Behaviorism was the main approach in psychology around in the middles of 1960. However, it was gradually be questioned by a lot of psychologists, mainly because of its element to exclude the cognitive processes from the study of human behavior. The Behavior therapy is characterized by a lot of different views among psychologists. Through the years, behaviorism was criticized by the different theoretical backgrounds in psychology and a lot of open debates were of a big importance within the field, where some of them are discussed even until today. Some issues of the controversies, that behavioral approach had triggered, were about conceptual bases, methodological requirements and evidence of efficacy (Wilson, 2011). It is a fact that, if behaviorism didn’t expand at all, it is keep expanding and consequently emerging with other psychological approaches, something that it is going to be discussed at the end of the chapter. However, behavioristic approach remains different from the others, as its basic and unique characteristic are clear and easily conclude its specificity.
5.1. Positive aspects of Behaviorism
5.1.1. Empirical Approach
Behavior therapy was the one that changed the face of psychotherapy, by introducing the research on psychological treatment (Wilson, 2011). Thus, a main characteristic of behaviorism is that it gives a lot of emphasis on the application of scientific methodology to a numerous psychological problems (Sharf, 2000; Corey, 2013). Additionally, Eysenck (1994) reported that the reason that behaviorism became so influential is that it tried to make psychology an experimental science. That methodological innovation can be considered as the major contribution of behavior therapy to the field of psychology (Wilson, 2011; Corey, 2013).
5.1.2. Specific and Client-Oriented Goals
Behavioral approach has the advantage of stating “clear and concrete behavioral goals that can be monitored and measured” (Corey, 2009; Corey 2013). At the beginning of therapy, baseline data are assessed, so that the progress of the individual can be evaluated at any moment of the therapy, compared to those baseline data (Corey, 2009). So, it is obvious that since the goals are well defined, it is clear from the beginning how well the treatment is progressing (Corey, 2009). Another advantage is that the client is asked to determine if he made the changes he wanted and so he is an evaluator of himself and his treatment (Corey, 2009). Thus, the client can take an active role and participate actively to its treatment (Wilson, 2011). Although this was mentioned as a positive aspect of the behavioral treatment, some psychologists think of it as a disadvantage, something that therapists shouldn’t be doing in therapy. Wolpe & Meichenbaum (2007) stated that from a cultural perspective this is something unacceptable, since according to their opinion, the therapist is the only appropriate person for making these decisions. Of course, they think that clients shall have some form of participation, but in terms of behaviorism, the therapists are just passive (Wolpe & Meichenbaum, 2007).
5.1.3. Contribution to treatment
Also, another thing related to treatment process, is that because behavior approach is characterized by specificity, the clients can easily convert unclear goals to concrete ones, with a specific plan of action (Corey, 2013). That helps both the client and the therapist that have specific plans targeted in mind (Corey, 2013). Additionally, Ledley and colleagues, in 2010, stated that therapists can learn to the client how his thoughts are related to his behavior, and what he can do to change that (as cited in Corey, 2013, p. 258). Wolpe & Meichenbaum (2007), writing from a integrative perspective, stated that behaviorism may isn’t a complete and successful treatment by its one, but it is still offered to psychology a different knowledge and some useful techniques, like desensitization, convert desensitization, biofeedback, cognitive restructuring, token economies, self-control, and problem solving. Corey (2013) reported “role playing, relaxation procedures, behavioral rehearsal, coaching, guided practice, modeling, feedback, learning by successive approximations, mindfulness skills, and homework assignments”. All these can be used effectively and widely by all psychologists, regardless of their orientation, or at least integrative ones, with combination with other effective methods (Wolpe & Meichenbaum, 2007; Corey, 2013). However, this variety of techniques is an advantage of behaviorists that use in therapy, especially because their approach is more “practical” than talking about problems and discovering the insight (Corey, 2013). So, it is convenient for behaviorists to use these techniques in order to follow an action plan and change behavior (Corey, 2013).
