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Journal of Rational-Emotive & Cognitive-Behavior Therapy, Vol. 23, No.

3, Fall 2005 ( 2005)


DOI: 10.1007/s10942-005-0012-z

A SOLUTION-FOCUSED APPROACH
TO RATIONAL-EMOTIVE BEHAVIOR
THERAPY: TOWARD A THEORETICAL
INTEGRATION
Jeffrey T. Guterman
James Rudes
Barry University, USA

ABSTRACT: A theoretical integration of rational emotive behavior therapy


(REBT) and solution-focused therapy is described. It is suggested that the
integrative conceptualization underscores these models complementary
aspects by addressing the limitations of each and enhancing their respective
strengths. The clinical theory and process of the integrative model is
explicated along with a case example. Directions for future theory building,
research, and practice are considered.
KEY WORDS: REBT; solution-focused therapy; integration.

In the last quarter century, there has been an increasing literature


regarding the merits and limitations of integrating diverse therapy
models. It has been suggested that the movement toward integration
is reflective of a trend that recognizes the restraints of adhering to a
single-based clinical theory and the benefits of rapprochement, dialogue, and convergence between schools (Norcross & Goldfried, 1992;
Safran & Messer, 1997). Proponents of the integrative movement recognize that no single model is adequate to account for all clients and
problems. For example, Liddle (1982) has suggested that the tendency toward integrationism seems relatedto our frustration with
the limits of any one approach or perspective (p. 247). As a result,
Address correspondence to Jeffrey T. Guterman, Barry University, 11300 NE 2 Avenue, Adrian
Dominican School of Education, Counseling Program, Powers Building, Miami Shores, FL 33161
6695, USA; e-mail: jguterman@mail.barry.edu

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 2005 Springer Science+Business Media, Inc.

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numerous integrative models have been set forth in which disparate


theories are combined in a multitude of ways.
The literature on integration has become proliferating, complex,
and at times, confusing. A consensus has been reached among some
theorists, however, with regard to the meanings of some of the prevailing terms used to describe integrative models. For example, many
writers have agreed that theoretical integration refers to combining
two or more distinct theories and thereby producing a new, superordinate clinical framework (e.g., Norcross, 1990; Safran & Messer,
1997). Various theoretical integrations have been proposed. In this
article, we present an integration of Elliss (1996, 1999, 2001)
rational emotive behavior therapy (REBT) and the solution-focused
therapy model developed by de Shazer (1985, 1988, 1991) and de
Shazer et al. (1986). This model describes and explains some of our
most recent work with clients.
In REBT, clinical problems are conceptualized as largely the result
of irrational beliefs, which consist of demands that humans escalate
from their healthy preferences (Ellis, 1996). The primary goal in
REBT is to help clients replace irrational beliefs with rational beliefs
through various cognitive, emotive, and behavioral techniques. In
contrast, solution-focused therapy conceptualizes problems in terms
of the clients talk or languaging about problems and the necessary
existence (either actual or potential) of exceptions (i.e., times when
the problem is not happening); in other words, problem/exception (de
Shazer, 1991; de Shazer et al., 1986). Solution-focused therapy tends
to emphasize clients existing strengths, rather than their deficits,
and often focuses on minimalist goals. REBT, on the other hand, places more emphasis on deficits (i.e., irrational beliefs) and seeks a
large scope of change by helping clients adopt a rational philosophy
of life. Despite these differences, leading proponents of REBT and
solution-focused therapy have suggested that there is significant
overlap between these models and, moreover, at times their presumed differences might be indiscernible (e.g., Ellis, 1996; Molnar &
de Shazer, 1987).
Petzold (1981) has proposed an integration of the clinical
approaches of REBTs Albert Ellis and Milton H. Erickson (1980), a
theorist who has significantly influenced the development of solutionfocused therapy. Our review of the literature, however, indicates that
there is a paucity of writing on the topic of integrating REBT and
solution-focused therapy. In this article, the position is taken that
there is a bonus to be attained by systematically integrating the

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clinical theories of REBT and solution-focused therapy. In particular,


it is suggested that an integrative conceptualization underscores
these models complementary aspects; that is, the integration compensates for their respective weaknesses and enhances the strengths
of each individual model. The result is a new clinical approach that is
more comprehensive than either of the singular models. The organization of this article is as follows. First, the clinical theories of REBT
and solution-focused therapy are described. Next, the integrative clinical theory is set forth. The clinical process of the integrative model is
then explicated along with a case example. Finally, directions for
future theory building, research, and practice are considered.

