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OVERVIEW OF BEHAVIOR THERAPY Key Figures and Major Focus Key figures: Arnold Lazarus, Albert Bandura, and Joseph Wolpe. Historically, the behavioral trend developed in the 1950s and early 1960s as a radical departure from the psychoanalytic perspective. Four major phases in the development of behavior therapy are (1) the classical conditioning trend, (2) the operant conditioning model, (3) the social learning approach, and (4) cognitive behavior therapy. Philosophy and Basic Assumptions Behavior is the product of learning. We are both the product and the producer of our environment. No set of unifying assumptions about behavior can incorporate all the existing procedures in the behavioral field. Due to the diversity of views and strategies it is more accurate to think of behavioral therapies rather than a unified approach. Contemporary behavior therapy encompasses a variety of conceptualizations, research methods, and treatment procedures to explain and change behavior. Key Concepts The approach emphasizes current behavior as opposed to historical antecedents, precise treatment goals, diverse therapeutic strategies tailored to these goals, and objective evaluation of therapeutic outcomes. Therapy focuses on behavior change in the present and on action programs. Therapeutic Goals The general goal is eliminating maladaptive behaviors and learning more effective behavior patterns. Therapy aims at changing problematic behavior through learning experiences. Generally, client and therapist collaboratively specify treatment goals in concrete and objective terms. Therapeutic Relationship Although the approach does not assign an all-important role to the client/therapist relation- ship, a good working relationship is an essential precondition for effective therapy. The skilled therapist can conceptualize problems behaviorally and make use of the therapeutic relation- ship in bringing about change. The therapist's role is primarily exploring alternative courses of action and their possible consequences. Clients must be actively involved in the therapeutic process from beginning to end, and they must be willing to experiment with new behaviors both in the sessions and outside of therapy. Techniques and Procedures Behavioral procedures are tailored to fit the unique needs of each client. Any technique that can be demonstrated to change behavior may be incorporated in a treatment plan. A strength of the approach lies in the many and varied techniques aimed at producing behavior change, a few of which are relaxation methods, systematic desensitization, in vivo desensitization, flooding, eye movement desensitization reprocessing, assertion training, self-management programs, and multimodal therapy. Applications The approach has wide applicability to a range of clients desiring specific behavioral changes. A few problem areas for which behavior therapy appears to be effective include phobic disorders, depression, sexual disorders, children's- disorders, and the prevention and treatment of cardiovascular disease. Going beyond the usual areas of clinical practice, behavioral approaches are deeply enmeshed in geriatrics, pediatrics, stress management, behavioral medicine, business and management, and education, to mention only a few. Contributions Behavior therapy is a short-term approach that has wide applicability. It emphasizes research into and assessment of the techniques used, thus providing accountability. Specific problems are identified and attacked, and clients are kept informed about the therapeutic process and about what gains are being made. The approach has demonstrated effectiveness in many areas of human functioning. The concepts and procedures are easily grasped. The therapist is an explicit reinforcer, consultant, model, teacher, and expert in behavioral change. The ap- proach has undergone tremendous development and expansion over the past two decades, and the literature continues to expand at a phenomenal rate. Behavioral approaches can be appropriately integrated into counseling with culturally diverse client populations, particularly because of their emphasis on teaching clients about the therapeutic process and the structure that is provided by the model. Limitations The success of the approach is in proportion to the ability to control environmental variables. In institutional settings (schools, psychiatric hospitals, mental health outpatient clinics) the danger exists of imposing conforming behavior. Therapists can manipulate clients toward ends they have not chosen. A basic criticism leveled at this approach is that it does not ad- dress broader human problems -such as meaning, the search for values, and identity is- sues-but focuses instead on very specific and narrow behavioral problems. GLOSSARY of KEY TERMS Assertion training - A set of techniques that involves behavioral rehearsal, coaching, and learning more effective social skills; specific skills training procedures used to teach people ways to express both positive and negative feelings openly and directly. BASIC J.D. - The conceptual framework of multimodal therapy, based on the premise that human personality can be understood by assessing seven major areas of functioning: be- havior, affective responses, sensations, images, cognitions, interpersonal relationships, and drugs/biological functions. Behavior rehearsal - A technique consisting of trying out in therapy new behaviors (per- forming target behaviors) that are to be used in everyday situations. Cognitive behavioral coping skills therapy - Procedures aimed at teaching clients spe- cific skills to deal effectively with problematic situations. Contingency contracting - Written agreement between a client and another person that specifies the relationship between performing target behaviors and their consequences. Exposure therapy - Treatment for anxiety and fear responses that exposes clients to situations or events that create the unwanted emotional responses. Eye movement desensitization reprocessing (EMDR) - An exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients. Flooding - Prolonged and intensive in vivo or imaginal exposure to highly anxiety-evoking stimuli without the opportunity to avoid or escape from them. In vivo desensitization Brief and graduated exposure to an actual fear situation or event. Modeling - Learning through observation and imitation. Multimodal therapy - A model endorsing technical eclecticism; uses procedures drawn from various sources without necessarily subscribing to the theories behind these techniques; developed by Arnold Lazarus. Negative reinforcement - The termination or withdrawal of an unpleasant stimulus as a result of performing some desired behavior. Positive reinforcement - A form of conditioning whereby the individual receives something desirable as a consequence of his or her behavior; a reward that increases the probability of its recurrence. Reinforcement - A specified event that strengthens the tendency for a response to be repeated. Self-management - A collection of cognitive behavioral strategies based on the idea that change can be brought about by teaching people to use coping skills in problematic situations such as anxiety, depression, and pain. Self-monitoring - The process of observing one's own behavior patterns as well as one's interactions in various social situations. Skills training - A treatment package used to teach clients skills that include modeling, behavior rehearsal, and reinforcement. Social learning theory - A perspective holding that behavior is best understood by taking into consideration the social conditions under which learning occurs; developed primarily by Albert Bandura. Systematic desensitization - A procedure based on the principles of classical conditioning in which the client is taught to relax while imagining a graded series of progressively anxiety-arousing situations. Eventually, the client reaches a point at which the anxiety- producing stimulus no longer brings about the anxious response.