Treatment Steps in Behaviour Therapy
Behaviour therapy/counselling is used to help “clients acquire new coping skills, improve communication, or learn to break maladaptive habits and overcome self-defeating emotional conflicts” (Corsini & Wedding, 2000). The behavioural therapist/counsellor focuses on interpreting the client’s behaviour, emphasising a collaborative and positive relationship with the client and values the use of objectivity to assess and understand the client. As well as working with the principles of behaviour therapy, there are a number of steps a therapist can utilise when in a session with a client (adapted from Seligman, 2006):
Identify the problem
This involves investigating what the problem is and its history. Also, identifying the baseline of the problem such as the frequency, duration and severity of the problem.There are a number of techniques used to assess and identify the problem of a client. Techniques include:
- Interviews: Interviewsare obviously the easiest way to obtain information about a client as the counsellor can obtain information straight from the client. Questions used in the interview include the use of what, when, where, how and how often (Sharf, 2000).
- Reports and ratings: Reports and ratings include using both self-report inventories that the client can answer about his or her behaviour and checklists and rating scales that those around the client may answer about the client’s behaviour. These self-report inventories may assess depression, fear, anxiety, social skills, health-related disorders, sexual dysfunction, and marital problems (Sharf, 2000).
- Observations: Direct observations of the client may also be used to asses a client’s behaviour. This can occur through a number of means including having the client record the target behaviour as well as the frequency and what was happening around him or her at the time. Another way is to observe the client in either a simulated or naturalistic observation (Sharf, 2000).
- Physiological methods: Physiological methodsinclude assessing the client’s physical functioning when in different situations such as measuring blood pressure, heart rate, respiration, and skin electrical conductivity (Sharf, 2000)
- Negotiate Goals: Identifying goals involves selecting goals related to the problem that are realistic, specific, and measurable. The goals also need to be relevant to the client and positive to help keep the client motivated.
This involves identifying and developing strategies that will assist in the change process. Techniques in behavioural therapies apply the learning principles to change maladaptive behaviours (Weiten, 2007). The techniques do not focus on clients achieving insights into their behaviour, rather the focus is just on changing the behaviour.
For example, if a behavioural therapist was working with a client that has an alcohol problem, the behavioural therapist would design a program to eliminate the behaviour of drinking but there would be no focus on the issues or pathological symptoms causing the alcohol problem. There are a number of techniques used in behaviour therapy that have been scientifically validated as being successful approaches to treating symptoms:
Systematic Desensitisation: Systematic desensitisation was developed by Joseph Wolfe and was designed for clients with phobias. This treatment follows a process of “counterconditioning” meaning the association between the stimulus and the anxiety is weakened through the use of relaxation techniques, anxiety hierarchies and desensitisation (Weiten, 2007). The process of systematic desensitisation is applied to an example of a client with a fear of spiders below:
Exposure Therapies: Exposure therapies are designed to expose the client to feared situations similar to that of systematic desensitization (Corey, 2005). The therapies included are in vivo desensitisation and flooding. In vivo desensitization involves the client being exposed to real life anxiety provoking situations. The exposure is brief to begin with and eventually the client is exposed for longer periods of time to the fearful situation.
As with systematic desensitisation, the client is taught relaxation techniques to cope with the anxiety produced by the situation. The example of the client with a fear of spiders will be used to demonstrate in vivo desensitization. To begin with the client would be shown a spider in a container on the other side of the room for one minute. This would gradually increase in time as well as the client getting closer to the spider until eventually the client is able to be sitting near the spider for a prolonged period.
Flooding: Floodinginvolves the client being exposed to the actual or imagined fearful situation for a prolonged period of time. The example of the client with the spider fear would be that the client would be exposed to the spider or the thought of a spider for a prolonged period of time and uses relaxation techniques to cope. There may be ethical issues in using these techniques with certain fears or traumatic events and the client should be provided with information on the techniques before utilising them so he or she understands the process.
Aversion Therapy: The most controversial of the behavioural treatments, aversion therapy is used by therapists as a last resort to an aversive behaviour (Weiten, 2007). This treatment involves pairing the aversive behaviour (such as drinking alcohol) with a stimulus with an undesirable response (such as a medication that induces vomiting when taken with alcohol). This is designed to reduce the targeted behaviour (drinking alcohol) even when the stimulus with the undesirable response is not taken (medication).
Modelling: Modelling is used as a treatment that involves improving interpersonal skills such as communication and how to act in a social setting. Techniques involved in modelling are live modelling, symbolic modelling, role-playing, participant modelling and covert modelling. Live modelling involves the client watching a “model” such as the counsellor perform a specific behaviour, the client then copies this behaviour. Symbolic modelling involves the client watching a behaviour indirectly such as a video.
Role-playing is where the counsellor role-plays a behaviour with the client in order for the client to practice the behaviour. Participant modelling involves the counsellor modelling the behaviour and then getting the client to practice the behaviour while the counsellor performs the behaviour. Covert modelling is where the client cannot watch someone perform the behaviour but instead the counsellor gets the client to imagine a model performing the behaviour (Sharf, 2000).
Biofeedback: Biofeedback involves the therapist getting feedback of the client’s bodily functions and in turn providing the information to clients to help him or her engage in relaxation techniques (Weiten, 2007). For example, during a therapy session the client is hooked up to an electromyograph (EMG) to measure the skeletal-muscular tension in the body. This information is then used for the client to help control their physiological responses and implement relaxation techniques.
Implement the Plan
This involves the plan that has been developed being implemented for the process of change to occur.
The progress of the plan is assessed and the plan is evaluated. The plan is revised for any areas of need and successes are reinforced. Reinforcing success helps to keep the client motivated and ensures more success.
Continue the Process
This is the process is continued by ensuring plans are continued and that plans include preventing relapse of problems.