CLINICAL THEORIES
Rational Emotive Behavior Therapy
Ellis (1988) has suggested that you can figure out by sheer logic
that if you were onlyto stay with your desires and preferences, and
if you were neverto stray into unrealistic demands that your
desires have to be fulfilled, you could very rarely disturbyourself
about anything (p. 21). From this thought flows REBTs most fundamental principle, namely, that emotional and behavioral disturbance
is largely caused by demandingness (Ellis, 1962, 1988, 1996, 2001).
REBTs theory describes the processes whereby humans create
irrational (i.e., self-defeating) philosophies and then indoctrinate
themselves with these ideas. In addition, REBT contends that
humans are taught irrational philosophies and frequently internalize
these ideas through persistent self-indoctrinations. According to
REBT, humans make themselves disturbed by thenceforth bringing
irrational philosophies to situations in their lives.
REBT theory is specified further by way of its distinction between
rational beliefs and irrational beliefs. According to REBT, rational
beliefs are evaluative cognitions that are nonabsolute and take the
form of preferences, desires, and wishes (Ellis, 1962, 1996; Ellis &
Dryden, 1990). Ellis and Dryden (1990) have suggested that rational
beliefs are relative and do not interfere with the attainment of basic
goals. Irrational beliefs, on the other hand, tend to be absolute,
dogmatic, and demanding and take the form of musts, shoulds, and
oughts (Ellis, 1962, 1996). When humans hold irrational beliefs
about negative events in their lives, these generally correspond to

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self-defeating (also referred to as inappropriate) emotions and behaviors (e.g., depression, anxiety, addiction) that usually block one from
working toward their goals (Ellis, 1996). Rational beliefs about negative events tend to result in self-helping (also referred to as appropriate) emotions and behaviors (e.g., sadness, concern, annoyance) that
aids one in working toward their goals (Ellis, 1996).
Ellis (1962) originally identified twelve irrational beliefs, which, he
theorized, are mainly responsible for creating disturbances. Subsequently, Ellis (1999) has condensed this original list to comprise
three core irrational beliefs:
(a) I must achieve outstandingly well in one or more important
respects or I am an inadequate person! (b) Other people must
treat me fairly and well or they are bad people! (c) Conditions
must be favorable or else my life is rotten and I cant stand it!
(p. 155)

REBTs ABC theory explains quite simply the processes whereby humans become emotionally and behaviorally disturbed (Ellis, 1962,
1988, 1996). A stands for Activating events. B stands for Beliefs. C
stands for emotional and behavioral Consequences. REBT holds that
Activating events (A) do not directly cause emotional and behavioral
Consequences (C). Instead, it is ones Beliefs (B) about Activating
events (A) that contribute most to emotional and behavioral Consequences (C). REBTs ABC theory posits that appropriate emotional and
behavioral Consequences (C) are largely caused by rational Beliefs (B)
about Activating events (A). Conversely, inappropriate emotional and
behavioral Consequences (C) are mainly caused by irrational Beliefs
(B) about Activating events (A). REBTs main clinical goal is to help
individuals dispute irrational beliefs and, in turn, eradicate emotional
and behavioral problems so that they can work toward their goals in an
effective and efficient manner (Ellis, 1996). The course of REBT includes introducing to clients the principles of REBT, and helping them
use various cognitive, emotive, and behavioral techniques aimed at
disputing irrational beliefs and modifying dysfunctional feelings and
behaviors. The disputation method, REBTs principal technique, has
been defined as any process where a clients irrational beliefs and
cognitive distortions are challenged and restructured (Ellis, Sichel,
Yeager, DiMattia, & DiGiuseppe, 1989, p. 34). REBT also employs a
variety of behavioral and emotive technique aimed at helping clients
change their self-defeating thoughts, feelings, and behaviors.

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Solution-focused Therapy
The clinical theory of solution-focused counseling is informed by a
social constructionist position that holds that there are no clinical
problems independent of the social interchange that occurs between
clinicians and clients (de Shazer, 1991). Accordingly, clinical problems are co-created in language between therapists and clients. De
Shazer (1991) has noted, however, that the notion of problem necessarily implies the existence of non-problem or exception, that is,
times when theproblem does not happen even though the client
has reason to expect it to happen, and, of course, the space between problem and non-problem or the areas of life in which the
problem/non-problem is not an issue and is not of concern to the
client. (p. 83)

In solution-focused therapy, the notion of problem has within it the


seeds of solution insofar as there are always exceptions (de Shazer,
1982, 1985, 1988, 1991; de Shazer et al., 1986; OHanlon & WeinerDavis, 1989). Hence, a clinical problem is conceptualized as problem/
exception. The change process results from identifying and amplifying exceptions. Clinicians use interventive questions to help clients
identify exceptions; for example, When has there been a time when
you have coped better with this problem? Exceptions may be amplified by encouraging clients to do more of the behaviors that have led
them to solve the problem in the past, to observe times when they
are dealing better with the problem, or to ascribe meaning to exceptions. The criterion for problem resolution in solution-focused therapy
is that the presenting problem is sufficiently improved or sufficient
progress has made been made in the direction of the goal.
The process of solution-focused therapy usually involves five
stages: (1) constructing a problem and goal, (2) identifying and amplifying exceptions, (3) interventions or tasks designed to identify and
amplify exceptions, (4) evaluating the effectiveness of interventions,
and (5) re-evaluating the problem and goal. In solution-focused therapy, the client and therapist collaborate to define a problem and goal.
The problem definition is then subsumed by the problem/exception
conceptualization. For example, if a client were to define the problem
as frequent arguing with their spouse, the problem would be conceptualized as arguing with my spouse/not arguing with my spouse. In
many cases, problem resolution is attributed to the clients own view