5.1.4. Effectiveness of Behavioral Techniques
Research in this field is also applied in the assessment of treatment outcomes and of all the other approaches, behaviorism and its techniques have the most empirical research (Corey, 2013). Behaviorists try to find out what particular interventions are the most effective, and through all these effort, indeed, studies show that behavioral methods are most effective than no treatment (Corey, 2013). According to the treatment direction and effectiveness, there is a number of differential behavior treatments, which are found to be the most effective available, given for depression, obsessive compulsive disorder, anxiety, phobias, panic disorder, post traumatic stress disorder, eating disorder, bipolar disorder, borderline personality disorder and childhood disorders (Sharf, 2000; Corey 2013). And, despite other therapeutic approaches, behavior therapy can also be applied to severe mental retardation problems and severe psychiatric disorders (Sharf, 2000). Also, the fact that it can be applied to very young children can also be considered as an advantage of this treatment approach (Sharf, 2000).
Consequently, although behaviorism was very successful in applying scientific methods to psychology, it was limited in many ways (Eysenck, 1994).
5.2. Controversial Issues
5.2.1. Research Limitations
One issue that behaviorism has been questioned for, is that behavior therapy was conducted mainly in well-controlled research settings, like universities (Wilson, 2011). There the therapists were selected due to the study needs and were well trained (Wilson, 2011). As for the participants, were also selected specifically for the treatment studies (Wilson, 2011). However, some of the practitioners use actual clinical environment with a variety of patients and clinical problems. Thus, as Wilson (2011) stated, the general picture of the research findings seem to occur in usual clinical practice. Wolpe & Meichenbaum (2007), discussing behaviorism, from a psychoanalytic perspective, reported that instead of getting a quality research, we get quantity something that it is useless if you think that some of the findings don’t reflect the daily clinical problems that a clinician faces. Parrish (2010) reported that “behavioural frequency is a sufficient measure, without consideration of the implication of intensity, quality, or length”. That statement reflects exactly the debate “quantity vs. quality”.
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Another thing that Wolpe & Meichenbaum (2007) reported, in terms of psychoanalytic perspective is that the most researches of behaviorists were conducted with a 2-years follow up, something that a psychoanalyst would think of as a rush to complete a research, rather than offer something to way of treating clinical disorders. Therefore, they wanted to express that behaviorism ignores the insight of people, their relationships and their self-awareness, things that matter the most (Wolpe & Meichenbaum, 2007).
5.2.2. Short-term Outcomes
Related to the above, is the criticism that the positive outcomes of behavioral treatment are only short term and don’t last lifelong. Because of the research nature of behaviorism, measuring things related to learning, like retention, rote learning etc, short-term experiences are easier than long-term, and that’s why they are conducted more (Woollard, 2010). However, Woollard (2010), refused that statement by referring to long-term benefits of behavioral treatment, like “turn-taking in verbal communication and long-term development of social skills by those with autism”.
5.2.3. Inability to explain all forms of learning
The issue that behaviorism can’t explain all forms of learning is a criticism received by some psychologists. For example, behaviorism can’t explain how language and speech develop in very young children (Woollard, 2010). However, Woollard (2010) stated that from a behavioral perspective, language is a complex behavior, but can be explained with the same terms as all the other operant behaviors. That means, that can be explained with terms of modeling and reinforcement (Woollard, 2010).
5.2.4. Treating Symptoms vs. Underlying Causes
A huge issue about behaviorism, still being discussed within the field, is that it is focused mainly on symptom relief, and therefore it treats only the symptoms. Wolpe & Meichenbaum (2007) writing from a psychoanalytic perspective claimed that it is not insignificant to target on symptom relief, but this is not the main and only goal of people that need treatment. Symptoms are only the superficial problems and the real root of the problem is hidden in the early life of the individuals (Corey, 2013). The humanistic perspective agrees with that issue, stating that behavioral research ignores the feelings of happiness and harmony of the individuals as significant reasons for an effective treatment (Wolpe & Meichenbaum, 2007). Additionally, Wolpe & Meichenbaum (2007), from a humanistic perspective, reported that the thing that is missing from behavioral research is the human sense of values, which should be the first thing to determine what a significant outcome of therapy is. Therefore, this outcome shouldn’t be measured only with numbers (Wolpe & Meichenbaum, 2007). However, behaviorism answers to that issue with the argument that changes in the behavioral symptoms, lead to a different treating from others and therefore changes in other aspects of client’ behavior too (Patterson, 1969). Additionally, they don’t disagree with the historical origins of the problem, but they just think that environmental events are more important than historical background (Corey, 2013). Thus they emphasize on changing environmental conditions, in order to change behavior (Corey, 2013). An extension to this criticism is that when the root of the problem is hidden in the past and therapy focus only on the present symptoms, then soon after therapy new symptoms will take place, replacing the previous symptoms (Corey, 2013). Behaviorists controvert by stating that they change directly the conditions that maintain the problem and therefore causing the symptoms. Furthermore, they add that there is no empirical evidence that other symptoms substitute the “treated” ones, when the maintaining conditions changed (Corey, 2013).
