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  • Writer's pictureDeric Hollings

Disconfirming Care


 

I practice Rational Emotive Behavior Therapy (REBT) for a living. This effective and evidence-based form of psychotherapy uses the ABC model to examine how irrational beliefs cause unpleasant emotional, bodily sensation, and behavioral consequences.

 

Once an illogical and unreasonable belief is pinpointed, an individual may then dispute the unhelpful assumption in order to alleviate self-disturbing emotive, sensation, and behavioral reactions to the belief. In this way, when presented with irrational beliefs, REBT seeks to disconfirm the assumptions—demonstrate that beliefs or hypotheses are not or may not be true.

 

Although not necessarily a stance assumed by the Albert Ellis Institute or other REBT entities or practitioners, I consider my approach to REBT as one related to disconfirming care. This is the antithesis of affirmative care, which one source describes as follows:

 

Affirmative practice is an approach to health and behavioral health care that validates and supports the identities stated or expressed by those served. Affirmative care requires the practitioner to actively honor and celebrate identity while at the same time validating the oppression felt by individuals seeking services. Validation and empathy fundamentally result from increased understanding of individuals’ history, cultural context, and lived experiences. Origins of the approach honored the experience of those in LGBTQ+ [lesbian, gay, bisexual, trans, queer, plus] communities; however, affirmative care should be valued across cultures, systems, and settings in which health and behavioral health care are offered. Affirmative care principles should be applied across cultures and communities while recognizing the worth of the individual and avoiding stereotyping.

 

There’s a lot to unpack with the nonsense expressed by this source. First, the views maintained by the source are unscientific, because they prescribe rather than describe an approach to health care.

 

Second, the source commits a moralistic fallacy – concluding that what is right simply is by violating the is-ought problem. When one attempts to derive an ought from an is, this sort of logical fallacy is at play (e.g., “Affirmative care requires the practitioner to actively honor and celebrate identity” prescribes what ought to occur).

 

Third, the source uses demandingness in the form of should, must, and ought-type statements, to include derivatives thereof (i.e., “requires” is an inferred must statement). Although authors of the source doubtlessly believe that behavioral health care providers should behave in a particular manner, I disagree with their demanding prescription.

 

Fourth, the source nonsensically claims that oppression is something that may be “felt.” Feelings relate to emotions (i.e., joy, fear, anger, sorrow, disgust, surprise, etc.) and bodily sensations (e.g., my head feels hot). While one may believe that one is being oppressed, oppression is not an emotion or bodily sensation.

 

Fifth, “validation” relates to recognition that a person’s beliefs are logical and reasonable, or at minimal are based in fact. As an REBT practitioner, I dispute irrational beliefs and do not validate them.

 

Sixth, “empathy” relates to sharing the emotions and sensations of another person, which I consider an impossible proposition. Although I may imagine or interpret what an individual feels, I cannot truly empathize with another person. Instead, I use rational compassion.

 

Seventh, one simply is or isn’t lesbian, gay, or bisexual. However, one cannot experience the emotion or sensation of an opposite sex (i.e., male or female) or gender predicated on sex (i.e., boy, girl, man, or woman) when one has no experiential point of reference to begin with.

 

For instance, I was born a male and I’m a man. I cannot “feel” like anything other than whom or what I am. I can no sooner accurately describe the experience of all other males or men than I can detail what it is to emote like or have the sensations of females or women.

 

Therefore, trans and queer so-called identities which proclaim to “feel” like a different sex or gender commit an irrational error of unfavorable assumption. As such, claiming that one ought to affirm another’s irrational beliefs is something with which I disagree.

 

Finally, while I agree with the source in regards to “recognizing the worth of the individual and avoiding stereotyping,” these actions may be done without the unhelpful model of affirmative care. Ultimately, my suspension of rational belief has its limits.

 

Now, imagine a prospective client reaches out to me and describes herself as a catgirl, which one source describes as a “female kemonomimi character with feline traits, such as cat ears, a cat tail, or other feline characteristics on an otherwise human body.” This is a fictional character.

 

However, much as the aforementioned source misused feelings-based terminology, suppose the prospective client tells me she “feels” like a catgirl and that her pronouns are “prrr” and “meow.” I maintain that it would be unethical to actively partake in this person’s delusion.

 

Consider that the clinical intervention I use as a psychotherapist in an outpatient setting coincides with what one source states about psychiatrists who operate in an inpatient setting:

 

Exploring the symptoms and finding out to what extent they influence the patient’s behaviour and functioning may be regarded as the professional duty of a psychiatrist who meets a new patient in an acute situation. In our study, all psychiatrists did this with all of their patients which might be seen as a sign of good quality of care.

 

I explore the symptomatic beliefs which influence behavior and functioning, because I consider it my personal responsibility to provide quality care by not joining with a client’s self-disturbed beliefs. In this regard, what may be done by an untrained person outside of a clinical setting is different than what is recommended for trained professionals.

 

For instance, one source encourages family members of people exhibiting delusions not to argue with what a person truly believes, not to directly reject the delusion, and not to pathologize the belief or behavior of a loved one. I concur with this suggestion.