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that he or she is no longer experiencing the problem. This might be


related to an increase in exceptions or an increase in the clients
awareness of exceptions. In each case, however, change is facilitated
by the clients ascribing significant meaning to the exceptions. As de
Shazer (1991) has suggested, for the client, the problem is seen as
primary (and the exceptions, if seen at all, are seen as secondary),
while for therapists the exceptions are seen as primary; the interventions are meant to help clients make a similar inversion, which will
lead to the development of a solution (p. 58).
Integrative Clinical Theory
Our integrative theory begins with the assumption that clients
have tendencies to think both rationally and irrationally. When individuals stay only with their rational beliefs (i.e., when they do not
escalate rational beliefs to irrational beliefs), they tend to experience
appropriate emotional and behavioral Consequences (C). When individuals escalate rational beliefs to irrational beliefs, this tends to result in inappropriate emotional and behavioral Consequences (C).
Furthermore, when individuals experience inappropriate emotional
and behavioral Consequences (C), they tend to simultaneously hold
rational beliefs and irrational beliefs. Ellis (1997) has described this
latter aspect of REBT as follows:
REBTshows[clients] that they have rational (self-helping) and
irrational (self-defeating) beliefs. REBT is both therapeutic and
preventive in that it holds that rational and irrational beliefs go
together and that when clients have the latter (e.g., I absolutely
must perform well), they also have the former (e.g., I prefer to
perform well, but its not the end of the world if I dont, and I can
still be reasonably happy). (p. 58)

It follows that disturbance is to be understood in terms of the coexistence of rational beliefs and irrational beliefs. The change process
entails helping the client replace irrational beliefs with rational beliefs by identifying and amplifying rational exceptions: instances
when, in the context of clinical disturbances, the client retains their
preference (rational belief), yet does not escalate that desire into a
demand (irrational belief). We recognize that there are also always
general exceptions to clinical problems; that is, any instance when the
client has experienced some improvement in their self-defeating
thoughts, feelings and/or behaviors, and all other aspects of their life

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in which the problem is less severe or not of concern. The identification and amplification of general exceptions does not necessarily imply that the client is not holding irrational beliefs. We have found,
however, that identifying and amplifying both rational exceptions
and general exceptions often contributes to more effective problemsolving and symptom relief.
The clinical process of our integrative model (described in the next
section) often includes both an educative phase and an application
phase. During the educative phase, the client is introduced to the
principles of REBT and is encouraged to begin conceptualizing clinical problems in terms of the ABC theory. During this phase, the client is also provided with instruction in disputing irrational beliefs
and various other cognitive, emotive, and behavioral techniques. The
application phase includes helping clients to identify and amplify
both rational exceptions and general exceptions. We have set forth a
reformulated expansion of the ABC theory, denoted as ABCDE, to account for the change process where D refers to Disputing irrational
beliefs and E refers to identifying and amplifying Exceptions (rational and general).
We now briefly describe Elliss (1977, 1980, 1996, 2001) distinction
between preferential REBT and general REBT in order to offer a
rationale for our use of various techniques and goals of treatment
within the integrative model. According to Ellis (1977), preferential
REBT (also referred to as elegant REBT) involves helping clients
make a profound philosophic change whereby core irrational beliefs
are replaced with rational beliefs. This approach is considered preferential because it prepares clients to deal effectively with both current
and future events by ascribing rational, rather than irrational, beliefs
and thereby avert self-defeating emotions and behaviors. General
REBT, on the other hand, refers to the use of alternatives to the disputation method, including many of the techniques used in Becks
(1976) cognitive therapy and Meichenbaums (1977) cognitive-behavior therapy. Ellis (1996) has pointed out that although his first choice
is to use preferential REBT, he does not rigidly hold to this treatment in cases where it is assessed that the client is not amenable to
such an approach; where there is significant resistance to such methods; or where such an application might otherwise impede progress.
Ellis (1999) has also advocated the use, in some cases, of techniques
that run counter to some of REBTs main principles:

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REBTincludes a reserve of other cognitive, emotive, and behavioral methods that may be useful for particular clients when its
most popular methods are resisted by the client, therapist, or
both. REBT practitioners are free to experiment with a wide variety of techniques, some of which may seem irrationalWhen all
else fails, REBT therapists can use various techniques from other
forms of therapy, including even some irrational techniques, to
help clients who resist employing the best methods. (pp. 157
158)

In a similar vein, we understand our integrative model as including aspects of preferential REBT, general REBT, solution-focused
conceptualizations and interventions, and virtually any other techniques that bring about effective change. We have found that a flexible clinical approach speaks to Pauls (1967) cogent point that
therapy is to be deemed as effective in relation to how it addresses
the question of what treatment by whom, is most effective for this
individual, under what set of circumstances (p. 117).

