Behavioral therapy: Bag of tricks or point of view? Treatment for homosexuality (original) (raw)
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Attitudes of behavior therapists toward homosexuality
Behavior Therapy, 1973
In view of widespread allegations that behavior therapists regard homosexuality as undesirable and hence a "problem" which should be eliminated, even against the wishes of the person concerned; and in view of the assumption that aversive procedures constitute the most frequently used treatment paradigm, an anonymous questionnaire was mailed to a sample of AABT members and to all members of an assoeiation of British behavior therapists with the request to provide their frank opinions on such questions as therapy goals with homosexual clients, parameters of homosexnality that are assessed prior to interxention, and nontherapy familiarity with homosexuality. In addition, those surveyed were asked to complete a Semantic Differential on the concepts "homosexuality" and "heterosexuality." Among the findings were that behavior therapists (a) do, indeed, overwhelmingly employ aversive procedures with such clients; (b) tend to neglect heterosexual aspects of homosexuals" life style; (e) do not generally inquire about the specific homosexual activities engaged in; (d) tend not to attempt behavior change with homosexual clients who do not wish to change; (e) do not view homosexuality as prima [acie evidence for psychopathology while holding the opinion that homosexuals can live happy lives without altering their sexual preferences; (f) do/would help homosexuals to become more at ease with a homophile orientation; (g) do not have as much direct acquaintance with homosexuality as might be desirable for professional change agents; and (h) seem to share stone common stereotypes of homosexuality as being less good, less masculine, and less rational than heterosexuality.
Toward an empirical clinical science: Behavioral psychotherapy in the 1980s
Behavior Therapy, 1982
From an empirical base, behaviorial psychotherapy is developing its own principles to solve clinical problems. Effective behaviorial treatment is a tool of experimental psychopathology which allows dissection of some behaviors and study of their interrelationships (e.g., exposure treatments lastingly improve phobias and rituals but not depression). The social repercussions of improvement on the family can be explained in terms of the "'problem-solving capacity of the relevant social field." Whether exposure will be habituating, as it usually is in the clinic, or sensitizing, as it is when phobias and rituals are developing, can only be partly explained. During exposure to the evoking stimulus, avoidance reduces as it ceases to act as a safety signal, but this does not account for concomitant decrease in anxiety. Response decrement to continuing stimulation is a widespread phenomenon in the animal kingdom and at different levels in the nervous system. Incubation effects are still unexplained. The central processing state during treatment seems one crucial variable, but current cognitive therapies have generally been ineffective as modifiers of this state in patients. Meaning and Aims of an "Empirical Clinical Science" This decade marks the coming of age of the discipline of behavioral treatment. It has finally been recognized that behavioral psychotherapy is indeed empirical and clinical and that it can stand on its own without having to borrow respectability by claiming antecedents from other areas. As in any science, it is now commonly realized that behavioral psychotherapy is developing its own principles to solve the particular problems of its area. To be scientific, these principles have to preserve the essential requirements of testability, repeatability, and objectivity, which usually mean intersubjective reliability. When we call ourselves empirical clinical scientists, it is sobering to glance at the variations which the meanings of the three components of our label have undergone through the ages. Regarding the first of the This paper is based upon an Invited Address delivered at the 14th Annual Convention of the Association for
Personal Perspectives on the Development of Behavior Therapy and Cognitive Behavior Therapy
W.H. O'Donohue & A. Masuda (eds.). Behavior Therapy, 2022
A review of the author's contributions over the past 50+ years to the development of behavior therapy and cognitive behavior therapy. Themes include cognitive restructuring of a paranoid delusion, arguing for agency in deep muscle relaxation and in countercontrol, attribution in the maintenance of behavior change, perceived as contrasted with actual control, integrating humanistic elements into CBT, the complexities of the science-practice dialectic, calling attention to the essential phenomenological nature of CBT, providing insights into therapists’ thinking through a pedagogical innovation in explaining clinical applications, social constructivism in clinical assessment, innovating with a laboratory-based think-aloud cognitive assessment paradigm, and the ethics and politics of conversion therapy for gay people.
