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Section 15
Using Rational-Emotive Therapy as Crisis Intervention: A Single Session with a Suicidal Client

Question 15 | Test | Table of Contents

As I have previously noted (Ellis, 1973), rational-emotive therapy (RET) overlaps with Adlerian Individual Psychology (IP) in several important respects:  (1) It is active-directive and problem-solving. (2) It teaches people that they largely (consciously or unconsciously) upset themselves. (3) It briefly and authoritatively zeroes in on clients’ basic irrational beliefs and mistaken life-styles and helps them subsequently do this for themselves. (4) It is antiperfectionistic and antigrandiose and keeps forcefully showing people that they can surrender childish grandiosity and rationally believe—and accept—the ideas that they do not have to achieve outstandingly, that there is no reason why they must be treated well by others, and that they do not need to have exactly what they want at the very moment they want it (Ellis, 1962, 1971, 1973, 1985a, 1985b, 1988; Ellis & Becker, 1982; Ellis & Bernard, 1985; Ellis & Dryden, 1987; Ellis & Grieger, 1987; Ellis & Harper, 1975).

Adler was a pioneer cognitive therapist who formulated some of the basic premises of RET in the early part of the twentieth century. Thus, he stated:

"It is very obvious that we are influenced not by ‘facts’ but by our interpretation of facts" (Adler, 1964a, pp. 26—27). "The individual. . . does not relate himself to the outside world in a predetermined manner, as is often assumed.... It is his attitude toward life which determines his relationship to the outside world" (Adler, 19Mb, p. 67). "In a word, I am convinced that a person’s behavior springs from his idea" (italics in original) (Adler, 1964a, p. 19). "We are self-determined by the meaning we give to our experiences. . . . Meanings are not determined by situations, but we determine ourselves by the meanings we give to situations" (Adler, 1958, p. 14).

RET, of course, deals with many severely disturbed people and some of them take a fairly long time—e.g., a year or two—to make basic changes. But it is also useful in crisis intervention just because, as Adler advocated, it quickly gets to the core philosophies that tend to drive people to states of panic, depression, and suicidalness. To show how it can be useful in crisis intervention and sometimes can head off a suicidal client in a session or two, let me present the following case.

Helen G. was an attractive, 27-year-old woman who was referred to me for consultation after she had seen one of our trainees at the Institute for Rational-Emotive Therapy in New York and was seriously threatening to kill herself. She was a resident in obstetrics and gynecology at a leading New York hospital but was so chronically depressed that she was failing at her residency. She also had lost her three last lovers, all of whom she really liked, because they all felt that she was "too nutty" and would not make a good wife. She was very confused and found herself "all over the place." She had extreme panic states, several phobias, and a dire need to be approved of and loved by significant others. She thought that she was "radically different" from all other people. She was still very upset about the suicide, two years ago, of her younger sister—who was also bright, talented, and very attractive but had suddenly, "without any good reason," deliberately taken an overdose of sleeping pills. Like her sister, Helen considered herself a "hopeless failure," threatened to commit suicide, and could easily do so because she had access to several lethal drugs and knew how to use them.

A real rough case! I didn’t exactly look forward with great joy to seeing Helen and (possibly) heading her off at the pass. But I kept my trepidation within normal bounds by using RET on myself and convincing myself that even if, at the very worst, I did not deter this client from suicide, I could stilt accept myself as a person. According to RET, such a failure would not make me a rotten therapist; but one who had merely failed this time. Even if I generally failed at therapy (which, of course, I generally didn’t), I would still not be a Failure with a capital F—nor would I be an incompetent person.

So, knowing in advance that I was to see Helen in a suicidal state, and using RET vigorously on myself, I saw that consulting with her would not be like battling the Devil to a fatal "faretheewell." indeed, I began to see my forthcoming encounter with Helen as a fascinating challenge and as a session (or two or three) to look forward to. My acute worry actually turned to, first, due concern for Helen’s life and, second, excited anticipation about seeing her.

