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Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
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CHAPTER 8: Behavioral Therapies
Chapter Review
Behavioral therapies are based on learning theory and empirical research rather than personality theory and abstract views of underlying human motivations. Behavioral counselors translate scientific findings into modes for helping clients change. Such methods allow clients to improve their lives by establishing desired behaviors, getting rid of bad habits, and by dealing with major negative behaviors such as alcoholism. The focus for behavioral treatments is not global personality change but specific behaviors that interfere with life functioning.
B. F. Skinner translated the learning experiments from laboratory trials with animals to human behaviors. He defined stimulus as a distinct condition, either internal, such as hunger, or external, such as cold air, and he defined a response as what observable behavior the person does. Skinner defined reinforcers as stimuli that increased the frequency of behaviors and punishment as stimuli that decreased the frequency of responses.
Dollard and Miller described counterconditioning, when original associations are unlearned by changing conditions. For example, a fear of snakes can be countered by pleasant experiences with snakes. Learning is also generalized, when similar stimuli become associated with the same response. Discrimination in learning occurs when stimuli become more distinct and responses more specific to certain stimuli. Dollard and Miller also redefined the psychoanalytic term repression as an avoidance response, when thoughts are so aversive they are expelled from consciousness.
Wolpe developed a technique called reciprocal inhibition that is widely used in behavioral therapy. To change a response the client learns a new response that contradicts an undesirable response. Then the client uses the new response to approach the conditions that originally produced the negative reaction. Examples are relaxation or assertiveness responses that are practiced in response to threatening cues associated with anxiety.
Mary Cover Jones developed another behavioral technique using the social learning concept of modeling. A client, Peter, was afraid of furry things, and his treatment included watching other children having fun playing with rabbits. The models provided by other children experiencing no harm helped Peter overcome his fears and enabled him to learn to deal with rabbits. Bandura's description of social learning included internal thoughts as responsive to the application of learning methods. Behavior therapies may apply learning techniques to the client's natural circumstances, by enlisting the cooperation of others to change conditions, or by planning reinforcements for the targeted behavior.
Behaviorists insist on defining client concerns as observable, measurable, and testable through research. Such characteristics can be defined in clinical manuals that describe symptoms
and appropriate clinical treatments. Some therapists object to the manualization of counseling, saying such procedures limit the breadth and depth of the psychological work.
Behavioral counselors do use core conditions, as outlined by Rogers, to create a warm relationship so clients gain trust in the process and a willingness to participate in the treatment. With a warm relationship established, the counselor becomes a consultant that collaborates with the client to set clear goals and to define target behaviors for change. Assessing current behavior and determining effective rewards can take considerable time and effort for positive results. It must be ascertained when and how frequently the targeted behavior occurs. The preconditions, post conditions, associated thoughts, feelings, and previous attempts for change must be defined. Prochaska and Norcross categorized behavioral goals: an excess of the behavior, a deficit in performing the behavior, or inappropriateness of behavior in the circumstances. To assist assessment efforts, clients are often required to record behaviors, to imagine targeted behaviors for a detailed rendering, to take inventories or questionnaires defining behavior. However, the very act of completing assessment records could change the client's behavior, and counselors need to take into account such reactivity to measurement. Evaluating reinforcements is important, too. It has been found that rewards that are unrelated to the reinforced task may not increase the frequency of the task behavior since the job is done only for the external reward, and there is no reinforcement through the intrinsic enjoyment of completing the task or the natural consequences of completing it.
Once a full assessment is accomplished, behavioral counselors apply techniques designed to change behavior. Acting as psychoeducational teachers, counselors could use contingency methods by making rewards contingent upon the appropriate behavior, using operant conditioning procedures. A behaviorist could recommend to parents or teachers a technique called shaping where a child is rewarded for behaviors that approach the desired behavior. Or, differential reinforcement could be applied when clients are rewarded for alternative behaviors. Rewards could be defined as the reactions gained for behaviors, so it could be recommended that reaction rewards are withdrawn as in extinction trials in a laboratory.
To reinforce client change, counselors may introduce self-management techniques including: public commitment, stimulus control, and positive reinforcement. Systematic desensitization uses reciprocal inhibition techniques by gradually pairing items in an anxiety hierarchy with progressive relaxation. Assertiveness training is used to help clients change social interactions. Behavioral techniques fit well with brief treatment models since changes can be created in shorter periods of time than those therapies that emphasize overall personality change. The very nature of behavioral therapy is an active approach where clients participate both in choosing what to change and in the activities that create change.
For some behavioral change, punishments for behavior may be included in treatments. Recalling Skinner's definition of punishment as methods that decrease the frequency of behavior, aversive methods require controlled conditions to meet the purpose of limiting behavior without inducing unintended side effects. Punishment must be immediate so the negative consequence is directly connected to the undesired behavior. Punishment has to be intense enough to be meaningful but not so overwhelming that the punishment outweighs the behavior. Punishment must be consistent, calmly delivered, and should be accompanied by reinforcers for alternative behaviors. Imaginal techniques utilize the client's picturing appropriate behaviors, whereas in vivo techniques involve exposure to actual conditions-either gradually or by flooding. In flooding the client is exposed to intense conditions from which there is no escape, teaching the client that major consequences he fears do not occur. Aversion methods could increase the response cost to undesired behaviors, as when Anabuse is taken to create major physical distress if alcohol is consumed. Implosion methods intensify the aversion experience with fearful symbols related to aggression
or sex.
Social learning concepts such as modeling can be used by behavioral therapists to facilitate client's imagining (covert modeling) an admired figure or by using other clients more well-versed in a behavior to serve as participant models. Group counseling is an application of social learning where clients learn from each other. Couples can alter small behaviors to demonstrate commitment to each other. Token economies are used in milieu treatments to reward some behaviors, to fine other behaviors, and to pay for privileges.
Evaluation of treatment throughout a counseling sequence can test client progress in changing behavior and can determine the effectiveness of rewards. Termination sessions also include reviewing methods to prevent relapses or a return to old behavioral patterns. Booster sessions are offered in which clients return to review previous treatment learning and report how maintenance of behavioral change is going.
Critics of behavioral methods express concern that counselors could enforce socially acceptable behaviors, reducing the client's freedom of choice. Behaviorist counselors would emphasize their practice of encouraging clients to choose what behaviors they want to change using the counselor's expertise. Some clients, like the severely mentally ill, are unable to articulate what behaviors they want, and to them the counselor's choice of treatment leads to improved functioning and relief from distress.
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