What distinguishes both behavior and cognitive therapies from traditional psychological treatment is their focus on the origin of a particular disorder and how best to treat it. Typically, behavior and cognitive therapies view disorders arising from an individual’s genetics and learning history. Treatment relies on changing an individual’s environment, thus altering the learning repertoire. Environment, broadly defined, consists of not only the external environment, but also the internal one. The internal environment includes not only emotions and physical sensations, but also thinking. All of these factors contribute to both adaptive and maladaptive patterns of behavior that are either desirable or undesirable to the individual. With behavior and cognitive therapies, the patient is an agent of change who takes an active role in their treatment. The patient is encouraged to act and practice desirable forms of behavior both in vivo and in session. Put simply, talk without action is of limited use in behavior and cognitive therapies. Data may also be collected to aid in progress towards stated goals.
In contrast, traditional forms of psychotherapy, to varying degrees, rely almost exclusively on more passive forms of treatment. Psychodynamic therapies, in general, attribute disorders to factors that are not readily accessible to the patient and clinician. These latent factors are believed to reside somewhere within a patient’s unconscious, an area of the mind that cannot be observed or measured. Instead, these factors can only be supposed to exist and hints of their operations gleaned from overt behavior. For instance, compulsive hand washing is viewed as a psychological metaphor for unresolved guilt. Depression is the result of anger turned inward. External symptoms are nothing more than emanations from the unconscious. The focus of treatment, therefore, cannot be on the overt symptoms, but the internal, unconscious sources of conflict. The idea is to get at the source of the disorder, not the superficial symptoms. Considering that neither the patient nor clinician can actively alter these unconscious factors, they can only come to understand them. Understanding the disorder takes the forms of talking about life experiences that are believed to have contributed to the development of these unconscious factors. In this way, understanding is the goal of treatment, not alleviation of suffering or enhancement of functioning.
As you can see, there are substantial
differences between these forms of treatment. These differences are
not merely reserved to the use of specific techniques. Instead, the
major difference that transcends technique is case
conceptualization. All good psychologists develop working
relationships with their clientele. All good psychologists interact
with their patients to form and maintain a rapport. It is case
conceptualization that differentiates forms of therapy and
orientation. Case conceptualization is how the clinician views the
etiology (cause) of the disorder and how to treat it. During the
course of treatment, techniques may change, but the essential case
conceptualization stays the same. A behavioral or cognitive case
conceptualization includes (Persons, 1989):
-Setting a primary therapeutic goal of
alleviating, solving, or eliminating overt clinical problems and
symptoms. As part of the emphasis on solving overt problems,
behavior and cognitive therapists work with patients to measure
these problems, whenever possible, in concrete, objective terms so
that the outcome of the therapy can be monitored and assessed.
-Adopting an active, problem-solving
approach to clinical problems.
-Focusing on the here-and-now rather than
the past. An effective cognitive and behavior therapist obtains a
good family and social history. This information is important for
several reasons, particularly in developing a useful case
conceptualization. The behavior and cognitive therapist may even
spend some time working on past events, but this is generally done
in the context of helping the patient solve here-and-now
difficulties.
-Building a collaborative patient-therapist
relationship. The behavior and cognitive therapist does not solve
the patient's problems; the therapist works with the patient to
develop solutions that are helpful to the patient.
-Maintaining an empirical attitude, both
with regard to the choice of the therapy modality itself (what does
the outcome literature say about which treatment approach is most
effective for the problems presented by this patient?) and with
regard to the conceptualization and interventions used to treat each
particular patient.
-Relying on cognitive and learning theories
that view clinical problems as understandable within a framework of
reciprocally connected behaviors, cognition, and affects that are
activated by environmental events, including, of course,
interpersonal events.
-Assigning homework. The key role of
homework in behavior and cognitive therapy draws directly on the
view of therapy as a learning experience in which the patient learns
new perceptions and skills.
The best advice for any patient is to work with a clinician who meets their needs, which may entail, “shopping around.” For behavior and cognitive therapy, the use of behavioral and cognitive techniques is not equivalent to the practice of behavior, cognitive, or cognitive-behavioral therapy! The research that demonstrates efficacy and effectiveness of behavior, cognitive, or cognitive-behavioral therapy is not based on haphazard use of techniques, but through case conceptualization and manualized treatment where available. The proper use of techniques, case conceptualization, and application requires years of study, internship, and supervision with like-minded psychologists.
Don’t be afraid to ask questions about education and training and what qualifies a clinician to practice a proposed therapy. In the long run, you will be glad that you did. Being a licensed psychologist does not qualify a clinician to vacillate between modes of treatment. As in medicine, specialization requires specialized training. Psychological practice is no different. Attending a weekend workshop does not qualify a clinician as either specially trained or an expert in treating a particular disorder.
References
Roth, A. & Fonagy, P. (1996). What Works for
Whom? A Critical Review of Psychotherapy Research.
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