Obviously, there are a lot more controversial issues around behaviorism and Follette & Hayes (2000) discussed some of them as “myths”. However, we are going to report them as more general attitudes, supported or disapproved by different approaches in psychology.
5.2.5. Mechanistic Approach
A well-known attitude about behaviorism is that it is considered by someone as a mechanistic approach, in other words that it treats people like machines. As Patterson (1969) mentioned, the conditioning as a mechanical process, that ignores and doesn’t involve cognitive activities, can’t be applied in human behavior. From a behavioral view, this conception belongs to the old model of 1920s, and that modern behaviorism has a contextualistic thinking, that takes into consideration the cognitive process through all the events, not only “in the person” (Follette & Hayes, 2000).
5.2.6. Environment Determinism
A concluding opinion, regards to the above is that behaviorism thinks of human behavior being affected, explained and directed by environmental conditions, out of his control. Like a human being is left, without doing anything, to his environment. Wolpe & Meichenbaum (2007), from a humanistic perspective, stated that this attitude isn’t the solution to people’s problems, submitting them to “even more mindless conditioning”. Furthermore, behaviorism supported that in the case of responses, behavior is caused by previous environmental stimuli, and that was a deterministic approach that characterized all of its research.
5.2.7. Reductionistic Approach
Another criticism of behaviorism is that is reductionistic, meaning that it reduces behavior in order to isolate the stimuli and responses, not taking into consideration the deep meaning of the behavior, the reason, the thinking, the emotion etc. indeed, behaviorists thought that even the most complex behavior could be explained in simple stimulus – response links (Eysenck, 1994). That’s why Eysenck (1994) referred to this criticism as the “parsimony” of behaviorism, ignoring the richness of human behavior. The whole research of behaviorism focused on stimuli and responses, because of the assumption that operational definitions of concepts in psychology can be better explained relating these concepts to observable stimuli and responses (Eysenck, 1994). An example of the effort of behaviorists to find ways to measure yard concepts is the assumption of Watson that thinking is a sub-vocal speech. On the other hand, Follette & Hayes (2000), referring to contemporary behavior therapy, stated that since behavior is explained in the unique environment that it occurred, behaviorists can’t reduce any behavior because they will miss the whole event. Specifically, they supported that behaviorists take into consideration the history and the context of the event and they don’t reduce the event in an isolate component (Follette & Hayes, 2000). Additionally, Woollard (2010) claimed that behaviorists do accept the complexity of human behavior, but they believe that even complex behaviors can be analyzed and explained by the stimulus – response model and the behavior can changed through simple techniques, like reinforcement.
5.2.8. Indifference for the emotion and thoughts
Another main criticism, relevant to the previous one, is that behaviorism ignores the thoughts and feelings of the individual. Wolpe & Meichenbaum (2007), from a humanistic perspective, stated that “what behavior therapy offers to people seeking happiness and harmony in a dehumanizing world is a bunch of gimmicks”. Indeed, behavioral approach focused on the empirical aspect of human behavior, ignoring the non-objective information of the individual (Eysenck, 1994). They emphasize so much on the external variables that they exclude other important ones, like genetics, insight world, motivations, thoughts, memory, communication and emotions (Parrish, 2010). Some related critics support that feelings should be changed first, before changing behavior (Corey, 2013). However, behavioral studies haven’t shown that emotions should be changed first (Corey, 2013). Follette & Hayes (2000) supported that the last years behaviorists argued that thoughts and feelings are proper items for study. Also, they stated that behaviorists often deal with thoughts and feelings, since clients usually come to therapy for these reasons. The difference between them and the other psychologists is that they view thoughts and feelings as dependant variables and not independent, and their purpose is to find the relationship between them and the observable behavior (Follette & Hayes, 2000).Approximately, this how Corey (2013) answered to those thinking that behaviorists are not encouraging patients to experience their emotions. They concentrate on how the person behaves and thinks and don’t give so much attention to solving emotional issues (Corey, 2103). However, behaviorists like to know about the bad feelings of the individual so they can connect these with the behavioral dimensions and afterwards concentrate in that behavioral change to make the person feel better (Covey, 2013). Woollard (2010) claimed that modern behaviorists don’t ignore the activities of mind, they just think that the scientific measuring should focus on the products of the mind, meaning observable behaviors.
