So far in this book
I have tried to present a general picture of the current domain of behavior
modification, defined in its broadest terms. Now it is time to consider the
field as a whole: how its various components combine, criticisms of behavior
modification, and how behavior modification interrelates with other
psychological change models.
A strength of behavior modification is that it
provides the practitioners with many concrete things they can do. Practitioners
have available to them a number of tools of great potential power, if they
learn to use them well. The trap in this is that many people simply become
technicians, learning the behavior modification techniques, but lacking
psychological breadth, interpersonal skills, or practical knowledge of the
givens and limitations of various situations. Although a need for such
technicians exists at the paraprofessional level, the optimal behavior modifier
is broader and more fluid. Practitioners need to know a lot about the settings
in which they will be working and the types of people they will be working
with. This includes social, political, bureaucratic, economic, and
physiological constraints. As much as possible, practitioners need to be able
to understand the people they work with, to see from their point of view. They
need the interpersonal skills to be able to interrelate with, communicate with,
and perhaps influence these people. Practitioners peed to be able to view the
flow of human behavior in its broadest sense, understanding its relationships
with other behaviors and various situations. And as much as possible, they
should do all this from an empathic, non-judgmental position.
Breadth in various
areas of psychology, such as social psychology and physiological psychology,
strengthen the effectiveness of the behavior modifier. My bias is that a strong
background in the psychology of learning and motivation (principles and paradigms,
not classical theorists) is currently the most useful to behavior modification.
Being able to see the contingencies and principles of learning and motivation
in all human behavior, including your own, is an enormously useful vantage
point, beyond most technicians. From this position behavior modification is
less a set of discrete techniques and more an empirically testable set of
special-case manifestations of principles of human behavior coupled with practical
suggestions for implementation.
For some psychological
approaches, such as some client-centered therapy, the relationship between
the practitioner and client is seen as the primary tool for therapeutic change.
For some theorists the therapeutic relationship is the necessary and sufficient
condition for therapeutic change. In behavior modification this relationship
is seen as not always necessary and seldom sufficient. Certainly, situations
exist in which the relationship is sufficient for satisfactory change. Perhaps
a client learns from the relationship with the practitioner effective ways
of interacting with people. Perhaps a client wishes to explore or expand aspects
of his consciousness and needs a practitioner who is an experienced guide
or mirror. And many people who enter therapy or counseling are primarily just
purchasing a friend they can talk to. But across the range of psychological
problems, the relationship as a therapeutic change tool is generally insufficient
or at best inefficient. Here is where approaches such as desensitization and
contracting are useful adjuncts.
Similarly, there
are many situations in which the therapeutic relationship is unnecessary or
detrimental. For example, with some autistic children, retardates, psychotics,
and catatonics, a therapeutic relationship (except in the simplest sense of
the term) is not possible. And attempting to establish such a relationship
in the early stages of therapy may actually impair progress. In other situations,
such as group desensitization of test anxiety or a problem that can be handled
via a programmed handout, imposing a required personal relationship could
dramatically impair the effectiveness of the program. And of course, this
whole discussion of therapeutic relationship is less applicable to some non-clinical
settings in which behavior modification is applied, such as most weight-loss
programs.
On the other hand,
a good therapeutic relationship is often a decided advantage to the behavior
modifier (Goldstein, 1975). A good relationship may lead to a better understanding
and assessment of the client; improvement in helping the client decide on
goals; overcoming resistance and misunderstandings about some aspect of therapy;
the client being freer and more open to discuss problems and explore feelings;
the client being more motivated; the practitioner being a more effective model
and source of reinforcement; and the opportunity to minimize factors that
often impair therapeutic progress, such as pre-conceptions and social roles.
Although the research suggests that behavior modification generally works
better than simple expectancy effects—such as placebo treatments—it is desirable
to have any expectancy effects working in the desired direction. And certainly
the relationship is a major determinant of expectancy.
A total program for
a client may include many components in addition to the psychological change
program, components such as medical aid, physical therapy, extensive
physiological assessment, changing nutrition, legal and financial aid,
vocational training, money management, training in problem solving, parent
training, or religious or spiritual counseling. The psychological change
procedures of the total program consists of behavior modification plus whatever
is part of your approach.
My concern here is
the breadth of the behavior modification component. For it is important to
be able to draw from the total domain of behavior modification a combination
of procedures logically combined together in a program geared toward your
client. Many behavior modifiers unfortunately only draw from a small subset
of behavior modification, such as practitioners who are basically entirely
operant in approach or clinicians who see most of therapy in terms of reciprocal
inhibition. Although such limited approaches are successful with restricted
types of behaviors or settings, I suspect that most people practicing behavior
modification, especially clinicians, could significantly improve their effectiveness
by increasing their breadth of knowledge and skills in behavior modification.
