Can contextual therapies save clinical behavior analysis?

Abstract

Behavior therapy has become separated from its philosophical roots in radical behaviorism. In many respects, operant techniques have gradually been substituted first by cognitive-behavioral and later by interventions. The main reason for the diminishing influence of behavior analysis in the area of clinical psychology is that radical behaviorists have not paid close attention to the importance of verbal processes in psychotherapy. Through new developments in basic behavior analysis, specifically in the areas of rule-governed behavior and stimulus equivalence, contemporary clinical behavior analysts have begun to re-conceptualize behavioral interventions. They no longer assume that private events need not be taken into account as there is ample evidence that verbally constructed events introduce additional variables that interact with, and often alter, the effects of contingencies. This thinking has led to the development of new contextual psychotherapies. Research is needed to demonstrate whether these behavioral interventions present alternatives to empirically validated non-behavioral treatments. The contributions of the successful therapist to clinical outcomes also need to be clarified. ********** During the early 1980's, I was a doctoral student in clinical psychology at the University of North Carolina at Greensboro. From the beginning I was drawn to a group of graduate students and faculty with a decidedly behavioral bent, including Steve Hayes, Rick Shull, and the late Aaron Brownstein. Our group thrived on conceptual debates and we particularly wrestled with the implications of Skinner's philosophical position for our clinical work. However, despite creative case formulations and penetrating conceptual analyses, those of us who worked in the clinical trenches often felt a sense of disillusionment with behavior analysis because its methods were not as useful with adult outpatients as our behavior modification textbooks would have us believe. Operant techniques had proved most successful in relatively closed behavioral systems with institutionalized clients and children. They were far less effective with adult outpatients who possessed sophisticated verbal repertoires and came to us from complex environments to whom we had no access. Although we were well trained in a range of empirically supported behavioral techniques such as self-monitoring, skills training, systematic desensitization, and exposure-based procedures, they appeared of limited value. These techniques worked reasonably well with circumscribed complaints, especially anxiety related ones such as phobias and obsessive-compulsive behaviors. But they were much less effective for clients who presented with long-standing, diffuse maladjustments characterized by emotional lability, low self-esteem, chronic relationship problems, and other self-destructive behaviors. For some of these clients it was difficult even to specify target behaviors; other clients were plainly uncooperative with operant procedures or they complied and did not improve; and still others improved but relapsed soon after treatment was completed. I should note that negative outcomes were not indicative of incompetent student therapists or deficient clinical training in Greensboro; rather, treatment failures in behavior therapy are a well-established fact (see Mays & Franks, 1985). Behavior Therapy with a Cognitive Twist Many of us who faithfully applied operant principles in our clinical work struggled with an increasing sense of frustration and disillusionment because our field seemed to stagnate. At the same time, in behavior therapy at large a cognitive revolution was in full progress. A new breed of behavior therapists adopted a constructivist philosophy, advocating that maladaptive behavior was not caused by the external contingencies but by a dysfunctional belief system through which clients filter and interpret the events of their lives (e. …