(7-5-18)
Definitions of behavior therapy
- Behavior therapy, behavior modification, behavioral counseling (family therapy, marital therapy, etc.)
- Applied behavior analysis, learning therapies, conditioning therapies
- Cognitive Behavior Therapy (CBT) as new paradigm?
- “third wave” behavior therapies
- Values of behavior therapy
- Direct focus on change efforts
- Objective conceptualization of target problems
- A focus on overt behavior
- A focus on consciously accessible mental events
- A focus on careful definition of problem behavior
- A focus on a shared conceptualization of the problem
- Emphasis on ongoing assessment of problem behavior
- Measurement and feedback as both a value and a process
- Use of repeated measures
- Public criterions for “success”
- Learning conceptualizations regarding problematic behavior
- Human efforts viewed a largely adaptive, even if flawed
- Relatively optimistic operating premise
- Relative emphasis on current determinants of behavior
- Maintenance can be different than development
- De-emphasis on etiology
- Relative emphasis on situational determinants of behavior
- Environmental factors actively considered
- Field theories, family therapy, and organism-environment interactions
- Relative de-emphasis on historical determinants of behavior
- Relative de-emphasis on unconscious determinants of behavior
- Emphasis on empirical evaluation of change efforts
- Empirical research as a value
- Single (small n) research designs
- Empirically supported treatment (EST’s)
Models of behavior therapy
- Conditioning models (single factor learning theories of neurotic behavior)
- Wolpe
- Salter
- “Classical” behavior therapy models (two-factor learning theories)
- Operant and respondent learning, environmental contingencies, behavior analysis
- Current models
- Social learning models, three-factor learning models, Cognitive Behavior Modification
- “third wave” model: DBT, ACT, MBSR, MBCT, other mindfulness based treatments
The ethics of behavior therapy
- Are ethical concerns greater/different for Behavior Therapy than other psychotherapeutic approaches?
- Issue of manipulation: what are we doing?
- Kazdin’s misconceptions/erroneous beliefs
- Issue of using aversive stimuli: when is it alright to hurt others?
- Issue of using punishment: suppressing behavior
- punishment of self-stimulatory behavior & self-injurious behavior in clients diagnosed with PDD
- Issue of target selection: “Sit down, be quiet, be still”
- controversial targets: gender identity, gender orientation
- Issue of patient populations: are we only for children and retarded citizens?
- under served populations
Therapeutic Relationship
- Wolpe’s view of the therapeutic relationship:
- “the psychotherapeutic interview itself evokes emotional responses in many patients. Sometimes the emotion is anxiety, but more often it seems to be a mixture of hopeful expectation, confidence in the expert, and positive emotions that have been previously conditioned to doctors and their offices. Altogether, it corresponds roughly to the psychoanalyst’s ‘positive transference’ without the presumed projection of a father-image.” (1990, p. 194). Wolpe believes such “interview-induced” emotional responses are the basis for the nonspecific therapeutic benefit or placebo effect associated with most psychotherapies (as well as behavior therapy).
- Persons view of the therapeutic relationship:
- “The case formulation approach assumes that the patient’s behavior with the therapist is similar to his behavior with others and that the interactions with both therapist and with others are driven by the patient’s underlying problems.” (Persons, 1989, p. 161)
- “The case formulation approach suggests that patients with different problems need different types of relationships with their therapists. Patients frightened of loss of autonomy need more interpersonal distance than those feeling unable to cope without support. Those who fear they will be rejected if they say the wrong thing need, at least at first, more structure and less open-ended time in the session than patients who feel the need to ‘just say what’s on my mind.’ Those frightened of humiliation may be unable to tolerate any teasing or joking by the therapist, whereas others may find it a welcome relief. Warmth is important for most patients, but as pointed out earlier, severely depressed patients, who feel worthless and unacceptable, may feel they are duping someone who seems to like and respect them.” (Persons, 1989, p. 165). Goes on to discuss the need for an early formulation to make adjustments to response to unique needs of client and prevent early dropout from therapy.
Problems in carrying out homework
- Persons (1989) suggest that, “the problems patients have that prevent them from carrying out homework assignments are likely to be the same problems that prevent them from doing other things in their lives and that produce many of the other difficulties that bring them to therapy.” (p. 143) She suggests the case formulation can be used to anticipate and remove obstacles to carrying out homework assignments, and suggests the following questions as a starting point to doing this:
- “’What is this patient’s key underlying belief? How might it interfere with carrying out this homework assignment?’” (p. 145) and “’What are the typical behavior patterns and automatic thoughts that are likely to arise when the patient confronts his homework task?’” (p. 145) She suggests common obstacles include:
- Perfectionism—“’Start where you are, not where you want to be.’” (p. 146)
- Fear of Failure
- Need to please others
The future of behavior therapy
- Association for Behavioral and Cognitive Therapies (ABCT) [formally Association for the Advancement of Behavior Therapy (AABT)]
- Does behavior therapy have a future?
- Development and growth vs. pseudo therapies and loss of definition
- Training and dissimulation of skills, knowledge, philosophy
- What is the role of models of change for helping professions?