Resistances to Learning Behavior Therapy
American Journal of Psychotherapy, 1988
Resistance to learning about behavior therapy, due to role conflict, model conflict, and disparagement, remains high in the mental-health field despite growing interest in behavioral methods and mounting evidence of their efficacy. Effects of these resistances on training and factors that may mitigate their influence are discussed. OVERVIEW In the last 20 years, interest in behavior therapy has grown within the mental health community, 1-3 especially as evidence of its specific efficacy for certain indications, e.g., phobias, sexual dysfunctions, obsessive-compulsive disorder, chronic pain, 3-9 has grown. The 1974 American Psychiatric Association Task Force report on the subject 1 and the influence of behaviorists upon DSM-IH (e.g., the formation of descriptive diagnostic criteria, the elimination of an exclusively psychodynamic pathogenesis for neurosis, and the explicit legitimation of behavioral approaches to treatment planning), 10 (pp. 11-12) all represent official acknowledgments of this growing role. Yet resistance to learning about behavior therapy still seems high within the profession. 3 ' 11,12 In this paper I will explore and exemplify the nature of these endemic resistances, describe their effects on training, and then discuss forces that may mitigate their effects. ROLE CONFLICT One obvious source of resistance is the conflict between the role of the therapist in behavior therapy and in psychodynamic work. In the latter, generally held to be normative among psychotherapies, 1314 the therapist's stance is generally one of verbal inactivity. Therapists should be nondirective (except regarding certain procedural issues) and not performance oriented; they should no more assign "homework" tasks than advise a patient to quit a job. The amount of verbalization should itself be sparing. 15 ' 16 What, then, is a trainee to think of a therapy in which the clinician frequently assigns homework, 17 may structure the interview and give specific advice, 15 and may talk 50 percent of the time? 18
1972
This paper provides a brief and selective overview of several areas of behavior therapy, or applied experimental psychology. with the usual concern for careful measurement, operationization of terms, and dispassionate examination of ideas which can be experimentally tested. The authors review the method of token reinforcement, with its subsequent problem of maintaining toker-induced behavioral changes in nontoken environments. Second, they look at systematic desensitization, concluding that researchers are far from even a reasonable tentative answer to why the procedure works. A third area of research explored is the Masters and Johnson therapy, whose treatment package can be construed as behavior therapy. Finally, aversive therapy-avoidance or aversive "conditioning"-with homosexuals is reviewed, with special emphasis on the work of Feldman and MacCulloch. The authors feel that the very essence of behavior modification is its critical and experimental stance towards the whole area of clinical psychology and psychiatry. References are included.
On the role of behaviorism in clinical psychology
The Pavlovian journal of biological science
This discussion presents the viewpoints of five well-known psychologists on the role of behaviorism in clinical psychology. The article is a condensed version of a symposium presented at the 1978 annual APA convention.
Dialectical Behavior Therapy: Current Status, Recent Developments, and Future Directions
Journal of Personality Disorders, 2004
Dialectical behavior therapy (DBT) was developed as a treatment for parasuicidal women with borderline personality disorder and has been adapted for several other populations. This article describes standard DBT and several adaptations of it and reviews outcome studies with borderline patients in outpatient, inpatient, and crisis intervention settings, borderline patients with substance use disorders, suicidal adolescents, patients with eating disorders, inmates in correctional settings, depressed elders, and adults with attention-deficit/hyperactivity disorder. This treatment outcome review is followed by discussion of predictors of change in DBT, possible mechanisms of change, and current developments in theory, practice, and research. Dialectical behavior therapy (DBT) was developed as a treatment for chronically parasuicidal women. The first description of the treatment in a peer-reviewed journal was in the first volume of this journal (Linehan, 1987) and subsequently it was described and illustrated in detail as a treatment for borderline personality disorder (BPD) in a pair of published manuals (Linehan, 1993a, b). The most fundamental dialectic addressed by the treatment is that of acceptance and change. The difficulties that Linehan encountered with a more purely change-oriented treatment led to attempts to balance and integrate her efforts to help the patient change with efforts to communicate acceptance of the patient as he or she is. The difficulties borderline patients commonly have in tolerating distress, and in accepting themselves and others, led to attempts to help them develop acceptance-oriented skills and change-oriented skills. Treatment strategies in DBT for helping patients to change draw primarily on standard behavioral and cognitive therapy procedures and on principles and findings from research on learning, emotions, social influence and persuasion, and other areas of psychology. Treatment strategies for helping the therapist to convey his or her acceptance of the patient draw primarily on client-centered and emotion-fo-73