INTEGRATIVE CLINICAL PROCESS


The following description of our models clinical process is meant to
serve as a guide that inevitably requires detours (cf., OHanlon &
Weiner-Davis, 1989). Because each client is unique, the descriptions
might not account for the details that are distinctive to a particular
case. In some cases, for example, we might choose to bypass the
REBT elements of the model and, instead, follow a straightforward
solution-focused approach. Nevertheless, our model often includes the
following stages: (1) problem definition and goal setting, (2) disputing
irrational beliefs and other techniques, (3) identifying and amplifying
exceptions, (4) assigning homework and tasks, (5) identifying and
amplifying exceptions derived from homework and tasks, and (6)
re-evaluating the problem and goal.
Problem Definition and Goal Setting
The process of defining a problem may be started by simply asking
the client, What is the problem that brings you here today? Therapists can also put the question in goal-setting terms by asking, What
would you like to accomplish through therapy? As the client
describes his or her problems and symptoms, the therapist begins to

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conceptualize the clinical presentation in terms of the ABC theory.


For example, if a client were to state, I feel anxiety in social situations and often avoid them, the therapist would conceptualize the
Activating event (A) as social situations, the emotional and behavioral Consequences (C) as anxiety and avoidance, and then attempt
to illicit the irrational Beliefs (B) presumed to be largely contributing
to the anxiety and avoidance; that is, I must achieve outstandingly
well in one or more important respects or I am an inadequate person! The client is also introduced to the ABC theory at this stage
and is encouraged to understand his or her problems in this mode. In
particular, the client is persuaded to understand that Activating
events (A) do not directly cause emotional and behavioral Consequences (C) but, rather, it is largely ones irrational Beliefs (B) about
Activating events (A) that are the main contributor. Furthermore,
the client is helped to understand the critical difference between
rational beliefs and irrational beliefs, how humans can simultaneously
hold both rational beliefs and irrational beliefs, and how each contributes differently to emotional and behavioral Consequences (C).
In some cases, the therapist might deem it appropriate to bypass
conceptualizing the problem in terms of REBT principles in order to
avert creating resistance or to avoid other impediments to change.
There also might be instances when the client presents a problem
and goal that is particularly conducive to a straightforward solutionfocused approach. Using a solution-focused approach in some cases
might create a context for bringing about the minimalist, albeit significant, change that might otherwise not be realized had REBT procedures been used. In such cases, we usually look to the client for
guidance in selecting a fitting problem definition and goal. Hence, it
is crucial to learn how the client makes sense of the problem (i.e.,
what, if any, cause the client might attribute to the problem). Clients
might attribute their problem to any number of various causes,
including an event, a mental disorder, another persons behavior, or a
psychological construct. In a case involving a married woman, for
example, the client attributed the problem to codependency. In
keeping with a solution-focused perspective, the problem was conceptualized as codependency/not codependency. The problem definition
stage involved obtaining a video description of what the client does
when she is thinking, feeling, and acting codependently. Exceptions
were then identified in the direction of change.

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Disputing Irrational Beliefs and Other Techniques


After defining the problem in terms of the ABC theory, clients are
instructed to use the disputation method, which entails identifying
and challenging irrational beliefs. Walen, DiGiuseppe, and Dryden
(1992) have described the disputation method as a process whereby
the validity and utility of irrational beliefs are questioned. The aim of
the disputation method is to help clients internalize a new, rational
belief system, which in turn, may be attached to future Activating
events (A). Ellis and Yeager (1989) have described disputation as a
technique that
employ[s] the hypothetical-deductive method of science
whereby[clients] reformulate their absolutistic notions about
the world into testable hypotheses, andtest these hypotheses.
Those beliefs that can be reasonably and realistically supported
with objective evidence will be kept and considered to be rational.
Those beliefs that are unproven or are contradicted by existing
evidence are given up. (p. 19)

