On the Couch with Dr. Michael Edelstein

Dr. Michael R. Edelstein is a licensed clinical psychologist with over 25 years experience. He is in private practice in San Francisco and is the author of Three Minute Therapy: Change Your Thinking, Change Your Life, a self-help book for overcoming common emotional and behavioral problems.

In his practice, Dr. Edelstein specializes in the treatment of anxiety, depression, relationship problems, and addictions, and is one of the few practitioners of Rational Emotive Behavior Therapy (REBT) in the Bay Area. He is a SMART Recovery (SR) Professional Advisor and has served as a Rational Recovery (RR) Specialist. He is a Certified Sex Therapist and has served as a Consulting Psychologist for the National Save-A-Life League, Inc., the oldest suicide prevention center in the United States.

Dr. Edelstein is a Training Supervisor and Fellow of the Albert Ellis Institute. He holds a diplomate in Cognitive-Behavioral Therapy from, and is on the Board of Advisors of, the National Association of Cognitive-Behavioral Therapists. He is Past President of the Association for Behavioral and Cognitive Therapy. He also writes the popular advice column, “Ask Dr. Mike,” which appears in the San Francisco Intelligencer.

Dr. John Grohol: Dr. Edelstein, we’ve long heard about the ABCs of cognitive behavioral therapy, but in your book, you talk about Three-Minute Therapy using the ABCDEFs of REBT. What is REBT, and can you walk us through the ABCDEFs?

Dr. Michael Edelstein: Sure, John. And I just want to thank you for inviting me to take part in this interview.

REBT stands for Rational Emotive Behavior Therapy. It was devised by Albert Ellis in 1955, and since then, it’s spawned a variety of cognitive behavior therapies, most notably those devised by Aaron Beck and David Burns. And REBT says that it’s never situations themselves that upset us or disturb us or cause us to feel anxious, depressed, angry, or act in addictive ways, but rather it’s our thinking about those situations.

It’s our ideas that use notions, thoughts, views, opinions in our head, what we tell ourselves about those adverse situations that cause our problems, not the situations themselves. And that’s a very powerful idea because that means, if you’re feeling anxious, depressed, or angry, you are in control. You are creating that. You are making yourself feel that way. So you can uncreate those feelings. And that’s what cognitive behavior therapy and Rational Emotive Behavior Therapy is based on.

And Albert Ellis took that theory, or actually devised that theory, and took it down to a simple ABCDEF that you mentioned.

And let’s take a problem. Let’s suppose your mate criticizes you unfairly, in your view, and you get angry. So let’s see how we can apply the ABCDEF model to that. And I call that the three-minute exercise.

Dr. Grohol: OK.

Dr. Edelstein: So, A stands for activating event or adversity. So, A is “My mate criticized me unfairly.”

Then B is what you tell yourself about it. Now, B normally starts with a reasonable notion, such as “I prefer he or she not criticize me unfairly. I don’t like it. This is unpleasant, frustrating. I wish he wouldn’t.” And that preference leads to appropriate negative emotions, such as displeasure, frustration, concern, disappointment.

And those are appropriate negative emotions in that they’re not dysfunctional to feel that way; if you get criticized unfairly, it makes sense to have some negative reaction. It doesn’t make sense to feel numb or happy about it, so it makes sense to have a more measured or reasonable response to it.

But then, being imperfect humans, we take our strong preferences and convince ourselves they’re absolute musts, shoulds, have-tos, laws of the universe, things absolutely have to be that way. So I take my preference, “I’d prefer my mate not to criticize me,” and insanely convince myself, “Therefore she must not criticize me unfairly. She must be fair. And she’s no good, she’s rotten, because of her unfair treatment.”

And we call that B irrational belief. And that irrational belief in B leads to C, undesirable emotional consequence: anger, resentment, hostility, wife abuse, those kinds of things. So it’s B that causes C. My demand is she treat me fairly, rather than A, activating event, her unfair treatment.

Dr. Grohol: Got you.

Dr. Edelstein: So, if we look at B, “She must not treat me unfairly, ” my goal is reasonable, that I be treated fairly. That makes sense. It’s just the must about it that’s the toxic part that does me in and gets me angry.

So the question is, how can I keep my goal, to be treated fairly by my mate, but get rid of the demanding, the commanding, the musting about it? And the answer is we go on to D.

D stands for disputing or questioning the irrational belief. And to do that, it’s a simple process. We just take what we have at B, “She must not criticize me unfairly,” and just put “Why?” or “What is the evidence?” in front of it, and we get a good question: “Why must she not treat me unfairly? Where’s the evidence she must always be fair in her criticisms? Where is it written that my mate must be understanding, fair, kind, and considerate?” So that’s a good question.

And then we go on to E. E stands for effective new thinking, or the answer to the question. And if you think about it, and think about it and think about it, you’ll normally never find evidence for must. Since you don’t run the universe, as far as I know–I didn’t see in this morning’s paper that any of us were elected ruler of the universe–there’s no reason why anyone must or has to act the way we want them to.

So that’s what we could put in E: “No reason she absolutely must treat me fairly, although I’d prefer she treat me fairly.” And then the more you have in E, the more persuasive it tends to be, as long as what you write in E is meaningful and not pie-in-the-sky.

So you can add more things, like “It is disadvantageous to be treated unfairly, but not the end of the world.” “I don’t like being treated unfairly, but I definitely can stand it.” “I’ve survived unfair treatment in the past, and I’ll survive it in the future.” “It’s not my mate’s unfair treatment of me that makes me angry, but rather it’s my unrealistic thinking about it, and I can change my thinking.”

“In order to have the advantages of a good relationship with a mate, a partner, or a friend, or even a colleague, it’s necessary to have the disadvantages. That’s inevitable.” “I can still have a happy life, even though I’m treated unfairly at times, although I’d be happier if everyone in the world always treated me fairly.”

So you write out all the reasons why the must is false and self-destructive. And then, if you do that on a regular basis, even daily, once or twice or three times a day, you practice writing out those three-minute exercises and reinforce the effective new thinking, then, due to the learning process which says “Reinforcement is the royal road to learning, ” you slowly, or not so slowly, get to F, your new feeling: concern, disappointment, displeasure, frustration, or if it’s a big issue, great displeasure, great concern, great disappointment. But not anger, not resentment, not hostility, because you’ve banished the must.