Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright.

Abstract

This paper traces the birth, quiescence and renaissance of clinical behavior analysis (CBA). CBA is the application of radical behaviorism to outpatient adult behavior therapy. It addresses the question of how talking in the consulting room helps the client outside of the office, in his or her daily life. The answer as formulated by CBA has led to exciting and significant developments with considerable promise for improving therapeutic interventions. A brief historical account of CBA is described that involves the interplay of three strands involving clinical applications of behaviorism: behavior therapy, applied behavior analysis, and the development of the Association for the Advancement of Behavior Therapy (AABT). These strands are traced through publications in Behavior Therapy from its inception to the present. We contend that there is a need in AABT and in behavior therapy in general for what CBA has to offer. As we see it, the major problems facing the AABT membership with its current emphasis on cognitive therapy and empirically validated treatments include the lack of a coherent theoretical base that can embrace all of the techniques used by behavior therapists. Now with all the behavioral procedures that have been developed, a horrendous question arises, When do you use which procedure for what kind of person? We conclude that far from being a thing of the past, CBA has a bright future in answering this question. Behavior analysis of the therapeutic situation offers a unique, coherent theoretical base that can embrace all techniques used by behavior therapists, including cognitive therapy strategies. ********** Clinical behavior analysis (CBA) is defined as the application of radical behaviorism (Skinner 1953, 1974) to answer the most basic question about outpatient adult behavior therapy (or any other type of psychotherapy) (Kohlenberg, Tsai & Dougher, 1993). Since outpatient treatment consists of verbal interchanges (1) between client and therapist, the question is this: what is the mechanism that explains how this talking helps the client outside of the office in his or her daily life? In this paper, we contend that CBA is an exciting, new, and significant development that holds considerable promise for improving therapeutic interventions. We also recognize that most behavior therapists are only superficially familiar, if at all, with CBA and are not aware of its considerable potential as a highly effective treatment. There are several factors that account for the relative invisibility of CBA, not least of which is its mercurial appearance over the last 46 years. THE BIRTH OF CBA In Science and Human Behavior (1953), Skinner gave an analysis of psychotherapy, including behavioral interpretations of terms such as resistance, repression, and free association. Following this work, very little was published on CBA other than the insightful, but largely ignored papers by Charles Ferster (1967, 1972a, 1972b, 1972c, 1979). Neither Ferster nor Skinner intended to devise new approaches to treatment in these writings. Instead they wrote in behavioral language, demonstrating a more useful way of describing, understanding, and in Ferster's case, teaching the change process. So, CBA got its start quite early in 1953 and then all but disappeared until its reemergence in 1987 with the publication of an edited book (Jacobson, 1987). The Jacobson book contained chapters by Hayes (1987) and Kohlenberg & Tsai (1987) that described in detail their approaches to using Skinnerian principles to treat outpatient adults. We will refer to this hiatus as the quiescent period of CBA. The reasons that behavior analysts did not pursue CBA play a role in understanding the nature of its renaissance. CBA's Quiescent Period Our historical account of CBA involves the interplay of three strands involving clinical applications of behaviorism. These are behavior therapy, applied behavior analysis, and the development of the Association for the Advancement of Behavior Therapy (AABT). …