Since cognition, emotion, and behavior are interactive and reciprocally related, we also encourage clients to dispute irrational beliefs in
conjunction with various cognitive, emotive, and behavioral techniques. Ellis & Dryden (1990) have suggested that cognitive change
is often facilitated by behavioral change (p. 173). Along similar lines,
Ellis (1980) has suggested that if people force themselves to actdifferently, they frequently will bring about cognitive modification (p.
332). Cognitive techniques include the use of coping self-statements
where clients are encouraged to write down and repeat to themselves
rational beliefs to supplement their disputation of irrational beliefs. A
variety of psycho-educational are also used, including encouraging
clients to read REBT self-help books and use REBT self-help forms.
Emotive techniques include rational-emotive imagery and encouraging clients to dispute irrational beliefs in forceful, evocative, and dramatic ways (Ellis, 1985). Behavioral techniques include in vivo
desensitization or exposure, and implosion (Ellis, 1985, 1999; Ellis &
Dryden, 1990).
We also employ a variety of practical methods aimed at helping clients change negative conditions in their lives; that is, Activating
events (A). These methods might include teaching clients specific
skills, such as parenting, budget planning, and problem-solving.
These techniques, however, are usually employed along with the

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disputation method. Although we strive to help clients change negative Activating events (A), we often encourage them to first change
their irrational beliefs about these circumstances since, it is assumed,
that once clients are less emotionally and behaviorally disturbed,
they will very often then be more adept in their problem-solving
strategies (cf., Ellis, 1980; Ellis & Dryden, 1990).
Identifying and Amplifying Exceptions
If we have previously employed an REBT conceptualization when
defining the problem, we usually begin this part of the clinical process by first seeking to identify rational exceptions, rather than general exceptions. It is reminded that rational exceptions refer to
instances when, in the context of clinical disturbances, the client retains their preference (rational belief), yet does not escalate the preference into a demand (irrational belief). For example, the therapist
might ask the client, When has there been a time when you felt sad,
but not depressed, about this situation? This question is aimed at
identifying those times when the client experienced an appropriate
emotional Consequence (C) about a negative Activating event (A). In
keeping with REBT theory, it is assumed that such instances are occasioned by rational beliefs, rather than irrational beliefs. Accordingly, the client would then be asked to recall their Belief (B) during
the time when they felt sad, rather than depressed. Thus, the client
might be asked a line of questioning in the direction of identifying
corresponding rational beliefs; for example, What were you telling
yourself about the Activating event (A) when you felt only sad, but
not depressed? (and so on). In other cases, the therapist might first
focus on identifying incidences of rational beliefs, rather than initially attempting to identify appropriate emotional and behavioral
Consequences (C). So, the therapist might ask the client, When has
there been a time when you thought rationally about this situation?
and then proceed to identify the corresponding appropriate emotional
and behavioral Consequences (C). In either case, the incidence of rational Beliefs (B) and corresponding appropriate emotional and
behavioral Consequences (C) signify rational exceptions that are to be
amplified (described below).
A rule of thumb when asking such questions is to use language
that creates a context for identifying exceptions. For example, it is
important to ask, When has there been a time when you felt sad,
but not depressed, about this situation? rather than Has there been

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a time when you felt sad, but not depressed, about this situation?
The latter is a yes-or-no question that leaves room for the client to
respond negatively. The former carries with it a sense of expectancy
that indeed there have been exceptions. Often there is a silent response because many clients are not accustomed to being asked at
such an early stage in treatment about times when things are going
better. This questioning is interventive as it produces a sudden shift
in the clients problem focus. The therapist should be comfortable
with the silence and give the client time to digest this line of questioning.
If the client identifies exceptions, then proceed to amplify them. If
the client states that there have been no exceptions, however, encourage the client to consider small differences. Clients can frequently recall exceptions when asked to consider small changes that have
occurred. It has also been found that small changes often lead to bigger changes (cf., Erickson, 1980). Although it is difficult to imagine
being less demandingthat is, you are either placing a demand (on
yourself, someone else, or life conditions) or you are notthere are
instances when small changes might represent rational exceptions.
Consider, for example, that a client might be able to identify a time
when they still felt significantly upset, but nevertheless less disturbed than usual. Further inquiry might reveal that in such cases
the client did not hold an irrational belief and, as a result, was experiencing an appropriate, rather than inappropriate, emotional Consequence (C).
If rational exceptions are identified, the client is helped through
various lines of questioning to amplify these exceptions. One of the
main functions of amplifying exceptions is to help clients to identify
the differences between the times when they have the problem and
the times when they do not. An example of such questioning might
be, How did you make that happen? OHanlon & Weiner-Davis
(1989) have stated that verbalizing [differences] produces clarity
both for us and for our clients. Once our clients identify how they get
good things to happen, they will know what it will take to continue
in this vein (p. 86). Questioning aimed at identifying such differences also reinforces REBT principles, including the differences between rational beliefs and irrational beliefs. Another purpose of the
amplification process is to empower clients with a sense of self-efficacy. Questions aimed toward this end include, What does this [i.e.,
the rational exceptions] say about you and your ability to deal with
the problem? and What are the possibilities? The former is aimed