5.2.9. Ignoring the Whole Person
Similarly, a lot of people support that behaviorism ignores the whole person. Indeed, Follette & Hayes (2000) argued that some behaviorists sometimes focus intensely on a specific behavior, when that behavioral event is severe. However, they added that most of the times, a comprehensive analysis is needed. Thus, they claimed that behaviorists consider all the context where the behavior occurred, such as the person’s character, history and motivational state, the time and place where the event occurred, the reactions of other people to the event, the genetics and biology of the person and any other thing that is relevant to the event (Follette & Hayes, 2000). Contrary to these, Wolpe & Meichenbaum (2007), come to state that from a cultural-systemic perspective, behaviorists ignore the family system and the social issues, which is the therapeutic unit for changing in treatment (Corey, 2013). However, contemporary behaviorism seems to find important the relationship between individual and environment and the behavioral techniques seem to help achieving treatment’s goals (Corey, 2013). Also, Corey (2013) continued stating that humanistic and behavioral approach could be connected, especially with the introduction of self-management, mindfulness (experiential learning, the client is discovering things alone following instructions) and acceptance-based approaches.
5.2.10. Basis in Animal Research
Because a lot of behavioral principles, used to explain psychological events, came from laboratory experiments with animals, a view was formed, claiming that behaviorism believes that humans are like animals. They assumed that the human behavior could be explained and modified like animals’ behavior, so that they focused on a single type of learning (Parrish, 2010). Eysenck (1994) claimed that because behaviorism couldn’t measure important aspects of human functioning, like attention and thinking, by just observing stimuli and responses, it tended to use scientific methods to more simple phenomena, like the salivation of dogs. Behaviorists answer in that inquiry by supporting that their evolutionary – behavior theory doesn’t assume that anything found in animals must be applied to humans (Follette & Hayes, 2000). In contrast, their opinion is that their assumptions come from a cross-species consistency, emerging the past information with the new one and vice versa, concluding a lot of things about different species (Follette & Hayes, 2000). Additionally, the study of animals and the learning about their behavior had seen as an opportunity to get bases and tools for the explanation of the human complex behavior (Follette & Hayes, 2000). Furthermore, it is acceptable that the above assumption wasn’t so wrong. Follette & Hayes (2000) continued supporting that no behaviorist thinks of human behavior as a simple thing, but instead they think of it as a very complex thing. Also, they gave a successful example, saying that as a physician knows how to generalize the study of a single cell to the entire human body, behaviorists can understand the limits of generalizability from animals to humans.
5.2.11. Therapeutic Relationship
Finally, another issue around behaviorism is that it is considered to ignore the therapeutic relationship. The importance of the therapeutic relationship was always a subject for debate in behavior therapy (Patterson, 1969). Follette & Hayes (2000) justified that by explaining that most of the behavioral research was conducted in institutionalize, developmentally disable individuals with specific problems. There, their goal was to change the environmental conditions. Additionally, Follette & Hayes (2000) gave examples of significant effective changes in severe mental disorder patients, like with schizophrenia and autistic children who were developmentally unavailable, using the modification of environmental contingencies, since there was inability of social interaction. According to this, it must be mentioned that even with those patients, psychotic and autistic children, the therapy includes strong personal relationship, using the interest, the concern and the attention of the therapist as reinforces (Patterson, 1969). As for the outpatient interventions, they claimed that behaviorists dealt with focused problems, like phobias, where the structure of therapy was very specific and included presentation of feared stimulus material at home or with automated presentation, where the therapist was absent. However, according to Follette & Hayes (2000), since the 1960s behaviorists were referring to the role of therapist in treatment and the contemporary behaviorism emphasized even more on the therapeutic relationship, such as the dialectical behavior therapy (DBT), the integrative couple’s therapy and the functional analytic psychotherapy (FAP). Finally, Patterson (1969) reported that most of the behavioral therapists admit the existence and the need of the therapeutic relationship, but they face it as a nonspecific variable. However, Patterson (1969) ended up with the conclusion that therapeutic relationship is considered to be much more important as it was considered before by the behaviorists.
