Office in Walnut Creek, California CA
Jay Slupesky, M.A., MFT
Behavior therapy is a direct and aggressive approach to treatment that has improved the quality of life for many people. It is distinguished from other therapies by its emphasis on objectivity, goal-setting, and empirical measurement of the client's progress. It departs from psychoanalysis with its disinterest in the unconscious and its focus on helping the client learn how to directly change problematic behavior patterns. As behavior therapy has evolved, several very effective therapeutic techniques have been developed, some of which are so successful that they are now the preferred treatment for problems such as anxiety and post-traumatic stress disorder.
Behavior therapy originated as a reaction against the long and involved introspection that is the essence of psychoanalysis. Rather than studying the client's unconscious processes or helping the client to understand how the past is affecting the presenting issue, behaviorists focus directly on the problematic behaviors and help the client to change them. Behavior theorists have their own unique views about human nature, mental dysfunction, wellness, and therapeutic techniques.
Behavior therapists consider human beings primarily to be learners. People have learned the behaviors and responses they exhibit in various situations and life events. The learning takes place by determining which behaviors result in the greatest reward and/or the least punishment. Hopefully we learn behaviors that society considers normal, but we can just as easily learn abnormal behaviors; the two types are learned in exactly the same ways, one as easily as the other. Of course, the classification of a behavior as abnormal is a function of the cultural context and therefore is not absolute. A key tenet of behavior therapy is the belief that humans continue learning throughout life and therefore abnormal behavior can be replaced by newly-learned normal behavior. In other words, people can help themselves by learning to change their behaviors (Corey, 2001). Behavior therapy helps people make these changes.
Since behavior theory is primarily concerned with how people respond in various situations, it views humans as beings who interact with their environment. External as well as internal stimuli cause specific human responses (Acton, 1997). Humans may or may not be conscious beings; this issue is irrelevant to behaviorists because consciousness can be neither observed nor measured.
The foundations of behavior theory are the theories of classical conditioning and operant conditioning. In classical conditioning we learn by association. For example, if a person has a very unpleasant experience on an airplane and suffers a panic attack, he or she might learn to associate the act of traveling on a plane with experiencing a panic attack, with the end result being a fear of flying. In operant conditioning we learn which behaviors reward us and which ones punish us. We then naturally repeat the reward-generating behaviors and avoid the punishment-seeking behaviors (Dewan, 1995).
Behavior therapists believe that emotional problems are simply learned abnormal behaviors, or in some cases, a failure to learn any effective response to an event. The client's problems are influenced by current conditions; any contribution from past life events is of little or no importance. At the lowest level, behavior considered inappropriate may be some action done at an inappropriate frequency, either too often or too infrequently. It may also be something done at an inappropriate time or an inappropriate place. At a higher level, various types of anxieties, avoidance reactions, obsessive-compulsive disorder, inability to complete a task, phobias, and post-traumatic stress disorder are viewed as problems that can be overcome via learning new behaviors. All of these disorders have been successfully treated with behavior therapy (Corey, 2001).
Wellness is explained as simply an absence of incorrect behaviors. Having learned to associate appropriate responses with various stimuli, the well person may choose from multiple healthy options for behaving and responding. He or she has an abundance of skills in dealing with life's problems. This rich trove of healthy options and the freedom to select among them is the essence of mental health.
Behavior therapy strives to quash incorrect behavior patterns and replace them with correct ones. Emphasis is placed on doing something about the problem rather than talking about it. The therapist spends little if any time probing the client's unconscious or searching for the root causes of the problem. Instead, the objective is to effect rapid yet lasting change of behavior. Critics argue, and correctly so, that behavior therapy is focused on treating the client's symptoms rather than his or her underlying issues. Proponents rebut this criticism by pointing to multiple studies showing that behavior therapy has been proven effective.
Because of its aggressive and direct style and the lack of time spent on introspection, behavior therapy is often shorter than other therapies. Another unique aspect is an emphasis on setting goals. The client is encouraged to set his or her own treatment goals at the beginning of therapy; the therapist then chooses how to achieve them. The treatment goals must be explicit and stated in concrete terms. Most importantly, the goals must be measurable, because this allows progress to be objectively determined at any point in the therapy process. In fact, the crux of behavior therapy is the continual assessment of the client's improvement. Since goals are stated objectively, it is easy to determine when they have been reached and therapy can be terminated. On the other hand, if the client stops making progress during treatment, the therapist may recommend a new course of action to better move toward the client's goals. The client may even decide to alter his or her goals during the course of treatment. The focus on the precise measurement of progress sheds light on the behavior therapist's disdain for using introspection as a part of therapy. After all, introspection can't be observed or measured (Corey, 2001).
Since so much emphasis is placed on the client doing things in order to get better, the best candidates for behavior therapy are those who are willing to work hard both in and out of therapy. Some types of behavior therapy include temporarily exposing the client to the very situation or thing to which he or she is most averse. This is patently unpleasant and requires a brave and motivated client. The counselor may assign homework exercises to be completed outside of therapy, and again, the client must be diligent in completing this work.
Many diverse procedures have grown out of behavior therapy and proven to be successful. Exposure Therapies are used to treat anxiety-related disorders and entail the client either imagining or intentionally participating in anxiety-causing situations while simultaneously trying to relax. As the client progresses, his or her anxiety levels are reduced. Exposure therapy has been repeatedly proven effective for treating anxiety. Eye Movement Desensitization and Reprocessing (EMDR) is used to treat post-traumatic stress disorders (PTSD) by having the client first imagine the traumatic image and then move his or her eyes rapidly while blocking out the frightening image momentarily. EMDR has been shown to be the most effective treatment for PTSD. Assertion Training is given to people who have problems in their relationships. Those who are afraid to state their opinion or ask for something they want are taught new techniques to increase their confidence. Clients learn more assertive and correct behavior, for example, how to show their negative feelings in ways that are not offensive to others (Corey, 2001).
Behavior therapy has changed much over the years and it continues to evolve. It has proven to work very well in treating many different disorders. It ameliorates difficult and unpleasant symptoms and has improved the quality of life for many people.
2004 Nov 29