Socrates and the Dodo bird: Clinical behavior analysis and psychotherapy research.

Abstract

Clinical behavior analysis (CBA) is characterized by inductive observation and a pragmatic focus on outcomes. This paper argues that CBA may be useful in addressing certain issues confronted by field of psychotherapy research. These issues include bird dilemma, where many therapies with different purported mechanisms appear to have same results; and Gordon Paul's famous maxim, which requires sorting out process by which different therapies affect different individuals. A behavioral analysis of experiential avoidance is presented and discussed as one example of a behavior analytic approach to therapy process. ********** One of strengths of Clinical Behavior Analysis (CBA) is its humble posture toward its subject matter. As Skinner wrote, the subjects [are] always right. They always behave as they ought (Skinner, 1972, p. 123). The truism that in order to hear one must first be willing to listen applies to this position. In order to listen carefully to our subjects have to tell us, to be as receptive as possible to events of interest, clinical behavior analysts consciously attempt a posture of ignorance. The inductive tradition underlying CBA requires that we stop talking/theorizing, and force ourselves to be quiet and pay attention. This Socratic respect for ignorance is an important part of we do and we have to offer to field as a whole: careful, honest observation. A second and related strength of CBA is its commitment to a pragmatic standard. As behaviorists, our interest is prediction and influence of behavior. This means that we are not only careful observers as we enter a situation, we are also careful observers of effects of our participation (1). The methods of CBA hold us accountable in that our interventions must be linked to meaningful changes in our client's actions. And in broader field of clinical psychology, a field historically complicated by opinion, myth and other cultural heuristics, a commitment to accountability is a significant strength. So might these principles look like, applied to field of psychotherapy research? Certainly there are some interesting questions facing this field at moment. For example, large multi-site clinical trials comparing different psychotherapies, such as NIMH Treatment of Depression Collaborative Study (Elkin, Parloff, Hadley, & Autry, 1985) and Project MATCH (Project MATCH Research Group, 1997), appear to result in moderate effect sizes of roughly same magnitude. So in some areas we are confronted by Dodo bird verdict, where in a Lewis Carroll world urges on their favorite therapy while bird happily declares that everyone has won and all must have prizes! (Luborsky, Singer, & Luborsky, 1975, p. 995). Thus, current challenges in psychotherapy research include following: (a) effects of psychotherapies are often equivalent, even psychotherapies with ostensibly very different ingredients, and (b) in these cases critical processes involved in clinical change remain unclear. Similar concerns prompted Gordon Paul's famous question: what treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances? (Paul, 1967, p. 111). There have been a number of solutions offered to this dilemma. One solution has been to gather variables within categories and create a matrix of treatment X therapist X client X problem X setting factors. A problem with this strategy is that it quickly leads to an inordinate number of cells. For example, evaluating 10 therapists X 10 clients X 10 treatments X 10 problems X 10 settings would require a matrix of 10,000 cells (Stiles, Shapiro, & Elliot, 1986). Such solutions could keep bird happy for indefinite future. In contrast, CBA encourages us to go back and ask data where and how to begin. What are active processes that occur in sessions? …