This is particularly true since the field is currently evolving and expanding
rapidly. The reader who is interested in staying current should follow journals
such as those given in the next chapter. The importance of combining procedures
creates research problems, for if the research only investigates the effects
of a single procedure or small number of procedures, the effectiveness may
be well below that of a more comprehensive approach, particularly with difficult
and complex problems. On the other hand, research on more comprehensive or
more individualized programs may have difficulty evaluating the relative importance
of the different components.
The combining of
procedures can be seen by looking at general problem areas like alcoholism.
But it must be remembered that the ideal program for one person who is alcoholic
may be very different from the ideal program for another alcoholic.
Consider behavioral
treatments of homosexuality (Barlow, 1973; Barlow & Abel, 1 976; Wilson
& Davidson, 1 974). First is the ethical question, discussed earlier (Chapter
2), of whether you should change such behaviors. Should you help the client
become primarily heterosexual? Should you help him be more effective and comfortable
as a homosexual? Assuming you choose to move toward heterosexuality, a treatment
program may include some form of aversive counterconditioning—perhaps covert
sensitization—to reduce sexual responses to homosexual stimuli; some approach—maybe
desensitization—to reduce anxiety associated with heterosexual situations;
procedures—like respondent conditioning of specific images with masturbation—to
increase heterosexual responses; and social skills-training and assertive
training geared toward heterosexual situations.
Although much research
is needed, many behavior approaches have been applied to the abuse of drugs
other than tobacco and alcohol (Callner, 1975; Miller & Eisler, 1975).
Procedures used include altering environmental cues, aversive counterconditioning,
desensitization, overt and covert reinforcement of incompatible behaviors,
contingency contracting, thought stopping, and assertive training.
Many successful behavioral
programs have been developed to reduce overeating (Abramson, 1973; Foreyt,
1976; Hall & Hall, 1974; Jeffrey, 1976; Leon, 1976; Mahoney & Mahoney,
1976; O’Leary & Wilson, 1975, chap. 12; Yates, 1975, chap. 6). Weight
control has three components: exercise, diet, and eating behaviors. Exercise
improves health and uses up calories. Diet controls the input of calories
and other components that affect health, behavior, and weight. Although control
of the diet, relative to the person’s metabolism and amount of exercise, is
a possible way to control weight, it
often is not effective. For many problem eaters
can lose weight by one diet or another, but they usually gain it back. Long-term weight control often requires changing eating behaviors
via behavior modification.
Behavioral approaches to deal with eating behaviors include stimulus control, such as restricting eating to one particular place in the house (no eating while reading, watching TV, etc.); reduction of anxiety that triggers eating, as by desensitization; aversive counterconditioning, perhaps covert sensitization, geared toward control of overeating; decreasing the reinforcing
value of some foods, as with stimulus satiation or by only preparing difficult
meals; coverant control and thought stopping to deal with thoughts related
to eating; reinforcing alternative incompatible behaviors to eating in various
situations; enlisting family and friends to provide support and social reinforcement
of behavior change and weight loss; and contingency contracting to reinforce
carrying out the program and losing weight. Changes during the actual eating
of a meal might include putting small quantities on the plate; slowing down
the actual eating; not putting more food on a utensil while still chewing;
paying more attention to eating, so enjoyment may not decrease, even though
quantity consumed may; and stopping just before being full and then quickly
removing the food from the table.
Essentially no approach
from any orientation has been proven to have more than temporary success in
reducing or eliminating cigarette smoking, although many programs will work
for a month or two or work with some types of clients. For cigarette smoking
gets tied into too much of the person’s daily behavior, in addition to being
physiologically addicting. There is often social support for smoking; and
many people, particularly teen-agers, usually begin for this reason. Smoking
becomes tied in with many situations and activities such as the cup of coffee
after a meal, cocktails, talking on the telephone, parties, or feeling anxious.
Smoking may reduce anxiety and/or give the person something to do with his
hands. About one third of everyone in the United States smokes. And many,
perhaps most, of these people are not able to stop smoking for more than a
short period of time.
Many behavioral programs
have been geared toward smoking (Bernstein, 1969; Flaxman, 1976; Keutzer et
al., 1968; O’Leary & Wilson, 1975, chap. 12; Yates, 1975, chap. 5). Several
programs have shown good initial promise, but much more research is needed.
Most of the programs so far have primarily emphasized only one or two procedures,
such as stimulus satiation or covert sensitization. I suspect that a program
more comprehensive in approach will be more effective. Behavioral procedures
that have been applied to smoking include stimulus control, such as removing
cues associated with smoking or only smoking in a special room; aversive counterconditioning,
as with hot stale cigarette smoke or covert sensitization; stimulus satiation,
as by rapid smoking; reduction of related anxiety or other negative emotions
leading to smoking; motivational changes as by contracting and peer support;
learning alternative behaviors; and thought stopping and coverant control
to decrease thoughts leading to smoking and increasing anti-smoking thoughts.