Probably because of my new challenge-filled attitude, I enjoyed my session with Helen from its first few minutes onward. I decided—yes, decided—to see her as an individual with great potential rather than as a grim (and "dangerous") basket case. I focused on her possible competent and enjoyable future rather than on her gory present and past. I imagined the good she might well, with my help, do for herself and others; and I saw her lifestyle, up to the date of our encounter, as benighted and invalid but definitely changeable. I was (probabilistically, not dogmatically) sure that she could restructure her disordered thinking (what Adler called her "private sense" rather than her "common sense") and come to see herself as a helpful, self-striving, and socially interested individual rather than as an incompetent who hardly deserved to continue her existence.

From the start, I took an Adlerian and RET-oriented highly encouraging attitude toward Helen (Adler, 1958; Losoncy, 1980). I tried to show her that she fortunately (partly because of her heredity) had most of the attributes for a good life—intelligence, ability to work toward a long-term goal, desire to relate intimately, and good looks. I joked about the discrepancy between her having all these assets and her paradoxical tendency to ignore these traits and (because of her perfectionism) put herself down. She easily laughed at my saying that the Martians, if they came to visit us on earth (and were sane!) would die laughing at her saying that she was no good when, by objective standards, she was really so good. When she responded with genuine mirth to my humorous sallies, I immediately congratulated her on her humor and remarked, "Anyone who can laugh as easily as you can at the same time she is plotting and scheming to kill herself really has a sense of humor Too bad that you won’t let yourself be around very long to keep enjoying it!"

As soon as Helen indicated that "life hardly seems worth it and I might just as well end it all"—which she said right at the start of our session—I showed her that I wasn’t personally intimidated by her suicidal tendencies. I respected her right to kill herself while showing her that I thought she was damned foolish if she exerted that right. I told her—half humorously and half seriously—that death, nonexistence, would be for a long, long time while accepting herself with her failings could be done swiftly and would leave her fifty or so more enjoyable years.

Although I only saw Helen once, I used several common techniques of rational-emotive therapy with her. Cognitively, I actively disputed her ideas that she had to be perfect and wasn’t ever permitted to fail at important tasks and love affairs. I showed her, very strongly, the disadvantages of prematurely ending her life and the advantages of continuing it. I quickly outlined and combated her demand for certainty—her irrational conviction that she must under all conditions do well and be loved. I pointed out that, logically, she was opting for just about the only certainty that exists for humans—death. But what a negative certainty. What a Pyrrhic victory! How silly to choose that certainty when choosing a high degree of probability that she could eventually succeed if she persistently worked at doing so would be a wiser, saner path. I appealed to her native intelligence to act wisely in her own interest and to preserve her life so that she could thereby help herself and contribute to the social good. I highlighted her low frustration tolerance: the crazy idea that just because she now was in emotional pain she thought that she was forced to end her life and all future happiness, forever.

Emotionally, I used encouragement and humor; and, perhaps best of all, accepted Helen with her foolish behavior and thereby gave her what Standal (1959) and Rogers (1961) call unconditional positive regard, and what RET calls unconditional acceptance. But I also taught her, briefly but forcefully, that she could always accept herself if she stopped giving a global rating to her self or her "essence" and only rated her traits and performance in relation to the values she preferred to actualize. I also showed her that no human—not even Hitler—is subhuman or damnable; and that she never had to denigrate her self or her personhood, no matter how bad her behavior was. Humorously, again, I convinced her that even if she killed herself, she would not be a fool or a worm but only a person who was acting foolishly and wormily (that is, against her own interest).

Behaviorally, though I knew I would probably not see Helen again— since I referred her back to my associate who was her regular therapist— I gave her three homework assignments: (1) To agree that she would call her therapist or call me before she actually tried any real suicide attempt. (2) To look for and write down all absolutistic and perfectionist musts and should that led her to become depressed and suicidal. (3) To sing to herself, at least three times a day during the next few weeks, some of my rational humorous songs, such as:

Whine, Whine, Whine!
(Tune: Yale Whiffenpoof Song by Guy Scull)
I cannot have all of my wishes filled— Whine, whine, whine!
I cannot have every frustration stilled— Whine, whine, whine!
Life really owes me the things that I miss,
Fate has to grant me eternal bliss!
Since I must settle for less than this— Whine, whine, whine!

