Sand Tray Therapy Lesson Plan for Rational Emotive Behavior Therapy: -Student #2

by Sand Tray Therapy Student

A-B-C Framework with Hope for Sand Tray Therapy / Rational Emotive Behavior Therapy

Rationale: The concept of the A-B-C Framework is central to rational emotive behavior therapy (REBT), a cognitive behavior theory that is effective for helping clients with depression. This model helps clients understand their feelings, thoughts, events, and behavior. A is an activating event or the behavior or attitude of a person. C is the emotional and behavioral consequence. B is the person’s belief about A and is the cause of C, the emotional reaction of the person. Clients can identify the irrational beliefs that cause their disturbed emotional consequences and change them. In addition, giving clients the opportunity to express reasons for staying alive will help to diminish their depression.

Materials: Handout of the A-B-C Framework
Assorted miniatures of choice
Directions:
1. Give client a handout of the A-B-C Framework and explain A, B, and C.

A=Activating Event (can also be a behavior or attitude)
B=Belief about the activating event
C=Consequence (emotional or behavioral; reaction)

Explanation: the beliefs about the rejection or failure at point B are the main cause of the depression.

2. Have client use half of the sandtray and select miniatures to describe the “frames in the film” that depict scenes of the sequence of events that led to the suicide attempt or self-harming behavior, the details of the actual event, and events that followed the destructive behavior.

3. Ask the client to describe each scene that they have created. The therapist asks them about their reactions to the events that led to the suicidal or self-harming crisis.

NOTE: The analysis includes identification of vulnerability factors and activating events such as a stressful life event associated with the crisis as well as the adolescents’ thoughts, feelings, and behaviors occurring at the moment of the unhealthy behavior along with their reaction to these events.
A-B-C Framework with Hope (p. 2)

4. Ask the client the following questions:

-- What might be ongoing vulnerabilities to environmental triggers?
-- What are short and long-term consequences for threatening suicide or self-harming behavior?
-- What are some thoughts or interpretations that lead to increased suicidal or self-harm thinking?
5. As the client is describing their suicide attempt or self-harming experience and the thoughts and emotions related to the experience, the therapist is looking for certain client deficits such as the inability to regulate emotions, the inability to resolve problems, the inability to tolerate distress, and the inability to address negative thoughts or beliefs such as hopelessness or worthlessness.

6. The therapist will listen for the clients’ cognitive distortions including “shoulds,”” musts,” and “oughts,””self-downing,” and “awfulizing” and make notes.

7. The therapist will teach the client about cognitive distortions and explain D-Disputing Intervention, E (Effect), and F (New Feeling) from the A-B-C Framework handout. The therapist informs client of the irrational beliefs, cognitive distortions, and negative thinking that they had noted while the client explained their experience of suicide attempt or self-harm and challenges their irrational beliefs. The therapist teaches the client how faulty beliefs lead to negative consequences.

8. The therapist encourages clients to actively dispute their faulty beliefs and substitute rational (self-helping) beliefs and behaviors for irrational ones. Also, the therapist will encourage clients to monitor their self-talk, identify maladaptive self-talk, and substitute adaptive self-talk for negative self-talk. The therapist teaches the client that they have the capacity to change their cognitions, behaviors, and emotions. Clients are instructed to avoid being preoccupied with A and acknowledge that it is not healthy to continue to dwell on the emotional and behavioral consequences of C. Instead, they are encouraged to choose to examine, challenge, modify, and uproot B—the irrational beliefs they hold about the activating events at A.

9. To help instill a sense of hope, the therapist asks the client to use the other half of the sandtray and choose miniatures to demonstrate their personal reasons for living. Delineating reasons to live is an important activity because learning to cope with suicidal urges is rather empty if there are no reasons to want to cope. The therapist tells the client that some of the their reasons may include the people who care about them, the things the patient can look forward to in the future, things the patient likes to do, and things that the patient cares about. The therapist explains to the client how recalling reasons to stay alive may be impaired during a crisis.

A-B-C Framework with Hope (p. 3)
10. Give the client homework so they can practice using the A-B-C Framework to describe a behavior that they will engage in over the next week.

FINAL NOTE: This lesson can continue to be used in treatment as the client continues examining how their beliefs affect their feelings and behaviors. The therapist can use this as an assessment tool for how well the client is progressing with improving their rational beliefs, recognizing their cognitive distortions, and moving toward the goals of unconditional self-acceptance and unconditional other acceptance.


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