This may be an area in which a gradual approach, such as gradually reducing
the number of cigarettes smoked, is sometimes inferior to a non-gradual approach,
such as stopping all smoking immediately. A program for smoking should also
deal with client behaviors that result from removing the smoking, problems
such as the client becoming more irritable or aggressive, increased eating,
or the client needing something to do with his hands and mouth.
Alcoholism is a major
health problem in the United States. Half of all fatal automobile accidents
involve a drunken driver. By one common definition there are about 10 million
alcoholics in the United States. Some types of treatments, such as Alcoholics
Anonymous, have been successful with some types of people. But most treatment
programs have not been successful. Many hospitals and mental health centers
will not work with alcoholics.
Drinking is encouraged
and reinforced by many facets of our culture. Drinking is a critical part
of many social situations; inebriated and uninhibited behavior following drinking
is often reinforced; and many parents are worried their teenagers are smoking
marijuana, then relieved if they are only drinking alcohol. Many men equate
part of manlihood with drinking and drinking capacity. This makes it more difficult for many men to admit they are too drunk to drive or admit
they need therapy. Alcohol reduces such emotional responses as anxiety and
boredom and thus is reinforcing. The reinforcing effects of drinking are fairly
soon after drinking behavior, while the adverse effects of drinking and being
alcoholic are often temporally more distant. Alcohol often is physiologically
addicting and withdrawal may produce nausea, vomiting, and fever.
Many behavioral programs,
some quite successful, have been established to treat alcoholism (Miller,
1976; Miller & Eisler, 1976; O’Leary & Wilson, 1 975, chap. 1 3).
Several programs have used a variety of behavioral tools and approaches. The
specific procedures that could be used depend on the individual clients and
include, among others, all the procedures mentioned above relative to drug
abuse, cigarette smoking, and overeating. In addition, Hunt and Azrin (1973)
show the importance of altering vocational, family, and social reinforcers.
For a long time it was assumed that a cured alcoholic must stay
totally abstinent or he would become an alcoholic again. Now researchers are
suggesting that for some alcoholics controlled drinking is a possible and
desirable goal (Lloyd & Salzberg, 1975). A person learns, perhaps in a
simulated bar, how to have one or two drinks and stop. One way to help clients
learn self-control over how much they drink is to teach them how to estimate
their blood alcohol level from the number of drinks they had and emotional
and physiological cues (Silverstein et al., 1974). This training requires
booster training sessions. Some researchers treat alcoholic drinking as an
operant behavior. Treatment then emphasizes determining situations in which
the client drinks and teaching alternative behaviors to these situations.
Sobell and Sobell (1973, 1976) successfully coupled this approach with an
emphasis on controlled drinking.
One example of a
behavioral program is reported by Voger and his associates (1975) for chronic
in-patient alcoholics. The patients while sober saw videotapes of their drunken
behavior in order to motivate change. Controlled drinking, rather than abstinence,
was the goal; and the patients were given training in estimating their blood
alcohol level. The patients were sometimes punished with electric shock for
overconsumption. There was training of alternative behaviors to drinking.
And some of the above treatment took place in a simulated bar. All patients
were also given a general education about alcohol and behavioral counseling,
which included relaxation training, assertive training, and learning interpersonal
skills related to drinking situations (e.g., refusing drinks). After leaving
the hospital the patients came back for an occasional booster-treatment session.
At a one year follow-up 62 percent of the patients were abstinent or maintaining
controlled drinking. There was also a change in what they drank (usually toward
lower alcoholic content), when they drank, and whom they drank with.
There have naturally
been a number of criticisms of behavior modification (see London, 1972; Mahoney
et al., 1974; Mikulas, 1972b). Some of the criticisms have been discussed in
the first chapter, such as the misunderstanding that behavior modification only
deals with peripheral behaviors and the contention that it does not deal with underlying causes. Here I consider some other common
criticisms.
Many writers in behavior
modification talk about the field being based on learning theory. But as some
critics rightly point out, there is little consensus among learning theories;
hence the theories do not make a solid base. To the extent that behavior modification
draws on the learning literature, it is based more on empirical relationships of learning, for which there
is some consensus, rather than theories of these relationships. For example,
we know much about the effects, parameters, and applications of reinforcement,
even though there are numerous different theories of reinforcement.
