturbance which REBT works vigorously to eliminate.
My reaction to patient resistance to change
I work hard to convince my patients to fight the good fight and strive for deep and enduring emotional insight. Many patients come to see that there are few quick fixes in life and go onto to earn significant psychological change. Some patients sadly do not. It is with these patients I stubbornly refuse to upset myself. I truly believe patients have a perfect right to not change, to avoid the hard work, and to not reap the benefits and satisfaction of achieving emotional insight. I am sorry this happens but I am honest with patients. Change is possible but it is earned. It is earned by first achieving intellectual insight and then working hard in a repeated way to put that insight to good use in the real world to achieve deep emotional insight. Consistent with REBT philosophy I teach my patients that this reality of human behavior is inconvenient but far from awful.