Behavior Therapy: An Overview
In every tired old cliché regarding psychotherapy there comes a point with the patient lying on the couch talking about his or her mother when the therapist asks, "and how do you feel about that?" What would therapy be like if feelings didn’t matter? If talking about your past wasn’t necessary, or even desired? In fact what if therapy involved action rather than words?
A heresy to some clinicians and clients alike, behavior therapy heads in this direction. Unlike psychodynamic approaches which are based on understanding why people do things, uncovering deep or even unconscious motivations or conflicts, and discussing them to develop insight into behavior to then decide to change it, behavior therapy offers a short cut. The basic premise of behavior therapy has to do with ideas about stimulus and response and the notion that doing comes first. Change what you do in order to change what you feel is the behaviorist’s rallying cry.
Early Pioneers in Behavior Therapy
Early in the twentieth century, psychologist Edward Thorndike studied animal behavior to understand the learning process. Thorndike conducted his research at Columbia University, and was well respected as a true pioneer in the field. His work greatly influenced B.F. Skinner, the psychologist who became best known for his work in behavior therapy, or behaviorism. These psychologists posited that animals (and ultimately people) can change their behavior simply by reinforcing desired behaviors and dis-incenting unwanted behaviors.
Two Types of Conditioning:
Conditioning is one of the basic concepts employed: think of Pavlov’s dogs. Classical conditioning usually involves connecting two different stimuli: in his famous example, Pavlov was able to make dogs salivate in response to ringing a bell. Salivating is a natural biological function and typically not under voluntary control. By pairing a sound with a stimulus that made the dogs salivate (the presence of food), over time, Pavlov was able to demonstrate that even without the food, a connection had been made in the dogs’ brains, and the ringing of the bell stimulated the salivation.
Operant conditioning is slightly different. The operator, or subject, makes a connection between a voluntary behavior (i.e. something you can choose or decide to do) and a result (such as the ringing of a bell, or another result that would be considered positive or enjoyable). Operant conditioning is the type of conditioning that is used in behavior therapy to help people change unwanted behaviors in themselves or, as in the case of parents dealing with difficult behaviors in their children, others.
The techniques used to help clients change their behavior using this modality include three basic approaches:
- Punishment, which most parents are familiar with, at least in theory, is a consequence that makes the person do that behavior less often.
- Reinforcement, which many people refer to as "positive reinforcement," is a consequence or result of behaviors that make people engage in that behavior more often.
- Extinction sounds fatal. This technique is sometimes called a "planned ignore" and is essentially ignoring or not responding to a behavior. If a behavior receives no response, as the theory goes, it will eventually occur less often or stop.
Going one step further, and getting even more technical, there are four more specific ways of using punishment, reinforcement and extinction. Very simply, you can reward or reinforce behavior by making good things happen when it occurs. The dog comes when called and you say "good dog." Your child studies for a test and earns a good grade. Your husband picks up his dirty clothes and places them in the hamper. You give him a kiss. This is called positive reinforcement, and in this context, all "positive" means is that you are making something desirable happen.
Negative reinforcement is when something unpleasant or annoying is happening and the behavior eliminates the unpleasant condition. For example, you nag your child to take out the garbage repeatedly and loudly. Your child takes out the garbage and you stop nagging. You car beeps a high pitched beep if you open the door while driving. Closing the door stops the beeping. In this context, negative simply means that the action you take makes something stop happening.
Positive punishment sounds like a contradiction in terms. This is what happens when you do something unwanted and something unpleasant happens to help you make a connection between the unwanted behavior and something unpleasant happening. For example, if your dog darts after a car, you scream "No!" or squirt the dog with a hose. The behavior is immediately connected to something unpleasant happening.
Negative punishment is a common parenting practice: this is what you are doing when you place a child in time out or take away a toy in response to an undesired behavior.
Putting it all together
Using these basic tools, behavior therapists refine their techniques to help people change behaviors. The idea is that by incenting and dis-incenting behavior, people can and will change what they do, regardless of what they think or feel. Further, some say that changing what you do will ultimately lead to a change in how your feel – the "act as if" premise.
While some critics complain that behavior therapy is overly simplistic and reductionist, and that understanding thoughts, beliefs, motivations, and emotions, as well as being able to place a person’s behavior in context by understanding their past is a critical component of eliciting behavioral change, most behavior therapists admit that a combination approach is possible. The promise of working behaviorally is that if applied correctly some relief from unwanted behaviors can occur quickly, eliminating such negative emotions as shame or hopelessness. Gaining some behavioral success can also be an important basis for trust in the therapeutic relationships, helping clients and therapists move into deeper work if necessary upon a foundation of success.