5.3. Ethical Issues
5.3.1. Treatment Goals
As it was mentioned above, behavior therapy encourages clients to be active in the treatment, by setting goals. Thus, the client is the one who determines the objectives of the therapy – the “what”, and the therapist is the one who determines the way behavior is to be changed – the “how” (Wilson, 2011). By doing that, the therapist engage in the process his own values, because he has to find alternative courses of behavior and analyze the consequences of pursuing the goals. Consequently, it is important for the therapist to detect his values that may affect the treatment and explain how they may affect it (Wilson, 2011). Also, it is important to take into consideration that this procedure is complicated when the therapy deals with disturbed clients, like institutionalized patients with psychosis (Wilson, 2011). Those patients are unable to participate actively to treatment and determine therapeutic goals (Wilson, 2011). In these cases, it is important for the therapist to determine the goals through conferences with other professionals (Wilson, 2011). However, Corey (2013) disagreed with the above statement and wrote about the ethical responsibility that characterizes behaviorism. He justifies that by the argument that behaviorists don’t choose whose behavior and what behavior should be changed, but they only determine how is going to change (Corey, 2013). Thus, that gives freedom to the client to determine by himself what behaviors he wants to change (Corey, 2013).
5.3.2. Social Influence
Another ethical issue is the social influence. All kinds of therapies are influenced by the social factor. The ethical issue is for the therapist to have awareness of this influence and how this influence is handled in therapy (Corey, 2013). It is important for the therapist to be aware of that influence and protect his client. According to Wilson (2011), behavior therapists recognize this influence process and that’s why they are concentrated into client-oriented goals. They make sure that there is an agreement between them and the client about the goals, the client is participating actively and the therapy progress is modified so that the client’s goals are achieved (Corey, 2013). Additionally, Wilson (2011) reported that behaviorists have planned specific procedures, in order to protect the human rights and the personal dignity of their clients.
5.3.3. Therapist Experience
Parrish (2010) reported that despite the simplicity that characterizes behavioral techniques, the application of them entails issues around the skills, the methods and the ethics. Changing an environmental or personal stimulus in the real world requires communicational skills and personal characteristics of the therapist, like responsibility and sensitivity (Parrish, 2010). There are risks involved, like the compulsion and the oppression of the individual, and skills needed, like the evaluation of the consent and preparedness of the person (Parrish, 2010). So, the procedure needs well experienced therapist, who has the knowledge and the understanding of the ethical demands of the approach (Parrish, 2010).
5.4. Future Directions
Behavior therapy has to deal with some issues. As behavior therapy is not being used so widely, it has to improve the adoption and spreading of effective behavioral therapies for some common disorders (Wilson, 2011). Wilson also suggested that behavioral therapy needed to develop effective treatments for a broader range of problems, as most of them until then weren’t good enough. As Patterson (1969) mentioned, “the existence of methods or techniques which are specific treatments for specific problems is questionable”. Although, some behavioral treatments are effective, the way of changing and the mechanisms used, are not fully understood. The understanding of these mechanisms would be helpful to the development of better interventions. Similarly, with the continuum research and experimental methodology that characterize behaviorism, the field will obtain a better understanding of what techniques work the best with specific disorders and further how to help a particular patient (Wolpe & Meichenbaum, 2007). Finally, Wilson (2011) reported the fact that since behaviorism engaged to emerge clinical practice in psychology and science research, it has to follow all the newest findings in biology and experimental psychology about the function of the brain, in order to come up with better theories and therapies.