Also many behavior
modification practices are substantially more complex than the experimental
paradigms on which they are based. Laboratory studies of respondent conditioning
usually use well defined and readily measurable stimuli (CS and UCS) and responses
(CR). While desensitization usually uses imagined scenes—which consist of
flows of imagery—and some subjective sense of relaxation, both generally assessed
by the client’s self- report, a questionable measure. Now desensitization
works well and may be based on respondent conditioning, but there are many
gaps between laboratory and practice that need to be filled by research. Similarly,
many laboratory studies are based on experiments with non-human animals. Extrapolation
from such studies to human behavior has proven useful, even though it offends some people. But such studies may not be the best approach for
understanding some variables of human behavior, such as aspects of cultural
socialization and symbolic processes.
Another related criticism
is that behavior modification is oversimplified; it reduces complex human
behavior to a few principles, such as respondent and operant conditioning.
Behavior modification is oversimplified; it is a relatively new field in the science of psychology, which itself is
a new, oversimplified discipline. Human behavior is currently the most complex
field of study; and most of our scientific investigation of it has been in
the last few decades. But behavior modification is less oversimplified than
approaches that assume that a generally sufficient approach to behavior change
can be based on insight, interpersonal feedback, or a primal scream. A strength
of behavior modification is the degree to which its constructs can be interrelated.
Without devaluating the uniqueness of a client, it is possible to break that
client’s behaviors down into a complex, interrelated set of components which
provides a useful conceptualization when designing a treatment program.
Another objection
to behavior modification is that it is dehumanizing, mechanical, and dictatorial.
It is sometimes argued that the client is conditioned in the same way one
might train a dog. These critics argue that other orientations are more responsive
to the client’s human qualities. Such criticisms certainly apply to some practitioners
of behavior modification, as well as to practitioners from many other orientations.
But these are not properties of behavior modification, which is more a technology
and functional conceptualization than a philosophy of man or style of interpersonal
relating. Behavior modification may be one of the most humane things you can
do with a client, whether you regard that client as an animal, biocomputer,
person moving toward self-actualization, or one who is consciously evolving
on a spiritual path. The practitioner’s philosophy, attitudes, and behaviors
are significant to the degree they affect the client, regardless of how the
practitioner may conceptualize what he does.
Some critics see
behavior modification as too controlling and argue for change models, such
as client-centered therapy, which minimize control of the client and are geared
toward the client becoming “self-directing” (Rogers & Skinner, 1956).
In one sense a self-control approach with behavior modification gives the
client more control of his own behavior. But in another sense the whole issue
of control is spurious. Anyone (e.g., teacher, counselor, therapist, parent,
minister) who influences another is involved in control. And this is true
regardless of what the controller believes he is doing or his awareness of
the extent of his influence. Any influence of a person, including toward being
“self-directing,” involves control. To the extent a practitioner does not
influence the client, he is not an effective change agent and may be leaving
the control of much of the client’s behavior to undesirable sources. By not
recognizing the ever-present issue of control or philosophically denying it, the practitioner may not adequately confront ethical decisions about the
direction of behavior change and/or not realize important ways he is influencing
the client (e.g., modeling and social reinforcement).
The next issue concerns
the current research evidence on behavior modification. Although it is still a young field, there are more controlled studies on behavior
modification than any other therapeutic model and most other behavior change
models. But there is great need for considerable more research in most areas
of behavior modification. The major strength of the field is that it is continuing
to evolve and expand through research. Currently some areas of behavior modification,
such as some of operant conditioning, have been well researched and shown
to be effective. Research in these areas is more on issues of implementation
and the comparison of variations of approaches. Other areas, such as desensitization,
have proven effective and generated considerable research. But there are still
many basic questions about what is going on that need to be answered. Some
areas—for example, aversive counterconditioning—have resulted in considerable
research with mixed results, partly because these procedures may be most effective
when part of a more complex treatment program. Some areas, such as contracting
in marriage counseling, have generated procedures that are used often and
reported to be effective. But there is currently little research in these
areas. Finally there are areas—such as most of the covert approaches—for which
there is too little evidence to evaluate. All of this, particularly my examples,
is currently changing. But for a while we can conclude that research on behavior
modification is encouraging, mixed, and needed.
Researchers using
a single-subject research design, mostly operant conditioners, have demonstrated
treatment effects across a wide range of settings and subjects. (Some theorists
even define behavior modification in terms of this approach.) Other forms
of controlled research have often relied heavily on relatively healthy subjects,
such as college students with test anxiety, while behavior modification with
more extreme clients, such as mental patients, is often more in the form of
a case study. Thus we need more controlled research in a wider range of clients
and settings. Behavior modification practice is also more complex than the
theory and the reports by the practitioner, particularly journal articles.
Hence we need more research on what successful behavior modifiers do, not
what they say they do.