Perfect Rationality
(Tune: Funiculi, Funicula by Luigi Denza)
Some think the world must have a right direction, And so do!! And so do I!
Some think that, with the slightest imperfection,
They can’t get by—and so do I!
For I, I have to prove I’m superhuman,
And better far than people are!
To show I have miraculous acumen— And always rate among the great!

Perfect, perfect rationality
Is, of course, the only thing for me!
How can I ever think of being
If I must live fallibly?
Rationality must be a perfect thing for me!

I’m Depressed, Depressed!
(Tune: The Band Played On by Charles Ward)
When anything slightly goes wrong with my life,
I’m depressed, depressed!
Whenever I’m stricken with chickenshit strife,
I feel most distressed!
When life isn’t fated to be consecrated
I can’t tolerate it at all!
When anything slightly goes wrong with my life,
I just bawl, bawl, bawl!

I Wish I Were Not Crazy!
(Tune: Dixie by Dan Emmett)
Oh, I wish I were really put together— Smooth and fine as patent leather!
Oh, how great to be rated innately sedate!
But I’m afraid that I was fated
To be rather aberrated—
Oh, how sad to be mad as my Mom and my Dad!

Oh, I wish I were not crazy! Hooray, hooray!
I wish my mind were less inclined
To be the kind that’s hazy!
I could agree to really be less crazy.
But I, alas, am just too goddamned lazy!
(Lyrics by Albert Ellis (1977) copyright 1977—1980 by Institute for Rational-Emotive Therapy)

I only saw Helen this one time, sent her out of the session laughing and was delighted to hear her say, at the end, "It was a pleasure talking to you. I really enjoyed it!" She returned to the institute therapist who referred her to me for consultation and I received, a few weeks later, a note from this therapist thanking me for my intervention, stating that Helen had completely given up her suicidal ideas after talking with me, and indicated that she and the therapist were now working satisfactorily on her long-standing problems of depression.

All suicidal cases where principles of Adlerian and rational-emotive therapy are quickly and briefly employed do not, of course, end as well as this one. But the techniques used in the kind of crisis intervention that I did with Helen often do work. They can include, in summary, (1) the therapist giving the client unconditional acceptance and encouraging her to fully partake of what Tillich (1953) called "the courage to be"; (2) the therapist’s steadfast refusal to feel intimidated by the client’s strong suicidal leanings; and (3) the active-directive approach of showing suicidal clients how life can be a fascinating challenge rather than an empty bore. These IP and RET methods frequently can interrupt a suicidal process and give severely depressed clients a chance to think and act more rationally and life­-preservingly.
- Ellis, Albert ; Using Rational-Emotive Therapy (RET) as Crisis Intervention: A Single Session with a Suicidal Client; Individual Psychology, Mar/June 1989, Vol. 45.

Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes

- Turner M. J. (2016). Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes. Frontiers in psychology, 7, 1423. doi:10.3389/fpsyg.2016.01423.

Rational Emotive Therapy With Children and Adolescents: A Meta-Analysis

- Saunders, Anita; Ann Galloway; and Craig S. Shwer. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS, WINTER 2004, VOL. 12, NO. 4, p. 1-235.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 250 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about using rational-emotive therapy as crisis intervention. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Effectiveness of rational emotive behavior therapy in reducing depression among undergraduate medical students

- Victor-Aigbodion, V., Eseadi, C., Ardi, Z., Sewagegn, A. A., Ololo, K., Abonor, L. B., Aloh, H. E., Falade, T. A., & Effanga, O. A. (2023). Effectiveness of rational emotive behavior therapy in reducing depression among undergraduate medical students. Medicine, 102(4), e32724. https://doi.org/10.1097/MD.0000000000032724

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.

Fuochi, G., Veneziani, C. A., & Voci, A. (2018). Differences in the way to conceive happiness relate to different reactions to negative events. Journal of Individual Differences, 39(1), 27–38.

Gross, J. T., & Cassidy, J. (2019). Expressive suppression of negative emotions in children and adolescents: Theory, data, and a guide for future research. Developmental Psychology, 55(9), 1938–1950.

QUESTION 15
How does rational-emotive therapy (RET) overlap with Adlerian Indi­vidual Psychology (IP) in four important respects? To select and enter your answer go to Test.