 

After all, an unskilled person may aggravate the situation by haphazardly disputing irrational delusions. However, as one source suggests for trained behavioral health care professionals, “therapy involves challenging the patient in regards to their belief in their delusion.”

 

Disconfirming care would be my approach with a client who reports irrational belief in her existence as a catgirl. This is the antipode of affirming care which one source describes as follows:

 

Gender-affirming care, as defined by the World Health Organization [WHO], encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those, and fluid.

 

The source’s citation of the WHO – the entity that played a key role in botching the response to the COVID-19 pandemic – was a questionable decision. Likewise, the source’s citation of the APA is dubious, as the APA has assumed a stigmatizing stance on “traditional masculinity.”

 

While perhaps most of my fellow behavioral health care colleagues may disagree with my controversial views regarding client care, I simply wouldn’t indulge a catgirl delusion. As such, I will continue practicing ethical disconfirming 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. If this form of psychotherapy is something you think may benefit you, I’m here to help.

 

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

 

References:

 

APA. (2018, August). APA guidelines for psychological practice with boys and men. American Psychological Association. Retrieved from https://www.apa.org/about/policy/boys-men-practice-guidelines.pdf

Boyle, P. (2022, April 12). What is gender-affirming care? Your questions answered. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered

Carter, L. (n.d.). Delusional disorder. Texas A&M University Central Texas. Retrieved from https://www.tamuct.edu/research/databases/disorders/delusional-disorder.html

David, D., Cotet, C., Matu, S., Mogoase, C., and Stefan, S. (2017, September 12). 50 years of rational‐emotive and cognitive‐behavioral therapy: A systematic review and meta‐analysis. Journal of Clinical Psychology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836900/

Hollings, D. (n.d.). Blog – Categories: Disputation. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/blog/categories/disputation

Hollings, D. (2024, January 7). Delusion. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/delusion

Hollings, D. (2022, October 31). Demandingness. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/demandingness

Hollings, D. (2022, October 5). Description vs. prescription. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/description-vs-prescription

Hollings, D. (2022, March 15). Disclaimer. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/disclaimer

Hollings, D. (2023, September 8). Fair use. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/fair-use

Hollings, D. (2023, October 12). Get better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/get-better

Hollings, D. (n.d.). Hollings Therapy, LLC [Official website]. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/

Hollings, D. (2023, May 18). Irrational beliefs. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/irrational-beliefs

Hollings, D. (2023, September 19). Life coaching. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/life-coaching

Hollings, D. (2023, September 8). Lived experience. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/lived-expereince

Hollings, D. (2023, January 8). Logic and reason. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/logic-and-reason

Hollings, D. (2024, March 3). Naturalistic and moralistic fallacies. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/naturalistic-and-moralistic-fallacies

Hollings, D. (2022, October 22). On empathy. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/on-empathy

Hollings, D. (2023, September 3). On feelings. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/on-feelings

Hollings, D. (2022, November 7). Personal ownership. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/personal-ownership

Hollings, D. (2022, March 24). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt

Hollings, D. (2022, November 1). Self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/self-disturbance

Hollings, D. (2022, October 7). Should, must, and ought. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/should-must-and-ought

Hollings, D. (2022, November 9). The ABC model. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-abc-model

Hollings, D. (2022, December 14). The is-ought problem. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-is-ought-problem

Hollings, D. (2023, August 6). The science. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-science

Hollings, D. (2023, November 23). Validation. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/validation

Kupferschmidt, K. (2021, May 12). ‘A toxic cocktail:’ Panel delivers harsh verdict on the world's failure to prepare for pandemic. Science. Retrieved from https://www.science.org/content/article/toxic-cocktail-panel-delivers-harsh-verdict-world-s-failure-prepare-pandemic

Mendoza, N. S., Moreno, F. A., Hishaw, A., Gaw, A. C., Fortuna, L. R., Skubel, A., Porche, M. V., Roessel, M. H., Shore, J., and, Gallegos, A. (2020, January 24). Affirmative care across cultures: Broadening application. Focus. Retrieved from https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20190030

Roboto. (2024, January 31). Cat-girl [Image]. Playground. Retrieved from https://playground.com/post/cat-girla-beautiful-young-hybrid-of-a-cat-and-a-womanfe-cls2grleo00c1s6018mf1qv8j

Tamara. (n.d.). Understanding your loved one: Coping with delusions. Anchored Child & Family Counseling. Retrieved from https://www.anchoredinknowledge.com/understanding-your-loved-one-coping-with-delusions/

Wikipedia. (n.d.). Catgirl. Retrieved from https://en.wikipedia.org/wiki/Catgirl

Wikipedia. (n.d.). Moe anthropomorphism. Retrieved from https://en.wikipedia.org/wiki/Kemonomimi

Zangrilli, A., Ducci, G., Bandinelli, P. L., Dooley, J., McCabe, R., and Priebe, S. (2014, June 16). How do psychiatrists address delusions in first meetings in acute care? A qualitative study. BMC Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067065/

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