The humanity of behavior therapy

Abstract

In relation to the topic of this symposiumExperimental Principles and Humanitarian Goals in Psychotherapy-Dr. Szasz has said quite a few things about behavior therapy; but his statements have concentrated on a small area and ignored all the rest of the field. To me, as a listener, the feeling is very much like having been led to expect an exposition of the geography of the world, and having heard only Siberia discussed. I want to speak about the wider world of .vhich Siberia is only a small part-though certainly not one to be ignored. A central thing to realize about psychotherapy is that it is concerned with habitual behavior. There are many kinds of problems for which people consult therapists. Some of them are immediate situational problems: “What college should 1 choose? What should my career be? Shall I marry the girl? Who is a good divorce lawyer?” and so on. All these questions call for guidance, but that guidance is not within the realm of psychotherapy. Psychotherapy consists of measures intended to eliminate habitual behaviors that persist, are unpleasant, and lead to various disabilities. The habits that are under the rubric of the neuroses are mainly disadvantageous to the individual, but some, the sociopathic habits, are predominantly inimical to society. It is important to realize that the behaviors of concern need not be motor or “doing” behaviors; they are, in fact, frequently emotional or cognitive, and very often the problem behavior is a composite of all three modalities. Actually, all three modalities of response are probably always involved in complex behavior; what varies is relative dominance. Most of the habits to which psychotherapists address themselves have been acquired-have been learned. It seems to be a logical inference that the most appropriate way to overcome undesirable learned behavior is by bringing about unlearning, and often, the learning of new, desirable responses. This is the central tenet of the behavioristic position. Behavior therapy is defined as the application of experimentally established principles of learning and related paradigms to overcoming unadaptive habits. The word “unadaptive” is of crucial importance. If a person complains about a habitual reaction, it must be unadaptive in some sense-unpleasant, like anxiety, or functionally inadequate, like impotence or frigidity. The definition of behavior therapy, basing it on experimentally established principles, may to some minds seem to be in keeping with a common image of the behavior therapist-moving straight from the laboratory to techniques, never giving a thought to the patient as a human being -an automaton mindlessly manipulating another automaton. This is a thoroughly erroneous picture. In the first place, it will be recalled, I alluded to the patient’s suffering, and that is what the behavior therapist starts from. Since the core of neurotic suffering is anxiety and its consequences, the therapeutic task is to eliminate the offending anxiety-response habits. The first step that the behavior therapist takes is to make an examination of each of the patient’s complaints. These are all the result of events taking place within his body in response to stimuli that may be internal or external, and in