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at eliciting a response to the effect, I am capable of solving this


problem or I am capable of thinking more rationally and not making myself disturbed. The latter is aimed at ascribing a sense of
hope, optimism, and determination in relation to the problem and
goal.
Sometimes clinicians become frustrated when clients are unable,
unwilling, or otherwise do not identify exceptions. The client might
be so problem focused that it is necessary for the therapist to help
them visualize what a solution would look like. Questions aimed at
identifying potential rational exceptions might take the form of,
What will you be thinking when you are feeling sad, but not depressed? This process is adapted from de Shazers (1978) Crystal
Ball Technique, which involves encouraging clients to picture themselves in a future situation in which they are functioning satisfactorily. Molnar and de Shazer (1987) have noted that the Crystal Ball
Technique came to be regarded as a precursor of a solution focus, in
that it was an early attempt to systematically focus the client on
solutions rather than on problems (p. 350). In some cases, clients
and counselors are unable to identify rational exceptions or potential
rational exceptions. When this happens, the therapist may consider
providing the client with more education in REBT principles or shifting to identifying general exceptions.
It should be remembered that general exceptions refer to any
instance when the client has experienced some improvement in their
problem, and all other aspects of their life when the problem is less
severe or not of concern. The process of identifying general exceptions
is essentially the same as those methods used in a straightforward
solution-focused approach. General exceptions are sought in cases
when REBT principles are bypassed during the problem definition
stage, when the therapist and client are unable to identify rational
exceptions, or as an adjunct to the process of identifying rational
exceptions. Questions aimed at identifying general exceptions are
designed to uncover virtually any instance of improvement or positive
difference in relation to the problem.
Assigning Homework and Tasks
After identifying and amplifying exceptions, the question arises as
to what extent the exceptions represent an attainment of the treatment goal; in other words, the degree to which the identification and
amplification of exceptions have bridged the gap between the problem

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and the goal. In some cases, the therapist and/or the client might
consider that further sessions are not required to achieve the goal. In
other cases, the goal might not have been fully reached, but it is
agreed that the client has displayed sufficient movement in direction
of the goal, making further sessions unnecessary. At this point in the
process, therapists proceed to the stage of re-evaluating the problem
and goal (described below). During the first session, however, it is
usually agreed that further sessions are needed because more progress is required. This is particularly relevant to the most important
insight that REBT emphasizes:
Because you naturally and easily think crookedly and behave defeatingly, because you have a strong biological as well as sociological tendency to disturb yourselfthere is normally no way, but
hard work and practice to change yourself and to keep yourself
less miserable and more functional. (Ellis, 1987, p. 111)

When REBT principles have been used in previous stages of treatment, homework and tasks are designed to help the client practice
disputing irrational beliefs, and identify and amplify both rational
exceptions and general exceptions. If REBT principles have not been
used, then this stage aims to help clients identify and amplify general exceptions. In either case, at the outset of this stage, the therapist can help carry the momentum by summarizing what has been
discussed thus far. The summary should include reviewing with the
client the problem, goal, and exceptions that have been identified. It
is also helpful to compliment the client at this time for taking the initiative to seek help and for his or her willingness to make positive
changes.
If the client is able to identify exceptions (rational or general), then
tasks are usually organized around encouraging the client to do more
of the same. If the client is not able to identify exceptions, then tasks
are designed to observe and build on the incidences of exceptions.
Following is a list of three tasks that we most often use with clients
and the corresponding criterion that generally guides our selection of
the task. These tasks have been adapted from those developed from
Molnar and de Shazer (1987) and address instances when the clinical
focus is on rational exceptions, general exceptions, or both.
Task 1. Client is told, Between now and the next time, I would like
you to continue to do more of the exceptions. (If the client is able
to define a problem and goal, and is able to identify exceptions.)

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Task 2. Client is told, Between now and the next time, I would like
you to observe for those times when it happens in your life (i.e.,
exceptions). (If the client is able to define a problem and goal, is
able to identify potential exceptions, but is not able to identify
exceptions.)
Task 3. Client is told, Between now and the next time, I would like
you to think about what you will be doing differently when the
problem is improved. (If the client is able to define a problem,
and is not able to define a goal.)