INTERRELATIONSHIPS
WITH OTHER APPROACHES
The student of
psychology is confronted with a bewildering mass of models and theories about
the nature of man and his behavior. Some are useful, some are detrimental, some
are silly, some are common sense translated into psychological jargon; but
psychologists do not agree on which are which. Most psychologists who work as
change agents drifted toward those psychological models that seemed to fit
their interpretations and preconceptions of their own experiences and how they
would like man to be. Clients often choose practitioners for similar reasons,
and the effectiveness of counseling or therapy often depends on the match
between client and practitioner.
Many students and
practitioners adopt an eclectic approach in which they intend to draw from
a wide range of psychological models and approaches. Although this is desirable
in theory, and I suggest some interrelationships below, it is difficult in
practice, for many approaches (e.g., aspects of behavior modification and
psychoanalysis) are incompatible in terms of assumptions and change strategies.
Thus a combination may be less effective than one or both approaches taken
separately. Also, being an eclectic generally requires a detailed knowledge
of the various approaches being combined. Learning about behavior modification
superficially and adopting a few of its techniques may leave the eclectic
less effective than a practitioner who has mastered behavior modification.
One problem in discussing
combining behavior modification with other approaches is that it is not an
area with specific assumptions and boundaries. In this text, particularly
in this and the first chapter, I have tried to convey the current status of
behavior modification and some of its working assumptions and strategies.
But behavior modification is more a movement toward better specification,
measurement, and research. As an evolving approach, which should draw from
all experimental areas, behavior modification will not combine with other
areas as much as incorporate parts of them. Although many people define behavior
modification in a more restricted sense—and thus some people propose variations
such as cognitive behavior modification and multimodal-behavior therapy—in
its broadest sense behavior modification is simply the application of the
systematic study of behavior. In this sense one could question whether there
really is an area called “behavior modification” and the pros and cons of
making such a distinction. Given these qualifications I will suggest some
interrelationships between the current practice of behavior modification and
a few other approaches. A detailed discussion here is far beyond the scope
of this book and I mean the following to just be a sample of ideas.
Throughout the book
I have suggested relationships between behavior modification and other approaches,
such as Rational-Emotive Therapy and the cognitive therapies in the last chapter.
Gestalt therapy, a potpourri of approaches, overlaps with behavior modification
in that both often help clients get in touch with their feelings (e.g., relaxation
training, anxiety management, assertive training), deal with affective responses,
and use role playing and imagery techniques. Others have suggested relationships
between behavior modification and group therapy (Johnson, 1975; Rose, 1977);
psychodrama (Sturm, 1970, 1971); and Morita therapy (Gibson, 1974). But I
wish to consider relationships with psychoanalysis, humanistic psychology,
transpersonal psychology, and multimodal therapy.
Psychoanalysis
In psychoanalytic
or psychodynamic approaches, discussed as the medical model in chapter one,
the emphasis is on resolving assumed underlying causes, often deep within
the client’s unconscious. Therapy generally centers around the relationship
between the practitioner and client with the therapist helping the client
gain insight into the causes of his behavior and interpret this behavior from
a psychoanalytic orientation. Psychoanalysis is basically a verbal therapy
using such tools as dream interpretation and word association to discover
intrapsychic conflict and other psychodynamic influences on behavior. Resolution
of these underlying causes, many of which are found in the client’s psychosexual
history, is the basis of therapy.
Many behavior therapists
(e.g., Levis, 1970; Rachman, 1 970) consider psychoanalysis and behavior modification
incompatible and suggest combining the two would weaken one or both approaches.
Differences between the two orientations include the following: Psychoanalysis
is basically geared toward “underlying causes,” perhaps in the unconscious,
while a behavioral approach avoids such constructs, which are difficult to
define and measure. Psychoanalysis usually traces historical causes of current
problems, while behavior modification emphasizes interrelationships among
current behavior. Psychoanalysis gives more weight to the treatment effects
of understanding and insight, while behavior therapy emphasizes structured
new learning.
On the other hand,
others see behavior modification and psychoanalysis as similar (e.g., Sloan,
1969) and/or compatible (Birk, 1970; Feather & Rhoads, 1972a, 1972b; Hersen,
1970; Marmor, 1971). It is suggested that if you look at what successful psychoanalysts
and successful behavior therapists do, not what they say they do, there are
many similarities in approach. One argument is that the two approaches are
applicable to different types of clients or problems. Or the two approaches
are complementary, dealing with different aspects or levels of people’s complex
problems. In either case, it is not clear what each approach deals with that
the other does not. Stampfl’s implosive therapy (Chapter 4) incorporates psychoanalytic
scenes as sources of anxiety; but it is not clear that this is necessary or useful.