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Another future evolution in the field is the introduction of the cognitive aspects of behavior. Although, some traditional behaviorists, like Skinner, thought that the consideration of the cognitive aspects should be a weakness for the field, the younger behaviorists are more flexible with that, and most of them practice both behavioral and cognitive techniques (Wolpe & Meichenbaum, 2007).
Wolpe & Meichenbaum (2007), also thought that behavior therapy has a good future applications, while behavioral techniques could be used in health care settings, for example relaxation techniques and coping skills could be used in behavioral medicine problems, like headaches, chronic pain, hypertension etc. Indeed, this is something that nowadays is happening and it could be happening more widely not only in case of psychiatric problems, but also in various aspects of health care, like pediatrics and cardiology (Wolpe & Meichenbaum, 2007).
In conclusion, after all these decades of development, now, behavior therapy has to focus its progress to the improvement of the existing techniques and the development of techniques for different disorders (Wolpe & Meichenbaum, 2007). Also, it has to improve the way that evidence-based treatments could be used more widely and more effectively (Wolpe & Meichenbaum, 2007). Wolpe & Meichenbaum (2007) estimated that the next years, behaviorism will be evolving more slowly and that its research will focus on the experimentation with its own identity.
5.5 The rise of another theory
From about 1920s to 1950s, behaviorism was the dominant approach in psychology (Smith, 2001). Around 1960s, behavioral theory and specifically stimulus-response theory, started to lose its luster (Follette & Hayes, 2000). It was back then, as Wachtel (1997) reported, that in an American Psychological Association symposium, therapists realized that in behavioral techniques weren’t almost no cognitive influence. Thus, in around that time a “cognitive revolution” happened, that had to do with the mental process of humans (Smith, 2001). That revolution called “cognitive psychology” (Smith, 2001). In 1990s Craighead (1990) found that 69% of the therapists in the Association for the Advancement of Behavior Therapy called themselves as cognitive – behavioral in orientation, and only 27% called themselves as behaviorists (as cited in Wachtel, 1997, p. 350). Similarly, Goldfried & Davison, in 1994, reported that most of the behaviorists were using the aspect of cognition in their interventions and assessments (as cited in Wachtel, 1997, p. 351). Some reasons of that change in the perspective of therapists were discussed above. Follette & Hayes (2000) explained the fact, as the inability of behaviorism to “solve the challenge of cognition by using strictly associationistic principles”. Another reason was that behaviorism focused so intensively on observable behavior and environmental conditions (Lahey, 2009). But generally, the reasons was a little bit from all the above discussions and debates, including the learning with associations, the learning from non-humans, the concentration to the stimulus – response links (Smith, 2001).
Soon, as a reaction to behavioral approach, cognitive approach appeared to transform this theory to a more flexible one, based on the computer model (Follette & Hayes, 2000). At around that time, 1960s, American psychologists rejected behaviorism (Smith, 2001). Their change was affected, at first, by ideas out of psychology, like technical developments during War II that led to the invention of digital computers (Smith, 2001). Soon, the idea of a relationship between computers and human intelligence was born (Smith. 2001). More specifically, cognitive psychologists connected human thinking with computer work, where it takes in information and it transforms them, stores them and retrieves them (Lahey, 2009). Therefore they thought of thinking as information processing (Lahey, 2009).
This perspective, cognitive approach, focused more on how people think and understand the world (Lahey, 2009). Also, it emphasized on finding out in which way people understand and represent the outside world in their minds and how their thoughts of the world affect their behavior (Lahey, 2009). It emphasized on the patterns and irregularities that our mind has, dealing with the way that normal and regular functions and activities happen, like watching TV or taking a decision (Lahey, 2009).
In conclusion, Wachtel (1997) stated that this cognitive change in the behavioral therapy, made the last one more effective and more comprehensive. Behavior therapy converted from a limited therapy, focused on specific symptoms and techniques, to a broader one, that was dealing, also, with the coping skills and capacities needed in facing unexpected life problems (Wachtel, 1997). Therefore, there is no doubt that cognitive approach managed to fill important gaps, found in behavioral therapy (Wachtel, 1997).