These tasks and criteria are a parsimonious attempt at setting


guidelines for the selection process. In some cases, it might be fitting
to construct a different task or not to construct a task at all. In other
cases, we might combine two or more tasks. We also frequently supplement tasks with other techniques, including in vivo desensitization, bibliotherapy, and writing exercises. In each case, it is critical
for the tasks to make sense for the client and their situation. Accordingly, we make every effort to determine if the client agrees that the
task is a meaningful activity given the problem and goal.
Identifying and Amplifying Exceptions Derived from Homework
and Tasks
It is important for the therapist to demonstrate at the outset of the
second and subsequent sessions that he or she remembers and is
interested in what was previously discussed. Doing so helps both the
client and the therapist remain focused. Accordingly, documentation
that includes specific data corresponding to the stages of our model
(including the problem, goal, and exceptions) is essential. The session
can be started by summarizing what was discussed during the previous session and reminding the client of the task. Identifying exceptions derived from the task should be done in a manner similar to
the previous session. As always, it is important to use language that
creates an expectancy of change.
If exceptions are identified, these should be amplified in the manner
discussed previously. After amplifying exceptions, we re-evaluate the
problem (discussed below). If the client states, I did not remember to
do it [e.g., Task 1], then avoid creating resistance and, instead, foster
a cooperative approach by responding, Okay. Lets think about it now.
When was there a time this past week when it happened in your life
(i.e., exceptions)? If the client reports that there were no exceptions,

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aim to identify small changes. If the client maintains that there were
no exceptions, it may be necessary to discuss or reconstruct the problem which, in turn, might provoke the identification of exceptions.
Often exceptions come out later in the session (i.e., the client might
recall exceptions after he or she stated that there was none). In some
cases, clients will be very problem focused at the start of the next
session. They might assert that things got worse or they might have
recently experienced a severely problematic situation (perhaps just
before the session). When this happens, therapists can suggest to the
client, I am very interested in hearing about this, but I would first like
to check on the task that we discussed at the end of the last session.
Most of the time, clients will agree to this. After inquiring about the
task (and hopefully identifying and amplifying exceptions), the problem can be re-evaluated and, if needed reconstructed.
Re-evaluating the Problem and Goal
After evaluating the effectiveness of tasks, the problem and the
goal are re-evaluated and, if necessary, redefined. During this stage,
the client is helped to consider the extent to which progress or the results of homework and tasks amount to an attainment of the goal. If
the treatment goal has been reached or the client has made significant progress in the direction of the goal, then it might be appropriate for the therapist to ask the client whether he or she thinks that
further treatment is needed at this time. Discussing whether further
treatment is needed maintains a focused approach and helps to curtail the incidence of drop outs. It is apparent that a large number of
clients drop out of treatment after just a few sessions either by canceling or not showing for appointments. Ideally, we strive to reach a
consensus with clients regarding the issue of when treatment is (and
is no longer) needed.
If the client reports that the goal has been reached or sufficient
progress has been made, yet additional sessions are needed, then
subsequent treatment might be organized around building on the clients gains. If the client has made significant progress and also
claims that further treatment is needed, then perhaps the problem or
goal has not yet been satisfactorily defined. The client may also indicate that the goal has been reached and that there is now a new
problem and goal. In such cases, it is important to help the client
reconstruct the problem and goal. It could be said that talking about
a problem at different times necessarily produces a change in its defi-

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nition (i.e., the words used and hence the meaning ascribed changes).
The therapist can use this inevitability to work toward reconstructing
more solvable problems. The goal might need to be more attainable,
more general, more specific, or more relevant to the clients problem.

CASE EXAMPLE
A 73 year old married man presented with the problem of depression. He stated that he had been diagnosed with major depression
two years ago following a myocardial infarction. He stated that he
experienced limited improvement after trying several antidepressants. The client stated that since becoming depressed he seldom engaged in recreational or social activities and was anhedonic. The
client stated that his goal was to become his old self again. The
therapist considered that the clients depression was, to some degree,
endogenous insofar as it related to the myocardial infarction. The
therapist also presumed, however, that psychological factors were
related to the depression. In particular, the client reported feeling
significantly guilty about his depressive condition. In REBT, the term
secondary disturbance has been used to refer to the emotional disturbances that clients sometimes experience about their principal inappropriate emotional and behavioral Consequences (C) (Walen et al.,
1992). In this case, the therapist understood the clients secondary
disturbance as an irrational Belief (B) about his depression (which
was conceptualized as an Activating event [A] in itself) that in turn,
resulted in an emotional Consequence (C) of guilt. The therapist provided REBT education to the client, including the ABC theory, and
encouraged the client to conceptualize his problems accordingly. It
was agreed that the client had secondary disturbance and, moreover,
that his guilt feelings about his depression exacerbated his condition.
The client was also asked to describe, in behavioral terms, what
being his old self was like. He stated that when he was his old self,
he was very active, socialized frequently, and enjoyed activities of
daily living. The client was able to identify an instance in the recent
past when he did not feel guilty upon thinking about his depression
but, instead, felt concerned (rational exception). The client also identified a few rare instances when he found that he was being his old
self (general exception). The client maintained, however, that these
exceptions were not significant. The client was then taught how to
identify and dispute the irrational belief that was contributing to his