Another possibility
is that behavior modification procedures produce wider range changes than
is assumed, perhaps including changes in psychodynamic conflicts. There is
not sufficient data to suggest this is true, but the following studies are
examples of support for this position. Kamil (1970) used desensitization to
reduce snake fears in college males. In psychoanalytic theory fear of snakes
is often seen as related to castration anxiety. Kamil found that the desensitization
produced a decrease in castration anxiety as measured by the TAT (Thematic
Apperception Test) but not a decrease as measured by the Rorschach inkblot
test. Kamil suggests that desensitization had an effect down to the level
of interpersonal themes assessed by the TAT, but not down as far as the castration
anxiety measured by the Rorschach. However, Kamil suggests that desensitization
does go far enough to strengthen the ego and thus avoid symptom substitution.
Silverman and associates
(1974) suggest that part of the effects of desensitization are due to activating
unconscious merging fantasies. They view the therapist during desensitization
as a mother substitute. This coupled with the client’s relaxed state and perhaps
prone position encourages regression and an unconscious fantasy of merging
with the therapist as mother. The client then uses aspects of the merging
experience to counter his fears. To test this, Silverman and associates treated
women with insect phobias with their own variation of desensitization. Instead
of having the client relax when experiencing anxiety, they quickly flashed
(“tachistoscopic subliminal exposure”) to the client the visual phrase “MOMMY
AND I ARE ONE.” Reporting this as an effective procedure, they see this as
support of their theory. In a partial replication of this study, Emmelkamp
and Straatman (1976) found no differences between subjects who viewed “Mommy
and I are one” and subjects who viewed “Snake and I are one,” questioning
the specificity of any merging fantasy.
Humanistic psychology
Humanists view
humanism as a “third force” in psychology, with behaviorism and psychoanalysis
the other two forces. They often view behaviorists as determinists who only
deal with the peripheral behaviors of humans, while they view humanists as
dealing with people’s human characteristics, their will, and what goes on
inside them. Such straw man arguments generate many apparent conflicts between
humanism and behaviorism (see Matson, 1973), with most of the disagreements
centering around models of people that humanists postulate behaviorists must
hold to. In fact, the fields of humanism and behaviorism both contain a wide
range of models and approaches, some compatible and some not.
Consider some of
the goals often cited as important to the humanistic approach in psychology:
reverence for the unique in the individual; appreciation of the dignity and
worth of people; and dealing with meaning, value, choice, experience, creativity,
and self-understanding. Goals for the client include experiencing life more
harmoniously, greater self- determination and responsibility, ability to communicate
better, ability to act more compassionately, and extended awareness. Now I
basically agree with all of these goals, as I imagine most of you do. Hence
we all can be humanists, and some of us are behaviorists. Many behavior modifiers
(e.g, Thoresen, 1 973) see themselves as humanists and sometimes speak of
behavioral humanism. Skinner, a favorite target of humanists, was voted Humanist
of the Year in 1972 by the American Humanist Association because he is a person
concerned about human behavior and the destiny of humanity.
The compatibility
of behavior modification and humanism can be seen in areas of behavior modification
such as the development of self-control and related awareness, dealing with
cognitive processes, and the general attitude that a person is capable of
changing. Often the most humanistic thing you can do for a person is to provide
that individual with help via behavior modification. Unfortunately, some humanists
have gone to the extreme of minimizing or disregarding scientific studies
of human beings. Others have confused how they would like things to be with
how things might really be.
A popular humanistic
psychology is the client-centered
therapy of Rogers (e.g.,
1958). According to Rogers, everyone has a natural motivational force toward
self-actualization. Counseling centers on the relationship between the client
and practitioner. Here the proper attitude of the counselor (genuineness,
empathetic understanding, unconditional positive regard) helps the client
in self-exploration and altering his self-concept, which leads to positive
personality changes. Some client-centered therapists see this relationship
as the necessary and sufficient condition for therapeutic change, while many
behavior modifiers, as discussed above, see such a relationship as often facilitory,
not always necessary, and seldom sufficient.
However, in many
counseling or therapy situations client-centered therapy and behavior modification
are compatible (Dustin & George, 1 973; Martin, 1972; Naar, 1970). The
client-centered approach provides practitioners with useful skills in developing
a facilitory relationship with clients, while behavior modification provides
specific programs to deal with behavioral problems.
Transpersonal
psychology
The field of
transpersonal psychology (e.g., Tart, 1 975) is fairly new and not well defined
(which is considered desirable by many transpersonalists). It is the
intersection of psychology with such phenomena and experiences as peak
experiences, mystical experiences, transcendence of the self, altered states of
consciousness, meditation, spiritual paths, and ultimate human potentialities.
As a western psychology, transpersonal psychology arose as a “fourth force” out
of humanism; thus writers in this area often perceive themselves as further
from behaviorism than the humanists are. However, behavior modification is
compatible with many aspects of transpersonal psychology.
