What is Behavioral Therapy?
According to most behavioral therapists, the method of choice for eliminating “maladaptive behavior” stresses identifying it, in vivo, and then labeling it, punishing or extinguishing it, and, at the same time, systematically rewarding alternative and more adaptive modes of behavior in replacement.
Idealized, behavioral therapy applies the laws of learning and conditioning, as developed in the laboratory, to the alleviation of human maladjustment. In 1970, Yates pointed that it is very narrow view and that behavioral therapists call on a wide range of concepts and techniques developed in experimental psychology.
Indeed, contemporary reviews Franks, Krasner reveal a diversity of procedure and an inventive flexibility in adapting psychological technology extending far beyond the traditional limits of animal experimentation, particularly into cognitive manipulation, use of fantasy, and instructional control.
Psychotherapy of whatever stamp must consider matters of cognition, expectation, subjectively perceived affect, personal commitment or intention, and other similarly “mentalistic” phenomena, but behavioral therapists generally nod, at least, in the direction of behavioristic orthodoxy when they do. Behavioral therapy remains behavioral in its conceptualizations and metaphors.
Distinctive Features of the Behavioral
Approach The affiliation with experimental psychology has produced distinctive features that mental-health practitioners from other traditions sometimes find strained, rigid, and even alien. For treatment operational definitions and objective definitions are considered. The goals, details of procedure, and the formulation of the “case” are supposed to be spelled out in depth as possible in behavioral terms.
Therapeutic effect is gauged in terms of overt behavior—by what the patient does. If the goal sought or end achieved is something as elusive and subjective (but important) as “happiness,” a criterion of improvement might be the patient’s self-rating, easily made overt and numerical. Preferably, criteria consist of such things as changes in the frequency of reliably identifiable overt behaviors, recorded mechanically, counted, or rated by observers uninformed (“blind”) as to what treatment the patient had. The behaviors to be changed (“target behavior”)1 are carefully defined and specified, both to facilitate assessment of effect and to permit comparisons among patients and among procedures.
Formal control groups, treated differently, or control segments in the treatment sequence for individual cases, are included to demonstrate that the specified experimental (therapeutic) manipulations have been responsible for the benefits obtained. Furthermore, workers in this field make every effort to find some rational connection between the procedures employed and the effects produced, all within the framework of an articulated learning or behavior theory.
Characteristically, the “case formulation” or behavioral analysis that identifies the factors responsible for the patient’s problems (and often even the definition of the problems) is stated in terms of such a theory, which also illuminates and guides specific therapeutic activities and the evaluation of results. Finally, reports of behavioral therapy tend to be written in scientific terminology and format, often closely resembling reports of regular laboratory experiments.
Behavioral therapists are enthusiastic, optimistic, and indefatigable protagonists, trying to make what they do, and why, public and explicit. They are active and inventive in adapting techniques or creating new ones to deal with symptomatic behavior that has proven relatively intractable to more conventional psychotherapeutic intervention.
This openness, this eagerness to strip the veil from the mysterious interpersonal exchanges called psychotherapy, this technological ferment and promise of “something new” have attracted widespread attention. The explicitness of theory and procedure implies that training for therapy can be both concrete and finite. Because of their flexibility, behavioral methods promise effective application across a broad range of situations that remain closed to methods that depend on dyadic verbal interchange in a therapist’s office—the school, at home, in organizations, and elsewhere in the field (Guerney, 1969).
Finally, behavioral therapy, with its emphasis on rational justification and pragmatic verification, offers the possibility of “doing good” and “being scientific” simultaneously, an attractive prospect to those who have been discouraged by the reported marginal effectiveness of most traditional psychotherapy. Of these promises, only the first—the promise of something new—can be considered reasonably fulfilled.
The others remain bright possibilities. Truly scientific validation, on a broad scale, has lagged, for understandable reasons of technical difficulty. As convincing validation data remain scattered, no one can specify the minimal training required for effective application, though teachers, parents, nurses, and attendants have been trained to carry out behavioral treatment satisfactorily. Nor can the situational or clinical limits for effective application be marked clearly.
Furthermore, though the design of behavioral therapy intends to be scientific and rational, substantial contributions from charisma and artistry are still required, however well concealed by the behavioristic rhetoric. A sophisticated clinician, viewing an example of effective behavioral therapy from the outside, may often suspect, justifiably, that the actual selections of what behavior to modify, and the procedure for doing so, reflect inspired implementation by a perceptive therapist, guided but not rigidly determined by explicit deductions from learning theory. Furthermore, the enthusiasm and optimism of behavioral therapists, plus the structure they introduce into the clinical setting, no doubt make substantial nonspecific contributions to therapeutic success.
Finally, critics have noted that behavioral therapists tend to be self-righteous and do not really achieve the scientific rigor they pretend, that laboratory procedures and definitions lose considerable precision when transposed to the clinical setting, and that behavior therapists may well be using the wrong models anyway when they rely on those derived from animal experimentation. In fact, Locke (1971) has seriously questioned the behavioristic status of behavioral therapy.
Even so, such valiant efforts to be explicit, such willingness to take on seemingly intractable clinical problems, and such emphasis on evaluation qualify behavioral therapy for the most serious consideration.