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secondary disturbance; that is, I must not be depressed or else I am


an inadequate person. At the end of the first session, the client was
asked to observe for times when he was able to successfully dispute
this irrational belief. The client was also asked to observe for times
when he found that he was being his old self.
At the start of the second session, the client smiled and stated, I
am my old self again! He invited his wife to attend the second session and she confirmed that her husband had made significant progress during the past week. The therapist proceeded to ask the client
and his wife to identify the many instances in the past week when he
was being his old self. Various general exceptions to depression were
identified, including the clients initiating a card game one evening
with a couple that he and his wife had previously socialized with on
a regular basis. The client also identified progress he had made with
regard to disputing the irrational belief that was identified in the
first session (rational exception). During the second session, the client forcefully affirmed, I am not an inadequate person because I
have been depressed! I am an acceptable human being who is still
the fine person I was before I became depressed!
During the third session, held one week later, the client was
encouraged to read an REBT self-help book. At the end of the third
session, the client was asked to continue to do more of the exceptions.
At the fourth session, held two weeks later, the client and his wife
reported continued progress. During the fourth session, it was agreed
that the client was being his old self again and that further sessions
were not needed at this time. It was agreed that the client could
schedule another session if he felt himself slipping away from being
his old self. Three months later, the therapist made a telephonic follow-up. The client reported that he was still being his old self; that
he seldom, if ever, felt guilty about his condition; and that he was
feeling much less depressed. The client was again advised that he
could schedule another session if he ever felt the need. The therapist
never heard from the client again.

CONCLUSIONS
Many questions remain regarding the theory, research, and practice of this integrative model. It could be argued that at times the
clinical applications are ostensibly similar to each of the models from
which the integration has been developed. This is especially pertinent

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241

upon considering that Ellis (1996) has acknowledged that his clinical
model allows for the inclusion of solution-focused techniques in cases
when REBTs preferred approaches are ineffective. We affirm, however, that our integration of REBT and solution-focused therapy is
valuable because it affords therapists with a basis from which to
combine these two models with conceptual clarity and consistency.
It is reaffirmed that integrating REBT and solution-focused therapy addresses the limitations of each model while enhancing their
respective strengths. In the case example, the therapist used REBT
principles to help the client dispute an irrational belief that was presumed to be significantly contributing to the problem. In addition,
the therapist helped the client to identify and amplify general exceptions in keeping with a solution-focused approach. It follows that the
integrative model is comprehensive in that it strives for both (a)
REBTs large scope of change and educative approach, and (b) solution-focused therapys emphasis on using the clients language and
striving for minimalist goals. In the case example, the therapist used
the clients language (i.e., old self) as an organizing metaphor. Using
the clients unique frame of reference is a hallmark of solutionfocused therapys cooperative approach (de Shazer, 1984). Conversely,
the therapist taught REBT principles to the client, which enhanced
the change process.
The use of REBT principles within the integrative model also provides much needed content that is missing from the solution-focused
approach. Like other models informed by a social constructionist perspective (e.g., Anderson & Goolishian, 1988), solution-focused therapy
is to be considered a process model because its theory of problem
formation and change, unlike traditional models, avoids imposing
predetermined content (e.g., irrational beliefs) during the change process (Held, 1992). It is reminded that in solution-focused therapy,
problems are conceptualized as the clients languaging about problem/exception. Solution-focused therapy does not, however, specify
what the problem/exception shall be. Process models like solutionfocused therapy, as a result of their positing such general theories of
problem formation, allow for the use of virtually any content that clients might bring to treatment. This preference to avert imposing predetermined content, however, can result in the therapist feeling less
than grounded during the change process (Held, 1986). The integrative model addresses this limitation of process models by allowing for
the use of REBT principles.

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We recommend that future research focus on both qualitative and


quantitative studies aimed at evaluating the effectiveness of this
model. In addition, further investigations might focus on articulating
the decision-making processes of clinicians for the selection of the
various conceptualizations and interventions available in the integrative model. Such a study would address the question, for example, of
when it is preferable to use a straightforward solution-focused approach, rather than a blend of REBT and solution-focused therapy. In
a similar vein, Colaptino (1979) has considered a framework whereby
therapists shift from one therapy approach to another on the basis of
various factors, including the type of client or problem. According to
Colapinto, an alternation pattern seems theoretically possible, but
then a second-order model will be needed whose function will be to
prescribe the differential applicability of the two modes in specific situations (1979, p. 439). More generally, then, research could focus on
identifying the criteria from which therapists choose to shift between
divergent therapies and the effects of the alternations.
Finally, it is reaffirmed that the integrative model set forth speaks
to the call that has been made by various writers for convergence
and rapprochement in our field. Indeed, the model holds promise for
guiding the systematic development, refinement, and expansion of
numerous divergent therapy models. Therapists can follow the process described in this article of invoking pertinent rationales for combining theories and techniques from different models. Such
applications may be worthwhile endeavors so long as therapists recognize the importance of developing integrative models that are systematic and consistent.
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