People in quest of
transpersonal goals often find the necessity of dealing with behavior problems
that are impeding progress. It is common for a spiritual leader to require
a disciple to first straighten out problems of daily living. Although transpersonal
experiences may provide more clarity or freedom from the behavioral problems,
the problems still often have to be dealt with. And here behavior modification
provides useful tools. As a person progresses transpersonally he generally
must confront his self or ego, a subjective sense of individualized and separate
existence. From a transpersonal point of view, this self is an illusion, basically
a product of learning, which needs to be superceded if one is to reach the
ultimate human potential. An understanding of learning then provides a conceptualization
of the processes of the self and how it can be “unlearned.” Note that behaviorists
generally avoid constructs such as the “self” and prefer to deal with the
processes that affect a person’s behavior. Humanists often exalt the self
and want to strengthen or actualize it. Then the transpersonalists complete the circle, see the self as an obstacle,
and run back into many of the processes studied by the behaviorist.
Through various disciplines,
such as meditation, a person may come to be a more objective witness of himself
and the world, including his own confusions, problems, behaviors, and processes
of the mind. Eventually the types of effects on behavior discussed in this
book fall into the natural flow of things; and cause and effect have more
a sense of “happening.” With more progress this witnessing orientation and
the related self dissolve into the flow.
Indries Shah (Hall,
1 975) when discussing Sufism,
a transpersonal approach
primarily associated with the mystical aspects of the Moslem religion, said,
“Nobody is trying to abolish conditioning, merely describe it, to make it possible to change it, and also to see where it
needs to operate, and where it does not . . . As a consequence of Sufi experience, people— instead of seeing things
through a filter of conditioning plus emotional reactions, a filter which
constantly discards certain stimuli—can see things through some part of themselves
that can only be described as not conditioned.”
Buddhism is a powerful
and important psychology often overlooked by western psychologists. Although
partially transpersonal in nature, Buddhism focuses on the practical problems
in the here and now; thus it
is very compatible with behavior
modification (Mikulas, 1978). For example, Buddha observed that life is filled
with suffering. People are not at peace; there is always some condition or
thing they believe they must have to be happy, even if a person achieves what
he thought he wanted, there is always something else. Buddha understood that
this basic (perhaps existential) source of suffering was based on peoples’
attachments (craving) to some model of how things should be. But such attachments
are relatively constant while the world is in a continual state of change
(impermanence). Thus seldom does a person’s model match the way things are,
so there is suffering. Freedom from suffering, peace of mind, and entrance
into transpersonal domains thus is based on getting free from the attachments,
a process which becomes very subtle. It is not that a person necessarily stops
doing many of the things he does, or that he stops trying to influence the
course of events, or that he gives up all preferences. Rather, the person
learns to continually live free from attachments to how things “should be,”
joyfully, peacefully, and compassionately accepting things as they are. The
way to gain this freedom from attachments is complex, but Buddha included
cleaning up one’s life-style and specific practices of meditation.
Now since the attachments
basically come about by learning, knowledge of learning processes and behavior
modification can facilitate identifying and dealing with attachments. Similarly,
Shapiro and Zifferblatt (1976) have drawn several comparisons between Zen
Buddhist meditation and behavioral self-control, for both lead to being more
observant of oneself and the influences on behavior. Differences are primarily
in terms of what is observed, how it is observed, and the reactive effects
from observing. From a behavioral standpoint, Zen meditation may facilitate
relaxation, learning to focus attention, becoming self-conscious while minimizing
reactive effects, desensitization of thoughts that come to “mind” during meditation,
a reduction in covert thoughts and images, and a greater openness to various
stimuli.
Multimodal therapy
Arnold Lazarus was
a major researcher and practitioner in the early days of behavior modification.
Over time he came to combine behavior modification with various other approaches
and techniques (e.g., Lazarus, 1971) under different names—such as technical
eclecticism, broad spectrum therapy, and multimodal therapy. Lazarus’s latest
statements of multimodal therapy (Lazarus, 1973, 1976) center around the acronym
“BASIC ID,” where each letter stands for a modality that may need to be treated.
The argument is that durable treatment results often depend on the number
of modalities treated. In the acronym B stands for behavior—overt behavior
and appearance. A is affect—affect and emotions, such as anxiety, fear,
anger, and depression. S is sensation—bodily sensations, such as sexual
and sensual pleasure, pain, and spasms. i is imagery, including images,
imaginations, and dreams. C is cognitions, including self-instructions, faulty
reasoning, misconceptions, lack of information, insights, and philosophies.
I is interpersonal relationships, ways of interacting, such as being
non-assertive. D stands for drugs, allowing for the necessity or usefulness
of adjunctive use of drugs.
One strength of Lazarus’s
approach is that he gets the practitioner to pay attention to the range of
possible components (modalities) that need to be included in the treatment
program. However, behavior modification in its broadest sense, as discussed
in this text, covers all of these modalities. So it is not clear what is added in the term “multimodal therapy.” Lazarus’s
works also contain many suggestions for new therapeutic tools and approaches.
Unfortunately, many of these have not been adequately researched; and some
may be based on change procedures which are more effectively carried out by
existing behavior modification approaches. Finally, Lazarus in his broad spectrum
practice easily switches from one therapeutic approach to another. Perhaps
Lazarus’s experience and knowledge allow him to do this effectively. But the
student who reads his works probably will have trouble successfully emulating
him. It may be that the new practitioner should begin by mastering a more
delineated approach, such as a combination of behavior modification and client-centered
skills.
It seems that anyone
interested in understanding and changing human behavior, whether one’s own
or someone else’s, will profit from learning about behavior modification.
How this knowledge is used or integrated with other concerns and approaches
is now left to the reader.
In its broadest
sense, behavior modification is the application of principles of behavior
derived from systematic studies of behavior, with emphasis on specification,
measurement, and research. Currently it is heavily based on the empirical
relationships, not theories, of learning and motivation, although breadth in
many areas of psychology is often advantageous to the practitioner and
theorist. Behavior modification should incorporate ideas and procedures from
any source, including other psychological change models, to the extent the
ideas and procedures are verifiable and prove useful. Combining behavior
modification with other procedures naturally depends on the compatibility of
the different sets of assumptions and approaches. Behavior modification
conceptualizations, like all conceptualizations of human behavior, are
oversimplified and are useful to the degree they suggest practical courses of
action. Similarly, behavior modification practice is often more complex than
reports of the practice suggest and usually much more complex than the
laboratory studies and paradigms on which the practice is based. Research is
currently filling in these gaps. A change program usually involves
psychological components, such as behavior modification, and non-psychological components, such as physiological limitations of the
client and social-political restrictions of the helping organization. The optimal behavior modifier draws from the whole domain of behavior modification
and related approaches to develop a change program geared toward the specific
needs of the client. Although behavior therapy does not require a specific type
of relationship with the client and does not assume that establishing a
particular relationship is sufficient for effective behavior change, a good
relationship with the client often greatly facilitates many aspects of
assessment and the change program. Finally, behavior modifiers, like any
influence agents, need to try to remain as aware as possible of the many
influences on their clients and related ethical issues.
|
1.
|
What
is behavior modification defined in its broadest sense? Discuss
the useful ness of this definition. Discuss the idea that behavior modification
is not a well-defined field, but rather a movement to emphasize the importance
of a more scientific study of human behavior and change programs. |
|
2.
|
To
what extent can experiments
with animals help us improve behavior modification
practice with humans? |
|
3.
|
Does
behavior modification exert
more control on a client than other psycholog ical approaches? Why? What are the implications of your answer? |
|
4.
|
Discuss the possibility of behavior modification procedures producing changes in psychodynamic conflicts. |
|
5.
|
What is behavioral humanism? Evaluate this position. |
|
6.
|
What
are important interpersonal
skills a behavior therapist should have? Describe a training program,
using behavior modification technology, to teach these skills. |
|
7.
|
What
general fields of psychology would be useful for a behavior modifier to
know for working in each of the following: an elementary school, a marriage
counseling center, a factory? |
|
8.
|
What
other psychological approaches would you couple with behavior modification?
Why? What would be the major problems in making such a combination? |
|
9.
|
What are the pros and cons of having goals of controlled eating of high-calorie foods, controlled smoking of cigarettes, and controlled drinking of alcohol, as opposed to goals of abstinence? |
|
10.
|
Outline
a change program for a hypothetical case of depression, which uses and
specifies all the modalities of multimodal therapy. |
|
11.
|
Outline
a comprehensive program, drawing from the whole domain of behavior modification,
for a hypothetical case of alcoholism. |
|
12.
|
Overall,
what do you think of behavior modification? Why? What would you do to
help improve the field? |
Bandura, A. Behavior
therapy and the models of man. American
Psychologist, 1 974, 29, 859—869.
Lazarus, A. A. Behavior therapy & beyond. New York: McGraw-Hill, 1971.
Martin, R. Legal challenges to behavior modification: Trends in schools,
corrections, and mental health. Champaign, Ill.: Research Press, 1975.
Mikulas, W. L.
Criticisms of behavior therapy. Canadian
Psychologist, 1972, 13, 83—1 04.
Skinner, B. F. Beyond freedom and dignity. New York: Knopf, 1971. Bantam paperback, 1972.
Stolz, S. B., Wienckowski, L. A., & Brown, B. S. Behavior modification: A perspective on critical issues. American Psychologist, 1975, 30, 1027—1048.